Anyone losing with Distal RNY Revision

There aren't many top revision surgeons, so I'd find one. It is certainly easier for a surgeon to revise RNY to ERNY, but that may not be best for you. I think it combines the worst of the RNY with the worst of the DS. Please see a surgeon who has done many revisions, (and does the DS as a revision, not just as a virgin surgery) for some unbiased input.

Learn the differences in the surgeries, and then select the surgeon that can give you what you need. I hate to see people get steered toward surgeries based on what is easiest for a surgeon, or what insurance wants to pay for, instead of what best for someone. I see it too often.

ETA - the most accurate list I know of is at DSfacts.com

I have a Distal (aka ERny or Extended Rny).  My common channel is 50 cc.  There are bunches of us who are doing great.  I'm at goal with a 19 BMI that is farely easy to maintain.

BUT....if you want a DS and there's no medical reason for you not to get one then go to a different surgeon who will do one!!!

I don't think I'd feel comfortable following through with a surgery that you're not educated about nor excited to have.  If all your pre-surgery hoops are checked off then it shouldn't be difficult to switch , right?

dsfacts. com for list.

"If" you want to know if Distals can be successful and if that guarantees that you'll have success?  YES many are successful and YES you CAN as well.  But no guarantees with any surgery cuz you are the captain of your ship, right?  Compliancy is te engine behind the tool:)

Good luck!

Joyce,

Was your stoma made smaller during your revision?

Nope!

Pouch or stoma wasn't even touched.  The only thing I had done at the same time as my shortened common channel was a chemical peel on my face!  Now THAT worked better than my revision cuz I did NOT want to open my blistered mouth!!!!  LOL!

Seriously....no need to pouch tweak if your common channel will be shortened tremendously.  Having both done is kind of a waste in my opinion.  And....like it has been pointed out before....we do need to consume larger quanities of food (healthy lean proteins) when we have high malabsorption!  so,  an itty bitty pouch might force you to chug nothing but protein drinks.  .....  I personally love my meat and am happy I can eat a small steak when I want to mix in with my protein regime.

BTW....I love your cheerful posts!  Don't let people drive you away again. 

You can definitely be successful with the ERNY, but you come out of it with all the challenges of the RNY that the DSers don't have and all the challenges of the DS that the RNY's don't have.....so it's the worst of both worlds.  You will need to eat like a DSer, high protein and fat.  The RNY pouch leaves you limited capacity though.  If you dump on fat, then you may be quite miserable.  It can be done, though, with great success, but it  will take some attention to detail.

ERny's are lucky dogs if they have some restriction but most surgeon's leave their pouches alone and simply add the malabsorption (of the DS).  So, many ERny's can eat a DS'er under the table!  1st time DS'ers have some sleeve restriction as well (hopefully, right?)

And "if" an ERny is lucky enough to dump on fats then he/she may avoid some of the DS orange oil slicks.  But, unfortunately, very few Proxy Rny's that revise to Extended Erny have any dump-o-meter working.

I LOVE the fact that I dump like crazy if I eat a cookie!  Woooo Hoooo!  Cuz...my ERny body absorbs every one of those calories; as does a DS body!

ERny =  BEST of BOTH worlds!!!

BTW, I have yet to run across an ERny who can't eat meat!  That seems to come up every now and then.

I'd say the DS reduces the challenges of the WL journey.  But, when we're talking a REVISION and not just your run of the mill 1st time DS, then there's the big RISK factor to consider.

 

Time alone loses the oil slicks.  They're an item of the Freshman year of the DS, and I also know an ERNY that had them her first year, so we're not cornering the market on those. 

Dumping on fat is truly something to keep into consideration, though, and a revision patient knows whether or not they dump on fat.  I can't even imagine life with our cc trying to live low fat.  I tried it my first month (by the recommendation of an idiot nut) and got constipated every time I didn't get enough.  If they don't dump on fat, this isn't an issue, but it's irresponsible of you to dismiss the possibility that could lead to a miserable existance.

The challenges are the B12 and iron for RNY and the fat solubles ADK&E for the DS, so yes, it is the worst of both worlds for nutritional challenges, and vitalady (also an ERNY who makes her life's work ensuring we know what we need nutritionally) will concur.

