Considering DS as a revision option, was RNY in 2005

Dayton, OH.  I have an appointment scheduled with him, but what is the difference.  The research I have seen indicates the DS has the gastrocectomy vs the distal which has the  pouch.  The malabsorption is still obtained along with 86 percent of excessive weight loss in 5 years.

The difference is that with a true DS, you'd have a real stomach again, and all the benefits of the same. You'd be able to take NSAIDs again, you'd no longer be troubled with dumping, you'd greatly reduce your odds of developing reactive hypoglycemia, and you'd have fewer vitamin issues. Many people who have the ERNY describe it as the worst of both worlds.

Oy, as you were told above, you would be getting the "worst" of both worlds.  Please, please, please, listen to this.  You've already made a mistake in choosing a RnY  to begin with / had issues with RnY / been disappointed / etc.... I don't know that whole story.  What I  *do*  know is what your story will be with a distal, or ERnY -- you will NOT have a pyloric valve to regulate your food / liquids into your intestinal system, AND you will have severe malnutrition issues.

This is your LIFE, and hopefully it will be a long one.  Please consider this carefully.  It is NOT worth living like this, and you have options.  *I* am familiar with your surgeon.  I know people who have had a virgin DS with Dr. Teel, and have been quite successful.  As you've been informed, he does NOT do a RnY to DS revision, meaning he does not take down your RnY pouch and reincorporate your pyloric valve -- only doing so will make your new intestinal configuration optimal.

You've been provided revision surgeon names, above.  I will add one more, which is your closest option:  Paul Kemmeter in Grand Rapids, Michigan.  He does a true RnY to DS revision, and is very competent.  I know people from OH and IN who have used Dr. Kemmeter for many different reasons (one being he does his DS surgeries lap, and he also has the best lap DS self-pay that I have seen).  You need to seriously consider what your life is going to be like with a ERnY, and do what is right for YOU, and not what is convenient (proximity).

It's not quite as simple as vertical sleeve gastrectomy vs pouch.  The intestinal configuration is very different between a DS and the ERnY.   You get malabsorption with both but you don't get equal malabsorption.  Plus you still have all the problems of a pouch which might include stretched stoma, rapid exit of food into the intestines without sufficient digestion, dumping syndrome.  With a true revision from RnY to DS you regain normal stomach function because your current hidden stomach gets reassembled and then converted to a sleeve gastrectomy thereby preserving your pyloric function and normal gastric digestion of food. 

This is a big deal surgery which is not performed by a large number of surgeons because of the difficulty involved in reconstructing the stomach and then creating a sleeve.  It's complex.  It's time consuming.  It's more difficult which is why many revision doctors will do the ERnY instead and tell the patient that it is just as good as a DS.  Please be sure of what you are going after.

i am confident my surgeon in Hamilton is competent. He only selects certain individuals to consider RNY to DS. I am not yet approved, but I won't settle for any other of the options all of you have posted.

I understand he has done a dozen or so revisions and have trained under one of the individuals above. He was confident he could do what was described above for a true DS, in two surgeries. I have agreed this was probably the best.

If anyone else has any comments, I will appreciate it.

If he can't do it in one surgery, he doesn't have the experience.  And a dozen or so?  Really?  This is the MOST COMPLICATED revision.  I wouldn't let him touch me unless the Dr. he trained under was in the OR with him.  He is not experienced enough yet to do it alone.  This is your life.  Don't screw with it!