Everyone should read this-Revision Procedures for Failed Gastric Bypass
On March 17, 2009 at 12:52 PM Pacific Time, Mary_J wrote:
On March 17, 2009 at 12:43 PM Pacific Time, MidwesternGirl wrote:
On March 17, 2009 at 12:36 PM Pacific Time, Mary_J wrote:
On March 17, 2009 at 12:08 PM Pacific Time, MidwesternGirl wrote:
On March 17, 2009 at 5:53 AM Pacific Time, Mary_J wrote:
You probably didn't 'copy' it from me - I took it out of my signature after it became a well used phrase :) But it's used often now!My PERSONAL opinion is that the DS is for EVERYONE - and tailor THAT to your individual needs (stomach size, common channel length). It's nearly an idiot proof surgery (NEARLY), and if you can't succeed with the DS, the odds are that you won't make the others successful (since they leave much of the work up to 'working the tool' rather than 'fixing the broken equipemnt' IMO). I'm rather opinionated, after my experience and research, and it tends to get me into trouble, so I should probably STFU! :)
I realize you think DS is for everyone but that isn't realistic. Some lucky folks don't need malabsorption, restriction is good enough. And I do mean lucky! I don't think most people can overhaul their diet completely. The food obsessions, cravings, etc. I think that is why I would have failed RNY. You can't turn those behaviors off the moment of surgery, it takes a lot of head work and by the time I would have completed the head work my pouch and stoma would be huge.
In my wildest dreams I never thought I could change my eating habits from fast food to veggies but I did. For the first time in my life I crave good foods. I eat what I want and when I want and I maintain easily.
Had I gotten DS I'd still be eating the same load of crap I was before surgery. It is very possible to be fat and malnourished and that probably described me well at the time I had surgery.
I never claimed you stated it as fact. I merely wrote it is unrealistic and it is.
If I would have had RNY or DS I'd still be eating horrible diet, if the band did anything for me it made me realize that I can change my eating habits. LOL
I'm a pretty blunt and up front person and I write exactly what I mean. I referred to MY eating habits. I ate a load of crap before surgery. If I COULD have eaten a load of crap with my band I would have. If *I* would have had RNY I would have failed as already explained.
When most of us refer to ourselves we don't mean everyone else.
There is no surgery type that adds vitamins to food that were not there to begin with. If I would have had RNY or DS I'd have no choice but to battle more vitamin issues because I wouldn't have gotten much from my food.
As for my original points, not everyone needs malabsorption and I am one that would have certainly failed RNY.
StacysMom
on 3/17/09 3:09 pm, edited 3/17/09 3:17 pm
on 3/17/09 3:09 pm, edited 3/17/09 3:17 pm
Mary_J and MidwesternGirl, I agree with both of you! Some people are able to get away with merely a restrictive procedure. They are able to amend their eating accordingly and change their lifestyle. Not everyone can do this and for the ones who cannot, it does appear as though the DS surgery is the best tool for their WLS. No one should be eating junk instead of healthy food, but many do and it's an addiction just like smoking or alcoholism - hard to break! There are also those who have metabolic issues which are either inborn or have come as a result of yo-yo dieting for their entire lives.
I would like to make a different point here. I am of the opinion that, because the RNY is so difficult to revise to the DS, that perhaps people should try a gastric sleeve as their first WLS or as a revision if their lapbands didn't work for them.
Of course, the actual reason that the lapband didn't work is a major consideration here. And, MidwesternGirl is the one to ask for advice about that! But, if someone gets the sleeve and not the RNY, they don't get stuck with the pouch which eventually stretches out and leads to failure for so many. For the MO and SMO, the DS is really the way to go - and for everyone else, it is still a good choice if the sleeve alone is not a strong enough tool. As long as they don't have the pouch, adding the malabsorption of the DS a much easier procedure which can probably be done laparoscopically, not that any WLS is easy! All of the RNY to distal or ERNY revisions that I've read about on OH have been done open. Contrast that to the initial sleeve surgery whic can be done lap and a revision to it which can also be done lap. With the limited long term results from the sleeve being equivalent to the RNY combined with the RNY failure rates, this is a "no-brainer".
Gosh, MidwesternGirl, do you think those members who think we're the same person will now believe that we're really two different people?? We even disagree at times! And, the important point here is that we're not afraid to disagree! And, we don't insult one another for having a different opinion!
I would like to make a different point here. I am of the opinion that, because the RNY is so difficult to revise to the DS, that perhaps people should try a gastric sleeve as their first WLS or as a revision if their lapbands didn't work for them.
Of course, the actual reason that the lapband didn't work is a major consideration here. And, MidwesternGirl is the one to ask for advice about that! But, if someone gets the sleeve and not the RNY, they don't get stuck with the pouch which eventually stretches out and leads to failure for so many. For the MO and SMO, the DS is really the way to go - and for everyone else, it is still a good choice if the sleeve alone is not a strong enough tool. As long as they don't have the pouch, adding the malabsorption of the DS a much easier procedure which can probably be done laparoscopically, not that any WLS is easy! All of the RNY to distal or ERNY revisions that I've read about on OH have been done open. Contrast that to the initial sleeve surgery whic can be done lap and a revision to it which can also be done lap. With the limited long term results from the sleeve being equivalent to the RNY combined with the RNY failure rates, this is a "no-brainer".
