failed RNY-do I get AGB or DS? Opinions NEEDED

Had a open RNY in 2001; went from 326 to 270.  Now I am up to 280 and looking for a revision.  One doctor suggested a Adjustable Gastric Band and someone else suggested a Duodenal Switch.  I am wondering which would be the most successful and if anyone out there knows anybody who had the RNY and was revised to either of these, please tell me if it was a success or failure.  Thank you so much.  This is my last go-round with a wl surgery...just trying to make an informed decision.  Thanks, PAt in Kentucky

You really have to look at whatever revision fits into your life.  I also had a "failed" gastric stapling from 1982 and really only enjoyed a couple of years of "normalcy" before I started to gain and didn't have the tools necessary to succeed. 

All things considered...my job, family, life style etc and especially what I was willing to subject myself to as far as risk, I have decided to have a lap band placed over my old bypass.  I will have this done on 12/10 and feel confident that I will eventually succeed.  It's not the easiest nor the fastest way to lose weight, but I have "spoken" to several on this site who have had it done and have had a good measure of success.

Look at all your options and choose what is right for you...and good luck!

Hi Pat,

To anyone who asks this question, I always give the same answer: Duodenal Switch. If you read the grads/revision board you will see more often RNY/Lap band regain vs. DS regain. The DS is an amazing surgery, it will take it off and it has better long term success as far as keeping it off. The surgery is a more complex one but a band IMO is a waste, especially if you didn't have much of a loss w/ RNY.

Good Luck and if you do decide to go through w/ your revision check out Dr. John Husted in Somerset!

Katrina

When you had RNY can you remember looking into the band and why you didn't choose it? In my mind theres a 'scale' of surgeries, the band is the least invasive, then the sleeve, then the RNY then the DS.

Why would you go backwards from number three to number one on the list? I'd want to find out why your RNY isn't working before I picked something else. You have other options as well as the ones you're thinking of, that involve improving your RNY rather than adding a list of band issues to the equation as well.

Here's an overview of my research comparing the 3 major surgeries (lap, RNY, & DS).  The first sets of statistics is based on the first study at the top.  They actually looked at most all published data & basically averaged out the results to give a better picture of what typically happens with the "average" person.

Buchwald, Avidor, & Braunwald, et al. (2004).  Bariatric Surgery:  A Systematic Review & Meta-analysis.  JAMA, 292(14), 1724-1737.

 

Excess Weight Loss:               Mean Change

Band                                                 47%

Gastric Bypass (includes long-limb)   62%

BPD-DS                                           70%

 

Diabetes - resolved

Band                   47.9%

Gastric Bypass     83.8%

BPD-DS              97.9%

 

Hyperlipidemia

Band                58.9%

Gastric Bypass   93.6%

BPD-DS           99.5%

 

Hypertension

Band                43.2%

Gastric Bypass   75.4%

BPD-DS           81.3%

 

Operative Mortality Rate:

Band & gastroplasty    0.1%

Gastric Bypass             0.5%

BPD-DS                      1.1%

------------------------------------------ 

 

Reservations on DS has been largely based on concerns of the long-term effect on malnutrition, as well as diarrhea, and is also likely influenced by the serious long-term consequences seen with the original malabsorptive procedure, the jujunoileal bypass.  The SAGES Manual:  A Practical Guide to Bariatric Surgery (2008) states that metabolic disturbances and the number of surgical revisions for malnutrition or diarrhea are considerably less using 100cm as the common channel length.  The manual also states that the DS short-and long-term weight loss exceed that of any other bariatric operation.  It does NOT state that DS should be reserved for super or super-super obese individuals, apparently due to the lack of evidence of high risk in malnutrition and diarrhea with the 100cm common channel, especially among those who adhere to physician advice for nutrition, vitamin supplementation, and regular lab work.  It specifies that the BMI guidelines are the same for all types of bariatric surgeries, including the DS.

I don't know the study off-hand, but the dr at the informational meeting I went to told us that very recently published research on the lap-band of % of excess weight loss at 5 & 7 years out was fairly poor for MOST people (some, the minority are successful).  In addition, for every year that the band is in your body, you risk of having to get it surgically adjusted (another actual surgery!) or removed increases each & every year due to hiatal hernias (stomach flips over the band into the esophagus), slippage, & adhesions/scarring.  I DEFINITELY think you should go with the DS over the lap-band.  I think there's more of an argument b/w the RNY & DS (though slightly better outcomes with DS than RNY).  But, if it's comparing lap-band & DS, the research is overwhelmingly clear - in support of DS.  It takes more self-control in eating to lose weight with the band than the RNY, so if the RNY didn't work, it's just another sign that the DS is probably your best choice.  You malabsorb calories, so long as you get your protein in & take your vitamins, you can still have other foods & eat at least 2000 calories a day once you're at your goal weight - awesome!

By the way - the adjustable gastric band is just a fancy way of saying lap-band or realize band - they basically all do the same function of being only a restriction component to aid weight loss.  RNY is restrictive & maldigestive.  DS is restrictive & malabsorbtion.

Pat 

 My revision was just to  shorten the  common channel -  gives me more mal absoption and weight loss ,   to do a full D.S. is possible - but not wise in my mind  ( I know I have a small mind and someone will go on attack for  critizing  the revision to D.S.  )   due to the amount of reconstruction that would be needed. if your up to it ?? and dont mind the  added increased risk of infections . The D.s is very effective .. Esp when its the 1st procedure ever done.  BUT  remember - you are going to battle  your blood labs the rest of your life. You have to be very dilligent in vitamins and protein.  the band is a  good choice too - if you dont mind  the fill and unfills and other risks associated.

best advice  - read the posts  and see what people are saying , go to the D.S. board and read.  also  ask people about  their  issue's ( we all have em )