any regrets with getting the RNY

I am having a revision surgery in October to an open RNY.  My previous surgery 7 years ago was the mini gastric bypass.  I've notice that most people on this forum seeking revision had the RNY.  I am hesitant about undergoing surgery again to find myself 2-3 years down the road going through the same thing.  I would like to hear some input on this matter and if you were in my situation would you go through with the open RNY?  Emotionally, I don't know if I can take another failure several years down the road.

I had a failed RNy and has a revision to DS. I would not let my daughter get an RNY, she had a Ds and is very glad she did.

I had a VBG in 1990 and needless to say it failed.  When I started researching a more effective, longterm solutionn, I started looking at Lap Band and RNY, which are the most known, by far.  The more I read of testimonials and studies, it became clear that both can end up in regain longterm.  Like you, I can't abide going through another surgery only to regain AGAIN.  Don't get me wrong, many people succeed with both.  I just don't think that I will, because I've already 'beaten' one surgery and want the least 'beatable' surgery.  That's how I got to the DS.  Honestly, I'm pretty sure it's 'beatable' too, but it seems to afford the least chance of it.  That's how I got to my decision to have the DS and I hope to once I get funding. 

Best of luck in whatever you decide.  Get all the information you can on every procedure (or no procedure) and you can't go wrong from a place of full knowledge.  Be well.

Robert, Can you share more specifically why you are going with the DS vs. the RNY? Physically, what is the biggest difference in the surgical procedures?  I had an RYN 10 years ago; I know almost nothing about the DS. Do more surgeons favor one over the other?

Hi Pat,

Actually, Robert was my doctor's name.  My name is Doron.  Your questino is a great one.  My main reason was to go for the surgery that had been shown to afford the lowest chance of regain.  Since I haven't even had the surgery yet and am no expert, I recommend you come by the DS board on here and ask any questions.  Everyone there is happy to answer all questions, as they did for me.

"what is the biggest difference in the surgical procedures?" RNY compared to DS

RNY - expected weight loss

• 50-65% expected excess weight loss (percentage varies in opinion – on average estimate)
  • Results may vary
• Regain
  • Can regain 50% of weight after 5 years
  • 100% regain of weight has been recorded
  • RNY must exercise and diet to maintain weightloss after 5 years

 DS – expected weight loss

• 85% expected excess weight loss
  • Results may vary
  • Studies show little to no regain
  • 20 lb gain from lowest weight has been recorded

 RNY – have a stoma (stomach made into a pouch – size of an egg)

• Size: 2 oz
  • Stretch to average size of 6 oz in 2 years  (can stretch up to 9-10 oz)
  • You can eat more as time goes by.
  • Average after 1 year is 1-1.5 cups of food
• Stoma: blind pouch
  • doctor evaluation cannot use an endoscope (to find ulcers and tumors)
  • cannot take Nonsteroidal Anti-Inflammatory drugs (NSAID).
• NSAIDs are: Advil, Alka Seltzer, Aleve, Anacin, Ascriptin, Aspirin, Bufferin, Coricidin, Cortisone, Dolobid, Empirin, Excedrin, Feldene, Fiorinol, Ibuprofen, Meclomen, Motrin, Nalfon, Naprosyn, Norgesic, Tolectin, Vanquish
  • NSAIDs are used for arthritis, bursitis, tendonitis, back pain, headaches, and general aches and pains. This could develop into a bleeding ulcer and interfere with kidney function.
• Possible Problems
  • Uulcers (Doctor’s recommend taking prilosec to try and prevent the ulcers)
  • Possibility of a staple line failure
  • Narrowing/blockage of the stoma
  • Vomiting if food is not properly chewed or if food is eaten to quickly
  • No Valves (pyloric valve that opens and closes to let food enter intestines is bypassed)
  • which means food empties directly into the small intestines and causes dumping and NIPHS.
• Dumping: food (most commonly sugar but not necessarily just sugar) enters small intestines and causes physical pain (some people believe this pain enforces good eating habits)
  • Dumping varies in degree of occurrence and discomfort
  • Dumping symptoms:
    • Nausea
    • Vomiting
    • Bloated stomach
    • Diarrhea
    • Excessive sweating
    • Increased bowel sounds
    • Dizziness
    • Emotional reactions
• NIPHS (insulin over production): “the body overproduces insulin in response to food entering the intestines at a point where food would normally be more digested already - this part of the intestine is not used to coping with metabolizing glucose in the condition it arrives after RNY, and it is suspected that the intestine signals the pancreas for more insulin to aid digestion, causing a MASSIVE overproduction.  The change occurs on a cellular level, hard to diagnose.  Treatment: Removal of half the pancreas.  A couple of folks who've had this done have posted on the message boards in the last 6 months.”
  • RNY stoma that is created allows food to go straight through the stomach into the small intestine unrestricted so it does not control the flow.  Because of that the body reads that it needs more insulin because the food is moving through so quickly and it thinks there's going to be a lot more food.  With the DS, the normal peristalsis works because the pyloric valve is in place and can control the movement of food into the small intestines.  

