Advice (DS) VS. (RNY) totally cluess

Hey all!   I had the lapband in 2007.  I currently have gained all of the ENTIRE 13lbs that i lost.
I am looking into a revision.  I've been jumping around the boards trying to get some advice.  I would luv to get some opinions from you all.

I weigh 278 and i'm 4'11!  I'm scared to death of another surgery!  I'm afraid of making a huge mistake.  I had my surgery at Magee in Pittsburgh, PA.  I liked my doctor but I've yet to see her a day after my surgery. 

I'm looking for answers to the following:

-which has more risk between the two surgeries
-those whom have been post op are you happy and do you have any regrets
-do you have to go through the same routine when getting a revision

I'm at a total loss and stand still here.  I don't know whether to try for a revision or give it a shot on my own without this miserable band that has truly done NOTHING for me!  I'm desperate........and scared

Please help!!

Thank you
Melissa

I cannot imagine the pain and self-doubt you must have gone through having bariatric surgery and only losing 13 lbs.  I HATE the CrapBand and false hope that some quacks sell.

I also think the RNY sucks.  Look at the statistics -- the DS has the BEST long term results, and it has the best quality of life.  No more dieting (watching sugar and simple carb intake yes, but essentially no restriction on fat or protein). 

* The risk of the surgeries themselves (DS and RNY) in the hands of a competent surgeon are essentially identical. 

* I am 6+ years out from my DS -- I am thrilled with my surgery and I have no regrets.  You should come over to the DS forum and talk to many other people who feel the same way, including other CrapBand revisions.

* What you have to do to qualify for a revision is entirely dependent on your insurance company -- they all have their own rules.

Good luck with whatever you decide to do.

Hi Diana,

Thank you for the advice.  I do work with several people whom have had RNY and have gained all of their weight back plus!  That scares me too lol   Plus I still do not have any children so this is a concern of mine too.  I will definately continue my research.  Please keep in touch and all advice or opinions are appreciated!!

10 year results for the DS: 94% have MAINTAINED at least 50% EWL (the hallmark of a successful bariatric surgery).  DS wins that test hands down.

And there have been MANY post-DS babies.  Check out ladynitewolf's posts on this thread http://www.obesityhelp.com/forums/ds/4065686/Calling-all-bor ing-DSers-stop-hiding-Come-bore-us-with-your/action,replies/ topic_id,4065686/page,2/ -- she served as a surrogate for TWINS post-DS.

 HI Melissa,

Sorry to hear about the lapband :(  I can tell you my personal experiences and thoughts.  I know many people have different and similar views, but these are mine:

I just had my surgery, but I did A LOT of research before I chose.  I had an RNY and I am really happy with it so far.  Every surgery has SOME risk of weight regain.  I spoke with people who had both, and I spoke with my surgeon who I really trust.

I chose RNY over DS because I was looking for a tool that would help me learn and develop new approaches to eating and nutrition.  With RNY, I will eat a normal range of foods, but a smaller amount.  As far as lifestyle, I am a teacher, and I spend my days around lots of kids.  I decided NOT to do the DS because of the severity of side effects (smelly gas, leaking bowels).  Frankly, I can't deal with that.  I know some people take supplements...but I didnt want a life where I had to take 5 pills so my poo and gas didnt offend myself and others.  Thats just my personal view.  I spoke with a woman who had DS and I worked with a man who had had one...and it was a big issue for them both.  The woman was always conscious of it, and frankly, the man often had a pretty bad odor about him.  (though they both looked good.)

 I may be able to eat more with the DS...but frankly, after going through this huge change, my goal was not to eat the same as before.  It was to eat better, exercise more, etc.  Dumping isn't the worst thing in the world, but it helps me not even to want to eat things that I shouldn't.  

Anyways, this is just my personal experience.  I can't predict how I will feel years from now, but with a good support group, a good doctor's office and a lot of dedication I know I can make this work.  It's a great tool!  Plus my doctor's office had done a ton of them and I can easily find support/medical help with it.  I wanted to be close to home so my family could be with me.  In Boston I could have found doctor's to do either, but for me, it was important to have my family around me and not be states away.  

