Okay so here is the last of it. Please dont anyone be mad. I am having my 1998 rny revised to a dr. Greenbaum distal bypass. By dr g. Basically ristriction from pouch (which i pretty much have), metabolic issue and malabsorption from the lower part which is basically a bpd. I can not take the chance of complications that will arise taking down my old ru n y.
Tpn leaks fistulas. People on this forum talk about these things like they are just par for the cause of this ru n y to ds revision. I am scared. There is a reason why rabkin takes $12,000 and dr k takes $4,000 above and beyond the cost of the surgery. As well they should if you read about the months of after care some rny to ds revisions require.
Is the ds a better surgery? YES
Do i wish i had it first instead of the ru n y? YES (IF THEY WHERE DOING IT WHEN I HAD MY SURGERY).
Am i still not sure i am doing the right thing?YES BUT I WANT TO BE THIN AGAIN AND THIS IS THE SAFEST OPTION FOR ME.

Wish me luck guys and please dont bash me for my decision cuz i am going to need you guys for support. Vitalady will be my new hero, i will follow her lead since the distal is working for her and her husband. I am very vitamin compliant and it has always been protein first for me.
May 16 th is the date. I'll keep in touch and tell you how it goes.

Hi! Just a little encouragement.... I had a RNY several years ago and just had it revised to a Gastric Distal Bypass on March 16, 2011.  I have lost 17lbs so far and haven't had any complications thus far!!  I'm very excited about my new journey.  Don't let anyone discourage you!!! Good luch and I hope you do well!!!

Thank you for that. Can i ask who did your surgery and what made u decide on this revision and not the ds? I am in turmoil trying to decide which one is best for me.
Thanks again, Randy

Look---you already KNOW that the DS is the procedure that's going to work the best for you, long-term. You also know that getting it is, in your case, riskier than going with the ERNY. Other peoples' experience doesn't really apply to YOUR situation.

You're simply going to have to decide whether you're more afraid of complications now, or complications later.

*I* would go to Dr. K in a heartbeat.

My surgeon is Dr. Osvaldo Anez in Herndon, VA and to be totally honest.... He doesn't do the DS.  I went into my surgery fully aware that weight loss is very slow with the Distal and it may take me two years to meet my goal.  I will say this though, I do know that I have to make changes in my own life as well as having this surgery.  Since I had the surgery I put myself on a 1200 cal a day diet and I know that's a good reason for the 17lbs I've lost thus far. I also joined a gym and hired a personal trainer before the sugery (although I can't do anything else with them until July so that I don't cause any complications).  I've struggled with my weight all of my life and it's going to continue to be a struggle for me until I change my way of thinking and the way I do and handle things.  I don't know your cir****tances and I wouldn't dare try to sway you one way or another.... You know your body better than anyone else and you need to do what's best for YOU!  I wish you luck and much success in your journey!

God Bless!
Milissa

Just to be clear, because it appears you don't understand things, and are coloring it in an unduly negative way:

Rabkin's pre-payment requirement is just that - a PRE-payment of 2/3 of his full fee for the surgery, because he does not contract with most insurance companies - he is almost always out-of-network.  It is not a payment "above and beyond the cost of the surgery."  It is 2/3 of his actual surgical fee.  If your insurance reimburses you more than the other 1/3, then he refunds the difference.

Keshishian uses a different model.  He accepts capped insurance reimbursement - and then recoups the difference by charging a "program fee" for certain aftercare services - whether you need or use them or not.

By the way, "they" (numerous DS surgeons) were in fact doing it when you had your RNY - the DS has been around since 1988.  YOUR SURGEON, however, didn't and just didn't tell you about it (an ethical violation, in my opinion), and you didn't research enough to find out about it yourself.

And I hope you are taking a realistic approach to the reason for doing this - your statement "I want to be thin again" sounds like a set-up for disappointment - or worse, a "careful what you wish for" post-hoc assessment.

Everyone makes choices - you have to do what you have to do.  I personally wouldn't do it, but I wish you good luck with it. 

