Info for those looking into a revision...(long but if it helps 1 person it's worth it)

I have a question.  I have gone to a surgeon in my area who has never performed a DS revision but does DSs.  So I started looking into alternatives; eRNY mainly because it bypasses so much of the common channel and isn't the risk that DS is.  Is a distal RNY similar? I have actually lost my restriction which brings me great saddness.  I didn't realize that I was depending on that so greatly and no I have failed my surgery.  What made you choose the riskier surgery and did you ever look into extended RNY?

Hi Shay,
Yes, I did look into the ERNY because that was the only revision surgery done in my area, but I chose to go with the DS because the surgeons said with the ERNY that they couldn't do much with the pouch. One surgeon said he could trim it ,but that in a few months it would stretch back out again. I needed the restriction to help get this weight off and I was afraid if I went the ERNY route that I would not lose as much as I wanted to. The DS and ERNY are similar in the bypassing of the intestines but my theory was... that part would help me maintain my weight but If I didn't have something to help me get this excess weight off what good would that do. For me it was all about my need to get the restriction back. Although I will say, I would only do a revision of this magnitude with a surgeon that has done a great many of them. Dr. Husted came very highly recommended and I did my homework on him before I officially chose him to do my surgery. It was worth every penny to fly from GA to CA to have him do my surgery!
Susan

PLease forgive me if I am too foward, but I am assuming you were a self-pay.  I may have to do that b/c my BMI is not 40 and I am not trying to wait until I gain another 40lbs.  Did you finance it?  I am looking for a way to pay for it because w/o my health and happiness what good does money do?  Thank you for the information about the pouch, btw. I am sure mine is stretched; to what degree I do not know, however as I can now eat an entire sandwich at any given time (w/ no dumping, I might add) I know something is not right.

Actually I wasn't completely self pay. My insurance BCBS FEP covered all the hospital costs and related expenses. but since Dr. Husted is out of network I had to pay the surgeons fees self pay. He actually makes patients pay the surgeons fees up front anyway then if the insurance covers any of the fees he reimburses what they covered to the patient. I financed the surgeons fees and travel costs through my credit union. I knew my pouch and stoma were stretched (I had an endoscopy) and looked into having a revision for almost 2 years before I decided I had to do something since I was continuing to gain weight steadily. I then had an upper GI and they found a small gastro gastric fistula (barium was flowing into the pouch and some was making it's way back into the stapled off stomach). Under my insurance this was the medically necessary reason for a revision. Some insurance will pay for a revision if you have a medically necessary reason for it, even if your BMI is around 35 if you have other comorbidities. Let me know if I can be of any help further into your journey!
Susan

Hey there Shay! .....            (Proximal, medial, distal, Extended = RNY's) are all measurements of the intestine/common channel.  Some docs use different lengths/terminology so it's important to be clear with what YOU want when chatting with a potential doc.  Distal and ERny can both =100 cm common channel.  But, usually the Distal stops at 100 cm where the ERny can be a bit shorter (50 cm up to 100 cm).  The DS common channel usually equals an ERny but most surgeon's wait to peek inside before deciding on exactness......"before hand" planning is based on your health history, previous losing history, compliance, etc.  As for worrying about your pouch and thinking you NEED restriction.....consider that most pouches will stretch out again (just muscles and muscle stretches).....and that the sleeve (arm) of the DS stretches with time as well (taken from Dr. Husted's DS site).  So, the key to the losing is the common channel (malabsorptive).....also, the key to keeping it off.  .............If I were a pre-op ...........meaning, never had any WLS or other abdominal surgeries that might mess me up with scar tissue......I would have a DS!!!!  As a revision from Proxy ...I had to choose the BEST possible outcome with the least amount of surgical risks (for me).  Whatever surgeon you interview; be sure they consider EVERYTHING!!!!  ..........to those who have safely had a revision from Rny to DS!  Congrats!  To those who have been banded over their Rny and have lost....GREAT!  ......  I say KUDOS to those who can be found happy, healthy and at goal weight in FIVE years or more!!!  That's my REAL goal now!                Good luck!  It's crazy figuring it all out so this forum is excellent for feedback and input.........getting a couple of surgeon's opinions is a must!  Read Dr. Schlesinger's ABC's of Revison.  You can enter that in the SEARCH above......Dr. Husted has great info as well.....as does Dr. Oh in Wash State. 

