Revision...Yes or No??
I had a Roux-en Y April 2001. Starting weight 475 lbs, lowest weight 250 lbs. Current weight 340 lbs. I went to the surgeon and he told me I had three choices: 1) lose weight on my own.... 2) lap land (which he said he wouldn't do) ... 3) a surgery to increase my malabsorption that will cause excess diahreea and bad smelling farts and possibly severe malnutrition.
Can you share your experiences? I am trying to decide. I need more information.
Thanks a million
Can you share your experiences? I am trying to decide. I need more information.
Thanks a million
I had rny in 2002,didnt lose but 50 lbs,gained it back. I'm having a revision to distal rny.their are people on here that do well.You should look up vitalady. She has had her surgery the longest.I think 14 yrs or so.She looks great,and knows all about the vitamins you will have to take faithfully.Good luck
Your doctor is not very ethical, although at least he's not suggesting a lap band.
I revised from RNY to the DS, and I'm doing great. Don't want farts and diarrhea? Don't eat crap. It's as simple as that. I invite you over to the DS board. There are a lot of revision people there and we're all doing well. My labs post-DS are better than they were for the 6.5 years after my RNY.
Someone who starts out at 475 can't lose it all without malabsorption. It's just the way it works. We're lucky to get off 60% of the excess with RNY. The DS will give you more of a fighting chance.
I revised from RNY to the DS, and I'm doing great. Don't want farts and diarrhea? Don't eat crap. It's as simple as that. I invite you over to the DS board. There are a lot of revision people there and we're all doing well. My labs post-DS are better than they were for the 6.5 years after my RNY.
Someone who starts out at 475 can't lose it all without malabsorption. It's just the way it works. We're lucky to get off 60% of the excess with RNY. The DS will give you more of a fighting chance.
ETA: My numbers are to show where a different review starts. They are NOT answers to your questions. Sorry if that confused anyone.
Yesterday I was going through Independent Medical Review outcomes for revisional surgeries and this is what I came up with. There were also some for first time surgery requests that were denied because someone had too high of a bmi and needed to have the ds to get acceptable results. I did a few highlights. I'm not saying that the ds is the best revision surgery all I can say is that my revision to distal rny did not work. I'm now trying for ds. Here is the link to the search I did. http://wp.dmhc.ca.gov/imr/results.asp?optFormat=html&cbo MC=Morbid+Obesity&cboDiagnosis2=0&cboDT=0&cboTre atment2=0&cboType=0&cboDetermination=0&txtDetail s=revisional&cmdSearch=Search
You can also do a search of your own. I just tried to pick through the ones that were denied because there was no documentation of mechanical failure with original rny or no documentation showing compliance on the part of the patient.
#1
A revision to the distal portion of the bypass has a significant risk for nutritional deficiencies. The only published data that supports revisional surgery after a failed gastric bypass dealt specifically with duodenal switch. Therefore, I have determined the requested surgery is not medically necessary for treatment of the patient’s medical condition. The Health Plan’s denial should be upheld.
#2
Review of the medical literature indicates revisional weight loss surgeries have a high complication rate. A patient who has failed a restrictive operation (Lap-Band) is more likely to fail another restrictive operation longer-term unless a malabsorptive element is added. The study cited above reported high incidence of protein and nutritional deficiency after revision of gastric bypass to distal gastric bypass. Furthermore, a patient with a BMI of 48 may have a high failure rate after a restrictive procedure. A more suitable option may be a hybrid procedure such as duodenal switch. Removal of the Lap-Band is medically indicated to prevent any further esophageal dilation. Revisional gastric bypass is not likely to be of benefit and is not medically indicated for treatment of the patient’s medical condition. The patient should be evaluated for consideration of a duodenal switch procedure. Based upon the information set forth above, I have determined that the requested procedure is not medically necessary for treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be upheld.
#3
The surgeon embarking on revisional surgery after failed VBG needs the option of the duodenal switch procedure depending on the intraoperational findings. The upper abdomen may be so scarred that it would be difficult, if not impossible to take down the VBG and convert to RYGB. Additionally, the duodenal switch procedure offers the advantage of resecting the stomach away from the original site, reducing acid secretion, and creating more malabsorption. Furthermore, duodenal switch requires less postoperative dietary restrictions. Moreover, the recent report by Anthone, et al. demonstrates the safety and efficacy of the duodenal switch procedure. Based upon the information set forth above, I have determined that the requested procedure is medically necessary for treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be overturned.
