The ABC's of Revision A to Z

Hanna, Are they planning to undo the switch portion of your DS? If your intestine is restored to its original state, you will likely have a significant weight regain. Giving you a small pouch will help off-set some of the regain, in part because there will still be some intestine by-passed. In order to make any kind of prediction, the exact nature of your revision is required. The planning of your revision is vital and something you must discuss thoroughly with your surgeon. How drastic a reversal you will have will depend on a number of factors. How severe are your vitamin and mineral deficiencies? Are you also suffering from protein malnutrition? Make certain that you understand precisely what operation is planned and why. It sounds like your surgeon has a lot of things to explain before you proceed. GOOD LUCK! Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Dr Schlesinger, my cc is 100cm and my weight at the moment is 145lbs  I'm 5feet 7inches My protein level is low but not very, it's my vitamins, iron, b12, PTH, calcium, b vitamins, d vitamins, low blood pressure 80/60 sometimes even lower. I'm taking b12 shots, d shots and iron infusions every 6 months as well as a number of vitamins and minerals, I'm suffering from acid reflux and the acid has eaten the enamel from my teeth dispite taking acid reducers and my vision has worsened in the last year so now I have to wear glasses mind you no-one in my family ever needed to wear glasses, I low carb and avoid all kinds of fat in my diet yet i'm always distended and have a lot of gas I've been on a course of flagyle 400mg 3 times a day for a month and the bloating, gas still remains. for the last year now I've just had no energy to do anything and my quality of life has become very poor. so yes I am going to get a full reversal of the switch portion of my DS. I've consulted many times with my surgeon he has helped quite alot with the shots and injections and we have discusses the reversal, he said that I will regain all the weight back. he only does the lapband and ds so he is at a loss as to what to do with me. this is why I have sought your help Thankyou once again,  Hanna

Hanna, I am very disturbed by the severity of your reflux. Have you been hospitalized for respiratory problems? Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Dr schlesinger no, but I've gone and had two gastoscopes done, lasttime i was given losac 20mg a day and this time they gave me a stronger acid reducer this time they've put me on nexium 40mg twice daily plus mylanta. I think that the reflux might be a side effect of my DS as I never had it prior, also I'm having acidic BM's too. I have been avoiding things like oranges, coffee, lemons, tomatoes, cucumbers, chocolate, coca and soft drinks because of their acid contents. I'm going in to have a colonoscopy tomorrow as my surgeon suspects that I have a rectal prolapse due to too many BMs. I know that this doesn't happen to everyone who has the DS and that everyone is different I just want to correct my problems so that I could have a better quality of life. I know that I'm being a real pain hear and probably have taken too much of your time already It's very hard sometimes to be able to get a second professional opinion and I thank you very much for this, you have been a god send not only to me, but to many others on this board. and have opened my eyes to a revision as apposed to a reversal.  But could I just ask a few more last questions and would really, really appreciate it if you are able to answer them for me,  1) if I were to lengthen my common channel from 100cm to 150cm or 200cm which would be the better of the two?  2) would that be enough to allow me to absorb my vitamins orally without having to have the shots and infusions. 3) would it reduce the amount of my BMs and make them less acidic. 4) would that elimenate the malodours stools and gas or just make it less malodours. 5) how much of a regain would I be expecting with this extra length of intestine.  6) how long does it take for the intestine to fully adapt to its environment is it months or years. I'm sorry to be a pain with my obsession with the weight regain, it was because of my lower back that I had to have weightloss surgery in the first place and now secondly because of the reconstructive/plastics that I've had. I really, really do appreceiate your help and anymore advise that you could give to me. now I can at least have more discussions with my surgeon and a much more clearer and knowledgable mind. P.S I forgot to mention the only reason why my surgeon does not know what to do with me is because of my acid reflux problem he doesn't want to reduce the gastric sleeve anymore than it already is as he thinks that I might have major problems later on.  Thank you, Hanna 

Hanna, The most important objective is to get you healthy. Lengthening your common channel would clearly improve your absorption. The question is: How much is enough? Unfortunately this question is impossible to answer. Your case is very complex and I cannot provide a simple answer. Based on what you have shared, I would give strong consideration revision to some form of a Rny. It would alleviate the acid component of your reflux. An upper GI that carefully measured the transit time of the contrast through your small intestine might provide some insight as to what kind of Rny would give you the best result (balancing correction of your defeciencies against weight regain). If you wanted to "play it safe" a very proximal Rny would offer you the greatest correction of your malabsorption. In all likelihood you would still require vitamin B12 replacement. It has the potential to improve your other vitamin, iron and calcium absorption as well. It should reduce the diarrhea, gas, odor, and bloating. Do not overlook the fact that with a Rny you would be at risk to "dump." Fastidious monitoring and follow-up would obviously still be required. If your malabsorption is well corrected, but you gain too much weight, by-passing more intestine at a later date could be considered. Please discuss these options thoroughly with your surgeon. NEVER GIVE UP! Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Dr Schlesinger,  Thankyou, Hanna

doctor, Have you worked with the VBLOC therapy for weight loss? And what do you think of it? Is it something that could be done instead of revision? Thank you.

Dr. S, Hi, I've got a couple of questions.   I had open RNY surgery back in 2002 and have since packed on approximately 70 lbs from an original weight loss of 123 lbs.  Although I've since experienced 2 miscarriages and a healthy baby boy (2006), I am beyond frustrated, disgusted, disappointed you name it....Anyway, I consulted my surgeon in regards to my situation and he suggested a biliopancreatic diversion w/ duodenal switch.  I'm confused because I've been reading posts from people that have had revisions and what is commonly mentioned is simply the duodenal switch.  Is there a difference? Also, he mentioned that the outcome might be a weight loss of 30 lbs or better but it depended upon my body and the malabsorption.  Like I said, Ive been glued to people that have had revisions on this sight and they seem to have lost quite a bit of weight.  I just want to get rid of the excess baggage and stop taking my bp medicine which was an original goal for me in the first place.  Could you please take the time out to respond or anyone that can offer some assistance/advise, this would be GREATLY appreciated. 

Zurbib, I believe that your surgeon is talking about an ERny. It would be best to ask. If the explanation is inadequate or confusing, ask that your surgeon draw pictures of your current operation and the changes that will be made. Depending on the length of the common conduit, much more than a 30 lbs weight loss can be achieved. CLAIM THE SUCCESS YOU DESERVE! Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Dr. schlesinger, I had a RNY oct./2000. I was 270 lbs.  one year later 9/2001, I was 200lbs. I never really reached my goal but I was happy to have lost 70 lbs. However, I have gained 30 lbs, which bring my weight to 230lbs at 5ft.2in tall and I am definitely seeking a revision.  I am 65 years young Female, retired for two years now.. I do not know which way to go, I am hearing about Stomaphyx, ROSE, sclerotherapy, I really would like your input and knowledge on these revisions and if you think I am a candidate for any of them.  I am in good health except for the tendency to gain weight. I have no high blood pressure, no high cholestrol, no cardiac problems and nothing organically wrong. I really appreciate your input.    Thanks, Quintette