Lap band over failed RNY and revision to DS

Hello,
  I am in need of some advice.  I had the RNY procedure about 6 years ago.  I lost about 80# but did not lose all that I needed to.  I have since regained the weight and a month ago had a revision to the DS.  The problem is.....I am not losing weight.  I have no restrictions on my diet as the doctors only worked on my intestine not my stomach, so I have the same size stomach that I had before, when I was gaining weight.  I am 1 month out of my DS and have not lost any weight.  I know it is because I am eating too much because I can.  I am wondering if anyone has any experience with something similar to this.  I would like to get the lap band over my RNY pouch for the restrictive component to help me lose weight.  Any thoughts?

Thanks for your help,
Lori

It's not possible that you have a DS, if you were left with a pouch. You still have a type of RNY, as your stomach would have to have been revised to a sleeve for it to be a DS.

That said, have you talked to your surgeon and nut about your loss problems? Maybe the stomach is the issue, if the stoma is stretched and empties the food to quickly, or is just too large? They should be able to check it out, but I'm wondering how good the information is that they are giving you since they are either mistaken or dishonest about the surgery they did.

I would find a highly respected revision surgeon that is familiar with all the surgeries, and have a consultation with them.

From what I have read on these boards, the DS is the "grand-daddy" of all WLS's.   If done correctly and completely, I am pretty sure you should be losing weight.  There are very few doctors that do the full DS so I would definitely confirm with him that is what procedure was done.

Good luck with everything!!

You should go to the hospital and order a copy of your operative report.  You Will fine out exactly what he did.  Keep looking , and never give up.  Glenda

If your doctor only worked on your intestines, you don`t have the full DS. The full DS has 2 parts - first the sleeve stomach which causes restriction, and second the intestines part which causes malabsorbation. There are probably some more factors involved, but that`s the main story. If you "only" got your intestines rearraged, you should have a lot more malabsorbation then before. That`s not the same like a revision from RNY to ERNY, but similar. Results with the ERNY seem to be mixed and not as good as getting the "full" DS.

Do you follow the DS diet? High fat, high protein, low carbs? You don`t need to count calories, but you should limit carbs as much as possible in order to make the most out of your malabsorbation. SOme people on the DS board think that the intestines part alone doesn`t do much for weight loss (and are therefore very scpetical if the ERNY will bring good results), but on the other hand, there are a number of people on the DS board who lost good amounts of weight years after their initial surgery and after having lost restriction by going back on a high fat, high protein, low carb diet.

If you are really one of those for whom the intestines part alone does not work to loose weight, I`d rather consider to make the full DS complete by getting your stomach re-done. The band has not proven to be very effective in longterm.

All the best!

I'll be brutally honest here.  It sounds like the problem is not your surgery (or what to call a hybrid of a RNY pouch and DS intestinal byopass)... the problem is -- as you yourself said -- your eating habits.  These surgeries are not magic... there is a certain element of self-control and un-learning old, bad habits involved.  I would think that nutritional guidance or a counselro would be more helpful than seeing a surgeon again.

Lora

I realize that the surgery is not considered "magic".  Can I ask how you lost your weight?  You had a RNY, correct?  So, therefore you had the restriction to get you losing weight.  After you lose 50-100# with out a whole lot of effort it is easy to keep going and keep your weight off.  If I didn't need "extra" help to lose weight than I would have never sought out surgery to begin with.  I am a Registered Dietitian and so I know "how" to lose weight, that is not the problem.  I have gone on several diets and lost a few pounds but it always comes back on.  I need to have the restriction to get my wt loss going as other people do that have WLS.  Do you believe that you would have lost the wt without the surgery?  Most people would not have, or they would not have gone through having surgery.  It is our last effort to lose wt. 

Lori

Yes, of course... I had the RNY because all my other attempts at weight loss had failed (and, no, clearly I would NOT have lost ti without the surgery).  Yes, I needed the restriction to HELP me lose the weight.  The point, however, is that you yourself said you are eating too much simply because you CAN.  *I* can eat quite a bit... and if I ate until I felt full at every meal and did not focus on eating protein, I would gain my weight back.

I'm confused because your reply to me makes it sound like you have NO restriction on your stomach, yet you said you had RNY several years ago... and that you are wanting a band around the "pouch"... but then your profile info says you had a DS in May (which does not give you a pouch... so do you have a RNY pouch with a DS-type bypass?).  Since I cannot tell what kind of surgery or surgeries you have had -- and you did not indicate any MECHANICAL failure of your pouch -- I still stand by my opinion that the surgery is not the problem.  If you are a dietician and already had WLS, you know what you need to be eating.  Now the problem is controlling hwo much.  If you are still overeating despite having a RNY pouch -- and you are the one who said that was the case -- then the problem is not the surgery.  MANY of us still struggle with controlling our eating behaviors, so there is NO shame in that.  I would just hate to see you go for a secnd (or third?)  surgical intervention that will not solve the problem.

Lora

I don't have any restrictions on my pouch.  I am not sure why that is?  I must have had a failed RNY because I never lost that much weight either.  I lost about 80# but was still over 200#.  I get no feeling of being full, unless I have just eaten at a buffet and eaten alot.  Even after I eat, I don't stay "full".  I could go back an hour later and have another meal.  I was told that my open from my pouch to my intestines was too big and food was going right through me.  I am not sure why my surgeon did not "fix" this with the DS revision?  I know that I can do this if I have some help again to see some results and feel full.  This is why I feel I need to have the band. 

Lori

I don't know your surgeon so what I'm going to say is just based on what you've written in these messages.  From the information you've given, as others have said, you do NOT have a DS.  You have an ERNY.  I had a surgeon that wanted to do the same thing for my revision and kept calling it a 'DS' but it was not, he did not want to touch my stomach just my intestines because the stomach is the riskier part with possibilities of leaks.  That is why I kept looking for the right surgeon and chose Dr. Husted.  It also sounds like you have a dilated stoma...and with that your food just falls straight through your RNY pouch.  I had that and could eat a LOT and only felt full if I consumed a very, very large amount of food.  And even that only lasted a very short time before I felt hungry again. It's not your fault, it's the failure of your RNY surgery. 
Forget the band. When your body is ready for another surgery look for an EXPERIENCED revision surgeon and get your stomach revised so that you have a full DS.  Right now your stomach is cut horizontally and you are not using the bottom half of your stomach that has your original pyloric valve. That is what regulates how fast your food goes into your intestines. You want that valve back.  With the revision to full DS they will put the 2 parts of your stomach back together and then make a vertical cut so that you'll have a sleeve and your pyloric valve will be back in place. No more pouch and no more stoma to worry about. 
Good luck.