What type of Revision should I choose?

I had a Lap RNY in December of 2003 with absolutely no trouble.  I lost 108 pounds and the weight stayed off for five years but for the past year I have been gaining the weight back.  And now it is a total of 65 pounds to be exact.  I have pretty good habits and really don't do anything different now than I did immediately post surgery.  

I have been wondering what to do and have consulted two doctors.   Both say it's a mechanical problem and I need to have a revision.  One wants to resize my pouch and remove part of my old stomach to reduce hunger pains while the other wants to create more malabsorption and also remove part of the old stomach.  I honestly don't know which approach will be better or if I should consider something different.  

I am eager to hear from others that have had a revision.  What will be best?

Thanks!

 Check out these two articles from a bariatric journal on the different revision options for the RNY and the pros and cons and success of each type:

www.obesityhelp.com/forums/revision/3886215/Everyone-should- read-this-Revision-Procedures-for-Failed/

and

www.obesityhelp.com/forums/revision/3886208/Great-article-on-RNY-revisions-from-Bariatric-Journal/


The articles both make a good case for the DS surgery (where they reconstruct your pouch back into a working stomach and then cut away the greater curvature to make it a "sleeve" stomach - then they reroute the intestines for increased malabsorption).   An additional benefit of the sleeve stomach (besides the renewed restriction) is that the area which produces the most Grehnlin (the hunger hormone) is cut away and completely removed, so you won't be churning out this hormone 24/7, like with the RNY.  

I don't know if the second doctor you mention intends to do this surgery, but it sounds like it.    Go over to the Duodenal Switch forum and ask the same question if you want to hear about the surgery from people who have already been revised to it (it's really not a revision, but a conversion to a surgery which works in a more metabolic fashion to correct what nature may have screwed up).  

Some people also have had decent results with lapband over RNY, if a restrictive-only surgery is enough for you.   The lapband is the least invasive of all the options and has a shorter healing time than a complete open revision or conversion.   

It is clear form the articles that merely tightening the pouch is only effective for a limited time, as it will stretch back out again.   It is important to notice exactly "how"  your doctor will make the pouch smaller - through Stomaphyx? The ROSE procedure?   Via Sclerotherapy?   If one of these is the method he/she will be using, post questions about that.   There may still be some Stomaphyx patients still reading this board.  No one has yet posted any long term success (nothing longer than six months with complete weight gained back and need for complete revision) with any  of these minimally invasive  modalities (and I've been reading since 2007, when Stomaphyx first started being done in the U.S.).   Some  revision'ers are still trying out these procedures and and maybe they'll be the first to achieve success and post about it.    So many are hoping and waiting to see.  

Thanks for the information.  I read the articles and that is very good information.

Actually neither surgeon I saw recommeded the DS.  One wants to simply redo the RNY and cut away part of the old stomach while the other wants to cut away part of the old stomach and shorten the digestive track to create more malabsorption. 

I had an EGD a few months ago and my anatomy is still pretty good so I still have a working pouch.  My problem is not eating but metabolism I think and how my body processes food.  

I really want to do something that is going to work and not continue to repeat this every few years.  

Well, I'll tell you what I chose as a revision from   my old gastric stapling from 1982.  I had a lap band placed over the old pouch which apparently had stretched out quite a bit.  The weight loss is much slower, but it gives me time for my head to catch up.

So far I am happy with my decision.

Good Luck!

Of course they only want to re-do the RNY, because that is the surgery they perform and sell. You can't go the the Ford dealer and expect them to recommend you go buy a Honda.

You need to do your own research on what surgery would be best for you, THEN select a surgeon that actually does them all, so they have no bias.

Dear Samuel:

You will get many different opinions, as expected on this site. Many will say DS, Many ERNY, Many Lapband over pouch, and some will say less invasive Endoscopic Therapies.

But you must decide ultimately....What does your insurance cover?, how long can you be off work? What are you mentally prepared to go through? How committed to long term after care are you. Because ERNY and DS require much aftercare...That is supplements, supplements, supplements. But, if you take them now religiously that should not be a problem for you.

There are many Dr's who do revisions, many have specialties and many have limited options...Check them all....Research which is best for you personally. Risks are a factor as well with some of the major revisions...You must realize, and I'm sure you already do if you had Lap RNY, that the risks with a revision is going to be much more considering it will most likely be open not lap...Read, Read, Read....2nd opinions are a must.

Good Luck to you Samuel....It's almost like putting yourself back through school when you begin this journey...I'm sure you'll get an "A"

Janie

I can't tell you which to choose either, but for both of the options your surgeons have suggested I'd want to see statistics of how many people they've revised to this, and how successful they've been.

Just getting two medical opinions is worrying - you'd think they'd at least agree with each other! I would be concerned that if there wasn't convincing evidence of the results of what they offer you might be back for a third revision, which is very tricky indeed.

I had RnY in April '05, and lost great for the first year, then stalled for a year, and then started gaining weight. I researched the Stomaphyx and the Rose procedure and since they were so new, no real studies, but many said they still were not losing or were gaining. My insurance didn't cover it and it would cost maybe $10 grand.  So I did check out lapband over my Rny as my local bariatric doc  suggested. I came home, got online, and someone steered me to the DS board. I have seen your question on the DS board. I researched and found that the DS has a better chance for me to take off the regained weight plus the 40 to my goal. I knew I did not want lapband as there are significant problems with the band eroding into the stomach, eating issues, etc. I am willing to take a a chance on life to get this weight loss right for once and for all. I wish you well.

Just keep reading and researching everything you can. You will decide based upon your knowledge and personal needs!

Good luck!

I chose the DS for various reasons. I did tons of research before going to a surgeon, so I knew what I wanted.

I knew this would be my second and last surgery, regardless of how successful or unsuccessful it ends up being, so I chose the surgery with the best stats for co-morbidity resolution, the best stats for excess weight loss, the best stats for sustained weight loss (I'd already been through the horror of regain and didn't want to again). I also chose the surgery that offered the best post-op quality of life (as defined by me, since I was the one that was going to be living with the surgery).

The DS surfaced over and over again as the superior choice for me.

Stacy's mom has given you some good links. Please keep in mind that if your doctors don't perform the DS, then it won't be one of the surgeries they'd suggest or recommend. Dr Husted is fond of saying, "if the only tool you have is a hammer, every problem begins to look like a nail."

The DS isn't for everyone. It takes an extraordinary level of commitment to yearly or twice-yearly lab work and the willingness to take your vitamins every single day, religiously. No excuses, no exceptions.

I very strongly suggest you explore ALL your options, independently. Then look for a surgeon that can give you what you've determined will be the best choice for yourself.

The very best of luck to you, Samuel.

Kathy