Revision from RNY to Biliopancreatic Diversion

I am scheduled for my revision on June 19th. Had RNY done 6 yrs. ago and have put 50 lbs. back on. My surgeon suggested I had teh BPD done. I am concerened  because I was hoping to have the DS done. I guess it's a tricky thing but just not sure what to think about it all.

Anyone had just the BPD from RNY??  My surgeon says my pouch is already restricted (although I can eat anything and a lot) and that the BPD should help me lose the extra weight.

Thanks,
Tara

Honey I do not believe that anybody does the biliopancreatic diversion anymore. Though it is sometimes called the biliopancreatic diversion with duodenal switch it is really nothing like the original BPD. If you are really about to have the old BPD run away now. That procedure had way too many complications. You really need to do yourself a favor and come to the DS board. They will help you out a lot more.
http://www.obesityhelp.com/forums/DS/

Dr. Kemmeter does the DS, I cannot imagine why he would recommend the BPD.  The BPD is an older procedure and really is not being done anymore.  It is not reverseable and folks had some really nasty side effects from it.  Please -- discuss this with your surgeon again to clarify if in fact he is proposing the BPD and not the BPD/DS.  If he is proposing the BPD, if it were me I would get a second opinion.

Red

I guess I'm confused... After speaking with my surgeon last week he said it's basically the same thing except he won't be touching my pouch..

I will be calling him on Monday to check out the details. Now I'm really worried.. AHHHH

Tara

Tara,

I'm a revision from RNY to DS and I can tell you there are very few surgeons who I would trust to do the revision. I would not trust any surgeon who said that he was doing the same thing and not touching your pouch. If that is really what he intends to do, what he is proposing is some kind of RNY revision, possibly a revision to Distal RNY. This is what I would have had to settle for had I not found Dr. Rabkin in San Francisco. And while a Distal RNY would most likely help you lose you excess weight, it is a less desirable revision than a true Full DS.

A Full DS would give you back your pylorus and you would have a fully functional stomach with no restrictions on NASIDs, chewing or any other problem associated with your current RNY pouch. A Distal RNY will leave you with the same "Pouch problems" you and other RNYs share plus it will give you a level of malabsorbsion and that level will be determined by the length of your common channel.

IMO, you need to educate yourself much better than you are now so you can talk to your surgeon about your options. It's a very bad idea to just go with what ever your surgeon suggests as most likely he will suggest something he does for a living and that may not be in your best interest.

Kerry

Tara-

Please talk more with your doctor about what he's suggesting. Educate yourself ahead of time as to the differences between the DS and the BPD. He may have called the procedure the Biliopancreatic Diversion with Duodenal Switch ... which is what the DS is sometimes referred to as.

But I would NOT go ahead with the flat-out BPD, if that's truly what he's suggesting. Please please please read up on the two procedures and then ask questions until you're blue in the face.

I also encourage you to post on the DS board, linked above. I can't explain the difference between the two procedures, but surely someone on the DS board can.

best of luck, Tara ... it's a huge decision.

Kathy

Hopefully this is just a communication issue and your surgeon is planning a true DS. The BPD is rarely, if ever, done in the USA anymore due to the nutritional complications and problems with diarrhea. The DS was created specifically to get the weight loss benefits of the old BPD but without the nutritional and other problems, and it has succeeded.

The biggest difference is that with the DS, the surgeon does the sleeve gastrectomy and you have a smaller but otherwise normal stomach that empties through the pyloric valve. With the BPD the stomach is made smaller by cutting out the lower half or the stomach, which means the pyloric valve is gone forever. Obviously this is not reversable, and it causes lots of nutritional deficiencies.  The stomach then empties into the small bowel, as with your RNY.

The other big difference with that with the classic BPD they made the common channel very short - maybe 65 cm. With the DS most surgeons make the common channel at least 100 cm, which helps to avoid both diarrhea and nutritional problems.

Please come over to the DS forum and learn more, but even more importantly have another talk with your surgeon and find out exactly what he has planned. And if it really is an old style BPD, run far and run fast towards another surgeon who does revisions. You can find a list of surgeons who do revisions to the DS at dsfacts.com.

 

Larra

No reputable Bariatric surgeon in these United States would perform the old style BPD In good conscience on you, or any other prospective virgin or revision candidate. I suspect this is an issue of semantics and sometimes confusing interchangeable medical nomenclature often used. DS/BPD - BPD or just DS.

Having stated that, please understand NOT ALL RNY to DS revisionists are created equal possessing a skill level set and the experience to perform same. Many of these practitioners refuse to, or more likely lack the skills to fully take down an RNY pouch and reconstruct a fully functioning subtotal sleeve gastrectomy in addition to the intestinal switch- an endeavor which requires extraordinary surgical acumen and technique! Each and every revision patient presents with unique obstacles. No two come to the surgical suite alike, and this FULL RNY TO DS revision is by far the me complex endeavor in Bariatric medicine.

There are real Risks here and I would encourage you to research your choice of surgeon very carefully. I can count  less than10, or more like 5 surgeons in the country I would trust with this revision were I in your shoes. Oh, it's likely quite doable, so do not let me dissuade you! I just implore you to choose your surgeon very carefully. And this may likely mean you’ll have to travel.

As Laura suggest come over to the DS forum and you’ll find lots of happy RNY to DS revison Post-Ops, and feel free to PM me or respond here if I can be of any further help.

Rockne

http://www.obesityhelp.com/forums/revision/4098880/BPD-DS-ER NY-Confusion/

Although I do not know personally exactly what Kemmeter has in store for you, I do know that when I had my surgery with him three years ago, the surgery is termed a BPD/DS (biliopancreatic diversion with duodenal switch) and NOT just a BPD.   Please clarify the issue with him.  I also know that three years ago, Kemmeter and his practice did pretty much a standard 100 cc common channel.