revison from ds to medial rny
I think it would help you if you took a look at the anatomy of RNY, to better understand what you have now and what you would have with RNY. They are very different. With your sleeve, you have a smaller stomach than you started with but a normally functioning stomach with the use of the pyloric valve. With RNY, a small pouch (not sleeve!) is created from the highest part of the stomach and the rest of the stoma*****luding your pyloric valve, is bypassed. You then have a small (for awhile, anyway) but NOT normally functioning pouch that has no valve to control how food empties. If the stoma (the connection between the pouch and small intestine) enlarges, food will just fall out of the pouch as soon as it gets there, leading to frequent hunger and reactive hypoglycemia. These are frequent problems with RNY after a few years, and one of the big reason that weight regain is a common problem with RNY.
Like everyone else here, the plan to change your stomach to RNY makes no sense to me. If your sleeve is too large, or not shaped right, a re-sleeve would fix that without causing you all the potential problems of RNY, including the above problems as well as dumping. If your common channel is too short,, fine, have it lengthened, but these are two separate issues with separate solutions.
And the vitamins... you will need to make a lifetime committment to taking them no matter what operation you have or don't have. You might need less of the fat soluble vitamins with RNY, but you will need MORE B12 and possibly other B vitamins, probably MORE iron, and just as much calcium.
I hope that at the very, very least you will get a second opinion from one of the very experienced DS surgeons who does a lot of revision surgery. You lose nothing by doing so, and might learn a lot. Given your location, I would recommend either Dr. John Rabkin in San Francisco or Dr. Ara Keshishian in Glendale (near Los Angeles). You can contact either or both by email. If you need to postpone your surgery, do so. This is not an emergency. Whatever you decide, you should walk into the OR with confidence in your decision, and you sure don't have that now.
Larra
Larra, Thank you so much for the detailed reply. That is exactly what I have pieced together over the last day or so. You wrote it perfectly. Thank you!!!!!!!!!!!!!!
I have decided no pouch.
The surgeon I have been seeing did put the re-sleeve as an option. I have sent an email asking if there is any issue with changing the plan since insurance has already approved a different route. He has done over 3500 ds; rny; sleeve's and I do think he is a skilled surgeon. I am changing jobs in a few weeks and that means changing insurance companies and not having any time off for at least a year. So I am in a bit of a crunch due to that. Assuming there is no issue with changing what we are doing with the insurance company, I don't see a problem forward with this Dr for the re-sleeve and added cc.
