Great article on RNY revisions from Bariatric Journal!
StacysMom
on 3/14/09 8:04 pm
on 3/14/09 8:04 pm
Of particular interest is the paragraph I've highlighted in BOLD (below). This research is very current - note the date:
Laparoscopic Conversion of Failed Gastric Bypass to Duodenal Switch February
2008 Manish Parikh, MD; and Michel Gagner, MD, FRCSC, FACS
Department of Surgery, Mount Sinai Medical Center, Miami Beach, Florida
Objective. To report preliminary outcomes after laparoscopic conversion of
gastric bypass to biliopancreatic diversion with duodenal switch for weight loss
failure.
Design. Retrospective chart review.
Setting. Academic tertiary referral center.
Participants. Twelve patients with weight loss failure after gastric bypass.
Measurements. Age, body mass index, excess weight loss, type of primary gastric
bypass, type of revision procedure performed (if applicable), method of
gastrogastrostomy, intraoperative and perioperative data, and morbidity and
mortality rates.
Results. All patients lost dramatic weight after conversion to duodenal switch:
Mean excess weight loss (EWL) was 63 percent at 11 months, representing an
average
11-point BMI decrease. There were no mortalities or leaks. Stricture at the
gastrogastrostomy was the most frequent complication, which was usually amenable
to endoscopic dilation.
Conclusions. Laparoscopic conversion to duodenal switch from failed gastric
bypass is highly effective with an acceptable morbidity
Introduction
Reoperative bariatric surgery is most commonly performed for inadequate weight
loss secondary to a failed bariatric operation.1 The Roux-en-Y gastric bypass
(RYGB), the most commonly performed bariatric procedure in the US, carries a
long-term failure rate of 20 to 35 percent.2 Especially in the superobese
population (BMI>50kg/m2), long-term failure rates can be as high as 60 percent.2
Surgeons are increasingly faced with the RYGB patient who has either failed to
lose weight or has regained his or her weight. The optimal treatment of these
patients has not yet been determined. The biliopancreatic diversion (BPD) with
duodenal switch (DS) is one of the most effective bariatric procedures currently
available. Both short-term and long-term outcomes exceed that of any other
bariatric operation.3 We recently published a report of our results of a small
cohort of failed gastric bypass patients who underwent laparoscopic conversion
to DS.4
Methods
We retrospectively reviewed data from all patients undergoing conversion from
RYGB to DS for failed weight loss. The following data were analyzed: age, body
mass index (BMI), excess weight loss (EWL), type of primary RYGB, type of
revision procedure performed prior to conversion (if applicable), method of
gastrogastrostomy, intraoperative and perioperative data, and morbidity and
mortality rates. Paired student’s t-test was used for statistical analysis.
Preoperative workup consisted of upper endoscopy and upper GI series to evaluate
the gastric pouch for dilation (>120cc), gastrogastric fistula, or other
anatomic abnormalities. Patients with minimal gastric pouch (or no gastric
pouch) were not considered for conversion to DS (lack of adequate gastric tissue
to perform gastrogastrostomy). All patients were evaluated by a nutritionist
preoperatively.
Laparoscopic conversion of RYGB to DS is essentially two separate procedures
(Figure 1). First the gastrojejunostomy is disconnected and a gastrogastrostomy
is constructed to restore gastric continuity, followed immediately by a sleeve
gastrectomy (sequential firings of a 4.8mm linear stapler along a 60 Fr Bougie).
Next, a duodenal switch is performed either in the same setting or as a staged
(i.e., several months later) approach. The duodenal switch consists of a
duodenoileostomy followed by an ileoileostomy, creating a long Roux-en-Y with a
150cm alimentary limb and a 100cm common channel. If the reversal of the gastric
bypass and subsequent sleeve gastrectomy exceeded four hours, then the patient
would return several months later for the duodenal switch to avoid prolonged
anesthesia and its attendant risks.
Results
Between 2003 and 2007, 12 patients were identified for analysis. Data including
age at time of conversion to DS, BMI at time of primary RYGB, type of primary
RYGB performed, revision procedure performed, and %EWL with the RYGB are shown
in Table 1. Overall, this patient cohort gained a mean 9kg/m2 by the time of
conversion to DS, representing 42-percent EWL.
Sixty-six percent of these patients had obesity-related comorbidities at the
time of conversion—most of these comorbidities reappeared with weight regain.
The mean time interval to conversion to DS was approximately four years.
The intraoperative details and postoperative outcomes are shown in Table 2. Most
patients underwent laparoscopic conversion to DS in one stage. In the two-stage
patients, mean weight loss between first and second stages was 19.3kg. There
were no mortalities or leaks. The most frequent complication (4/12) was
stricture at the gastrogastrostomy, which usually responded to a single episode
of endoscopic dilation. One patient required laparoscopic revision of her
gastrogastrostomy.5 There were no cases of protein-calorie malnutrition. All
patients lost dramatic weight after conversion to DS: Mean BMI and EWL were
31kg/m2 and 63 percent, respectively (p<0.001 compared to pre-conversion BMI of
41kg/m2 and EWL of 42%). At mean follow-up of 11 [2–37] months, the overall EWL
of 79 percent is similar to published data regarding DS.3 Mean BMI decrease was
11 points and overall mean weight loss was 36kg. Comorbidities resolved in all
patients.
