25 yr post-op DS and now regaining weight....options? suggestions?

Hi Everyone!  I am coming up on my 25th anniversary of having biliopancreatic bypass...I'm not sure whether there was the DS or not, but I'm assuming there was. The surgeon who did my surgery has passed on...so has the hospital where I had the surgery, so I'm not even sure it's possible to locate my past surgical records.

When I had my surgery 25 years ago, my doctor told me it would probably have to be modified in about 15 years...that the pouch would stretch, and since I have a very low metabolism I would start to regain weight.

I was never completely satisfied with my weight loss...but my surgeon considered it a success. I lost from 363lbs to 220ls.  I hovered between 220-235lb for 23 years. I tried dieting again, but never could lose more than 10lbs despite staying on a high protein, low carb diet with exercise. Recently I've started slowly gaining. I'm up to 255lbs and not happy about it all.

My employer/insurance company has a nurse that we are required to see monthly. She keeps harassing me about my weight. I truly am sticking to a diet (1200 cals per day), with vitamin supplements and exercise. I horse back ride 3-5 times a week, and walk 3 miles 3x per week...but I'm only maintaining my weight in the 250-255lb area. I've told myself if I gain more, that I will stop riding (although my horse doesn't seemed bothered by it). But I really don't want to do that, as it is my most vigorous and enjoyable activity.

Is revision even an option? I haven't checked with any doctors or the insurance company yet. Just now beginning to feel out the topic as I'm getting very frustrated at being back to the place I was 25 yrs ago of constant dieting with minimal weight loss.  

You might want to visit and post on the ds board, lots of smart folk over there... I will send them a link to this post also.

Hope you find what you need.

It is possible that you have the BPD rather than the DS. I guess the only way to find out now is to see a DS surgeon and have him take a look.

It was explained to me that there are three things that can contribute to weight gain after having the DS surgery. Excessive sugar (as we malabsorb very little of it), the stomach becoming increasingly bigger, and/or the common channel lengthening (the body does have an amazing ability to compensate).

Only a DS surgeon can give you the best advice, but if you are not able to lose weight by limiting carbs, then I guess the only options are to have surgery to reduce the stomach size and/or shortening the common channel.

 If you have a pouch, you DO NOT have the modern DS surgery.   The DS surgery as it is done today involves a sleeve stomach ... not a pouch.  You probably have the older version, which was similar to the RNY, except they removed the remnant of the old stomach (with the RNY, they leave it inside you, but it isn't attached to anything which can be scoped and is therefore called "blind").  The older BPD/DS left a larger pouch than the RNY.

As others have suggested, you would need a qualified DS surgeon to take a look at your insides and see what was done.   If you need more restriction, perhaps a band could be put over your pouch, which has been done for some RNY'ers -- it's known as BOB (band over bypass).  If you were left with a large enough pouch, maybe a surgeon could cut away the outer curvature and leave you with a sleeve stomach like in the modern DS.   Another option is to add more malabsorption and take your common channel shorter (depending on how short it was made in the first place).  And, if you can get the sleeve made along with more malabsorption, you would have the modern DS surgery, which has the best statistics for keeping weight off in the long term.

Please be aware that there are only a handful of DS surgeons who are qualified to do a revision of this nature, and unless you see one of them, you cannot get a true picture of all of your options.  Any old surgeon who says he/she does revision will just NOT do.

If you ask this question on the DS board, they will be able to direct you further.   They're pretty sharp over there!

Good luck with your surgery.

There is some well meant but inaccurate information in the above replies.

First, it should be possible to figure out what operation you had with an upper GI x-ray, rather than with someone  opening you up while unsure of what you have already, let alone what, if anything, could be done surgically to help you.

