gastric bypass revision surgery with distilization

Hello,

Iam wondering if anyone else has ever had gastric bypass revision surgery with distilization.  I had RNY gastric bypass in 2005, start weight was 256.  Lowest weight was 172.  I Have been regaining since 2009, and am currently at 259.  I met with Dr. Shikora and am scheduled in a few weeks for surgery.  Please let me know if anyone else has had this surgery.

thanks

Hi jwo1083,

We suggest you post this on the Revision Weight Loss Surgery Forum and Roux-en-Y Gastric Bypass Surgery Forum (RNY).

Good Luck

I have not had a revision, but Dr. Shikora was my surgeon. He's the best. Maybe I'll run into you at one of the local support groups.

Hello,

Where/how do I find local support groups?  I have never attended any but would like to start.

Thanks!

They are organized by the surgical program, or you can find a schedule online.

What, pray tell, is 'distilization'? I've never heard of this.

I assume you talking about "distalization".  This is just the term for making the bypassed portion of the intestine longer than it was originally, and is pretty common with RNY revisions.  Since there is a limit to how much they can do to increase restriction  (re-stapling the pouch and rebuilding the stoma can be done, but both of those have a complication rate higher than during the original surgery and there is a limit to what they can do (much more so than during the original surgery)), what they CAN do is extend the bypassed intestine.

Some surgeons prefer this approach over converting a RNY to a DS, but apparently the complication rates are a little higher on the RNY revision than the conversion to DS. We had one surgeon where I work who did DS surgeries and did RNY to DS revisions, but he wouldn't do any other type of RNY revision. He retired recently and neither of the remaining two surgeons will do RNY revisions because of the increased complication rate and what they say is a poor "rate of return". 

If your surgeon has not talked to you about the types of potential complications from the revision, please be sure you discuss this before you have the surgery.  Even with an excellent surgeon, the revision carries greater risks of complications than the original RNY, and you need to be able to give informed consent.  I assume your surgeon has told you that you will need to increase your vitamin supplementation because of the increased lack of vitamin absorption. If not, please ask him about this as well.

Good luck on your revision.

Lora

Hi Lora,

That is exactly what I am having done.  My stomach hasn't stretched significantly, however my stoma has enlarged, but due to a complication during my RNY they cannot touch/redo/operate on my stoma.  He has gone over in detail with me the change in vitamin/nutrient absorption as well as me most likely not being able to tolerate any fatty foods (gas/diarrhea) as well as more and looser bowel movements through out the days.

I'm curious- since I haven't met or talked with anyone who has actually had this surgery about their outcomes.  you said the doctors you work with don't do it bc the risks outweigh the benefits.  have they done this?  what were their results?  Have you met anyone who has had it done?  Dr. Shikora doesn't do DS surgery, nor does anyone at Brigham and Women's to my knowledge in Boston, and I wanted to stay there...

Your input has been very helpful and informative, any additional info would be great!

thanks,

Jen

The surgeon *****cently retired did the RNY revision and the RNY to DS conversion.  He was the one who preferred to convert to DS.  

The two remaining surgeons don't do RNY revisions (other than the very rare case of a pouch complication or an over stretching of the pouch but not the stoma) because the experience of the retired surgeon was that there were many more complications (mostly related excess scar tissue) than from the original RNY and the amount of weight lost and maintained wasn't much different long term than for the original surgery (meaning that, unfortunately, most people who lost adequately but then regained with their initial RNY also lost and regained with the revision (whereas those who were switched to DS had better long term success the second time around because of the extreme malabsorption).

All of that depends greatly on the factors at work in those individuals, though.  That certainly doesn't mean that no one who has a RNY modification is successful long term!

I only personally know of one woman who had the bypass extended, and she has had only limited success since the revision. Her second surgery was done before the office required psych evals for revisions, though -- and she was self-pay, so no one pushed the issue -- and now we require them for any kind of revision.  If I had been the one doing her psych eval, I wouldn't have given her immediate psych clearance on the revision.  I would have strongly recommended 6 months of counseling to deal with the psychological contributors to her regain.

Lora