Discussion
Weight loss failure after RYGB represents a challenging problem facing bariatric
surgeons today. Although this is occasionally due to an identifiable anatomic
abnormality (e.g., gastrogastric fistula, disrupted staple line), the vast
majority of these patients have a technically sound RYGB. Given recent data
showing categorically superior outcomes in DS over RYGB, especially in the
superobese, we have revamped our strategy in dealing with these difficult
scenarios and now favor conversion to DS.3,6 Our early results indicate that
this is highly effective: 63 percent EWL and 11kg/m2 BMI decrease with an
acceptable morbidity. Frequent use of the two-stage approach helps minimize
complications.
Multiple treatment options for RYGB failure exist, including endoscopic
therapies, placing an adjustable gastric band on the upper gastric pouch,
revising the gastrojejunostomy, and converting to a distal RYGB (Table 3).
However, none of these therapies have been shown to be as effective as
converting to a DS. Although conversion to a distal RYGB delivers significant
weight loss, the high rate of protein malnutrition and subsequent operative
revision is problematic.
Conclusion
Our early results indicate that in experienced hands, laparoscopic conversion of
failed RYGB to DS is highly effective (63% EWL, 11-point BMI decrease at mean 11
months) with an acceptable morbidity. Longer follow-up is required to determine
if this weight loss is sustained.
References
1. Behrns K, Smith C, Kelly K, Sarr M. Reoperative bariatric surgery—Lessons
learned to improve patient selection and results. Ann Surg 1993;218:646–53.
2. Christou N, Look D, MacLean L. Weight gain after short- and long-limb gastric
bypass in patients followed for longer than 10 years. Ann Surg 2006;244:734–40.
3. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: A systematic
review and meta-analysis. JAMA 2004;292:1724–37.
4. Parikh M, Pomp A, Gagner M. Laparoscopic conversion of failed gastric bypass
to duodenal switch: Technical considerations and preliminary outcomes. Surg Obes
Relat Dis 2007;3:611–8.
5. Parikh M, Gagner M. Laparoscopic revision of anastomotic stricture after
gastric bypass with a transoral circular stapler. Surg Innov 2007;14:225–30.
6. Prachand V, DaVee R, Alverdy J. Duodenal switch provides superior weight loss
in the super-obese (BMI>50kg/m2) compared with gastric bypass. Ann Surg
2006;244:611–19.
7. Spaulding L. Treatment of dilated gastrojejunostomy with sclerotherapy. Obes
Surg 2003;13:254–7.
8. Spaulding L, Osler T, Patlak J. Long-term results of sclerotherapy for
dilated gastrojejunostomy after gastric bypass. Surg Obes Relat Dis
2007;6:623–6.
9. Thompson C, Slattery J, Bundga M, Lautz D. Peroral endoscopic reduction of
dilated gastrojejunal anastomosis after Roux-en-Y gastric bypass: A possible new
option for patients with weight regain. Surg Endosc 2006;20:1744–8.
10. Bessler M, Daud A, DiGiorgi M, et al. Adjustable gastric banding as a
revisional bariatric procedure after failed gastric bypass. Obes Surg
2005;15:1443–8.
11. Gobble R, Parikh M, Grieves M, et al. Gastric banding as a salvage procedure
for patients with weight loss failure after Roux-en-Y gastric bypass. Surg
Endosc 2007 (in press).
12. Muller M, Wildi S, Scholz T, et al. Laparoscopic pouch resizing and redo of
gastro-jejunal anastomosis for pouch dilatation following gastric bypass. Obes
Surg 2005;15:1089–95.
13. Fobi M, Lee H, Igwe D, et al. Revision of failed gastric bypass to distal
Roux-en-Y gastric bypass: A review of 65 cases. Obes Surg 2001;11:190–5.
14. Sugerman H, Kellum J, DeMaria E. Conversion of proximal to distal gastric
bypass for failed gastric bypass for superobesity. J Gastrointest Surg
1997;1:517–2.
Here is the direct link to the journal if anyone is interested in sending it to a friend:
bariatrictimes.com/2008/02/28/laparoscopic-conversion-of-fai led-gastric-bypass-to-duodenal-switch\
Laparoscopic Conversion of Failed Gastric Bypass to Duodenal Switch February
2008 Manish Parikh, MD; and Michel Gagner, MD, FRCSC, FACS
Department of Surgery, Mount Sinai Medical Center, Miami Beach, Florida
Objective. To report preliminary outcomes after laparoscopic conversion of
gastric bypass to biliopancreatic diversion with duodenal switch for weight loss
failure.
Design. Retrospective chart review.
Setting. Academic tertiary referral center.
Participants. Twelve patients with weight loss failure after gastric bypass.
Measurements. Age, body mass index, excess weight loss, type of primary gastric
bypass, type of revision procedure performed (if applicable), method of
gastrogastrostomy, intraoperative and perioperative data, and morbidity and
mortality rates.
Results. All patients lost dramatic weight after conversion to duodenal switch:
Mean excess weight loss (EWL) was 63 percent at 11 months, representing an
average
11-point BMI decrease. There were no mortalities or leaks. Stricture at the
gastrogastrostomy was the most frequent complication, which was usually amenable
to endoscopic dilation.
