Considering a Revision

I am new to this board and I am considering a revision from a RNY done 15 yrs ago to a DS. I originally lost 225 lbs, but after the first 2 yrs the surgery was not as effective, I slowly started to regain.  Now I have an awful reflux to the point that I sometimes start choking in my sleep unless I am in an almost sitting position, and even then it can still happen.  Have tried several meds that did not help.  PCP thinks I should look into a revision, but has not ordered any tests.   I wanted one anyway since after having 2 kids and a desk job for 11 years, I regained 100 lbs.  I am hoping that a DS can help me.  I was considering a revision to a Sapala "Micro Pouch" with a proximal to distal switch, but from what I have been reading here, it seems that people like me are having great success with the revision to DS.  I am not sure that insurance will cover it, have not gotten that far yet. Here are my questions to all of you: 1. Has anyone had a revision from a standard RNY to the "mirco-pouch" and if so, what were your results and were they long lasting? 2. For those that had a DS, do you have problems with reflux? 3.  Right now I would like to get a consultation with a surgeon to discuss the possibilities of a revision to a DS.  I have read that people have found really great doctors in San Francisco, and other states.  I live in Northwest Ohio and would not be able to afford plane travel.  Can anyone recommend an excellent surgeon for this in OH (NW, SW or NE), or Southeast Michigan, or Northwest Indiana?  I would need to have someone in one of these areas that we could reasonably drive to.   I have read that revisions are complicated and an excellent, knowledgeable, and experienced physician is the key. Thank you so much, I am so happy to have found this site.  I was feeling so alone in all of this. I would be greatful for any recommendations or information. Thanks. Fondly, Kat

Hello Kat, I am glad you found this site as well, I was in your shoes a few months ago so I know how you feel.  I actually just had a revision in Dayton, OH with Dr. Maguire last week.  He does not do the complete DS revision so I had just the BPD part. When I was considering the complete DS  I looked around for surgeons that do the  RNY to DS revision but I didn't find any in Ohio.  The closest I found were in Chicago,  New York, and of course there is one here in Baltimoe, MD (I live in MD but my family is in Ohio).  You might want to post this on the DS board if you have not already they will be able  to provide more help with finding a surgeon. Good Luck S

Hi Kat, I am new to this site, I am considering a revision also. Dr. Sapala did my RNY 20 years ago. I lost 130 lbs. Now over the years I have regained 60 lbs. It may not sound like much but it feels  horrible. Dr. Sapala is now in NY, however Dr. Woods who developed the micro pouch is in Warren Mi. I seen him 3 years ago and tried just losing the weight on my own. Did ok for a while, but just like before it has come back. I am going to try and go thru him. I also have been checking out the DS. I don't know if this helps,but I hope so. I have never regretted having the RNY. Dr. Sapala was great, I wish he was closer. Dr. Woods is also very nice.  Good Luck   Debbie

Hi Kat, You may want to check out www.duodenalswitch.com for experienced DS surgeons. With a revision, of course, you don't want to take any chances with an inexperienced surgeon, DS or not. Shawnta is right and she checked out all her options. Good luck and come on over and ask questions on the DS board. There are several there who have had revisions or are waiting for their surgery dates. Good luck. Gina  

I understand that you cannot afford plane fare to the areas outside of where you're willing to travel.  However, this list of surgeons who do or do not perform RNY-to-DS revisions is as follows: List of DS Surgeons Doing Revisions