Whew, this was a long post!  I put a lot of thought into it, and you should too. Its a big, but really exciting, decision.

Best of luck!!!

~Danielle

Hi Melissa,

I had RNY for 28 years, so I know what it's all about. It did help me lose my excess weight, but after a year or so it was no help what so ever in keeping it off. Because of the dumping and foods like roast beef, steak, rice, celery sticking you end up eating high carb soft foods like pizza because you can eat them and not dump or have it stick. Even so I fought the re-gain pretty successfully for 15 years, with restricting how much I ate and because I exercised pretty much every day. Then I got sick and couldn't exercise and lost control of my weight. It took about 10 years of yo  yo dieting to gain it all back, but that's where I ended up. I had RNY dumping, food sticking and I was morbid obese again. I developed hypertension, sleep apnea and gout, I was miserable, I was a mess.

In the summer of 2007 I finally decided I had to get serious about my weight and see what my surgical options were; I had no clue. I started investigating what was available; I knew I didn't want any more of the dumping or food sticking, but had no idea how I could do that. I found the OH web site and started asking questions and was invited to the DS Forum. What I found there was quite amazing; happy people, living and loving life, enjoying food again and losing and keeping the weight off. The more I learned, the more I liked and soon I knew it was the DS or nothing for me. 

I had some difficulty finding a surgeon with the skills needed to revise me, but Dr. Rabkin did it. It took two surgeries; one 8 1/2 hours and one 4 1/2 hours to get me all straightened out, but he did it! The recovery was a bit rough, but by 6 weeks I was feeling pretty good and things just got better and better. Nowadays I'm loving life and feel like I'm 30 again (I'm actually 57) and I tell you what. I would pay the $40,000.00 and go through the whole order again in a heartbeat to have or keep what I have today; it's like I'm in heaven. 

You can read my profile if you want more information or to see some pictures of where and what I've been doing. And you can read my 1 year post here if you want to: 

www.obesityhelp.com/forums/DS/4024505/One-year-ago-today-who -could-have-known/action,replies/topic_id,4024505/page,1/


But the long and short of it is this as far as I'm concerned; RNY sucks compared to the DS, there is nothing as good or better about RNY over the DS, absolutely nothing. The stories about bowel issues and odor are nothing more than myths. The very few DSers who have these problems have them because they either don't know how to avoid them or refuse to alter their eating to do so. DSers usually have a difficult time with white flour products, some like me have no problems with anything, but many will have trouble if they indulge in too much white flour. 

As to the supplements; yes you will have to supplement, with either RNY or DS, but each surgery and each person will require different supplementation; that's why you will have to get blood drawn and labs done at least yearly for the rest of your life. It's not a big deal, unless you ignore it and if you do that with either WLS you could get very sick.  


I would suggest you visit the DS Forum and read the posts, see what the people living with the DS are doing and how they live and love life. Also take a look here and on the regrets board, see how many RNY's are looking for a revision or regret having the surgery and compare it with how many DSers there are.

What ever you choose has to be right for you, the DS was and is perfect for me; I just love, love, love my DS!

Kerry

 I actually chose the DS over RNY because of the negative things I personally saw at a bariatric clinic... all happening to RNY patients.

I think it is really quite funny how rumors start on the internet.  A lot of the things people list as negatives towards the DS are not true.

Here is a link to abstracts of studies comparing DS and RNY.   You will see bowel habits are the same.  http://www.dsfacts.com/Duodenal-Switch-Compared-to-Gastric-B ypass.html

Here are my favorite conclusions:

CONCLUSIONS: Although duodenal switch is associated with more bowel episodes than gastric bypass, the difference is not statistically significant. Bowel habits are similar in patients who achieve 50% estimated body weight loss with duodenal switch surgery or gastric bypass.

CONCLUSIONS: Direct comparison of DS to RYGB demonstrates superior weight loss outcomes for DS.

Hello Melissa,
Needless to say that I am supporter of the DS.