Conclusions. Laparoscopic conversion to duodenal switch from failed gastric
bypass is highly effective with an acceptable morbidity
Introduction
Reoperative bariatric surgery is most commonly performed for inadequate weight
loss secondary to a failed bariatric operation.1 The Roux-en-Y gastric bypass
(RYGB), the most commonly performed bariatric procedure in the US, carries a
long-term failure rate of 20 to 35 percent.2 Especially in the superobese
population (BMI>50kg/m2), long-term failure rates can be as high as 60 percent.2
Surgeons are increasingly faced with the RYGB patient who has either failed to
lose weight or has regained his or her weight. The optimal treatment of these
patients has not yet been determined. The biliopancreatic diversion (BPD) with
duodenal switch (DS) is one of the most effective bariatric procedures currently
available. Both short-term and long-term outcomes exceed that of any other
bariatric operation.3 We recently published a report of our results of a small
cohort of failed gastric bypass patients who underwent laparoscopic conversion
to DS.4
Methods
We retrospectively reviewed data from all patients undergoing conversion from
RYGB to DS for failed weight loss. The following data were analyzed: age, body
mass index (BMI), excess weight loss (EWL), type of primary RYGB, type of
revision procedure performed prior to conversion (if applicable), method of
gastrogastrostomy, intraoperative and perioperative data, and morbidity and
mortality rates. Paired student’s t-test was used for statistical analysis.
Preoperative workup consisted of upper endoscopy and upper GI series to evaluate
the gastric pouch for dilation (>120cc), gastrogastric fistula, or other
anatomic abnormalities. Patients with minimal gastric pouch (or no gastric
pouch) were not considered for conversion to DS (lack of adequate gastric tissue
to perform gastrogastrostomy). All patients were evaluated by a nutritionist
preoperatively.
Laparoscopic conversion of RYGB to DS is essentially two separate procedures
(Figure 1). First the gastrojejunostomy is disconnected and a gastrogastrostomy
is constructed to restore gastric continuity, followed immediately by a sleeve
gastrectomy (sequential firings of a 4.8mm linear stapler along a 60 Fr Bougie).
Next, a duodenal switch is performed either in the same setting or as a staged
(i.e., several months later) approach. The duodenal switch consists of a
duodenoileostomy followed by an ileoileostomy, creating a long Roux-en-Y with a
150cm alimentary limb and a 100cm common channel. If the reversal of the gastric
bypass and subsequent sleeve gastrectomy exceeded four hours, then the patient
would return several months later for the duodenal switch to avoid prolonged
anesthesia and its attendant risks.
Results
Between 2003 and 2007, 12 patients were identified for analysis. Data including
age at time of conversion to DS, BMI at time of primary RYGB, type of primary
RYGB performed, revision procedure performed, and %EWL with the RYGB are shown
in Table 1. Overall, this patient cohort gained a mean 9kg/m2 by the time of
conversion to DS, representing 42-percent EWL.
Sixty-six percent of these patients had obesity-related comorbidities at the
time of conversion—most of these comorbidities reappeared with weight regain.
The mean time interval to conversion to DS was approximately four years.
The intraoperative details and postoperative outcomes are shown in Table 2. Most
patients underwent laparoscopic conversion to DS in one stage. In the two-stage
patients, mean weight loss between first and second stages was 19.3kg. There
were no mortalities or leaks. The most frequent complication (4/12) was
stricture at the gastrogastrostomy, which usually responded to a single episode
of endoscopic dilation. One patient required laparoscopic revision of her
gastrogastrostomy.5 There were no cases of protein-calorie malnutrition. All
patients lost dramatic weight after conversion to DS: Mean BMI and EWL were
31kg/m2 and 63 percent, respectively (p<0.001 compared to pre-conversion BMI of
41kg/m2 and EWL of 42%). At mean follow-up of 11 [2–37] months, the overall EWL
of 79 percent is similar to published data regarding DS.3 Mean BMI decrease was
11 points and overall mean weight loss was 36kg. Comorbidities resolved in all
patients.
Discussion
Weight loss failure after RYGB represents a challenging problem facing bariatric
surgeons today. Although this is occasionally due to an identifiable anatomic
abnormality (e.g., gastrogastric fistula, disrupted staple line), the vast
majority of these patients have a technically sound RYGB. Given recent data
showing categorically superior outcomes in DS over RYGB, especially in the
superobese, we have revamped our strategy in dealing with these difficult
scenarios and now favor conversion to DS.3,6 Our early results indicate that
this is highly effective: 63 percent EWL and 11kg/m2 BMI decrease with an
acceptable morbidity. Frequent use of the two-stage approach helps minimize
complications.
Multiple treatment options for RYGB failure exist, including endoscopic
therapies, placing an adjustable gastric band on the upper gastric pouch,
revising the gastrojejunostomy, and converting to a distal RYGB (Table 3).
However, none of these therapies have been shown to be as effective as
converting to a DS. Although conversion to a distal RYGB delivers significant
weight loss, the high rate of protein malnutrition and subsequent operative
revision is problematic.
Conclusion
Our early results indicate that in experienced hands, laparoscopic conversion of
failed RYGB to DS is highly effective (63% EWL, 11-point BMI decrease at mean 11
months) with an acceptable morbidity. Longer follow-up is required to determine
if this weight loss is sustained.
References
1. Behrns K, Smith C, Kelly K, Sarr M. Reoperative bariatric surgery—Lessons
learned to improve patient selection and results. Ann Surg 1993;218:646–53.
2. Christou N, Look D, MacLean L. Weight gain after short- and long-limb gastric
bypass in patients followed for longer than 10 years. Ann Surg 2006;244:734–40.
3. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: A systematic
review and meta-analysis. JAMA 2004;292:1724–37.
4. Parikh M, Pomp A, Gagner M. Laparoscopic conversion of failed gastric bypass
to duodenal switch: Technical considerations and preliminary outcomes. Surg Obes
Relat Dis 2007;3:611–8.
