RNY and adding a Lapband?

I looked into the modified BPD/DS procedure as well before I decided on getting the full monty.  I didn't want to live with the pouch anymore the inabiliity to take antiinflammatories,dumping, diarreahea(sp), etc. 

I've found through my research and many of overseas surgeons from Brazil, Spain and Mexico are going that way because it's an easier procedure and less risky.  Guess it boils down to, do you want the pouch anymore and all of the problems it comes with.

I would advise anyone considering a revision to keep all of your options opened - I think it's important to speak to a surgeon who is able to bring down the pouch and give your pyloric valve back, better absorption of some vitamins and getting rid of all of the junk that comes with a pouch, in addition to talking to a surgeon who does the modified procedure and consider from there. 

It's a tough decision, lots to think about, I was ready to book a trip to Brazil for the modified procedure and reconsidered.  It was worth the risk to me to go all the way and I've been very fortunate that I've had no complications.  Just food for thought...

Oh I forgot and Debbie I still use inflammatories, after going to the emergency room for severe migraines the gave me like a ****tail of medicine to allievate the pain and one of them as I remember was an inflammatory and it never bothered me.  I also no other RNY patients that use them also without a problem.

Shirley,  I'll bet your surgeon doesn't even do the DS, and that you're subtly being turned off to it.   Please do your own research before you make any decision and go to a doctor who actually performs the DS to get honest answers!

 Hello Shirley,

The use of Band over RNY is tempting because of the perceived ease of placement and maintenance. There are some issues that one has to consider to go with "BOB" (band over bypass).
One is that it is unproven. There are probably less than three articles in all the surgical literature that talk about BOB and its short term results. No one knows where this is going to go in few years down the road, with regards to sustainability, and outcomes.  The second issue is the actual outcome of the band itself, that under the best of the cir****tances it results in a 50% EBWL (half of the excess weight).

In your particular case, as a surgeon I would be more concerned about leaving a foreign body in a place where there was a leak in the past (as distant as it is) and have to worry about erosion of the band, than the risk of leak from RNY to DS revision.

Now here are the disclaimers: I do both the DS, banding and Sleeve as primary operation. In my opinion all comers all patient DS is by fat the best option. Do your research, ask questions and expect scientific answers and not anecdotal stories.

Good luck.
Ara

(Joyce here is my response!)

Dr. K,

I would just like to say thank you for being here to aid in our success and can't wait for the day I become a full DS paitient too. Of course still jumping through the hoops but hope to have you as my doctor.

Sophia

Hello,

I loved all the replies, they were very helpful in my decision. I have decided on the DS... now the problem begins, my surgeon thinks its too dangerous in my case to do a DS first, he thinks doing a sleeve will be better, then if I am still having malabsorption problems go back and do a DS....

Anyway, we are gonna ha**** out in an appt in 2 weeks... any feedback? anything I can throw at him for my case would be welcomed! 

Shirley

I just checked in after being away quite awhile and am glad you are not going with the band over RNY...........I was talked into that and have had nothing but trouble ever since.  Very little weight loss, numerous fills and unfills, now completely empty and was waiting surgery with Dr Husted.  Apparently that will be put off until he and the crazy hospital in  podunk KY come to some agreement. That is another problem all together, but PLEASE DO NOT CONSIDER BAND OVER RNY!!!!!!!

Anyone know any GOOD surgeons who can reverse the RNY, take out the LapBand, and do a real DS without killing me?  DR Husted is the only one I really trust, but admit I haven't checked around for anyone else..........

OOPS..............just noticed a good surgeon posted before mine ~ see I still don't read or pay attention!  Will be checking out that website, thanks!!

Ask your surgeon if he has ever done a full RNY to DS conversion.  If he hasn't, there's your answer as to why he wants to do only the sleeve first and then add the malabsorption later. Unfortunately, quite a few doctors put their pocketbooks ahead of patient care and he may be "convincing" you that his way is "better" so that he can keep you as a patient, rather than have you "jump ship" to a surgeon who can do both parts of the DS at once.  With the current economy, this is happening more and more.

If you do opt for the sleeve as a stand alone procedure, you will lose the synergistic effect of having a fresh sleeve with fresh malabsorption all at the same time.  It is a more successful procedure with regard to amount of excess weight lost when done together. 

I just took a look at your surgeon's (Provost) website and there is no mention of him even doing either the sleeve OR the DS surgeries, so if that's who will be doing your surgery, you  may want to seriously question going to a doctor with more experience in the surgery that you want.   This doctor appears to only promote the RNY or lapband and is even promoting the Stomaphyx surgery (which everyone knows does not even work!).    If this is your doc ... be wary.

Well, he is very well trained in DS and has worked on me before, I have a lot of scar tissue and have underlying medical issues, etc.... Anyways, found out today my insuranc Tricare Prime does not cover Biliopancreatic bypass or DS... So, the point is moot now... I am going to have to either get the sleeve or band.

Shirley