RNY 1999

I am wondering if anyone can give me information about the process of revising a RNY.  I had mine in 1999 and kept my weight off for 5 years until I got pregnant. I have since gained back 120 lbs and am seeking a revision.  For those of you who have had revisions, what was the RNY revised to, what effects have you had from the revision and are there any problems as the result of the revision. I appreciate any information...thank you, Chrissy

Hi Chrissy  Welcome to OH

If you have not done so post this on our Revision Forum too for more responses. 

Regards,

Member Services

Well, one of the problems with RNY is that there is no simple revision.  Why do you believe that you need a revision?  Have you had an EGD done that shows that your stoma or pouch are substantially enlarged?  My surgeon indicated that less than 20% of the people she ordered EGDs for (people who believed they had gained weight because of an enlarged stoma or pouch) actually HAD any enlargement beyond what is normally expected.  The problem wasn't mechanical, it was behavioral (so a surgical change likely wasn't going to help anyway). 

There are a couple of procedures to try to address an enlarged stoma, but the statistics on them are pretty abysmal and most insurance companies won't pay for them. It is possible to have the bypassed length of intestine enlarged, but doing that increases the problems with vitamin absorption and it requires quite a bit of intestinal cutting and sewing and there aren't many surgeons who have experience with the procedure.

It is also possible to change the entire bypass to a DS type of bypass, but there are VERY few surgeons who are trained to do that.  If you are even considering that, be SURE you find a surgeon who is trained in it, because it is a complicated surgery.

Lora

This is my issue. When I had my surgery in 1999 there was no dietart education available to me. No follow up except the medical part. I had no support group etc. I did it all on my own and lost 160 lbs. I have since had one test that showed my stomach has stretched but the opening hasn't.  I was also told prior to 2003, a  2 Oz 👝 was done and stats show that a large number if people with that size pouch have significant regain. After 2003 they started to do 1 Oz pouches and have seen a difference in continued weight control. I know that after I had my son and had gained 60 lbs, I felt defeated, fat and miserable and returned to my old habits. However, I have tried numerous "diets" and failed each time. I feel I need the physical restriction of WLS to regain my control. I see a counselor for depression and impulse issues and feel I need a revision to help me regain that control. I have to say ur post made me lose hope that this can be done. I understand from a medical standpoint that some surgeons feel it is risky and that it is strictly the patients fault for regain. In my case I feel it is a few factors that I cannot resolve without a revision. 

Unfortunately, maintaining the weight loss for all RNYers is a matter of exercising some portion control ourselves once we have "mature" pouches.  You are never going to get a surgery that permanently retains that tiny pouch that you originally had and forces you to not overeat.  Your pouch is supplied to stretch out some over the course of the first year, B****he smaller pouch still helps a lot (as opposed to having the large natural stomach), but it cannot do it all.  I truly don't say that to make you feel bad; I say it to make sure that you have realistic expectations.  Even if someone were to completely re-do your pouch, you would eventually still have to do some portion control (and make good food choices, of course) yourself.

It is not surprising that your post-op dieting efforts have failed.  Dieting post-op isn't any different than it was pre-op: the limited foods and sense of deprivation still kick in and make it impossible to stay on a very restrictive diet.  I'm sorry you didn't get any dietary support after your surgery, but many of us don't.  There are many people here, though, who can help you with getting back on track with what you are (or should be) eating in a way that doesn't feel like a perpetual diet.

Have you tried going back to basics (eating a protein forward, very limited carb diet), and measuring and logging your food? Are you still refraining from drinking with your meals? (If you are drinking with meals again, please stop that right away because that makes it possible to eat MUCH more than we should because it washes the food out of the pouch and then we don't feel full with a smaller amount of food.)  

If the impulse control issues include eating behaviors, that is likely partially sabotaging your efforts and, unfortunately, isn't going to change with a surgical revision.  Is the therapist you are seeing doing any cognitive behavioral therapy with you?  

If you can find a surgeon who specializes in RNY revisions -- please don't let just any surgeon willing to "try" a revision operate on you, no matter how much you want a revision -- (s)he may be able to give you additional info on potential revision options or may be able to offer nutritional help.  I would post on the Revisions board here and specifically ask for recommendations for surgeons somewhere reasonable close to you who have done RNY revisions and reversals.  

Going back to basics with measured portions is truly worth the effort and will reinforce the healthy eating habits and food choices that will be necessary to maintain the weight loss long term even if you are able to get some type of revision.

Lora