Help with revision decision-Dr. Keshishian/Dr. Foote

Ok, a little background for people that may not know.  I had RNY in 2002 and regained all my weight.  I then had a revision to a distal RNY (I am not actually sure what to call my revision).  This was on May 12,2009.  I have done fairly well and have lost about 90#. However, shortly after my surgery I developed an odor coming from my pores.  I have been to my PCP, infection control doc and my surgeon and nobody knows what is going on.  I have been taking antibiotics and flagyl works temporarily but when I am off, the smell comes back.

I went to my surgeon today and he is proposing lengthening my common channel to 200 cm and trying to make my stomach smaller. He stresses that this is risky and there is a chance that I may only be able to take liquids for some time.  My surgeon is Dr. Foote in GR. 

I have also spoke with Dr. Keshishian in California who I hear is one of the best revision surgeons.  He says he can revise me to a full DS.  With this route of course I will have to get insurance approval which is tricky.  It is also a lot more complicated of a surgery. 

My issue is, I have screwed up twice with this weight loss journey. I don't want to screw up again. I want to make the right decision no matter if it is a longer recovery.  I just don't know if I am better going with the lengthening of the common channel and making my pouch smaller with Dr. Foote or go with Dr. K which could potentially convert me to a full DS.  I am looking at about 1 week off work with Dr. Foote and about 6 weeks with Dr. K.  Dr. K route would be expensive as well because of the travel involved.

Anybody that has any input on either surgeon or either surgery is appreciated.  I just want to make the best informed decision this time.

Thanks,
Lori

I don't know if I can help but I had a DS in 2002 and I lost a lot of weight (120 lbs) but in the few yearsI regained 100 lbs back.  I actually lost weight for about 2 years and since then I have been gaining at least 10 to 15 lbs. a year.  I also had terrible diarrhea and gas.  It was life altering.  I could not go anywhere and I was always embarrassed by the smell.  I also have been suffering from fatigue even though my labs were pretty good.
I went to see my surgeon because I no longer had a quality of life.  I didn't even care about the weight gain as much as the constant diarrhea and fatigue.  He recommended I have my common channel lengthened and my stomach made smaller.
I am about 11 days post op and I already feel better as far as the diarrhea and gas being gone.  It is taking some getting used to not being able to eat.  With the DS I seemed to lose all restriction so this is an adjustment. 
I also had problems in the past with bacterial overgrowth and had complications due to that.  I am glad I had my common channel lengthened.  I feel so much better even though I am still very tired, hopefully that is because I had surgery just over a week ago and will improve.
I wish you luck in what ever you decide.

Hi and thanks for your post.  How long was your common channel length when you were having all the issues and body odor?  What did you have it lengthened to?  Did you have the body odor as well?  I am also tired all the time. 

Who did your original surgery? And do you know why you had such dramatic weight regain? Your story seems so unlike all the other DSers I've talked with.

Dr. Clifford Deveney did my DS and my revision.  I take full responsibility for my weight gain.  I honestly believed that I could eat whatever I wanted after my DS.  I did lose weight for 2 years but after that I started gaining 10 to 15 lbs a year until I had regained almost all my weight.  I felt like I had no restriction.  I must have had malabsorption because I had constant diarrhea but I guess I out ate the surgery. 
I went to Dr. Deveney because I wanted the diarrhea to stop.  It was definately affecting my quality of life.  I honestly didn't even care about the weight gain.  He suggested lengthening the common channel and making my stomach a pouch.  I am glad I did even though he was honest and said I may not lose much weight.  I am just glad the diarrhea and gas are gone.  I didn't have many more hopes then that.
Also, I have spoken with other people who had the DS at the same time as me and they have regained a significant amount of weight, too.  I know at least one or two that had their stomached reduced more.  I choose the DS because I was under the impression that weight gain was less with the DS.  It may be but not in my case.
Again, I blame no one but myself.

Are the people yu know who've had significant regain patients of Dr. Deveney's, too? I ask because it does seem that some surgeons have better outcomes than others.I don't know if it's a difference in the way they do surgery, common channel length, or what.

I had my DS in 2003, and I really DO eat whatever I want. But I do still have restriction, so I'm satisfied with small-to-normal sized portions, and I've had no regain. I've had more trouble with constipation than diarrhea. My common channel is 90cm.

No, we all had different doctors.  I am glad the DS is working for you.  I think my main problem was lack of restriction.  I could eat as much at 7 years out as I did pre op.  I had constant diarrhea so I am sure I still had malabsorption I just ate too much.  I guess all people are different. I know one person that had her stomach made smaller and another that was talking about doing it.  I also heard of others that regained weight, though not as much as I did.

You say at seven years out you could eat as much as you could pre-op---when did this start? And how much and what were you eating? (Protein/fat/carbs?)

What sorts of things did you try to stop the diarrhea and odor problems, before having your revision? I'm not having any problems NOW, but I want to know as much as possible of others' experiences should I start to have problems.

hi
would dr. K do the full DS and lengthen the common channel? Or Just the DS part. I know with the full DS your pyloric valve comes into play again but sounds like some people still have issues with a shorter  common channel, even with a DS. If not mistaken Joyce had her common channel lengthend also? As you know I wanted the full Ds but had too much scarr tissue and twisted intestines so had to settle with distal rny. Then my problems started also with the smell. I had a common channel of 100 like the DS but things didn't get better for me until I had it lengthend. Now  I have no smell, (body odor) and no diarreah!  Just wondering if the your common channel would get lengthend with the DS?

Lori Evers

Hi Lori,
  Dr. K is hopefull that he would be able to do a full DS but nothing is for sure until he gets in there.  I too have a lot of scar tissue and twisted intestines so I am a little sceptical that I will be able to have the full DS. I think that if I get the full DS I am going to request him to do my common channel longer cus I don't want the gas and diarrhea issues.  Joyce did have hers lengthened, I believe, to 110 cm (I think).  Isn't yours 200 cm now?