By the way, here's a newly published paper for you: http://www.ncbi.nlm.nih.gov/pubmed/21145293

Surg Obes Relat Dis. 2011 Mar-Apr;7(2):189-93. Epub 2010 Oct 11.

Long-term results of malabsorptive distal Roux-en-Y gastric bypass in superobese patients.

Kellum JM, Chikunguwo SM, Maher JW, Wolfe LG, Sugerman HJ.

Abstract

BACKGROUND: The purpose of the present study was to evaluate the safety, efficacy, and nutritional outcomes of malabsorptive distal Roux-en-Y gastric bypass (D-RYGB) 20-25 years later at a university hospital.

METHODS: From 1985 to 1989, 49 mostly superobese (body mass index >50 kg/m(2)) patients had undergone D-RYGB. D-RYGB consisted of open laparotomy with a 50-mL proximal gastric pouch and gastroenterostomy performed 250 cm proximal to the ileocecal junction, with common channels of 50-150 cm. These 49 patients were compared with a similar group of 92 consecutive patients who had undergone long-limb RYGB, with a 75-cm biliopancreatic limb and 150-cm alimentary limb.

RESULTS: The mean ± SD preoperative body mass index was 58.9 ± 9.3 kg/m(2). After 1 perioperative death secondary to pulmonary embolism, limb-lengthening revisions were required in 21 (43.7%) of the 48 remaining patients for protein-calorie malnutrition. Of the 23 with a 50-cm common channel, 13 required revision compared with 8 of 25 with ≥100-cm common channel (P <.05, chi-square). Of the 48 patients who had undergone D-RYGB, 8 had died 6-19 years after D-RYGB. Of the nonrevised patients, 19 (70.4%) of 27 had >5 years of follow-up. In these, the latest body mass index was 34.2 kg/m(2) at 10 ± 6.1 years. The percentage of excess weight loss was 66.8% ± 14%. The lowest late serum albumin level was 3.4 ± .5 g/dL (range 2.3-4.4). The mean 25-hydroxy vitamin D level was 14.6 ± 11.3 ng/mL. Compared with patients who had undergone long-limb RYGB, the D-RYGB patients had a significantly greater percentage of excess weight loss after 5 years but significantly lower albumin, hemoglobin, iron, and calcium levels.

CONCLUSION: Although D-RYGB afforded superior long-term weight loss, it caused protein-calorie malnutrition requiring frequent revision. The nonrevised patients had frequent severe metabolic derangements. Thus, D-RYGB should not be the primary operation for morbid or superobese patients.

I would never have had the ds the way they where doing it then   That in my opinion is irresponsible.
The info about the charges from those doctors where given to me by their offices so I haven't misconstrued anything.
I do not have delusions of grandeur of being skinny and taking 5 words out of an old text that I wrote is infantile on your part 
You should take the nasty tones out of your emails Diana.  Its not nice.
But maybe you don't care to be nice.
I do.

Hello
I have to say that I am seeing a couple of nasty posts when someone asks a question.Wow if the DS brings out such nastiness in some people, I'm so glad I went with the RNY.You should take your doctor's advise as he/she knows your specific needs.You should be able to ask a question or just post whatever you choose.Just ignore the rudeness and know there are people that care.

You flat out misstated Rabkin's policy:

"There is a reason why rabkin takes $12,000 and dr k takes $4,000 above and beyond the cost of the surgery."

RABKIN'S CHARGE IS A DEPOSIT ON HIS FULL SURGICAL FEE.  IT IS NOT A CHARGE "ABOVE AND BEYOND THE COST OF THE SURGERY."

You are characterizing Rabkin's requirement for pre-payment of a portion of his fee as if it was unusual or a rip-off.  He doesn't contract with any insurance companies, so he needs to be sure that most of his fee will be paid, without having to go SUE the patient afterwards.

