up-coming revision from VBG to RNY..... Question re open or lap?

Hello everyone,

This is my first post here and would love to talk with those who have had this particular revision.

I saw 2 surgeons.... Dr. Poplawski at the Barix in Michigan, and Dr. Klein in Toronto.  After weighing pros and cons on both sides, I decided to go with Dr. Klein and stay closer to home.  But I'm confused about one thing....

Dr. Pop... said that he would do it but it would have to be open... that he can see better that way.

Dr. Klein said he would do it but he will do it by lap method.... he said he only does lap.

Obviously, lap makes it easier for recovery, so I'd prefer that.... but now I'm worried about his ability to "see better" what's going on inside and make a mistake.

I'm 63 and am told that my age along with the revision makes this a high risk surgery and I want to feel confident that the best approach is taken to give me the best chance possible.

So my question is this..... to those of you who have had a revision from VBG to RNY... 

-  was it done by lap or open?
-  who was your surgeon?
-  how was your recovery?
-  any complications in the first few weeks/months?
-  has your weight loss been slower than most?

Thank you for taking the time to answer this.  My surgery is scheduled for August 5 so this is very close and I'd like to hear from you before I call my surgeon and get some answers from him as well.

Hello Bolara and Welcome!

I have a question and will follow up with answers to your questions...My question is are you having revision due to a staple line breakdown or to shed more weight?

Now I had a VBG in 1979 and it opened in 1987 I was revised to a RNY in 1989...My staple line was completely brokedown and I was able to eat normal again.

My first procedure was open, my second was open and my 3rd was open, which I just had on May 20th.

My early surgeries were all open because they didn't do lap back then...But I can tell you from personal experience that if I would have had open on my RNY Revision I would have been in big trouble...There was so much scar tissue in there the Dr. would have never been able to get through it...So when it came to my 3rd procedure I wouldn't have agreed to have it any other way but open...When you do a procedure lap you have a very small window to see and there can be so many things going on you don't even know about such as hernias, ulcers these would be hard to see if you weren't open. Also, it prevents having to be opened again.

My surgeon for the first 2 was Dr. Richard Catlin one of the ground breakers in San Diego, CA for Staplings and then RNY's...My recovery for my RNY Revision was remarkable and so much better than my first surgery which I thought I was going to die from because I didn't eat for almost a year...No complications at all for my RNY Revision. My weight loss was super fast in my revision and equaled that of the first stapling.

If I can be of further help, please feel free to ask.

Again, welcome good to have you.

Janie

Hi Janie,

Thanks for your reply.  To answer your question.... its both.  I had VBG some 15 years ago and one of my surgeons said (after some tests) that my staple line is 40% busted.  It probably has been for at least the last 14 years.  I only lost 50 lbs. from that surgery and quickly regained it back and then much more over the years.  I now weigh 315 lbs., so I have a lot to lose.

You're not the first person who tells me this.... about scar tissue and the preference of open rather than lap.  I plan on calling my surgeon and asking him about this.

Thanks for your input.  it was helpful.

Hi there!  I'm a VBG to RNY patient.  My pouch was completely intact, but the opening from my esophogus to my pouch was so narrow, I couldn't even swallow a birth control pill.  I threw up at least once or twice a day for almost 3 years. 

My VBG was open.  My revision surgeon is Dr. Carter at Madigan Army Medical Center at Ft. Lewis, WA.  He said he needed it to be another open surgery.  He did a complete gastrectomy after taking down mypouch and making a whole new one.  I had a ridiculous amount of scar tissue.  He said it would have been virtually impossible to do it lap.  Yes, the recovery was harder with a 12" incision, but I am glad he could do the revision period.  I had gained all my weight back (125lbs or so) and was feeling pretty bad. 

I was in the hospital 6 days.  I had trouble producing urine and getting enough oxygen.  I would have been out a few days earlier if my body would have "woken" up sooner :-) 

I went back to work (I work in computers) part time on week #3 and #4 then full time by week 5. 

So I'm about 12 weeks out now.  I feel 99% marvelous. 

