RNY to Band or DS

I had Open RNY in Sept 04, I lost 220 lbs and have gained back 50. I am ALWAYS physically hungry and can eat everything just like I use to. I find myself eating more and more and saying ok I will start tomorrow the same thing that lead me to 404 lbs!! YIKES. I thinking about a revision to the band so I can control the restriction or possible DS. Anyone have a successful revision from RNY to either of these?

Thanks

 Sure, I'm a revision from an old RNY - circa 1980 to the DS Sept. 17, 2008. 

What do you want to know?

Kerry

Is recovery long? How long to wait before returning to work? Is the restriction better?

Is recovery long? How long to wait before returning to work?

It's different for everyone, a lot is going to depend on how old you are, what kind of shape you're in. how long you're under anesthesia etc.

I was 56 when I had the revision; the first surgery took 8 1/2 hours; I had scar tissue to beat the band and adhesion's all over the place; I was a mess. But even with the 8 1/2 hours, Dr. Rabkin still missed a scar tissue flap inside my stomach and it blocked anything from getting through so I had to have another surgery a few days later; that one took 4 1/2 hours. It was rough, but I went back to work after 6 weeks and by 2 months I was starting to feel good and things just got better and better. 

I think the average is about 4 weeks before people go back to work.


Is the restriction better?

Depends on what you mean by better. You don't have a pouch anymore, you have a fully functional, but smaller stomach called a sleeve. Mine was made 130 mL or about 4.5 oz. At first you can't eat much at all, but the sleeve stretches and within about a year you can eat like a normal thin person who doesn't eat much. But that isn't the great thing about the DS, the great things are that there is no dumping, no foamies. no food sticking, you can drink with your food; you have your pyloric valve back so there's no worry about washing food through. You can take Ibuprofen or any NSAID; you have a fully functional stomach, it's not a pouch, it's a sleeve.

The sleeve is great, but that's not what's so cool about the DS, the really cool thing is the malabsorbtion. We only absorb 10-20% of the fats we eat, so there's hardly any calories for us in eating fats, we eat lots of yummy high protein, full fat foods with no ill effects. My cholesterol went from 210 before the DS while eating low or non-fat every thing, to 117 eating full fat foods like bacon, cheeseburgers minus the bottom bun, BBQ ribs, full fat salad dressings, mayo etc. I don't really look for high fat foods, I just don't worry about fats. We also malabsorb 50% of the protein we eat so we need to eat a lot of protein, I shoot for 150 - 200 grams a day, but that's high. Most DSers shoot for 100 grams of protein a day; I'm eating more because I work out and lift weights 3 days a week, play tennis 2 or 3 days a week and am just generally very active.

We also malabsorb 40-60% of the complex carbs, we absorb 100% of the simple carbs and sugar, so that's what we avoid. 

I actually love how I need to eat, but I've never been a big sweets person. The really great thing about the DS is that it gives you so much freedom to eat like a normal person and still be able to lose or maintain you weight.

Kerry

Thank you so much!!! You have no idea how appealing that sounds! I cant wait to see my surgeon on Monday!

Oh I don't know, I think I have a pretty good idea how appealing it sounds; remember I lived with RNY for 28 years.

Remember, there are only a very few surgeons with the necessary skills and experience to do a revision from RNY to DS. I'll bet your RNY surgeon is not one who can or should even try it. See what he has to say, but remember, this is not something most surgeons can do. You would probably need to go to a surgeon who does the DS and has lots of experience. 

Check here to find one who is close to where you are:

 www.dsfacts.com/duodenal-switch-surgeons.html

There isn't even one listed there for my state, guess I may have to try someone in New York.

It's quite common to travel to get a revision to DS, I live in Southern Utah and had to travel to San Francisco; which is about 650 miles away. Having to travel is a bit of a PIA, but once you've had the surgery and your surgeon releases you to go home, it's no biggie at all. You may need to educate your PCP as most of them don't have a clue about the DS. They usually assume it's some kind of RNY, so you have to teach them about it. Again, no biggie, just something you should know to expect. 

I'm not sure which of the NY DS surgeons do revisions, you would need to call them and see; I do know that Dr. Greenbaum in NJ does and has an excellent reputation. Some of the NY DS surgeons may also do revisions, I'm just not sure which ones. You may also want to post a question on the DS Forum about which NY surgeons do revisions, there are probably some people there who would know for sure.

Kerry

Don't know if you'll know the answer to this question...but figured I'd try...

I had RNY 3 1/2 years ago.  Before RNY, I had heartburn every day...sometimes several times a day.  Since RNY, I have not had one incident of heartburn.  If I were to have a revision to DS...with them re-routing things to having an actual stomache with the acids etc (If I'm understanding the way  it's done), woudl I then go back to experiencing heartburn?  I had a hiatal hernia (however it's spelled).  Can that be fixed if they did the DS to stop the heartburn at the same time? 

I love ny RNY...I just haven't lost as much of the weight as I'd like...mostly due to lack of exercising due to several reasons, not because I eat a lot of what I'm not supposed to.  I still have about 50-60  pounds I'd like to lose....but wouldn't want to switch to the DS at the cost of the return of my heartburn.

Thanks.

I don't know the answer to your heartburn question for sure, but my understanding is that having the DS does improve heartburn issues because so much of the stomach is removed. When your stomach is made into a sleeve; the greater curvature of the stomach is removed; which is where much of the acid is produced. However, from what I've read RNY is a little better at resolving these issues than the DS is. On the negative side RNYers are still susceptible to stomach ulcers in their blind stomach because the acid is still being produced there, but has no where to go and no food to mix with.

I wouldn't recommend a revision to DS if you only need to lose 50-60 pounds. A revision to DS is a tough surgery, it's difficult and what I would call "big time" surgery and unless you have some serious co-morbidity's not recommended for such a small loss of weight. 

Kerry