Valerie,
You are so right on target with so much of your information.  I do NOT diagree that possibilities and challenges exist with an ERny.  I shout it out daily to bunches that an ERny is a VERY high maintenance option.  But it remains one of the top choices for failed Proxy Rny's because of the HIGH RISK conversion in the Revision to a DS!  It seems irresponsible to not mention the complication possibilities when one has a Rny revised to a DS.  In fact, some of the active posters who have succeeded in the Rny to DS have had weeks/months of very touch and go struggles as a result of their high risk choice; even needing to get emergency follow-up care elsewhere.  We are delighted that they are healthy and alive to post their pictures and claim that the DS is the superior procedure!  But, isn't it irresponsible to glaze over that high risk scenario? And about those who never post again?  What really happened?

I think the problem in communicating "exacts" and being a "responsible" poster is in comparing a virgin procedure with that of a Revision procedure. 

1st surgery or revising from a failed lapband or sleeve?  DS absolutely!

By the time most Proxy Rny's get to the point of needing/wanting a revision, they generally have minimal restriction (#1 reason they are seeking a revision).  So the point that ERny's just do not have enough room to get the proper nutrients is mute.  And, the very slight possibility that a REVISED Erny would dump on fat is like mentioning the upper 5 % complication rate of either the DS or ERny.  It should be considered but chances are likely that the ERny "healthy" fat consumption is in fact part of most post-op regimes.   Sugar and processed carbs are the evil goodies that set off most traditional Rny "dumps" and so that remains a blessing with the ERny since those 2 goodies remain the evil twins for ERny's and DS'ers alike!  Thank Heavens that I dump on sugar!   Fat dumping is VERY rare even amongst the Proxy Rny active crowd.

Vitalady does in fact have a "preventive post-op pkg" that she recommends to stay on the up side of our labs.  My list is long.  It's the exact same list that she gives the Distals and the DS'ers.   I do in fact take A, D, E, K, B12 sublingual, Iron, mag citrate, copper, zinc, multi, biotin, B Complex, B1 sublingual, calcium citrate, milk thistle, inositol, and an OTC prilosec.  It runs me around $50 a month when I buy in bulk.  I used to have a $600  co-pay for all of my medications.  I don't take ANY medications now so my handful of vites and protein drinks is a happy trade-off.  But, there is definitely focus required forever.  An ERny is high maintenance!

The big hurdle that seems to be minimized consistently is that the Rny to DS REVISION (not a 1st choice procedure) is a VERY high risk procedure.  There are very few surgeon's who perform it brilliantly and safely so access for the majority is often financially or phsycially impossible.  Insurances are touch and go so out of pocket expenses are often excessive.  And, many of the population have racked up a "few" abdominal type surgeries in their history; leaving the poor Rny body a medical mess for the BEST of surgeon's. 

There is a considerable population who just can NOT have a DS.  So, it seems irresponsible  to drop tidbits that are irrelevant or not facts to the big picture when surgeons are finding that the ERny is having similar results and is a safer revision procedure.

ANYONE who has any type of weight loss procedure should be aware and willing to follow through with post-op protocol for optiimum results and good health!

Sorry....long babble for a small point.  So, short version.  "if" an Rny has experienced FAT dumping in the past, then they absolutely should think twice about having a revision to an ERny since fat in our diet makes us happy:)

I just had this revision done on June 19th and so far so good. I will say it was a challenge at first with what I could and couldn't eat. I was pretty miserable the first month or so but things DO get better. I'm learning what I can and cannot eat. So far I'm down about 30ish lbs. Very happy with the results.

Good luck and definitely ask your questions. I did the same thing to my surgeon.

Tara

Llittle,

I really do understand what you are going through. I also wanted the full ds surgery.  I decided though FOR ME, that the bottom part of the ds was what worked for my situation. No one but YOU can make this decision!

I was truly afraid of complications, as I have 5 children at home, 2 of them teen boys with special needs and a 3 year old in the mix.  Guess what? I ended up with 2 transfusions and wound infections.  These are very rare for Maguire, as they will go over his stats in your pre-op teaching day.  I put my trust in him due to his many years of experience, and MY comfort level with his abilities and expertise.

I guess what I am trying to get at is, ONLY YOU can make this decision, and YOU have to live with your surgery.

I am very happy with my choice, the only thing I wish I could change would be my cc. As I told you before due to the way my rny was performed, I could only get revised to 120.  But it is working IF I DO MY part! I tell you that is the biggest thing I have learned from all of this, No matter what you decide, there is no magic bullet for most of us!

I did check my ewl and I am at 40% and I am a little over 4 months out! That is great for a revision!

Just keep reading, call the office and talk to them, get another appointment to talk to him, be prepared, he has always taken his time with me. BUT if you don't like what you hear, or feel,  get another consult from another surgeon!  This is YOUR life! Do what YOU feel is right!