Yesterday I was going through Independent Medical Review outcomes for revisional surgeries and this is what I came up with. There were also some for first time surgery requests that were denied because someone had too high of a bmi and needed to have the ds to get acceptable results. I did a few highlights. I'm not saying that the ds is the best revision surgery all I can say is that my revision to distal rny did not work. I'm now trying for ds. Here is the link to the search I did. http://wp.dmhc.ca.gov/imr/results.asp?optFormat=html&cbo MC=Morbid+Obesity&cboDiagnosis2=0&cboDT=0&cboTre atment2=0&cboType=0&cboDetermination=0&txtDetail s=revisional&cmdSearch=Search
You can also do a search of your own. I just tried to pick through the ones that were denied because there was no documentation of mechanical failure with original rny or no documentation showing compliance on the part of the patient.
#1
A revision to the distal portion of the bypass has a significant risk for nutritional deficiencies. The only published data that supports revisional surgery after a failed gastric bypass dealt specifically with duodenal switch. Therefore, I have determined the requested surgery is not medically necessary for treatment of the patient’s medical condition. The Health Plan’s denial should be upheld.
#2
Review of the medical literature indicates revisional weight loss surgeries have a high complication rate. A patient who has failed a restrictive operation (Lap-Band) is more likely to fail another restrictive operation longer-term unless a malabsorptive element is added. The study cited above reported high incidence of protein and nutritional deficiency after revision of gastric bypass to distal gastric bypass. Furthermore, a patient with a BMI of 48 may have a high failure rate after a restrictive procedure. A more suitable option may be a hybrid procedure such as duodenal switch. Removal of the Lap-Band is medically indicated to prevent any further esophageal dilation. Revisional gastric bypass is not likely to be of benefit and is not medically indicated for treatment of the patient’s medical condition. The patient should be evaluated for consideration of a duodenal switch procedure. Based upon the information set forth above, I have determined that the requested procedure is not medically necessary for treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be upheld.
#3
The surgeon embarking on revisional surgery after failed VBG needs the option of the duodenal switch procedure depending on the intraoperational findings. The upper abdomen may be so scarred that it would be difficult, if not impossible to take down the VBG and convert to RYGB. Additionally, the duodenal switch procedure offers the advantage of resecting the stomach away from the original site, reducing acid secretion, and creating more malabsorption. Furthermore, duodenal switch requires less postoperative dietary restrictions. Moreover, the recent report by Anthone, et al. demonstrates the safety and efficacy of the duodenal switch procedure. Based upon the information set forth above, I have determined that the requested procedure is medically necessary for treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be overturned.
WHEN LIFE KNOCKS YOU DOWN TO YOUR knees, JUST REMEMBER THAT YOU ARE IN THE PERFECT POSITION TO PRAY. HW 395, RNY 4/2/07 345, Lowest Weight 248, Revision to Distal RNY 1/13/09 278,Revision to DS 10/15/10 Option no. 3 is most likely not a DS, but the ERNY - leaving the RNY intact with just bypassing more of the small bowel. That is a relatively easy procedure and it seems that it leads to considerable weight loss when the common channel is short enough. But the side effects are often terrible if the common channel is that short- here are serveral members who decided to get the ERNY but who are now seeking revision AGAIN due to malnutrition problems.
The problem is the heavy maabsorbation combined with the RNY pouch is a bad, bad combination because the malabsorbation starts in the stomach. If you have a DS, you have an intact (just much smaller) stomach and a lot of vits are absorbed better then with the RNY pouch. Therefore, the heavy malabsorbation of the DS due to the short common channel is usually not leading to malnutrition. Additionally, many RN`'ers can`t eat enough protein due to pouch problems. RNY pouch + heavy malabsorbation = recipe for disaster.
So look into option no. 4 which your surgeon didn`t tell you because he isn`t qualified to do it: revision to a full DS. It`s not true that it leads to severe malnutrition and bathroom problems if some rules (high protein diet, vitamin supplements) are follwed. You can find plenty of information on the DS board and in the old threads on this forum.
The problem is the heavy maabsorbation combined with the RNY pouch is a bad, bad combination because the malabsorbation starts in the stomach. If you have a DS, you have an intact (just much smaller) stomach and a lot of vits are absorbed better then with the RNY pouch. Therefore, the heavy malabsorbation of the DS due to the short common channel is usually not leading to malnutrition. Additionally, many RN`'ers can`t eat enough protein due to pouch problems. RNY pouch + heavy malabsorbation = recipe for disaster.
So look into option no. 4 which your surgeon didn`t tell you because he isn`t qualified to do it: revision to a full DS. It`s not true that it leads to severe malnutrition and bathroom problems if some rules (high protein diet, vitamin supplements) are follwed. You can find plenty of information on the DS board and in the old threads on this forum.
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