How did you choose which WLS for your revision?

My RNY was in '03 and was very successful.  Due to patterns I see in my life, relationship with food, weight, etc. I decided to do a revision and go with a band for the tool of additional restriction.  As I read through this board, I wonder if that was the right choice.

I realize none of you can tell me what is right for me, but I would love to hear your process and thoughts and know there is very valuable knowledge and insight with each of your stories.

I honestly chose the band because it was the least invasive and at this point I'm being more proactive then anything else.  My weight gain is not yet out of control but I am at the minimum BMI for the band.

I don't know very much about the DS, but the more I read the more I'm interested from the long term perspective.

Any insight or info you could share about your decison making process and journey is very welcome!

Thank you all so much,

Jackie

Hi Jackie,

For me it was an easy choice to revise to DS rather than anything else. I had a gastric bypass back in 1980, so I lived with the bypass / RNY for 28 years. I was successful at keeping the weight off for the first 15 years with diet and exercise, but got sick and couldn't exercise for a year and during that time I lost control of my weight and over the next few years, yo yo dieted and gained back all the weight I had lost.

The more I tried to diet the more I realized that I was sick to death of dieting, I was sick of feeling deprived every time we had a birthday and there was cake & ice cream, I was sick and tired of dumping and I was sick and tired of food sticking in my stoma, I was just sick and tired of the whole RNY type of life.

I was also really discouraged about my weight, I had developed hypertension, sleep apnea and gout, I was miserable and knew I was headed for an early grave unless I found a way to get the weight off and keep it off. But what could I do? I didn't have a clue what to do or where to go, so I started with my PCP and had him order a barium swallow and an upper GI so I could see what my digestive tract was like after so long. What I found was that I had a real mess, I had a staple line disruption about the size of a quarter; so some of the food and drink I would consume would go into the lower or blind part of my stomach and then recirculate back into my pouch. The doctor who did the GI was also a RNY surgeon and he wanted to revise me to a modern RNY ASAP. But I wanted nothing more to do with RNY so I started digging.

I looked into the Lap Band and found that it had so many problems that I wanted nothing to do with it. I looked into a Mini Bypass which was very similar to what I already had, so I knew I didn't want that. Then I found the OH site and started asking questions just like what you're doing now and someone told me to check out the DS Forum. At first, I just lurked, but what I saw was people who were loving their new lives, losing all their excess weight and eating like naturally thin people eat, it was like it was too good to be true. The more I learned the more I liked and before long I knew I wanted the DS.

Then I had the problem of finding a surgeon who would revise me; I was such a mess inside that the first three DS surgeons I spoke to wouldn't do it, they said it would be too dangerous. I was devastated, I wanted the DS, I didn't want some other half measure, I wanted a full no compromise DS. Then I found Dr. Rabkin and he was just what I was looking for, he had done a number of revisions like mine and said he would and could do it and that it was just a matter of taking the time to do the job right. As it turned out, it took two surgeries; the first one was 8 1/2 hours and then three days later the second one took 4 1/2 hours, but he did it. It was tough and the recovery was difficult, but my oh my what a life I have now! I never dreamed life could be so good for me.

The revision ended up costing me $40,000.00 out of pocket and it took two months to recover, but I would do it again in a heartbeat to get what I have today.

You can read more about my experiences on my profile if you want more details and here's a link to my 1 year out post:

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

Here's the long and short of it from what I know and where I've been: You need to really look at how you want to live the rest of your life. Do you want to have to diet and exercise to lose and maintain your weight? If you don't mind doing that, then some kind of a restriction only revision will do the trick. How about your pouch? Are you having any pouch problems? If you don't revise to VSG or DS, what ever pouch problems you have now, you will keep. 

If you want to live and eat like a naturally think person does then there's only one real choice; the DS. Nothing else I know of offers you the same options and flexibility. The DS also allows you to take NASID's so if there any arthritis or condition that you will need pain killers for in your future, only the DS and VSG allow NASIDs. How about Type Diabetes? The DS had an over 98% cure rate, not a remission rate, CURE rate, RNY doesn't have a cure rate it has a remission rate in the 80% range and then when weight is gained the Type II often comes back.

I can't answer what you should do, only what I did and how it's working out for me and offer my experiences as something you can look at and consider how they relate to your situation.

Here's wishing you success in what ever your decide is best for you; if you have any questions for me, feel free to PM or post them.

Kerry 

Kerry,

Thank you so much for the response.  You have so much valuable information and experience to offer this community with your journey.  Thank you for being so willing to share!

Until recently my RNY has given me that release from the bondage of dieting and constantly struggling with food.  I've had absolutely no medical issues with my RNY since 2003 and believe my digestive tract and system are in good shape.  My choice to do the revision is entirely proactive because I know myself and know where I'm headed. 

As an aside, I've been a bit surprised (and discouraged) by some of the responses I've received in regard to my choice to do this revision with a low BMI.  Regardless, I know it is absolutely the right choice for me, it is only the mechanics of the choice that I'm working through now.

Even as a self pay (which I am), I have to wonder if there is a surgeon that would do a DS on me without having the RNY being a complete failure and gaining all my weight back?  Obviously I don't want to do that!

Your thoughts?  Would a surgeon consider a procedure that invasive without significant comorbidites?

Many Blessings!

Jackie

Jackie,

Well first off there are only three or four surgeons I know of in the country who have the skills and experience to do a RNY to DS revision; two in CA, one in NJ and possibly one in KY. There may be others who would do it, but those are the ones I would trust; it's a tricky operation.

That being said, the requirements for a revision to DS are the same as any other WLS. In general it's a BMI of 40 or more with no co-morbidity's or 35 with co-morbidity's. I don't know what your BMI is, but that's the general rule to any WLS as I understand it. 

If you're not having any pouch problems; like dumping or food sticking and your stoma isn't stretched out and you're OK with RNY life, I would think a RNY revision would be easier to get and easier on you. There's also ERNY which leaves your pouch intact but re-arranges your small intestines to give you the same kind of malabsorption the DS has. Some of the DS surgeons I spoke to wanted to revise me to ERNY, but I wanted to be rid of the pouch so that was a deal breaker for me.

There are a couple of DS surgeons in TX, you may want to talk to, but I doubt they do RNY to DS revisions; here's their contact information:

Texas

Erik Wilson, MD * 
Email: [email protected]

UT Houston
6700 West Loop South, Ste 500
Bellaire, TX 77401
Phone: 713-892-5500
Fax: 713-871-0071

 

Daryl A. Stewart, MD *

Weight Loss Specialists of North Texas
Denton Surgical Group
3321 Colorado Blvd.
Denton, TX 76210
Phone: 940-382-9429

 

You should look at this link, I know you said similar but the ERNY is actually quite a bit different than the DS configuration.

http://www.dssurgery.com/newsletters/dec-5-09.pdf

Yea, I know it's not the same, just couldn't think of the right adjective...

Kerry

Kerry - What is the name of the surgeon from  NJ?  I am thinking about having a revision and NJ is very close to me. - Thanks

It's Dr. David Greenbaum, here's his contact information:

David Greenbaum, MD, FACS
Email: [email protected]

Surgical Specialists of New Jersey, LLC
Rancocas Division
1000 Salem Rd., Suite A
Willingboro, NJ 08046
Phone: 609-877-1737
Email: [email protected]

 

Thanks so much,  Kerry.