5. Parikh M, Gagner M. Laparoscopic revision of anastomotic stricture after
gastric bypass with a transoral circular stapler. Surg Innov 2007;14:225–30.
6. Prachand V, DaVee R, Alverdy J. Duodenal switch provides superior weight loss
in the super-obese (BMI>50kg/m2) compared with gastric bypass. Ann Surg
2006;244:611–19.
7. Spaulding L. Treatment of dilated gastrojejunostomy with sclerotherapy. Obes
Surg 2003;13:254–7.
8. Spaulding L, Osler T, Patlak J. Long-term results of sclerotherapy for
dilated gastrojejunostomy after gastric bypass. Surg Obes Relat Dis
2007;6:623–6.
9. Thompson C, Slattery J, Bundga M, Lautz D. Peroral endoscopic reduction of
dilated gastrojejunal anastomosis after Roux-en-Y gastric bypass: A possible new
option for patients with weight regain. Surg Endosc 2006;20:1744–8.
10. Bessler M, Daud A, DiGiorgi M, et al. Adjustable gastric banding as a
revisional bariatric procedure after failed gastric bypass. Obes Surg
2005;15:1443–8.
11. Gobble R, Parikh M, Grieves M, et al. Gastric banding as a salvage procedure
for patients with weight loss failure after Roux-en-Y gastric bypass. Surg
Endosc 2007 (in press).
12. Muller M, Wildi S, Scholz T, et al. Laparoscopic pouch resizing and redo of
gastro-jejunal anastomosis for pouch dilatation following gastric bypass. Obes
Surg 2005;15:1089–95.
13. Fobi M, Lee H, Igwe D, et al. Revision of failed gastric bypass to distal
Roux-en-Y gastric bypass: A review of 65 cases. Obes Surg 2001;11:190–5.
14. Sugerman H, Kellum J, DeMaria E. Conversion of proximal to distal gastric
bypass for failed gastric bypass for superobesity. J Gastrointest Surg
1997;1:517–2.
Here is the direct link to the journal if anyone is interested in sending it to a friend:
bariatrictimes.com/2008/02/28/laparoscopic-conversion-of-fai led-gastric-bypass-to-duodenal-switch\
StacysMom,
You have a lot of great information...what procedure have you had and do you have more info on your profile? I think it's helpful to people to share a something about yourself...it lends more credibility and confidence in your posts.
Sue
You have a lot of great information...what procedure have you had and do you have more info on your profile? I think it's helpful to people to share a something about yourself...it lends more credibility and confidence in your posts.
Sue
"The Joy of the Lord is your strength." Nehemiah 8:10START: 330 CURRENT: 274.5 lbs GOAL: 190 TOTAL: 55.5 lbs
StacysMom
on 3/14/09 10:27 pm
on 3/14/09 10:27 pm
I don't post about myself because the internet is a big place and all kinds of weirdos can get info about you, steal your identity, cross-reference to get more information, etc. There are "back doors" into every website that hackers know how to use. I feel it is dangerous to put up any info, especially with a picture. I can't believe so many on here do it. Too many folks have had their identities stolen that way and through phishing scams. I even know someone who was stalked from the internet! Plus, I know who's cheated on her husband, who's taken drugs, who had her car crashed by her daughter and all kinds of info that is none of my business, just from reading profiles on OH. I know what cities these people live in, and some even post links to their MySpace and Facebook profiles. I would never put my personal information up on any website. You never know who is watching.
I'm all about the research anyway. I think everyone should learn their doctor's lingo and thoroughly research all of the available procedures so that they can depend on themselves and not what some doctor tells them. Doctors are people and people are not always truthful and have hidden agendas. The research speaks for itself and only then can people make the correct choice for themselves. My "support" is in the form of providing whatever research I've come across and exposing falsehoods when I notice them. I seem to have made some enemies here because of that.
All I will say is that I have had some experiences with doctors where they did not tell me all of my available options and I was not able to make an fully-informed decision because of this That is why I crusade for people to do their own research. So many do not and then they are disappointed when the outcome of their surgery does not match their expectations. The truth is that they never made an fully-informed choice in the first place, but never realized it until it was too late.
If someone doesn't want to read what I've put out there because I don't have a photo posted, it's their loss.
BTW, how are you doing with your lapband? I was closely following your Stomaphyx experience and sorry to read that it didn't work for you. You were so excited and full of anticipation as the date approached and then you posted for several weeks afterwards. I hope the lapband is working bettter than the Phyx.
I'm all about the research anyway. I think everyone should learn their doctor's lingo and thoroughly research all of the available procedures so that they can depend on themselves and not what some doctor tells them. Doctors are people and people are not always truthful and have hidden agendas. The research speaks for itself and only then can people make the correct choice for themselves. My "support" is in the form of providing whatever research I've come across and exposing falsehoods when I notice them. I seem to have made some enemies here because of that.
All I will say is that I have had some experiences with doctors where they did not tell me all of my available options and I was not able to make an fully-informed decision because of this That is why I crusade for people to do their own research. So many do not and then they are disappointed when the outcome of their surgery does not match their expectations. The truth is that they never made an fully-informed choice in the first place, but never realized it until it was too late.
If someone doesn't want to read what I've put out there because I don't have a photo posted, it's their loss.
BTW, how are you doing with your lapband? I was closely following your Stomaphyx experience and sorry to read that it didn't work for you. You were so excited and full of anticipation as the date approached and then you posted for several weeks afterwards. I hope the lapband is working bettter than the Phyx.