I was so hoping to have lost 50 lbs on my 12 week anniversary but I'm at 49 lbs.  I think I'm slower than normal and Dr. Carter said that would probably be the case.  I'm okay with that (most of the time). 

I've gone from a 24 to an 18 in 3 months.  Who could ask for more?  Good luck.  You are going to do great. 

-  was it done by lap or open?
-  who was your surgeon?
-  how was your recovery?
-  any complications in the first few weeks/months?
-  has your weight loss been slower than most?

  Hi.   I had this exact revision on June 8 this year.   My surgeon was Dr. Thomas Sonnanstine in Georgetown, KY.    He told me he would do laproscopic but said that if necessary he could convert to open.   Luckily that didn't happen.   He told me everything went great.   He actually seemed excited about it afterward.  He had to spend over an hour removing scar tissue from the previous surgery.

My recovery has been great except for little annoyances.   I have had no complications this first 4 weeks.  

My weight loss so far has been right around what a first time RNY of my size would be.  At just under 3 weeks, I was down 20 pounds from my surgery date.  I haven't weighed this week yet...

There were lots of people praying for me and my doctor.   I believe that God carried me through this.

Hi Sue,  (I'm asuming that's your name?)

Thanks for your positive and hopeful story of how it was for you.  I must say, I'm getting almost equal stories of Lap and Open. I posted on 2 forums.  Some have caused me great concern and others great hope.  Of course, we're all different and that's to be expected. 

I also believe in prayer.  Could I ask for your prayers on my behalf around 8:30 a.m. on August 5?  I don't know what time zone you're in, but I'm on EST. near Toronto.  I'm sure that prayers reach beyond time zones, so whatever the time, I would trully appreciate that support.  Would your church be willing to participate?  I don't have a church community right now so don't have this to fall back on.  I have to admit, I'm feeling a bit less confident than I would like to be.  Being 63 yrs. old does add a different dimention to it... so I'm told by Dr. Klein.

Good luck on your continued weight loss!

You give up shorter table time with a lap revision. Yes, there are surgeons that will do it. But depending on the amount of scar tissue they find when they get inside, your table time could be *greatly* increased.

I revised from a '87 VBG to a DS just two months ago, and traveled across country to do it. Yes, a revision from a VBG to an RNY would have been simpler and I could have had it done locally, but with all things considered, I wanted to get RID of my VBG pouch and regain a normal-but-smaller stomach. I also take NSAIDs for arthritis, and didn't want to have to give them up with the RNY.

I hope you've considered *all* your surgical options, including the Duodenal Switch - there are a lot of reasons to consider the DS as a revision ... not the least of which is that we've got super-stubborn metabolisms, after our first surgeries. The DS has the best excess weight loss statistics of all the surgeries, and the best stats for keeping it off.

My surgeon (David Greenbaum in New Jersey) spent the first 45 minutes of my open surgery doing nothing but separating organs from each other ... lots and lots of scar tissue. Had he done that lap, it would have easily taken 3X longer.

Yes, the initial recovery is longer with an open surgery. But your surgeon will be able to feel the amount of tension being applied to your organs ... be gentle when removing scar tissue, etc. The incision scar wasn't an issue for me at all - he went straight over my old scar!

best of luck, and feel free to ask questions on the DS board, if you'd like to know more.

Kathy

Thank you Kathy.   Table time is one of the concerns my surgeon has.  The longer on the table, the greater possibility of error, infection, etc....  Also, at 63... its hard on the body.  But I'd rather go through a longer recovery and know that I had the best possible surgery than going lap if it means that not as good a job is being done.

About the DS..... I have looked into it but personally, the extreme malabsorption factor scares me a bit.  Guess I prefer the RNY for the greater ability to absorb nutrients.  Tha's important to me.  But thanks for the suggestion just the same.

 Hi,
I had the revision to DS from a VBG as well. Both mine were open. Dr Marchesini in Brazil was my surgeon. My time on the table was just under 2 hours, My recovery was great, no issues. Good for you for doing a revision, I am so glad I did. All the best and keep us posted.