Revised my RNY and stayed the same !!!!!

 Good catch, ZeeStarrlite!  OMG, do you think she only had that lousy Stomaphyx surgery?   That would explain why it's not working.   It hasn't worked for anyone that I have seen on here!  Latinasol, you really need to find out what that doctor did to you!

I am so sorry of all the attacks that have happened here.  You are experiencing some very discouraging issues and you are allowed to feel pissed off.  I have some of your issues and understand some of your pain.  I had surgeries on my feet and the recovery from those is horrendous, way worse than my two WLS surgeries and unfortunately it takes years to recover and they will never be the same, sorry to say.  I would never assume I know the pain you are in as I don't live in your shoes.  I just hope that you can get some relief from the pain and able to get some sound advise to your weight loss and other health issues.  Please do see your surgeon and/or see an endocrinologist if you haven't already.  They truely have more knowledge than some Dr.'s.  Don't ever believe that you are a failure.  You haven't failed.  Keep the faith.
Deanne

 Latinasol,  It sounds like you are metaphorically trying to hike up to the top of a mountain and every time to think you are going to finally make it to the top, something happens and you slide right back down again.   You must be very frustrated, especially since you are happy to see your sister's success and you are yet to achieve the same.  What is happening to you is awful.   You sound like you are in so much pain.  I wish there was something I could do to wave a magic wand and make this revision surgery give you what you need.  I wish you had gotten the WLS that worked for you, the first time around.   I'm not going to make any more suggestions.   I am pretty sure you know what you need to do and I wish you the very best of luck.  

  

I'm not really sure how Ghrelin works with bypassed folks, I don't know how it is altered, I've heard varying comments on it.

But what I would like to throw out there is that I've read a couple of studies (sorry, I didn't save the links) that show obese people can produce as much as three times the amount of Ghrelin as a naturally thin person.

Not fair, eh?

Not fair. "Fair" was a word I wouldn't let my children use around the house. because it implied that God had somehow screwed up when he made the world. Now that they are adults, we can use the word freely. Yes, so much of the metabolic issues surrounding obesity are not fair.

Revisions to BPD/DS from RNY can be done, and is the most agressive way to adress the root cause of metabolic failure. It involves a "paradigm shift" in thinking, but I believe it is the best way to get patients to where they need to be after RNY failure I do them all the time. Also note that black women have more "b" type fat cells, which are particularly more stubborn to weight loss.

John D Husted, MD

I have deleted this post because I think it deserves a thread of its own and I have started one.  

Can you give me more information about "b type fat cells?"  I googled this and didn't get any hits.  I am helping a black woman prepare for a telephonic appeal for her revision from RNY to DS with a judge and a representative from her insurer next week.  A citation to a reference would be appreciated.  A COPY of the reference even moreso.

I have provided her with several references already on this topic -- but I only have the abstracts of these -- copies of the original articles if you have them would be great.

1: Obes Surg. 2008 Jan;18(1):39-42. Epub 2007 Dec 15. Links

The impact of race on weight loss after Roux-en-Y gastric bypass surgery.

Harvin G, DeLegge M, Garrow DA.

Department of Medicine, Division of Gastroenterology and Hepatology, Digestive Disease Center, Medical University of South Carolina (MUSC), 96 Jonathon Lucas Street, CSB #210, P.O. Box 250 327, Charleston, SC, USA.

BACKGROUND: Gastric bypass surgery for morbid obesity has dramatically increased in volume over the past decade. Caucasian patients have been noted previously to lose more weight after bariatric surgery than African-Americans patients. Data regarding predictors of maintaining weight loss after surgery are minimal. We sought to determine predictors of long-term weight loss after bariatric surgery. METHODS: Retrospective analysis using a multivariate logistic regression model of all patients undergoing Roux-en-Y gastric bypass surgery at the Medical University of South Carolina from May 1993 to December 2004 for whom 2 years of follow-up data was available. Our dependent variable was the percentage of weight lost from baseline, dichotomized at +/-35%. Our primary independent variable was race, defined as Caucasian, African-American, or other. Relevant covariates were added to the model to control for their potential effects on outcome. RESULTS: One hundred eleven patients (17 male/94 female; 85% Caucasian, mean age 44 years (range 18-68 years). In our model, Caucasian subjects (adjusted odds ratio [OR] = 7.60, 95% confidence intervals [95%CI] = 1.83-31.5) and late post surgical complications (adjusted OR = 2.67, 95%CI = 1.05-6.80) significantly predicted weight loss at 2 years, after controlling for relevant confounders. Other covariates did not significantly impact the model. CONCLUSION: Race and late post surgical complications significantly impacted the percentage of weight loss at 2 years for patients undergoing Roux-en-Y gastric bypass surgery at our institution. Future research should be directed at determining potential genetic and/or social reasons for these differences.