On March 15, 2009 at 5:27 AM Pacific Time, StacysMom wrote:
I don't post about myself because the internet is a big place and all kinds of weirdos can get info about you, steal your identity, cross-reference to get more information, etc. There are "back doors" into every website that hackers know how to use. I feel it is dangerous to put up any info, especially with a picture. I can't believe so many on here do it. Too many folks have had their identities stolen that way and through phishing scams. I even know someone who was stalked from the internet! Plus, I know who's cheated on her husband, who's taken drugs, who had her car crashed by her daughter and all kinds of info that is none of my business, just from reading profiles on OH. I know what cities these people live in, and some even post links to their MySpace and Facebook profiles. I would never put my personal information up on any website. You never know who is watching.I'm all about the research anyway. I think everyone should learn their doctor's lingo and thoroughly research all of the available procedures so that they can depend on themselves and not what some doctor tells them. Doctors are people and people are not always truthful and have hidden agendas. The research speaks for itself and only then can people make the correct choice for themselves. My "support" is in the form of providing whatever research I've come across and exposing falsehoods when I notice them. I seem to have made some enemies here because of that.
All I will say is that I have had some experiences with doctors where they did not tell me all of my available options and I was not able to make an fully-informed decision because of this That is why I crusade for people to do their own research. So many do not and then they are disappointed when the outcome of their surgery does not match their expectations. The truth is that they never made an fully-informed choice in the first place, but never realized it until it was too late.
If someone doesn't want to read what I've put out there because I don't have a photo posted, it's their loss.
BTW, how are you doing with your lapband? I was closely following your Stomaphyx experience and sorry to read that it didn't work for you. You were so excited and full of anticipation as the date approached and then you posted for several weeks afterwards. I hope the lapband is working bettter than the Phyx.
I agree with you about a picture, but I just think it's helpful to know something about where a person is coming from.
Sue
"The Joy of the Lord is your strength." Nehemiah 8:10START: 330 CURRENT: 274.5 lbs GOAL: 190 TOTAL: 55.5 lbs
Thank you SO much for posting this information!! You replied to my post about a failed RNY, and I happened upon this post you made about RNY to DS conversion. THANK YOU!! I don't know yet what the outcome will be. I have a barium swallow tomorrow morning to see if my surgery is intact. If it's not -- then it's another surgery. And if it is -- it's another surgery. I don't think I really win in either case unless the 2nd surgery is a success.
Thank you for saying you believe me. It's the most desperate feeling in the world to be working harder than you've ever worked in your LIFE at weight loss, and you keep saying, "This isn't supposed to be this hard!" and you go to a doctor for help, and they've already surmised that you're not telling the truth. What an isolated feeling. If you're not depressed before you go see a doctor, then you are when you leave. You're left to carry it all yourself, and that's a burden too heavy for anyone to bear without emotional consequences.
Actually, I have Kaiser Permanente insurance. And as I've talked to the head endocrinologist that heads up the Metabolic Obesity Clinic (he's the one who approves everyone's gastric bypass surgeries through Kaiser here in Southern California -- if you have Kaiser and have this surgery, at one time or another you're going to have to see him), he told me that Kaiser has several "revision surgeons." They are surgeons who specialize specifically in revision RNY surgeries.
He knows all the ins and outs of how WLS approvals work through Kaiser since he's the one who approves or disapproves them all, and he already told me that Kaiser will NOT send me back to the doctor who originally did my surgery. This means that I don't have a choice -- unless I pay out pocket, which I can't -- in choosing which surgeon I'm going to have. It's reassuring, however, that Kaiser has REVISION SURGEONS -- surgeons who specialize in revising RNY surgeries. That gives me a great measure of assurance.
Believe me, I'm totally aware it's a high-risk procedure, and I can't tell you how much i hate that I'm even having to consider it! More than anyone else, I wish there was another way out of this. Barring outright starvation (I've already been at 1000 calories with no results) or liposuction, I'm powerless. I hate being in this position. I just wish the first time through had done what it was supposed to. But as it is right now, I can't lose another ounce unless I have a second surgery.
The reason a second surgery is necessary is not for comestic reasons, but because my BMI is still dangerously high! I am at extremely high risk for diabetes -- it runs in my family, and I've been a gestational diabetic twice (which raises the chance of getting Type 2 by 60%). Even if I were to stay at this weight, I'm doomed to more health problems as I get older (which is why I had the surgery in the first place!) unless I can get my weight down. And I can't get my weight down because the effects of surgery has trapped me where I am. The power to change my weight is no longer my own, no matter what I do.
So . . . I'm either doomed to a life of illness if I don't have the surgery and stay where I am, or I'm risking more complications by having another surgery. What a choice to have to make.
Thank you for saying you believe me. It's the most desperate feeling in the world to be working harder than you've ever worked in your LIFE at weight loss, and you keep saying, "This isn't supposed to be this hard!" and you go to a doctor for help, and they've already surmised that you're not telling the truth. What an isolated feeling. If you're not depressed before you go see a doctor, then you are when you leave. You're left to carry it all yourself, and that's a burden too heavy for anyone to bear without emotional consequences.
Actually, I have Kaiser Permanente insurance. And as I've talked to the head endocrinologist that heads up the Metabolic Obesity Clinic (he's the one who approves everyone's gastric bypass surgeries through Kaiser here in Southern California -- if you have Kaiser and have this surgery, at one time or another you're going to have to see him), he told me that Kaiser has several "revision surgeons." They are surgeons who specialize specifically in revision RNY surgeries.
