Revision from RNY to DS

Hi, 

I am considering a revision from RNY to DS. My highest weight was 412, got down to 205, now back up to 266-274. No surgeon near me does revision to DS. who is the best? I am going to do self-pay. Is it Dr. KESHISHIAN? 

Does anyone know the risks associated with the revision to DS, how long the operation takes and if you can recover in a step down facility instead of a hotel. (Won't have a support person with me, since they need to take care of my daughter).

Any experiences you have here are sought. Also, when choosing between revising the RNY to a smaller pouch or choosinga DS, what are the pros and cons?

Dana

Dana, some of your questions can only be answered by the surgeon. What I can tell you is that Dr. Keshishian is considered one of the best and most experienced at this difficult type of revision. Others for you to consider are Dr. John Rabkin of Pacific Laparoscopy in San Francisco, Dr. Greenbaum in NJ (he does them on a selective basis), possibly Dr. Ayoola in Denton, TX, and Dr. Roslin in NYC.

IMHO going to a smaller pouch is unlikely to be helpful unless your only problem is too large a pouch. It used to be thought that this was a reason for weight regain or inadequate weight loss with gastric bypass, but it turns out that the size of the stoma is more important. Too large a stoma and no matter how small the pouch, whatever you eat just falls out of the pouch and straight into the small intestine, and the operation loses all benefit (and also this can cause dumping and/or hypoglycemia). It is certainly simpler and lower risk to just make the pouch smaller, but, again only IMHO, much less likely to help you. It's always a balance of potential risks vs potential benefits, and if the potential benefits are not there, lower risk becomes meaningless.

Larra

I will also send you a pm

How much is a revision with Dr. K

depends, but in the neighborhood of 25-28K

Dana,

Dr Keshishian had performed many RNY to DS and takes patients that no other surgeon will, that is who I would suggest.  contact the office and or Dr K they can give you the specifics, but you cant leave Huntington hosptial without a support person.  Essentially it is an expensive baby sitter (as Dr K put it) you wont be going to a nursing home after the hospital etc so you need someone.  But there are facilities out there that you can pay someone by the hour.   Typically you will be in the hospital for 3 nights (with no complications)  you will have a feeding tube for at least 6 weeks and he would want you to be local for about 10 days PO, depending on how surgery went.  find a friend, to stay with you for the week.

Personally I would not go the RNY route, I dont like that surgery, at your BMI, DS is your best bet at reaching a normal BMI and will give you a much better quality of life.

Call Dr Keshishian he will give you a consult and explain to you.

Good luck on your journey

Hi Dana,

I had a revision to DS in April 2012 from RNY which was done in 2008.  My highest weight was 370.  I originally lost about 130 pounds with the RNY, but over 4 years, went back up to 330.  Since having the DS, my weight has been between 155 to 170 for over a year now.  

I can actually eat a lot more than I could before the revision, since you no longer have a "pouch", but since I don't absorb all the fat, it keeps the weight off.  Plus, I keep a very high protein, low carb lifestyle now.  As soon as I eat carbs I do not feel good at all.  It's like my body rejects it, and tries to get it out as fast as possible, so when I do eat a lot of carbs, I make sure I'm near a bathroom and have my poo-pourri.  LOL

I would do it again in a second.  My recovery from the DS went a lot more smoothly than when I had the RNY.  I was in the hospital for only 2 days and then recovered at home.  I was back to work after 3 weeks.  I had my revision done by a surgeon here in Phoenix, AZ, but I heard a lot of people wouldn't recommend him, but I know several people that had the DS done with him and are just as happy with the results and care.  I know he's done other revisions to DS, but I don't know any of them personally.  

Let me know if you have any specific questions, and I'll answer the best I can.

Kristic

Hi Dana,

I'm right there with you with almost same stats, except I'm 12 years post op. I'm also researching and have come to realize my best bet at success will be the RNY to DS revision and I will be self pay so I am also working with the vetted surgeons list trying to figure which doctor will be most feasible (to travel to) and most affordable. 

I've contacted Keshishian (southern CA), Roslin (NY, NY) and Marchesini (in Brazil) who, from everything I've read, are beloved and highly experienced. 

I would love to connect with you for support and to exchange notes! 

Have you contacted any surgeon yet for consult? Would you consider traveling out of the country if no sacrifice to quality and more affordable? 

The pros and cons become evident the more you read over all the forums and get other's experience. I like what Larra said as this is consistent with a LOT of the testimony available out there.

Hope we can chat soon

Nickie

Excellent. Did you decide on a surgeon? I decided on Dr. Keshishian and am waiting for a surgery date. Would love to keep in touch.

Hi Dana,

I had RNY to DS revision with Dr. Ayoola in North Dallas 5/13/15.  He is fantastic and very skilled.  I have the "zipper" from my original RNY in 1996, so there was a lot of scar tissue to deal with.  It took between 4-5 hours.  No unforeseen complications as of yet.   I also travelled from out of state, but I am with relatives so I don't if there is a facility they use.  I would contact his office because I don/t believe I am his first out of towner.