1: Obes Surg. 2007 Apr;17(4):460-4. Links

Are African-Americans as successful as Caucasians after laparoscopic gastric bypass?

Madan AK, Whitfield JD, Fain JN, Beech BM, Ternovits CA, Menachery S, Tichansky DS.

Section of Minimally Invasive Surgery, Department of Surgery, University of Tennessee Health Science Center, 956 Court Ave., Room G210, Memphis, TN 38163, USA. amadan@...

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been demonstrated to provide weight loss comparable to open gastric bypass. It has been suggested that African-Americans (AA) are not as successful as Caucasians (CA) after bariatric surgery. Our hypothesis was that AAs are just as successful as CA after LRYGBP in terms of weight loss and comorbidity improvement. METHODS: A retrospective chart review was performed on all AA and CA patients who underwent LRYGBP for a 6-month period. Success after LRYGBP [defined as (1) 25% loss of preoperative weight, (2) 50% excess weight loss (EWL), or (3) weight loss to within 50% ideal weight] was compared by ethnicity. RESULTS: 102 patients were included in this study. 97 patients (30 AA patients and 67 CA patients) had at least 1-year follow-up data available. Preoperative data did not differ between both groups. There was a statistically significant difference in %EWL between AA and CA (66% vs 74%; P<0.05). However, there was no ethnic difference in the percentage of patients with successful weight loss (as defined by any of the above 3 criteria). Furthermore, there was no statistical difference between the percentages of AA and CA patients who had improved or resolved diabetes and hypertension. CONCLUSIONS: LRYGBP offers good weight loss in all patients. While there may be greater %EWL in CA patients, no ethnic difference in successful weight loss exists. More importantly, co-morbidities improve or resolve equally between AA and CA patients. LRYGBP should be considered successful in AA patients.

1: Obesity (Silver Spring). 2007 Jun;15(6):1455-63. Links

Weight loss and health outcomes in African Americans and whites after gastric bypass surgery.

Anderson WA, Greene GW, Forse RA, Apovian CM, Istfan NW.

Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, MA 02118, USA.

OBJECTIVE: The objective was to describe differences in weight loss, dietary intake, and cardiovascular risk factors between white and African-American patients after gastric bypass (GBP). RESEARCH METHODS AND PROCEDURES: This was a retrospective database review of a sample of 84 adult patients (24 African-American and 60 white women and men) between the ages of 33 and 53 years. All subjects had GBP surgery in 2001 at the Bariatric Surgery Program at Boston Medical Center in Boston, MA, and were followed for one year postoperatively. Patients were excluded if weight data were missing at baseline, 3 months, or 1 year after GBP. A total of 9 African Americans and 41 whites provided data at all 3 time-points and were included in the study. Differences in weight loss, diet, and cardiovascular risk factors were analyzed. RESULTS: There were no differences in baseline characteristics between African Americans and whites. Mean weight loss for the entire sample was 36 +/- 9%, with a range of 8% to 54% relative to initial body weight. Whites lost more weight (39 +/- 8%) than African Americans (26 +/- 10%) (p < 0.05). Dietary parameters, as well as improvements in blood pressure and lipid profiles, were similar in the two racial groups. DISCUSSION: Differences in weight loss between severely obese African Americans and whites undergoing open GBP are unlikely to be related to postoperative dietary practices. Our data are consistent with previous reports implicating metabolic differences between the two racial groups.

1: Obes Surg. 2006 Feb;16(2):159-65. Links

Ethnic differences in obesity and surgical weight loss between African-American and Caucasian females.

Buffington CK, Marema RT.