Hey J, haven't seen you in a while.  I am in a quandry about second guessing myself.  I thought I was really well informed six years ago and here I am doing it all again.  I really like Dr. S and his demeanor and so b/c I have been treated rudely by some docs...and fairly cavalier by others, beside manner is really important to me.  Since I wasn't even aware of DS the first time around I gotta make sure I get it right this time.  Even though I have gained 30 lbs this year; I was still excited when I jumped on the scale and had dropped 2.  It's funny but I really want to regain control of my life and this research along with everyone's insight is helping me do that.

I'm sure you considered the lap band over the original surgery, but did you feel that it wouldn't produce the loss you needed.  I'm in a similar situation to you and am considering the lap band over my RNY (done 9 yrs ago).  I'm sort of overwehlmed with it all and finding information very hard to come by.  I live in a rural state with few providers who are hesitatnt if willing at all to even consider a revision.  Thank you for your post.  It's given me something new (again) to ponder.
Lori

Hey Lori,
I considered EVERYTHING before deciding on such an invasive revision procedure. I spent countless days on OH and any other WLS website I could find. I was almost all set to try the Stomaphyx, but insurance denied it and if I was going to have to pay out of pocket for anything, I had to know the chances of it working were pretty darn good. Unfortunately, those that had the stomaphyx already were reporting no restriction and difficulty losing weight, so that eliminated that option. I did consider the band over RNY but I couldn't find many people that had good results with that either. Then I had an Upper GI and the surgeon said the shape of my pouch would not allow for a proper fit of the band so that option was out for me too. I was seeing Bariatric surgeons in the Greater Atlanta area and I only found one that does revisions and he revises to distal or ERNY. Once they found the gastro gastric fistula, I knew I no longer wanted a blind stomach that couldn't be scoped or worse yet would get another fistula so I concentrated on the DS. No surgeons here did revisions to DS and I wanted someone with plenty of experience, which is why I chose to fly to California for Dr. Husted. One thing I did learn is if the surgeon is not comfortable with revisions or just plain doesn't do them, then you will get the song and dance about how risky they are and you shouldn't have one. If I hadn't been my own advocate I definitely wouldn't have had this surgery. Good Luck in your journey! Let me know if you have any other questions along the way!
Susan

Susan:  what perfect timing for me and some of my own questions.  It is great to see someone be so open with their answers.  There is no one in the Buffalo, NY area who does revisions.  I am in the beginning stages of a DS revision from a RNY.  I have BCBS with POS.  My primary is all for a revision and Wednesday she sent over the request for an out of network referral for a Dr. in Ohio.  I  already received a letter from the ins. co. telling me they are requesting my primary send me to a general in network surgeon saying I need a DS.  First, I cannot believe a general surgeon who does not know me would give the ok for that nor would any other GBS give their ok for me to get a DS especially since non of the local ones do it.  When I first had my RNY in 2003, I asked my original surgeon for a DS because he does do them (he is also out of network but at the time the only one who did lap wls) and his answer to me was " I decide who gets a DS".  I know he will not do revisions, period.  I think that being BCBS POS, I can have the DS but I would have to pay the deductible, like the original BCBS.  If that is the case, I will go through with it no problem.  I don't think I can swing the full cost nor get a loan for the full cost.

Thanks for sharing so much information,
Joyce

Hi Joyce,
I really hate dealing with the insurance company. They make it as hard as possible in hopes you will give up and they won't have to cover you for anything. I ended up filing a complaint with my state insurance commissioners office. I still had to pay out of pocket for the surgeon's fees. I called numerous surgeons that I had heard were good at revisions to DS and none of them contracted with my insurance so in the end I just chose the one I wanted and intend to fight for payment of surgeon's fees after the fact. I don't understand why they would send you to a general surgeon for a referral for DS either, my guess is in hopes you can't find one that says you need the DS and they will be off the hook. Sorry I don't have any answers as to what you can do but you might want to hop over to the DS board and post about it. I know there are a couple people *****ally know the ins and outs of the insurance biz and they might be able to give you some ideas. Good Luck!
Susan