RNY Revision Questions

I had a RNY done 10 years ago and since having my two children six years ago, I have been gaining. I've gained about 60 lbs. back from losing 200 lbs. I'm talking to my surgeon about my options and wanted to hear from some of you who have had revisions from a RNY. What revision did you have, how long ago, how has it been going, and how did your surgery go? Did you have any complications? Did you feel like the way you did after your original RNY as to restricted eating and feeling full and not wanting to eat? How has the weight loss been going? How was your recovery? I would like to have a revision, but I don't even know what my options are with my surgeon until I go see him, but I would like some info to take with me, so I can discuss it with him and hopefully make a decision on what to have done. Thank you for any help you can share with me.

I am a revision from RNY to DS due to stoma enlargement and staple line disruption.  I chose the DS because it allows a much more normal way of eating, retaining the pyloric valve (no stoma) and they removed 3/4 of my stomach (took down my pouch)  I just didn't want revision to another RNY that could and IMO, would fail again. I had it 19 months ago, lost 130 lbs, got to goal in 12 months, feel terrific, have had zero complications and would do it again yearly if I had to! With the DS the restriction is more in the beginning but the malapsorption is what keeps you from regaining.  You could sabatoge any WLS by not following the program but with the DS it's really very simple with no dumping, food getting stuck, vomiting, fills, etc. 1.  100 gr. protein daily 2.  64 (min) oz fluids daily 3.  low carb until you're close to goal 4.  Vitamins and labs for life

Hi starry1st, I have a question for you. I had RNY 7 years ago. I have now gained back half of what I had originally lost and I am trying to decide if a revision would be worth it for me. Through my research I came across some information that in most cases when doing a revision to a DS from a RNY that the surgeon does not actually do the "true DS" because they would have to put your stomach back together and then resection it down a different part for the DS procedure. The article said that it is very rare they will do this because of the seriousness and complications it could cause. My pouch was totally separated from the remainder of my stomach rather then the use of a staple line. The article said they consider it a DS revision because what they do is move the intestine down further much like the DS procedure for greater malabsorption and this is why they call it a "DS revision". Did your surgeon talk about this at all when you were going through the process of the revision? Can I also ask what criteria you had to meet to get the approval from the insurance for the revision?

I have heard this too. That once an RNY is done, it is very hard to reconstruct the stomach, so the surgeon does an extended RNY with the intestines and that is suppose to be same as done with the DS intestines. If the stomach has only been stapled, the stomach is still together, so it is easier to do the DS. THey just have to take out the staples and do the DS surgery almost from scratch.

I recently asked my surgeon this question.  (good one, BTW) This is copied directly from the email: me: Hi Dr. Husted.   If someone has had a roux-en-y gastric bypass and was transected can one be revised to a Duodenal Switch or is it only people that the stomach was not truly cut apart but divided with staples. Dr Husted: Non-divided gastric bypasses can be revised to DS as well.   Gastro-gastric fistulas suggest staple-line failure, whether the pouch was divided or not.   John D Husted, MD

 

The criteria was the same as pre-op with the RNY with my insurance, but that is a question you will have to ask your insurance.

Thank you so much for your reply Starry1st. You seem so knowledgeable about this kind of stuff and I do appreciate your sharing it with me. I guess I am still a little confused...Dr. Husted states that "non-divided" gastric bypasses can be revised to DS as well....So am I reading it correctly that since my pouch was totally separated that I would not be able to have the traditional DS???

I had staple-line disruption, a fistula, adhesions galore, hiatal hernia...... and I had regained all of my weight except for 5 pounds. It took me forever to get a correct diagnosis and a surgeon willing to treat me.  It was terrible.  Now that I've had a revision, the weight is not coming off as I hoped it would.  Great. I wasn't given any option except for restoration of the RNY.  My pouch was damaged (probably due to errors in the original surgery) so I had no other options.  Too much was going on for any other possible surgeries, and I was OK with that. First of all, you need to see a qualified surgeon to determine what, if any, mechanical failures you have had.  Then they can help you make a decision from there. Good luck to you.