From Dallas, Looking for from RNY revision to ds doc and ds advice.

I posted part of this under my Dallas Dr. Question but really its for anyone who has had a rny gastric bypass revision or a rny bg revision to a Ds OR just a DSer who can tell me about life after surgery All Gas and diarrhea? 

 I met with Dr. Alexander  in Dallas recently who did my original rny gb but he does not want to do a DS – he says that I should just have a gastric bypass revision where they cut out the expanded small intestine part of the pouch and then cut out about ½ of the disconnected stomach to reduce the production of ghrelin – the hunger hormone/enzyme. Has Anyone had this done? Was it successful? I'm concerned about the amount of people I've read here that thought a revision rny was a waste of time and they wish they had done a ds. 

 I really think I just want to be done with all this and have the DS. I’m worried that with the revised gastric bypass I’ll just be back in the same boat I’m in in 10 years.

 Also, another question, it really doesn't;t matter who I do my sleep study, Psyche eval and endoscopy right? All of that is through insurance so it should be usable by any doctor?

I have never, ever, heard of that type of RNY revision! Frist of all, the pouch does not include any small intestine. It's just a small portion of the stomach that is cut off from the rest of the stomach. And while I have heard of revising the RNY such that more small intestine is bypassed, I've never heard of cutting out any of the small intestine. I've also never heard of attempting to promote weight loss by removing part of the stomach for the sole purpose of reducing ghrelin, not for creating restriction. This is all really off the wall. And of course he isn't going to offer RNY to DS revision for you because he probably doesn't do the DS at all, nevermind the much more difficult RNY to DS revision.

What some RNY surgeons often do to revise RNY is to go from proximal RNY to distal RNY. However, this has not been shown to create any significant longterm weight loss. So, some surgeons go further, to ERNY (the E stands for extended) in which a great deal of small intestine is bypassed. this probably helps with weight loss but adds to the already present nutritional issues of the pouch and RNY all the possible nutritional deficiencies of the DS. You keep all the pouch issues - possible dumping, inability to safely take NSAIDs, etc. The trade-off is that the surgery is less complicated than going from RNY to DS.

So, I doubt you will find anyone here who has had this done. You may not find anyone anywhere who has had this done! You could ask that surgeon if he has any other patients with this operation that you could speak with.

There are just a few surgeons doing RNY to DS revisions. You will need to travel. It will be worth it.

Larra

If I were looking into a revision of any kind, I would get several opinions from many D.S. surgeons. OH has an approved list of surgeons to choose from. Traveling is not out of the question for superior surgical care. I researched all about the D.S. and other bariatric surgeries. I chose the D.S. for its malabsorption qualities enabling me to reach goal weight and maintain it. I definitely made the right decision, easily maintaining now for the second whole year at 117-123 lbs. I have no bathroom issues, just as normal as I was before surgery. Food choices can help or hinder a slow or speedy system. Trial and error helped me figure out what works best for me. Everyone's system seems to run differently. I need more fiber than most, and less fats. Sugar is no problem, ice cream every night is easy on my system. Eliminating flour products has helped eliminate gas. Sourdough bread is fine in small amounts. Each of the possible weight loss surgeries has positives and negatives we have to learn to deal with. In the end, the D.S. keeps a working pylorus for digestion of beef, steak, all meats, veggies, fruit, dairy, and anything I ate pre surgery. Keeping the weight off was my goal, and eating healthy foods. As a result I am healthy, my labs are super, and I feel in top shape, much younger than my true age. If I needed pain meds, I can take Ibuprofen, and any OTC pain meds. I don't need any now my weight is normal BMI, my knee and hip arthritis don't hurt at all, exercising is easy. Keeping a gluten free diet, gas is a non issue.

I traveled outside my town for a D.S. surgeon. If I had stayed in town I would have had a RNY, and been unhappy with all its restrictions and problems. I would travel anywhere in the country for the best surgeon for a revision. 

My sleep study, endoscopy and bone density scan for base line pre surgery were ordered by my PCP, the psych eval was done within my surgeons office, Yes they were used by all my Dr's. I take report copies to all my Dr appointments, especially the extensive lab reports.