RNY to BPD/DS Revision! Surgery DEC 9th 2021

Hello OHELP family! Feels so good to be back on Obesity Help... I had RNY Gastric Bypass back in 2004 (I was 15 years old at the time) and was a very active member on Obesity Help. (DR.ADAM NAAMAN, RETIRED, HOUSTON MEMORIAL HERMANN) I was 430 LBS at the time of surgery. I got down to my lowest weight of 185 after 6 years... which was age 21. I slowly, VERY slowly gained weight over the years... today I am 320 LBS and 34 years old. I have been seeing my Gastric Bypass surgeon for about 10 months (DR.MARIO DEL PINO, MCALLEN, TX RGV HOSPITAL) pondering the idea of a revision and decided about 6 months ago that I wanted to do it... so I am past all of the red tape, dietician visits and have full approval (by the grace of God) to have the BPS/DS revision performed... surgery date is 12/9. I am SUPER excited but also a little nervous, so I wanted to chat here with those who have had the same/similar procedure or in the process etc.

Help keep me honest here, I cant remember for certain but I am almost 100% sure that my doctor told me he wont be modifying my pouch.. he said during my scope that the pouch size was still nice and small (even though I can eat much more than when I 1st had my RNY) and that I would "technically be able although absolutely not recommended" to still eat whatever I wanted because this procedure is malabsorptive in nature and not changing anything with the stomach. He did state the 1st 4-8 weeks its still recommended to follow the clear liquids and then soft foods/puree portions of the diet... Does this sound right?

Question about common channel... should I be asking how much or how little of this he is bypassing? I am not certain that I fully understand that it even truly matters with an experiences surgeon but would like to hear from you all as well.

Vitamins, Vitamins, Vitamins... I am currently taking a daily multivitamin, Iron, Vitamin C (Gummy) and B12 (Gummy) every day, I never miss a vitamin... my understanding is that I will need to add Vit A and Vit K... is this accurate? How much of those vitamins? What other vitamins?

Weight loss expectations? My surgeon said he believes that with the revision, he believes I can lose anywhere between 85-90% of my excess body weight and keep that off... what are your experiences or thoughts? He stated my age is still on the younger end of things and with proper diet and exercise, he feels I can be a true success story. Does this operation generally promote fast weight loss?

And LASTLY... What advice or recommendations do you have? Doing it laparoscopic, any idea about how much time I may need to take off? I feel like a week is ample, what are your experiences?

My aunt had it almost 9 years ago after chaining weight back from bypass she lost all her weight and has stayed there since. I'm going to see a surgeon on Monday November 8th I had the bypass in February of 2003 and have kept my weight off but for the last year I'm menopausal and can't seem to lose no matter what I'm steadily gaining!! I'm scared with my Bypass being open they won't do it they will say to much scar tissue! Was your bypass open or laparoscopic and so you know my aunt has never been malnourished she always taken her vitamins.

Thank you so much for sharing! That's really good to hear that she has maintained her weight loss for that long. My original surgery was laparoscopic, and the surgery will also be laparoscopic. I have friends who have had revisions with both their original and their revision being open, there was additional screen but it did not prevent the doctors from feeling confident on operating.

I will say this too she eats all day long she said the other day oh my I've been eating to much and get on the scale and she weighs the same.

That's fine I understand

If he is leaving your pouch intact then he is not doing a BPD/DS, as that uses a sleeved stomach as in the VSG. What he might be doing is a distal RNY, which is a more malabsorptive version of the RNY which has a common channel length on the order of what is done with the BPD/DS. As the RNY to BPD/DS revision is very complex revision that few surgeons have the experience to perform, even experienced BPD/DS surgeons, and Dr. del Pino doesn't list the BPD/DS as an option on his website, (he lists the simpler SADI/"modified" DS instead) I doubt that this is what he is proposing - perhaps there is some nomenclature confusion going on?

Post op diets vary all over the map, and there is more variation between surgeons than there is between procedures. With our surgeon (my wife had a BPD/DS from him, and he is one of the ones who does the RNY to BPD/DS revision) we were on purees and soft foods immediately as tolerated and then everything else as tolerated after a month, so that's a big YMMV thing.

The vitamins sounds about right, but as usual there's lots of variation in recommendations. The BPD/DS and distal RNY both malabsorb more of the fat soluble vitamins A,E,D and K, so more emphasis is put on them. Many recommend a separate dry ADEKs tablet to handle that, but most people split it up and go with individual vitamins over time as their labs show what they really need, and they may need, say, more D and K but less A and E than the standard tablet provides (or some other combination.) It all comes down to what you as and individual needs as shown by your periodic labs.

Revisions typically do not do as well on weight loss as a virgin procedure (my simple minded view is that your stomach started out being able to hold 32-64 oz; after your first WLS, even with some stretching and adaptation, it only holds maybe 4-8 oz, compared to 1-2 oz right after surgery, so the volume difference isn't nearly as big as the first time around - you have learned how to "eat around" the smaller volume.) The BPD/DS and distal RNY generally offer the best results as the significantly greater malabsorption comes into play, but still isn't usually as strong as a virgin procedure. Being a younger guy helps significantly, though, on the metabolic front. Some do fantastically with a revision, but that is not the average, so it pays to really look at it as a "do over" that helps you get back on track rather than a total cure. Those who do best, from what I have seen, are those who dedicate themselves to "not letting that happen again". That said, the BPD/DS is the best around at helping to keep it off in the long term - we have a dinner support group (or at least did, pre-covid) of mostly 15-20 year DS vets, and by and large all are maintaining well over that time. Sure, there are ups and downs, but mostly the weight comes back off more or less like a "normal person" with a few months of effort and attention.

Time off is another big variable, particularly with type of work contemplated; being younger and presumably stronger plays in your favor, the more extended clear liquid diet post op tends to play against it as its harder to get and maintain the energy than on "real" food. Add in there the luck of the draw - complications in the surgery and individual responses to it all and you may feel like you've been run over by a truck for an extended time, or up a ready to take on the world in a couple of days, or anything in between. I would not make any big commitments toward work that early out, but do as much as you feel like doing.

I would be very careful here....The surgeon you picked does not do the DS, he does SIPS. You will not be getting a DS, you will be getting a distalized RNY (depending on your common channel) so you will have one anastomosis ......

CAUTION here. Your surgeon is telling you he wont touch your pouch since there are only a handful of surgeons in the world that can revise a RNY pouch to a VSG. YES you need to ask questions about what he intends on doing to you.....in other words common channel...is the place where the 2 DS limbs meet and where absorption is. the shorter the common channel the greater the weight loss and PAY ATTENTION the greater the malabsorption. It has been agreed on that a 50 cc is too short, but I know one surgeon that is still performing them. Years later, yes you will lose the weight, but the # and severity of deficiencies could be overwhelming.....you are not at all ready for the # of vitamins/supplements you could be taking if you are distalized.....ask a lot of questions! best to you

I get my vitamins from Bariatric Pal and always buy the liquid vitamins. I highly recommend Buying the Wellesse vitamins. I have the DS and at one time got really sick because I was not absorbing anything at all. I ended up with a PICC line and on TPN for several months. On June 1st my doctor did a small revision which has helped me so much. The problem that I have is that I am back on insulin because the TPN did something to my body. My starting weight was 270 and before June 1st I had gotten to 199. Currently I am fluctuating between 208 and 215. I'm struggling with the fact that insulin can make you gain weight. I am determined to get below 200. Good luck on your new journey!