I didn't take your words from an old text - I took it from your OWN POST RIGHT HERE.  You want a revision surgery to be thin again.  WLS is about getting HEALTHY, and that is PARTICULARLY the case with revision surgery, which is already a much higher risk procedure.  You are chosing to revise to get thin?  And chosing a surgery that has less of a chance of success than one that will cost you a few thousand dollars more?  I hope you aren't disappointed with the results - because you are NOT necessarily going to end up thin with an ERNY, or - as has also happened - you may end up with more malnutrition issues than you would have had with the DS.  Or both.  Thin isn't the goal, HEALTHY is.

And no, I'm not taking my cue on how to talk to people on the message board from you.

Actually, i don't know of anyone in the US who supplemented like we do in the 80's and 90's.

My own doc did the Scopinaro, which was a specific version of the BPD (no DS), and had trouble managing the nutritional stuff. The stomach size in those days was 7-10 oz to start, 50-100cm common channels. The wt loss was not as good as smaller reservoir-types, and the nutrition scared everybody.

By the mid-90's, no B PD was offered, but his thinking had changed to smaller reservoir, more reasonable common channel. True, while at one point in my early on line days (1998(, there were 5 docs around the US doing distals RNY's to this model, man of those ppl died or revised what I call "backard" to a less malabsorptive procedure, and had substantial regain.

The art of supplementation and monitoring is still kind of a new fangled thought to some docs. Of the 5 who did them, one is now doing DS, maybe 2. One had very bad things happen is no longer practicing. Dr Fox is pretty well retired. Dr Oh no longer does 100cm common channel.

A distal RNY or ERNY in the wrong hands is clearly a death sentence, but so is any form of WLS that changes your ability to eat a fully balanced diet and absorb all of it at textbook rates. I say it that way, because restrictives only end up with iron and B12 issues because they cannot ever eat enough red meat again.

B12 is a special issue in that aging alone takes it, WLS or not. WLS takes it, aging or not. Add up WLS and aging, and seriously, it is not worth saving $20/yr to ignore it.

Of all the thing we supplemented in the 90's, no B12. And as of this week, Dr. Fox still doesn't think we need it! I started this whole aging thing a LONG time ago, and all WLS did for me was allow me to do more of it! LOL

Generally short common channel with some personal restraint will get better WL MAINTENANCE, tossing out speed of loss or degree of thinness as a criteria.

It IS possible to stay alive and well after these surgeries, tho I'm beginning to think that we need pretty pink and blue banners that we wear in public to our local docs saying, "results not typical".

We are not guessing at this point on things like protein, iron, calcium, fat solubles. There it is, on the map of the gut, on the labs of thousands of ppl. So, it's not the deep dark mystery it was in the 90's.

Since you are not vomiting and you do have restriction, I suspect I may be your only cheer leader in going forward. I adore Dr. R, Dr. K and Dr. G in no particular order, so that's not the issue. The issue is minimizing your risk and your ability to travel for surgery and after care. Dr. G knows what he is about, and his reasons for not wanting to knit you back together and DS you may be to do with insurance or other issues that we cannot see from here.

Sometimes I feel as if I am a voice in the wilderness. Mind you, I do not recommend this surgery out the gate because it's too hard to manage if no one knows what they've done to you.

But sounds like your decisions are based on talking to the best, research, asking questions of different surgery types and following up on how we keep ourselves healthy.

I had to revise my pouch in 2000, and they told me then that my risk was triple a new surgery. But that's the part that was broken. My labs were as good as we could get them in that day, with what we knew and the tools we had. I built myself for months with protein, iron and C. I told Dr Fox we could do it in the office, just snip and go, but he can be SO stubborn and insisted I'd prolly prefer it with anesthesia. LOL Shoot, it's the anesthesia that makes me feel bad! Then I had to go negotiate with the hospital and anesthesia docs for a good rate with my insurance.

But it got done, I was in and out, in an old fashioned open procedure and had no issues.

My common channel length has never been changed. I have no inclination to change it. I'm looking at overly high A, D and a fe others, kinda wondering how I chased them for so long, got them right and they kept on going. It rather amuses me to have to tweak some down a bit with THIS surgery.

For the record, given a choice today with my surgery no longer offered, I WOULD choose a DS, but when that option is no longer available, this surgery is not a death sentence in good hands.