REVISION QUESTION

OK.. i'm really not a dumb person... old maybe, but not dumb. I keep reading about people having or asking for a revision... usually from a VSG or RNY to a DS because they have usually had a regain. Is this common practice and most of the people are patients from St Joe's.. (where I had surgery 7 yrs ago and YES I too am one of those who have had a regain.. but I know why I regained!!!)... Is it that easy to get a DS these days?? and wouldn't it be a better option to receive some sort of counselling or therapy re: how we can beat food addiction, etc.? I know I went through some big changes and even an unexpected passing of my only sister so I turned to food for consoling... and yep, the frig became my best friend. I need to beat that addiction but that's MY story and issue. I'm not saying everyone has this problem... but was just wondering if the DS is that easy to get these days.. because we have gained 20, 30, 50lbs or even more??

I may be entirely wrong here but I'm going to throw my hat into the ring on this one. :)

My understanding is that there are very few surgeons who are qualified to do the DS surgery. I know for a fact that for the longest time Dr. Hong was the only one in Ontario and anyone having a DS was being referred to him. I have heard that one of the other surgeons at St. Joes, either Dr. Gmora or Dr. Anvari is now qualified as well.

As a result you see a higher number of DS surgeries coming out of St. Joe's.

The next part of the equation seems to be the process of a 2 step surgery process. I don't know why so I won't wade in, but the original plan is for the patient to eventually have a DS but they don't seem to do them right away. They start with a Sleeve or an RNY. They hope that it will work well enough that the second step won't be needed. For some reason, the Sleeve or RNY doesn't work. The patient stalls and regain starts and it doesn't seem to matter what they do, but they can't halt the regain.

So they move forward and do "the revision" to DS.

I don't think it's "that easy" to get a DS. I know several who have had the two step process and it is arduous and difficult. I do believe you see a lot of them at St. Joe's because the surgeons that do DS surgeries are there. It's probably appearing disproportionate but I think overall it's not.

thanks for your explanation... my take on it was... "i haven't lost all my weight or i've had a regain.. so i'll see if i can get a DS".. unfortunately that's how i was seeing it! and yes i understand Dr Hong seemed to be the only surgeon at St Joe's... and that's great there are other surgeons performing the DS as well! i've moved away from the hamilton area and not too many are getting the DS where i now live. i was just wondering if that's what was happening.

take care of you! and thanks again!

I had my VSG February 4, 2019 with Anvari at St. Joe's in Hamilton. I think the DS option only exists with the sleeve. How Anvari explained it to me is that after 9 - 12 months and/or 100 lb weight loss, the DS is performed after the sleeve. It is typically done in two surgeries, though I understand you can do the sleeve/DS in a single surgery.

I don't think the DS is a revision. It is the second step of a two-step process for qualified patients. How patients are qualified is beyond me, but Anvari said he thought the sleeve/DS would be the best option for me.

One thing that stuck with me from the orientation and sessions pre-op was that St. Joe's is there for you, one year post-op or 10 years post-op, so if you think you need some support, I would encourage you to reach out to the bariatric team.

St. Joe's also has an updated handbook that includes the DS option, so you could get info from them on that as well.

Good luck,

Jennifer

Hey Jennifer... thanks for your comments... i'm not looking for a DS. but as you explained i remember it being a 2part possible for those who have had the sleeve as i know a couple who have had it performed, along with knowing someone who had the DS done in the states years ago. i just commented that i had seen a few people asking for a DS because they had either not lost enough weight in their minds or had a regain. Good luck to them and yourself!!! But, 7 years ago we were told 5 years and you're out.. and that's what it was when i had my 5 yr check up!

take care of you!!!

Now it's 1 year and you're out.

The only way, they are there for you is if you are experiencing issues and get re referred once you've been discharged.

I was at the Support Group Meeting last night at St. Joe's and this was explained to us by the Social Worker who runs the support group.

If you were in the system prior to May 2018 you are in the 5 year program. If after, 1 year.

That's what I understood.. now.. it's 1 year and you're out! Even baseball players get 3 strikes!!!

That's really too tooo bad!!! and as Jennifer said previously contact the clinic.. i've had other WLS friends who have tried to contact the clinic to arrange for their follow-up appointments and never hear back so they just give up... that's they're choice - i think i'd still bug the clinic.. but i was fortunate enough not to have that problem.

My problem is maintenance and i think that's when I (we) need support more than ever... especially with the possible regain and head games!!

Oh well, it is what it is!!

It's very short sighed IMO.

I'm lucky in that I managed to lose everything I needed to lose in the first year. The real struggle has now begun. This is when we need the support and expertise the most.

They've also doubled the number of surgeries that they do, but can't accommodate follow up even in the first year.

I really feel sorry for people entering the program now. I mean, what happens if it takes you 2 or 3 years to lose the weight you need to lose? After 1 year you're done and out there on your own. Very sad.

yes i too was lucky to follow the program as instructed and lost all of my weight and had a wonderful "a ha" moment... last a while but with life issues..the bad habits came back and now a regain has occurred.. i'm human.... it's life! BUT... yes... after losing the weight is when support is needed!!

and i too feel sorry for those entering now... it's awesome we are given this opportunity to get our weight under control.. i believe that's what this tool does for us.. sure the pounds peel off.. but it's dealing with it when we hit goal!!

sure, not everyone has problems/issues/regain!! and good for them!!!

and we could discuss this issue over and over and over!!!

Revision to DS would typically only be done if the person was a very high weight to begin with. Even with rny, a patient who is 300-500 lbs might lose only so much and so the DS would be done as a further enhancement. DS at erarely given out anymore in Ontario. Unfortunately they do DS as a two step here. You'd have to still meet the criteria to qualify for surgery and yes you would go through the process and typically the revision process makes you have to "prove yourself " a little

more.