 DS – whole stomach (size of banana)

• Whole stomach means the stomach’s outer curvature is removed as opposed to making a pouch/stoma.
  • Part of the stomach removed is where most of the hormone called Grehlin is produced.
  • Grehlin gives the sensation of hunger so by removing most of that section, a Dser is not as hungry as before.
• Whole working stomach: no blind stomach.  Endoscope can be used.
• Can take NSAIDs
• Do not need to take Prilosec to prevent ulcers
• Valves are in tack: no NIPHS

 RNY – Eating

• Recommended to chew food to liquid (most important early out)
  • Foods need to be thoroughly chewed to prevent blockage (hole leaving stomach and into intestine is the size of an eraser).
  • To get food unstuck, patients drink meat tenderizer mixed with water.
• 64 oz of water
  • Stop drinking within 15-30 minutes of a meal
  • Do not begin drinking after a meal for 1-1.5 hours
  • Not encouraged to use a straw
• Low carbohydrates (carbohydrates can slow weight loss)
  • Avoid sugars (in fear of dumping and slowed weight loss and/or weight gain)
• Eat protein first
  • 60g of protein a day
• Water Loading
  • 15 minutes before the next meal, drink as much as possible as fast as possible. 
  • Water loading will not work if you haven’t been drinking over the last few hours.
  • You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.

 DS – Eating

• Daily intake of 80-100g of protein
• 64 oz of water
  • Can drink with meals
  • Can use a straw
• Low carbohydrates (carbohydrates can slow the weight loss)
  • No dumping syndrome from eating sugar
• Only absorb 20% of fat (do not need to eat low fat)
  • DS patients can eat more food than any other type of weigh loss surgery.

 RNY – Possible Issues

• Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
  • Common vitamin deficiencies found in vitamins B12, iron, and zinc
  • Calcium must be supplemented for the rest of your life
• Bathroom issues
  • Gas
  • Constipation
• Reversible procedure but complicated
  • Revision often performed instead of revision

 DS – Possible Issues

• Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
  • Common vitamin deficiencies found in vitamins A, D, and iron
  • Water soluble/ water miscible / dry vitamins absorb best (in other words get vitamins that are not fat/oil based)
  • Calcium must be supplemented for the rest of your life
• Bathroom issues
  • Stinky gas
  • Loose stool
• The intestinal bypass is reversible for those having malabsorptive complications
  • Stomach portion removed is obviously not reversible

 RNY - Diabetes

• RNY does not cure diabetes but puts it in remission.
  • Can come back in two or three years--even if the patient maintains most of their weight loss.
  • Even a small weight gain long-term can cause a diabetes relapse.
  • 85% cure rate

 DS – Diabetes

• A 98 percent cure rate for type II diabetes.

I heard that a distal RNY is the worst surgery, because you have all the stomache problems of an RNY (ulcers, strictures, can't take Ibuprofen, dumping, anemai) and all the worst aspects of distal surgery (malabsorption of vitamins, diarrhea, gas) I chose a revision to biliary pancreatic diversion (not a DS) and had my RNy pouch left alone. I now will have stomaphyx in3 days to get more restriction. I like my new bowels, I have lost 70lbs eating the same food I gained 40lbs on the year before the surgery. I take all my vitamins and can control the diarrhea and gas by chosing to eat better.

I had RNY in 94. 

In 96, I had horrendous pain and looking back on it later, knew that was the very moment my staple line broke.  I'd only had coffee that morning so mytiny pouch wasn't full.  I think the 2 years of vomiting weakened my staple line. 

I also had stoma enlargement (had an upper GI and an endoscopy late 2005 and early 2006, which confirmed this and made approval for my revision easy)  No wonder I was hungry every 2 hours.  I was completely empty!!!!!!

When I started looking into revision surgery, the good people here told me to get an upper GI and an endoscopy to take during my consult.  I did and you know what Dr. Husted saw/read?  I had a "large gastric fistula" and "stoma enlargment"......which all means, my staple line had come undone and the artificial opening from my pouch to my small intestine was enlarged (emptied out my pouch within 2 hours so I was hungry because I was empty!)

When I decided to have a revision, I had quite a few consults with respected surgeons and they all wanted to "fix" my RNY.  They just didn't get it.  I did not want another surgery that could and, in my opinion, most likely would fail me.  I wanted the surgery that would give me the best odds of losing my excess weight AND keeping it off.      http://tinyurl.com/y7y4ya

 At 53 years old, I wanted to get it right and once I heard about the DS and there would be nothing mechanically to fail, I knew I'd found the right surgery for me. 

With the DS I can eat like a normal person.  I no longer vomit, I no longer dump, food no longer gets stuck and best of all I don't fear regain.

It was pre-Internet days (for me) and I had no way of finding out my options but I would have loved to had those 12 years of freedom from obesity. 

Better late than never.

I had my RNY revision done because my first surgeon screwed up and despite his mistakes I still managed to lose 100 lbs..  I will tell you my opinion though.. regardless of the surgery we choose if we are looking for way's to "beat" the surgery.. we are looking for ways to fail.  Every surgery can be  beat if we choose ..  If you follow the rules and do what your suppose to regardless of the surgery it will work.  Yes there are mechancial reasons for failure and if that happens it needs to be fixed.  Many people will beat themselves up saying they failed and they dont understand why.. you have to look at your own behaviors and if you feel you have done it all right then look at the surgery itself.  Someone very wise once told me about weight gain.. "Five pounds is to much, once you gain 5, 10 is easy"  So I do weigh every single day if I see the scale go up...  I do something about it right then.. I wont let myself get 5lbs over...  Good luck with your surgery, you will do fine!!! Debby