Lap band is a restictive procedure, There is no reason to belive that another procedure, restrictive, will be any more succesfull for you than the first one.

The  importnat points to remember is that
1- the outcome of the surgery does not in any way reflect on what the patient did or did not do. Your outcome after Lap band is not unique. Check the information on their site.
2-get many objective opinions from surgeons that do different revisions.
3- As a surgeon doing revisions, the least risk involved woulb be the first revision. Majority of the time, a quck fix operation now, will only result in having to revisit another revision down the road."


" Conclusions
Laparoscopic RGB, AGB, and BPD-DS have all been proved effective. Laparoscopic AGB has the lowest perioperative risk and the lowest rate of metabolic complications, but the lowest potential weight loss. BPD-DS provides the highest and most durable long-term loss of excess body weight, but is the most complex and has the highest major complication and mortality rate. All procedures improve comorbidities, though BPD-DS and RGB provide the most rapid comorbidity improvement. AGB is most reversible, and RGB is the least likely to require reoperation. RGB provides patients the most autonomy from healthcare providers and is favored by most bariatric surgeons."


This was taken from
http://bariatrictimes.com/2009/07/14/approach-to-selection-o f-type-of-laparoscopic-bariatric-surgery/

The important issue that is never discussed in boards like this is why the percieved higher risk of DS operation to other procedures.  Majority of the patients that are having  Lap Band  tend to be younger healthier females, versus the patients that are having the RNY or DS, that may be a little older with more complex medical conditions and comorbidities. This by itself selects the high rick patients to gravitate toward the DS and the RNY Vs. Lap Band.
I would suspect that if you were to compare the complication and the mortality rate of all procedures for the same patient population the rates would be the same, if not very close to each other. (example : all patient ages 30-40, with no comorbidities, and same BMI, and see what the complication and mortality rate is for different opeation.)

 Good luck. 
Ara

Dr. Keshishiana CAN you give me your opinoin.Every one speaks so highly of you it will be greatly appreciated.
Orignally I had gastric bypass in 2001.I am having a revision done with my doctor using cpt code 43848 .I have regained about 50 lbs. in the last year.Does anyone know what this coding procedure entails.My doctor said he is going in to repair my original surgery.My pouch and stoma is enlarged. My doctor submitted my paper work on Dec 16,2009 and then Bluecross/Blueshield of Tx. requested a  compliant diet history with a prescribed nutrition and exercise program following the original surgery. My doctor office faxed over my diet history I had with weigh****chers from 5-09 to 11-09 and from the time I had been seeing my doctor ,plus my employer has a health program for us to join on line within our company and that was submitted also I have been complying with for the last 2 years.They also ask that my doctor give details of the procedure for the coding of 43848. On my policy code 43848 is covered.Do you think my insurance carrier will cover my surgery. My doctor  faxed over the information originally on Dec 22,2009 but they said they never recieved it but as of  Dec 29,2009 it is now posted in their system.(dr. office had to refaxed information. Since this is all they are requesting  I am hopeful it will be approved.What do you think ? Anyone had this revision before?

Bluecross/Blueshield Policy

C.  Repeat of a covered bariatric surgery:  Repeat of a covered bariatric surgery may be eligible for coverage only when ALL of the following criteria are met:

For the original procedure, patient met all the screening criteria, including BMI requirements, AND
The patient has been compliant with a prescribed nutrition and exercise program following the original surgery, AND
Significant complications or technical failure (i.e., break down of gastric pouch, slippage, breakage or erosion of gastric band, bowel obstruction etc.) of the bariatric surgery has occurred that requires take down or revision of the original procedure that could only be addressed surgically, AND
Patient is requesting reinstitution of an acceptable bariatric surgical modality.
 

 Hello,
43848 code is a revision of a RNY code. I think anything passed this I would refer you to a billing expert, that I am not.
I would however tell you that I asked out biller in our office and I was told that she does not use that code when I do the RNY revision to the DS.
It is also very hard to predict what insurance companies will and will not do.
Hope this all helps.
Ara