Gosh, MidwesternGirl, do you think those members who think we're the same person will now believe that we're really two different people?? We even disagree at times! And, the important point here is that we're not afraid to disagree! And, we don't insult one another for having a different opinion!
(deactivated member)
on 3/18/09 12:07 am - Woodbridge, VA
on 3/18/09 12:07 am - Woodbridge, VA
On March 17, 2009 at 10:09 PM Pacific Time, StacysMom wrote:
As long as they don't have the pouch, adding the malabsorption of the DS a much easier procedure which can probably be done laparoscopically, not that any WLS is easy! All of the RNY to distal or ERNY revisions that I've read about on OH have been done open. Contrast that to the initial sleeve surgery whic can be done lap and a revision to it which can also be done lap. With the limited long term results from the sleeve being equivalent to the RNY combined with the RNY failure rates, this is a "no-brainer".
Couple things...first, as far as I have seen, there are no long term results for the VSG. I believe Jossart and Cirangle released a presentation with the longest term data currently available for the sleeve, but then they basically said they don't do the sleeves the same way as they did when that data started, so the data is not really applicable to current sleeves.
Next, unfortunately, it's not really as easy as just adding the malabsorption to a sleeve as a revision in most cases. The restriction and the malabsorption need to work synergistically, so, unless the sleeve is fairly recent (less than 12 months old), the sleeve will likely need to be tightened at the time of performing the DS revision.
I do get what you're saying, and it makes complete logical sense to me (with the exception that I just assume start with the DS and have a lower likelihood of needing a revision to begin with!), but until more surgeons start offering sleeves and more insurance companies start covering it...and neither will happen until there are concrete long term results.
As long as they don't have the pouch, adding the malabsorption of the DS a much easier procedure which can probably be done laparoscopically, not that any WLS is easy! All of the RNY to distal or ERNY revisions that I've read about on OH have been done open. Contrast that to the initial sleeve surgery whic can be done lap and a revision to it which can also be done lap. With the limited long term results from the sleeve being equivalent to the RNY combined with the RNY failure rates, this is a "no-brainer".
Couple things...first, as far as I have seen, there are no long term results for the VSG. I believe Jossart and Cirangle released a presentation with the longest term data currently available for the sleeve, but then they basically said they don't do the sleeves the same way as they did when that data started, so the data is not really applicable to current sleeves.
Next, unfortunately, it's not really as easy as just adding the malabsorption to a sleeve as a revision in most cases. The restriction and the malabsorption need to work synergistically, so, unless the sleeve is fairly recent (less than 12 months old), the sleeve will likely need to be tightened at the time of performing the DS revision.
I do get what you're saying, and it makes complete logical sense to me (with the exception that I just assume start with the DS and have a lower likelihood of needing a revision to begin with!), but until more surgeons start offering sleeves and more insurance companies start covering it...and neither will happen until there are concrete long term results.
Hi Mary:
I'm so interested in the revision procedure you had. But I guess I'm still not understanding how it was done. So you have a pyloric valve? Did your revision surgeon do anything to revise the stomach at all? Did you only have the malabsorptive procedure portion of the DS?
I am scheduled to go through a RNY Revision and I tell you I am agonizing over what to do. This procedure you had is very interesting but, I don't know if I would even be a candidate because they think my Pyloric Valve may have been severed in my RNY Revision. I revised from a Gastric Stapling in the 70's.
Please advise...I'm very interested.
JRolfson
I'm so interested in the revision procedure you had. But I guess I'm still not understanding how it was done. So you have a pyloric valve? Did your revision surgeon do anything to revise the stomach at all? Did you only have the malabsorptive procedure portion of the DS?
I am scheduled to go through a RNY Revision and I tell you I am agonizing over what to do. This procedure you had is very interesting but, I don't know if I would even be a candidate because they think my Pyloric Valve may have been severed in my RNY Revision. I revised from a Gastric Stapling in the 70's.
Please advise...I'm very interested.
JRolfson
My VBG (stomach stapling) was 'repaired' (about a year after my original VBG) but not revised to anything - but it was two surgeries on my stomach, previous to this one. No doc thought the tissue of the upper part of my stomach could hold up to a third procedure (to do the sleeve portion of the DS - they would work on the bottom for the RnY stomach revision, but I didn't want that). So, I've never had an RnY pouch. What I DO have is a fully functioning stomach, full sized - the small stomach empties into the bigger one. So I still have the same VBG stomach that got me to 317.5 lbs, nothing was done to my stomach during this revision. I have no regrets with my choice. IF it were me in your situation, and they couldn't do a complete DS revision because of the two surgeries on your stomach . . . .I'd see if they could 'undo' your RnY (which would only be working on your lower stomach and intestines) and just do the switch portion of the DS. But that's me! I just couldn't live with the RnY pouch and it's complications and repercussions with an ERNY. If you're pyloric valve is shot, there isn't much you can do except hope a very distal RnY works - you already live with the pouch, so you know what that entails, and the distal gives at least some of the same advantages as the DS configuration. There's my opinions :)
5' 5" - 317.5 / 132 / 134 SW / CW / GW
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