He knows all the ins and outs of how WLS approvals work through Kaiser since he's the one who approves or disapproves them all, and he already told me that Kaiser will NOT send me back to the doctor who originally did my surgery. This means that I don't have a choice -- unless I pay out pocket, which I can't -- in choosing which surgeon I'm going to have. It's reassuring, however, that Kaiser has REVISION SURGEONS -- surgeons who specialize in revising RNY surgeries. That gives me a great measure of assurance.
Believe me, I'm totally aware it's a high-risk procedure, and I can't tell you how much i hate that I'm even having to consider it! More than anyone else, I wish there was another way out of this. Barring outright starvation (I've already been at 1000 calories with no results) or liposuction, I'm powerless. I hate being in this position. I just wish the first time through had done what it was supposed to. But as it is right now, I can't lose another ounce unless I have a second surgery.
The reason a second surgery is necessary is not for comestic reasons, but because my BMI is still dangerously high! I am at extremely high risk for diabetes -- it runs in my family, and I've been a gestational diabetic twice (which raises the chance of getting Type 2 by 60%). Even if I were to stay at this weight, I'm doomed to more health problems as I get older (which is why I had the surgery in the first place!) unless I can get my weight down. And I can't get my weight down because the effects of surgery has trapped me where I am. The power to change my weight is no longer my own, no matter what I do.
So . . . I'm either doomed to a life of illness if I don't have the surgery and stay where I am, or I'm risking more complications by having another surgery. What a choice to have to make.
To have what you've never had, you must do what you've never done. Victories don't come at discount prices.
I don't post about myself because the internet is a big place and all kinds of weirdos can get info about you, steal your identity, cross-reference to get more information, etc
I'm kind of offended by this statement. I had wondered myself if you had a ds revision since you always seem to promote the ds, if you were planning to have it, or just what your story was. Then you say this, when you sent me a private message asking me to post about my experience with my revision. Thanks to you and a few others I'm worrying constantly that I'm not going to be able to get the weight off with the revision that I have chosen. You post all of these things about how a distal or erny revision is a bad choice, but what have you had done? What makes you the expert? I know you are finding reports that say ds is a good revision choice, but are you even trying to find anything that may say that distal or rny may be as well or are you just looking for things that say that it isn't to support your point.
I guess all of that is besides the point. My point is how dare you say that you don't post anything about yourself after you have asked me to post stuff about me and I did.
I'm kind of offended by this statement. I had wondered myself if you had a ds revision since you always seem to promote the ds, if you were planning to have it, or just what your story was. Then you say this, when you sent me a private message asking me to post about my experience with my revision. Thanks to you and a few others I'm worrying constantly that I'm not going to be able to get the weight off with the revision that I have chosen. You post all of these things about how a distal or erny revision is a bad choice, but what have you had done? What makes you the expert? I know you are finding reports that say ds is a good revision choice, but are you even trying to find anything that may say that distal or rny may be as well or are you just looking for things that say that it isn't to support your point.
I guess all of that is besides the point. My point is how dare you say that you don't post anything about yourself after you have asked me to post stuff about me and I did.
WHEN LIFE KNOCKS YOU DOWN TO YOUR knees, JUST REMEMBER THAT YOU ARE IN THE PERFECT POSITION TO PRAY. HW 395, RNY 4/2/07 345, Lowest Weight 248, Revision to Distal RNY 1/13/09 278,Revision to DS 10/15/10StacysMom
on 4/13/09 8:24 am, edited 4/13/09 8:47 am
on 4/13/09 8:24 am, edited 4/13/09 8:47 am
"I guess all of that is besides the point. My point is how dare you say that you don't post anything about yourself after you have asked me to post stuff about me and I did."
I am sorry that you were "offended", but I don't understand why that would be. All I did was ask a question. You had already chosen to put a profile up with your photo and story and everything else. That was YOUR choice and had nothing to do with me. The only reason I asked you to post about your experience was because I am still compiling information on the different types of revisions and which were successful, to what degree and why. I did not seek you out. You were already on the forum complaining about your revision choice. I never purported myself to be an "expert" on anything! I asked you to explain further because information is power and I'll take it anywhere I can get it. I contacted you via PM because there was so much contention on the boards towards me at the time because I was catching people in lies and outing them, so I was trying to "lay low". YOU have never lied and I have no beef with you and don't understand why you would have a "beef" with me. Especially now, when all of this revision controversy happened over a month ago. FYI, I have chosen nothing - I am still learning! And, if you and others want to spread your personal information and a photos all over the internet is YOUR business - please don't INSULT my choice. I was asked to explain myself and I did.
You had posted on the forum that you were unhappy with your revision choice WAY before I ever said anything to anyone. Maybe you now need a scapegoat and I am a convenient choice for you. I only posted the info that I read in these journals because I wanted everyone to have the same information that I did. They can choose to read it or not. They can choose whichever surgery they want, just like you did. However, it's much better to undergo ANY surgery when you are better informed about the statistical outcomes. If you don't like what the studies say, DON'T READ THEM. No one is saying that the ERNY is a "bad" choice - sometimes it is the ONLY choice available to someone, either because it is the only surgery their insurance will cover, their scar tissue left over from previous surgeries or because of their proximity to a particular surgeon. But, they should know what the research is saying about it, no? They should know it's not the only choice available to them - that there are a lot of choices. Maybe you are upset because you didn't know this at the time you chose your surgery. Maybe you weren't give a choice by your surgeon. Only you know what your situation was at the time, but please don't blame your unhappiness on ME. I don't know you. I didn't make your choice for you and I have nothing to do you you.
