RNY to DS or VS?

I have been in contact with my bariatric surgery dept (Richmond Kaiser) since 2 years post op. My surgery weight was 235, the lowest I got was 180, stood still at 185 for a bit but slowly got up to 200 regardless of working out. I have two more children and weigh more now than I did 9 months pregnant and she is 2.5. I have been bugging my surgeon about examining my pouch, the constant abdominal hunger pain, my slow metabolism and I get a "you're not doing it right" or "Go to a support group" response. I am currently 235, I did 3 6 week challenges and even sticking to meal plans and working out extremely hard, I couldn't lose 20lbs!

I don't know what to do next, I'm only 33, my body is physically hurting. I can eat according to plan and still have abdominal pain like I haven't eaten in a week. Water makes it worse. I'm very good about NOT drinking before or after eating - can't do it while eating. My metabolism has slowed significantly, it seems the moment I go over 1200 calories, I'm packing on pounds. Forget trying to eat more calories because then I really gain weight.

Is it possible to get a revision through nor cal kaiser? Which surgeon is the most likely? I'm frustrated, the bariatric department pretty much never called me after a year post op. The hunger pain in my abdomen has been since day one and I have them in my kp.org account of all the times I had contacted them. I just want this weight off, I feel like I was jipped from the very beginning. BTW I'm 5'7 and my highest was 340! It was easier to lose weight before bariatric surgery.

If your metabolism is shot, then the sleeve won't do you any favors. The DS will kick that metabolism in the "what, what" into high gear.

What Val said but you will need a very experienced DS surgeon - revisions from RNY to DS can be complicated. Are you in Richmond, VA? Consider contacting Hazem Elariny in Fairfax, VA. He has definitely done many RNY to DS revisions.

AFAIK, John Rabkin still has the contract to do the DS for Kaiser norcal, and he is one of the few that one would trust to do an RNY/DS revision. As noted, with your metabolic issues, the DS would be the choice to bring things back in line; the VSG and RNY are too close in power to be a useful revision in this case.

California has two of the best DS surgeons in the country, Rabkin and Keshishan. I'd consult with one of them.

A sleeve does have metabolic changes, actually, that a RNY does not due to the removal of the stomach area which alters ghrelin expression significantly, among other things. The DS alters more enteroendocrine cells, though, which is a powerful effect in addition to the malabsorption which is more durable.

Having said that, it makes more sense to convert the RNY to a DS possibly. I haven't really seen anyone get an RNY to a sleeve without a DS, at least where I'm at. This is a very technically difficult operation, and you absolutely must see a surgeon who is experienced in doing this.

I would definitely contact one of the surgeons in the area ASAP for a second opinion, especially since you have abdominal/hunger pains...some things can mimic hunger but are not hunger. I would not wait another day. Dr. K in particular is known for being extremely helpful and quick to respond.

So doctor bags refused to see me and yet again referred me to a dietician. I asked to transfer to south sac since it's closer and they insist I must take their class before I can see a surgeon. I've been in contact with bariatrics for years trying to get this resolved. How do I contact doctor K? I definitely want to revise to the DS now that I've researched it but it's very difficult to get anything accomplished when all the doctors blow me off. It's frustrating.

Here's the info from his webpage. Good luck...I am sorry you are going through this.