-  Dr. Warden in Louisiana has revised a lot of people who have failed RNY by making what is usually a large pouch into a small pouch and sometimes extending the limb length to increase malabsorption. -  Dr. Anthone in Nebraska stopped doing RNY-to-DS surgeries in 2006. -  Dr. Prachand in Chicago does RNY-to-DS revisions only if the BMI is over 50. -  Dr. Gagner in Florida (formerly NY) performs RNY-to-DS revisions.  Members have reported that he is one of the best! -  Dr. Alverdy in Illinois evaluates case-by-case but they are very selective. -  Dr. Inman in Indiana has only done 20 RNY-to-DS revisions (as of 9/2007). -  Dr. Lutrzykowski in Michigan wants RNY op reports before he decides if he will do revisions. -  Dr. Lane in Ohio usually does RNY-to-DS for those with higher BMI but determines on case-to-case basis. -  Dr. Anderson in Ohio does not do revisions. -  Dr. Peters in Pennsylvania does not do revisions. -  Dr. Shah in NYC does revisions on a case-to-case basis. -  Dr. Deveney in Oregon performs RNY-to-DS revisions. -  Dr. Husted in California performs RNY-to-DS revisions. -  Dr. Antelmo Sasso Fin in Brazil does RNY-to-DS revisions. -  Dr. Maguire in Ohio does not do RNY-to-DS revisions but does a distal RNY.  He told a member on the Revision board that he used to do the RNY-to-DS revisions for patients who insisted on them.  However, he mentioned that in his experience, his patients who had distal RNY revisions achieved the same weight loss results with less risks and fewer complications than with the RNY-to-DS revisions.  Therefore, he no longer performs the complete DS revisions.   -  Dr. Greenbaum in New Jersey has done 50 DS surgeries and 8 DS revisions (as of 9/2007). -  Dr. Roslin in New York does DS but when doing a revision from RNY, makes it a distal RNY.  But he does not do RNY-to-DS. -  Dr. Feng in California does not do RNY-to-DS revisions. -  Dr. Jossart in California has done 150 DS surgeries and has done many revisions (as of 9/2007). -  Dr. Schlosser in Minnesota is no longer working in Minnesota. She is overseas at the moment (9/2007) and will be for several months.  She is not returning to the state...no longer doing DS. -  Dr. Maynard in Georgia performs DS but in his response did not mention revisions.  Did encourage a member to attend seminar for more questions.  However, another member reported in 12/2007 that he does not do RNY-to-DS revisions. -  Dr. Smith in Georgia performs DS as well but it is unclear if he also does RNY-to-DS revisions.  One member thinks he does while another doesn't think so. -  Dr. Cirangle in California has performed hundreds of DS procedures, including revisions from RNY. -  Dr. Keshishian in California performs RNY-to-DS revisions.  However, he charges a $4K fee upfront for revisions that are not covered by insurance.  Plus, he requires his out-of-town patients to stay in a hotel for 10 days after being released from the hospital. -  Dr. Rabkin in California performs RNY-to-DS revisions, according to several members on the DS board. -  Dr. Buchwald in Minnesota performs DS; however, one member thinks he performs RNY-to-DS revisions. -  Dr. Hess in Ohio is retired now. -  Dr. Ungson in Mexico does RNY-to-DS revisions on a case-by-case basis. -  Dr. Inabnet in NY performs RNY-to-DS revisions and has performed hundreds of DS, according to a member on the DS board. -  Dr. Crookes in California performs RNY-to-DS revisions, according to several members on the DS board.

A number of members reported on the DS board that DS surgeons in California may charge upfront fees of $4K-$8K to cover services that are not reimbursed by insurance.

The following DS surgeons have no info on performing RNY-to-DS revisions (source: http://www.duodenalswitch.com/surgeons/surgeons.html):

-  Dr. Oakley in Idaho. -  Dr. Edinger in Idaho. -  Dr. Schweitzer in Maryland. -  Dr. Vanguri in Maryland. -  Dr. Hares in Michigan. -  Dr. Sudan in Nebraska. -  Dr. Herron in NY. -  Dr. Kurian in NY. -  Dr. Nicastro in NY. -  Dr. McMullen in NY. -  Dr. Sparks in NY. -  Dr. Voellinger in NC. -  Dr. Thomford in Ohio. -  Dr. Teel in Ohio. -  Dr. Hoddinott in Pennsylvania. -  Dr. Elariney in Virginia. -  Dr. Fichter in West Virginia. -  Dr. Marchesini in Brazil. -  Dr. Alcides Jose Branco Filho in Brazil. -  Dr. Baltasar in Spain. -  Dr. Marco in Spain.

Initial research done by Karla H. Source: http://www.obesityhelp.com/member/karlahook/ Click on "September 2007" blog Hope this helps!

Dr. Elariny in Vienna, VA DOES do revisions from RYN to DS; I'm working on getting it approved from insurance right now.....

Thank you for the updated info, Pat. The updated info will be included in our list. Thank you again.

Go hangout on the DS Forum for a couple of days. It will help you make the right decision

Thank you so much to all of you who have replied.  I have a lot of research to do.  I have been trying to read in the other forums and will also go to the sites that you have listed.  Thanks again so much for your help!--Kat