So, you are free to go and "find" reports and studies which support any surgery you want and post them on these forums. DO NOT FAULT ME FOR AT LEAST TRYING TO DO SOME RESEARCH AND MAKING IT AVAILABLE TO OTHERS.
I am editing this because I just went back and read some of your old threads and here is what you said:
"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."
Here is the thread you said it on: www.obesityhelp.com/forums/revision/3883925/Revised-my-RNY-and-stayed-the-same/#31245056
Here is a link to ALL of your posts, so that everyone can see that you are only attacking ME because you are unhappy with the choice YOU made for yourself:
www.obesityhelp.com/forums/revision/board_id,5360/user_id,77 4093/a,messageboard/action,memberPosts/
IT IS NOT NICE (OR FAIR) TO ATTACK SOMEONE FOR PROVIDING INFORMATION WHICH YOU WISH YOU HAD KNOWN WHEN MAKING YOUR DECISION - DON'T BLAME THE MESSENGER!!
I am sorry that you were "offended", but I don't understand why that would be. All I did was ask a question. You had already chosen to put a profile up with your photo and story and everything else. That was YOUR choice and had nothing to do with me. The only reason I asked you to post about your experience was because I am still compiling information on the different types of revisions and which were successful, to what degree and why. I did not seek you out. You were already on the forum complaining about your revision choice. I never purported myself to be an "expert" on anything! I asked you to explain further because information is power and I'll take it anywhere I can get it. I contacted you via PM because there was so much contention on the boards towards me at the time because I was catching people in lies and outing them, so I was trying to "lay low". YOU have never lied and I have no beef with you and don't understand why you would have a "beef" with me. Especially now, when all of this revision controversy happened over a month ago. FYI, I have chosen nothing - I am still learning! And, if you and others want to spread your personal information and a photos all over the internet is YOUR business - please don't INSULT my choice. I was asked to explain myself and I did.
You had posted on the forum that you were unhappy with your revision choice WAY before I ever said anything to anyone. Maybe you now need a scapegoat and I am a convenient choice for you. I only posted the info that I read in these journals because I wanted everyone to have the same information that I did. They can choose to read it or not. They can choose whichever surgery they want, just like you did. However, it's much better to undergo ANY surgery when you are better informed about the statistical outcomes. If you don't like what the studies say, DON'T READ THEM. No one is saying that the ERNY is a "bad" choice - sometimes it is the ONLY choice available to someone, either because it is the only surgery their insurance will cover, their scar tissue left over from previous surgeries or because of their proximity to a particular surgeon. But, they should know what the research is saying about it, no? They should know it's not the only choice available to them - that there are a lot of choices. Maybe you are upset because you didn't know this at the time you chose your surgery. Maybe you weren't give a choice by your surgeon. Only you know what your situation was at the time, but please don't blame your unhappiness on ME. I don't know you. I didn't make your choice for you and I have nothing to do you you.
So, you are free to go and "find" reports and studies which support any surgery you want and post them on these forums. DO NOT FAULT ME FOR AT LEAST TRYING TO DO SOME RESEARCH AND MAKING IT AVAILABLE TO OTHERS.
I am editing this because I just went back and read some of your old threads and here is what you said:
"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."Here is the thread you said it on: www.obesityhelp.com/forums/revision/3883925/Revised-my-RNY-and-stayed-the-same/#31245056
Here is a link to ALL of your posts, so that everyone can see that you are only attacking ME because you are unhappy with the choice YOU made for yourself:
www.obesityhelp.com/forums/revision/board_id,5360/user_id,77 4093/a,messageboard/action,memberPosts/
IT IS NOT NICE (OR FAIR) TO ATTACK SOMEONE FOR PROVIDING INFORMATION WHICH YOU WISH YOU HAD KNOWN WHEN MAKING YOUR DECISION - DON'T BLAME THE MESSENGER!!
First of all at first the only thing I was disappointed in was not being able to have more intestines bypassed so don't try and put words in my mouth like I see you try to do others. As I said before reading all the posts from you and others have me paranoid that I'm not going to lose the weight. I'm still doing what needs to be done to lose the weight. You contacted me asking me to post my story because some other person was considering the same surgery and this was BEFORE all of the drama that you were in. As I told others in my posts just make sure that the surgeon bypasses enough intestine on you. That was and is my problem I feel. I'm not blaming that on ANYONE. I'm not unhappy with my choice I just wish a surgeon who bypassed more would have done it SO GET IT STRAIGHT. As far as reading the studies, I do believe that you were making a point to point them out to me right? I didn't ask you for the info you were making it your business to give it to people no matter if they are asking you or not. After reading posts from others I would have like to have a ds and still do recommend it to others, but I'm curious what your agenda is. If you haven't chosen why are you pushing the ds to others? Do you really need a revision? Why are you here if you have already done so much research and know what is the best surgery? Why haven't you done it yet if that is what you need? You're right I don't know you and you don't know me, and its best for you that we don't.
"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."
And that was about the thread that YOU pointed out to me about African American women not losing. AS I SAID BEFORE YOU AND OTHERS HAVE MADE ME PARANOID ABOUT THE SURGERY THAT I HAD!!!!