It was suggested that you probably have the older BPD operation, not the modern DS. This is almost certainly the case, as the DS has only been done in the USA since 1988, and of course the numbers were very small at the start. This makes a huge difference in what might be done as far as revision goes. If you have the BPD, it is IMPOSSIBLE to convert this to a modern DS as someone suggested. This is because the lower part of the stoma*****luding the pyloric valve, was removed with the BPD. Obviously, this can't be undone.
     Depending on what's going on, maybe the pouch could be made smaller, or the stoma may be very wide and maybe could be narrowed. This is sometimes done for people with gastric bypass, and with BPD you have a pouch that isn't exactly like the RNY pouch that is being made these days, but sort of. But you can't be converted to the sleeve stomach of the DS.
     As far as putting a lap band over the pouch, maybe that would be possible, but I have no idea what benefit that would offer you. Some surgeons are doing this for gastric bypass with regain, but there are no longterm results known as yet. Sounds awful to me, but others might disagree.
     So step one, get a study to see what your present anatomy is. Step 2, consult with a surgeon with extensive revision experience and see what could or could not be done.
     Best of luck to you!

Larra

Yikes! I apologize if it appeared I was suggesting that it would require surgery to ascertain what type of procedure she has. I didn't mean that at all. I obviously did not word my answer well. Yes, they should be able to use an upper GI x-ray. I just figure that a DS doctor would have the most knowledge on which to base a diagnosis.

I also agree that if it is indeed a BPD, then it is impossible to convert to a DS as the pyloric valve is removed in a BPD. I would imagine that just a revision where they reduce the stomach and/or shorten the common channel would be the most likely choices.

I know I need to investigate this further...not sure who to consult with in my area. My original bypass surgery was July 17, 1985 and was described to me as a "biliopancreatic bypass", the doctor described it as taking out 2/3rds of my stomach and bypassing part of my intestines so that it tied in "much lower down" than normal. he told me that I would not be able to eat nearly as much as I had previously and that I would not absorb/digest the food as thoroughly as before.

So it's sounding as if the DS may not have happened after all. I know I was the 10th patient in WNC to have this surgery....and it was quite extensive/invasive at the time.

So I need to find a surgeon who does DS? And have him assess me? 

I know a couple of years ago I had a severe case of shingles that attacked my stomach and intestines causing them to swell and creating a blockage from the swelling. Fortunately that resolved itself as the inflamation decreased. A contrast study was done by the general surgeon. He said he "really didn't want to go there if all possible", meaning if he had to operate. The radiologist was just plain baffled, saying he'd never seen anything like my bypass.

Any suggestions as to whom to consult with in Western North Carolina? It may be a moot point, as I'm not sure my insurance will even consider it since I've already had a gastric bypass.

In re-reading your post, and doing some more research from this site, I am beginning to believe you are right and that I had the BPD procedure and not the DS. 

I have had some significant malabsorbtion issues in the past. Specifically iron and B vitamin. Calcium has not been a problem, in fact, I tend to have too high a concentration of calcium which has resulted in excessive bone growth, spurs and multiple, multiple kidney stones.

It's taken a lot of discipline and experimentation to come up with the right combination to  manage my vitamin deficiencies. I've also had a history of loose bowels regardless of what I ate (my gallbladder was also removed when I had the bypass). I've found a supplement specifically for that issue call cholochor....which replaces the bile salts. The results has been normal bowels movements for the first time in 25 years!

I'm encouraged by the replies. I guess I really do need to find the right surgeon for a consult and go from there. The worse they can tell me is that there isn't any other option to persue.

Thanks,

Ann

Have you considered that the Cholacol might be a factor in your weight regain? From what I can tell on Google, it helps the body break down and absorb fats.

I suggested consulting a DS surgeon because they are most likely to be familiar with whatever issues you may have and how to fix them. Too bad you are not on the west coast. I know that Dr. Rabkin was working with a woman who was (if I remember correctly) a 10 year BPD vet at the time I had my surgery.

I suppose it's possible the Cholacol could be a factor, but the truth is that I started inching my way up before I started on it (two months ago). Biggest weight gain came about a little over a year ago when I was hospitalized for kidney stones. I gained 20lbs in one day     (I'm assuming from all the fluids they were giving me in the attempt to flush the stones) and never lost it. I was very shocked by the gain. Since then I've gained another 5-8lbs....

The Cholacol has helped with the loose bowels, smell and gas that I suffered with often.  It wasn't just from surgary or fatty food either, many vegetables would effect me that way as well.