U. S. Bariatric, Fort Lauderdale and Orlando, FL 33308, USA. drbuff@...

BACKGROUND: In the general population, African-American females are more obese and resistant to weight loss than Caucasian women. In the present study, we examined the severity of obesity among morbidly obese African-American and Caucasian females, studied the effectiveness of Roux-en-Y gastric bypass (RYGBP), and sought to identify factors contributing to obesity and weight loss. METHODS: The study population included 153 morbidly obese females randomly selected from our general bariatric patient population. Anthropometric measurements consisted of body weight, body mass index (BMI), excess weight, and waist, hip, thigh, and neck circumferences. Factors that may contribute to obesity included age, age of obesity onset, number of childbirths, calorie intake, diet composition, and degree of psychological distress. The effects of RYBGP were studied in weight-matched groups of African-American and Caucasian females (n=37 per group) at weight loss nadir, i.e. 12 to 18 months after surgery. RESULTS: We found that morbid obesity is more severe among African-American than Caucasian females. The greater degree of obesity of African-American, as compared to Caucasian, females is not due to ethnic differences in calorie intake, diet composition, age or age of obesity onset, number of childbirths, and psychological distress. RYGBP is less effective in reducing body fat and, consequently, excess body weight of the African-American than the Caucasian females, suggesting possible ethnic differences in fat metabolism. CONCLUSION: African-American females with morbid obesity have greater adiposity than do Caucasian women and lose significantly less body fat after RYGBP.

1: J Assoc Acad Minor Phys. 2001 Jul;12(3):129-36. Links

Bariatric surgery for severe obesity.

Sugerman HJ.

Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia 23298-0519, USA. hsugerma@...

Severe obesity is associated with multiple comorbidities and is refractory to dietary management with or without behavioral or drug therapies. There are a number of surgical procedures for the treatment of morbid obesity, including purely gastric restrictive, a combination of malabsorption and gastric restriction or primary malabsorption. The purely gastric restrictive procedures, including vertical banded gastroplasty and laparoscopic adjustable silicone gastric banding, do not provide adequate weight loss. African-American patients do especially poorly after the banding procedure with the loss of only 11% of excess weight in one study. Gastric bypass (GBP) is associated with the loss of 66% of excess weight at 1 to 2 years after surgery, 60% at 5 years and 50% at 10 years. For unknown reasons, African-American patients lose significantly less weight than Caucasians after GBP. There is a risk of micronutrient deficiencies after GBP, including iron deficiency anemia in menstruating women, vitamin B12, and calcium deficiencies. Prophylactic supplementation of these nutrients is necessary. Recurrent vomiting after bariatric surgery may be associated with a severe polyneuropathy and must be aggressively treated with endoscopic dilatation before this complication is allowed to develop. The malabsorptive procedures include the partial biliopancreatic bypass (BPD) and BPD with duodenal switch (BPD/DS). The BPD appears to cause severe protein-calorie malnutrition in American patients; the BPD/DS may be associated with less malnutrition. Weight loss failure after GBP does not respond to tightening a dilated gastrojejunal stoma or reducing the size of the gastric pouch. These patients may require conversion to a malabsorptive distal GBP, similar to the BPD. However, because of the risk of severe protein-calorie malnutrition and calcium deficiency BPD should be reserved for patients with severe obesity comorbidity. The risk of death following bariatric surgery is between 1% and 2% in most series but is significantly higher in patients with respiratory insufficiency of obesity. In most patients, surgically induced weight loss will correct hypertension, type II diabetes mellitus, sleep apnea, obesity hypoventilation syndrome, gastroesophageal reflux, venous stasis disease, urinary incontinence, female sexual hormone dysfunction, pseudotumor cerebri, degenerative joint disease pains, as well as improved self-image and employability.

Oh how I wish I would have read this before deciding to have the revision that I did.  I probably would have waited until I could get all the upfront money that ds surgeons require and had the ds . I do, however, refuse to be another statistic and will find a way to lose the amount of weight that I need to lose.

 Latinasol, 

Here is a link to a post on another thread with links to two bariatric journal articles, one which describes the outcomes of the different types of RNY revisions and another one which talks about the revision from RNY to DS as compared to other RNY revision surgery, including the distal or ERNY.    I was answering someone else who had RNY questions.  

The first article mentions stoma reduction, which I believe is what your surgeon did to revise you,  as not being very effective.   I wish you had read this one before you had your revision.   I knew about this, but I was just a non-member reader and not posting then, or I would have told you about it.  I used to assume that everyone on here already knew about this stuff.

Please take a look at these articles and you will be better prepared if you need to have another revision.  At least you will know the lingo and the outcomes of the various procedures and can speak to your surgeon in  his or her language so you can get what you want.

www.obesityhelp.com/forums/revision/3883518/What-is-dif-betw een-distal-and-proximal-RNY/#31233006