"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."And that was about the thread that YOU pointed out to me about African American women not losing. AS I SAID BEFORE YOU AND OTHERS HAVE MADE ME PARANOID ABOUT THE SURGERY THAT I HAD!!!!
WHEN LIFE KNOCKS YOU DOWN TO YOUR knees, JUST REMEMBER THAT YOU ARE IN THE PERFECT POSITION TO PRAY. HW 395, RNY 4/2/07 345, Lowest Weight 248, Revision to Distal RNY 1/13/09 278,Revision to DS 10/15/10On April 13, 2009 at 3:49 PM Pacific Time, Monique H. wrote:
First of all at first the only thing I was disappointed in was not being able to have more intestines bypassed so don't try and put words in my mouth like I see you try to do others. As I said before reading all the posts from you and others have me paranoid that I'm not going to lose the weight. I'm still doing what needs to be done to lose the weight. You contacted me asking me to post my story because some other person was considering the same surgery and this was BEFORE all of the drama that you were in. As I told others in my posts just make sure that the surgeon bypasses enough intestine on you. That was and is my problem I feel. I'm not blaming that on ANYONE. I'm not unhappy with my choice I just wish a surgeon who bypassed more would have done it SO GET IT STRAIGHT. As far as reading the studies, I do believe that you were making a point to point them out to me right? I didn't ask you for the info you were making it your business to give it to people no matter if they are asking you or not. After reading posts from others I would have like to have a ds and still do recommend it to others, but I'm curious what your agenda is. If you haven't chosen why are you pushing the ds to others? Do you really need a revision? Why are you here if you have already done so much research and know what is the best surgery? Why haven't you done it yet if that is what you need? You're right I don't know you and you don't know me, and its best for you that we don't."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."And that was about the thread that YOU pointed out to me about African American women not losing. AS I SAID BEFORE YOU AND OTHERS HAVE MADE ME PARANOID ABOUT THE SURGERY THAT I HAD!!!!
~~AS I SAID BEFORE YOU AND OTHERS HAVE MADE ME PARANOID ABOUT THE SURGERY THAT I HAD!!!!~~
That's not really fair, it's not fair to try to stop others from getting information because it might make you uneasy about your own procedure.
You had your surgery, you are losing weight, that's all that matters.
Nobody can "make" you feel any way at all. You feel how you chose to feel -- this is YOUR responsibility. Staceysmom can't "make" you regret your choice of surgery, or "make" you feel badly at all.
You did what you did -- you have to live with that. If you are unhappy with the outcome, make sure people know about it, know what you think went wrong, how they can avoid it. At least you will been of some help. "If you can't be a good example, at least be a dire warning." The other side of "paying it forward."
You can't blame Staceysmom for putting the stats out there. They are what they are.
And here are a few more -- this is a really complicated Abstract and the paper isn't available so I'll highlight the data regarding revision of RNY to distal (=extended?) RNY:
1: Ann Surg. 2008 Aug;248(2):227-32.
Weight loss outcome of revisional bariatric operations varies according to the primary procedure.
Brolin RE, Cody RP.Department of Surgery, University Medical Center at Princeton, Princeton, New Jersey, USA. [email protected]
BACKGROUND: Revisional bariatric operations performed for weight loss failure are frequently associated with inconsistent weight reduction and serious perioperative complications. METHODS: Outcomes of 151 consecutive revisional operations performed by one surgeon for unsatisfactory weight loss were compared to determine whether postoperative weight loss is influenced by the type of primary procedure. Minimum follow-up was 12 months. RESULTS: Primary operations included 14 jejunoileal bypass (JIB): one revised to gastroplasty, 13 to RY gastric bypass; 71 gastroplasty/banding (GP/B): all revised to Roux-en-Y gastric bypass (RYGB); and 66 gastric bypass: 49 revised to distal/malabsorptive RYGB, 12 restapled without malabsorption, and 5 loop bypasses revised to standard RYGB. Perioperative morbidity/mortality rates were 21.8% and 1.3%, respectively. Follow-up at 12 months was 93%. Mean weight/body mass index unit loss after revision of JIB was 90 pounds/17 units versus 113 pounds/16 units after revision of GP/B and 71 pounds/11 units after revision of gastric bypass (P < or = 0.05) with corresponding mean percent of excess weight loss of 51% for JIB, 56% for GP/B, and 48% for gastric bypass. Five of the JIB revisions (38%) lost > or = 50% excess weight loss versus 39 of the GP/B revisions (61%) and 28 of the gastric bypass revisions (48%). Comorbidities improved/resolved in 100% of those who lost > or = 50% of excess weight versus 89% who did not. CONCLUSIONS: Weight loss after revision of pure restrictive operations is significantly better than after revision of operations with malabsorptive components. Improvement of comorbidities in the great majority of patients justifies revision of all types of bariatric operations for unsatisfactory weight loss.
To summarize: of 66 RNYers, 49 were revised to a distal/malabsorptive RNY. (I wish they didn’t bunch all the stats of the different RNY surgeries together, but most of them [49/66] were RNY to ERNY of some sort.) The outcome was that on average they only lost 71 lbs and 11 BMI units (not so great if your BMI was 50 to start with, huh? or even if it was 41 – you’d still be obese). And less than half of the RNY revisions even lost 50% of their weight, so more than half would be considered WLS FAILURES.
So, if you want to look at it this way, it's not your fault if you fail your ERNY revision -- you were sold the wrong surgery.
I assume you have seen the RNY and Lapband statistics for African-Americans, right?
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