Sleeve to DS or Sleeve to ByPass

Hey guys!

Im trying to decide between sleeve to DS or sleeve to Bypass revision. Everytime I eat or drink anything it hurts going down. My last dr injected botox in my sleeve because it was bent and that was causing a lot of the pain. Once the botox wore off it went right back. I also have bad GERD and im only able to eat a very small amount but depending on what im eating i have to rush to the bathroom. Has anyone had these issues? If so did the revision help? I was sleeved in March of 2011.

I've heard of people switching from RnY to DS for GERD but not the other way so I am really no help.

It sounds like they messed up your initial sleeve. That should be the real talking point with your new(?) surgeon. In general. Would they be able to redo your sleeve to fix some of the issues you are having while doing the DS or conversely if they change the sleeve to a pouch (rnY) how does that help your issues?

You might contact Dr. Keseshian (sp?) in California for a consult. I've seen several people post that he was able to help at least releive the GERD a little. I remember one person *****layed the story that he told them there wasn't anything he could do for them on that issue and that always struck me as pretty honest for someone who cuts for a living.

Pete

Actually I heard going from sleeve to rny is quite common since many people do develop gerd. It's the going from rny to ds that was more complicated & needs a surgeon that specialized in revisions.

It's not a question of needing a special surgeon. I just know from past posts that Dr. K has looked at several people that commented on what he recommended to relieve their Gerd or at least make it better.

Another opinion might point out something to their surgeon that hadn't been considered before. Sure you need to get someone good to do that kind of revision (rny to ds) but I wasn't thinking they should have him cut just see if he would look at the case for more information.

Hi, I'd try cross posting on the revisions,rny & vsg forums. You might get more answers there. I did hear that revising from sleeve to the rny is quite common for people who developed gerd.

Hope you get some relief soon.

What does it mean that your sleeve is bent? Do you have a hernia? What was the diagnosis? Have you had an EGD (upper endoscopy)?

If you have GERD, the DS weight loss actually can often help with GERD since obesity is a big cause, however if it's due to the sleeve, whatever the issue is must be determined first. GERD can cause cancer down the road, and there are questions as to whether or not being on PPIs long-term is wise. The RNY pouch tends not to have many, if any, parietal cells, which is why RNY patients do not typically have GERD. Parietal cells which create acid are mostly in the fundus and the second half of the stomach, so sleeves will still have them.

They need to sort out the cause of the sleeve issue before you decide what to revise to, because that is the #1 priority I'd argue. Rushing to the bathroom after a sleeve is...highly odd. Your stomach may have damage if it's been "bent."

I would get a second opinion from a surgeon well-versed in general surgery and not just bariatrics. It's a very complicated situation. Many DS surgeons are extremely experienced general surgeons, and several also do the RNY if needed. It's also possible to get a distal RNY which has the same malabsorption on average as a DS (150cm common channel) but then you'd have to eat quite a bit more frequently to make sure you get fat and protein since a pouch is smaller than a sleeve on average.

I am revising to a distal RNY rather than a DS myself because I do have GERD and it was not ameliorated with weight loss, sadly, and I just don't want to mess with it.

if there is something wrong with your sleeve, converting to the DS is not going to help, because the stomach of a DS is still a dleeved stomach.

if there is something wrong with your sleeve and it is causing the problem, I think only the bypass, would solve the problem by removing most of your sleeves stomach and making a bypass pouch.

I see you're in TX. Consider contacting Dr. Ayoola for a consult before you decide. He is an excellent surgeon who also seems to truly care about his patients ( I am not one of them FYI). Sounds like your sleeve needs to be re-done.

I myself would never get a RNY because you're basically sentencing yourself to a lifetime diet and I've seen so many people regain with it.

One of the things that we have to contend with in sleeveland, particularly those who had them done 6,7,8 or more years ago was that the VSG was very new to the bariatric world at that time, and most surgeons were still quite low on the learning curve with them. Consequently, we would expect to see a greater than average rate of complications and shaping issues with these early sleeves, and this looks like what the OP is going through (paraphrasing Dr. K, ..."twenty years of doing bypasses and they think that they can do a sleeve...") This is one of the reasons that I went with one of the legacy DS practices for my sleeve. These days, most surgeons can (or should be able to) consistently produce a competent sleeve.

However, the next problem is whether they can successfully diagnose and correct a problematic sleeve - this is another layer of complexity and skill that needs to be developed. In the VSG world, we often see people being revised to an RNY to correct GERD problems, and this does make some sense as the RNY is fairly resistant to GERD while the sleeve is predisposed to it (much as the RNY is predisposed to bile reflux, dumping and marginal ulcers, while the sleeve and DS are not.) The question that is difficult to answer is how many of these revisions are genuinely needed by the problems of a particular patient, and how many are done because that's all the surgeon knows how to do?

The way around this problem is to get second (and third!) opinions from long experienced sleeve/DS surgeons - Dr. K has been mentioed and there are several others around, too; most can do an initial consult via phone and email to check whether they see obviously correctable problems with your sleeve. From what I have seen over the years, most of these DS docs are very willing to recommend an RNY to a patient if that is what they genuinely need, whereas most bariatric surgeons will not recommend a DS even when appropriate as they won't recommend a procedure that they don't perform, and won't refer you to one who can.

A bypass will likely solve the problems that you have by all that we in the amateur world know, and that would probably be the most straightforward solution, but if you really want a DS (and there is good reason to!) then you should seek out the best DS expertise that you can to get a good answer.

Thank you for the feedback. I am currently waiting on insurance approval to go see Dr. Keshishian. Simce he does all types of surgery Im hoping he can suggest the best solution to my problem.