RNY to Distal Gastric Bypass (not as happy)

I second what Sandy has said!!!!!  Please do not do yourself this dis-service in having the distal RNY/ERNY!!!!  You will be disappointed!!!!
Here is a link, with diagrams to look at:
http://www.dssurgery.com/newsletters/duodenal-switch-and-dis tal-gastric-bypass.php

Get a second opinion!!!!!  Go to Roslin, or California, to Keshishian, or Rabkin.  They ALL do the RNY to DS revision!!!!!!



You have CHOICES!!!!!!  You are NOT stuck!!!!
-Jamie

Suzanne, I was in a very similar situation to yours. My insurance approved me to have a distal RNY in 2008. I could have had it done by October '08 but I found out about the DS in the mean time. I did a lot of research and with the Distal RNY often came the phrase, "the worst of both worlds" as it has the cons of the RNY such as dumping, hypoglycemia, less weight loss and the nutrient malabsorbtion of the DS but at least with the DS you have your pyloric valve which will help you to get full easier and stay full longer. It also slightly eases the malabsorbtion because some nutrients can be absorbed in your stomach. The cons of the distal far o0utweight those of the DS and the pros of the DS far outweigh the distal. Don't take this route because it's the easy route, you will be sorry later on. You'll need to find another surgeon (mine was Dr. Gagner in Montreal - he's done a few out of network surgeries since he got there.)Dr. Gagner did my surgery laproscopically even though my original RNY was open. I can not tell you enough about the difference in healing time! Really think this over Suzanne, it may mean a bit of a fight but you're worth it!
If you have any questions he could anser them [email protected] .

Suzanne I had a different experience and it wasn't good with the distal rny. My doctor told me the weight would just melt off of me. Umm NOT! I ate 800-1000 calories a day and exercised 1.5-2 hours a day 4-6 days a week and still only lost 36 pounds. I know I have a really messed up metabolism, but I should have had better results than that. I ended up going back and having to fight with insurance to get a revision to DS. The weight hasn't just melted off of me with this surgery either but it has at least gotten me almost to my first goal of 165. I'm shooting for 145 I think.  Anyway I had to have an Independent Medical Review (IMR) done when fighting the insurance and this is what they came back with.

A 37-year-old female enrollee has requested bariatric revision surgery (duodenal switch) for treatment of her obesity.  Findings:  The physician reviewer found that the medical literature supports the opinion that the performance of a revisional procedure similar to the initial operation will fail in many instances, because the basic problem is metabolic and not mechanical. Rapid gastric emptying, as seen in this patient's case, leads to an enhanced insulin response resulting in either hypoglycemia or hyperglycemic episodes, and the most dramatic rises and falls have been associated with small pouches and wide anastomoses. Duodenal switch is a medically appropriate solution to the problem. If this procedure is not performed, the patient's comorbididites will likely worsen. Thus, bariatric revision surgery (duodenal switch) is medically indicated for this patient.


PLEASE PLEASE FIGHT FOR WHAT YOU WANT!!!!!  If you don't you might end up like me, fighting for it anyway.

 

Greenbaum is officially OFF my personal list of surgeons I would send anyone to for a revision.  Just because HE isn't confident - or competent - do to a proper RNY-to-DS conversion, doesn't mean other surgeons can't or shouldn't.  Call Rabkin or Keshishian.

Hi Suzanne,
I have to say that I have lived with the Standard RNY the ERNY and the Distal.  ERNY, I lost all my weight, but I became very protein malnourished.  I also found out that I have colitis (which is one of the only reasons to be fully reversed), which added to the malabsorption, which puts into question as to should I ever have had the RNY to begin with when we look back at lab results as I was protein malnourished before I ever had surgery to begin with almost 7 year ago, DS was not an option when I had my surgery 7 years ago, I only had 1 surgeon that I could go to and she didn't perform the DS.  If you at all have a protein problem or have problems with supplementing your protein via high protein diet and protein shakes, you don't want the ERNY.

In December of 2010 I was revised from the ERNY 90cm common channel to a Distal with a common channel of a generous 200 cm.  I have to say, that at this length of common channel, I haven't lost any weight that I put back on with the TPN that I was on for 6 months just to sustain life, but I haven't gain any either as I am healthy now.  If you are a carb eater you can out eat any of the surgeries.   I have regained my life, so just be careful as to which surgery you choose, one size does not fit all.  If you do decide to go distal, please ask the doctor about how long he makes his common channel.  You can lose weight, I just have alot of new food intolerances now since more of my intestines were put back in play. 

I do have to say that I am also off of all protein supplementation and most of the high doses of vitamins that are required with the ERNY or DS as I now have normal labs.  I chose not to revise to a DS for many of the same reasons that you have but I also was advised to totally reverse my surgery and decided against going that route due to the drastic risk and that I would redevelop all my co-morbidities. I couldn't travel either.

Know your labs, get a second opinion, if the DS is what is best for you by all means go that route. Only you can make the decision that is best for you, but make an informed decision, don't go into this surgery without asking the tough questions of yourself and your surgeon.

I also know of many very happy ERNY's, but they don't post anymore.  I know that I probably will get attacked, but it is worth letting you know what I have also gone through.   The good, the bad and the ugly.  You can PM me if you want.

Deanne
RNY/ERNY/DRNY

Deanne, I recently had the distal can you share your journey with me? Such as total weight loss, daily eating& vitamin regemin 

Suzanne, only you can make this decision. The good news is that if your insurer has approved you for revision to the DS, it shouldn't matter if you switch surgeons to get it. 
      I have nothing but respect for dr. Greenbaum's surgical abilities. I think he has stopped doing RNY to DS revisions because one of his patients had some very serious complications. I understand that, and any revision is more prone to complications than a first time around operation, and of course you can't force any surgeon to do an operation he doesn't want to do, but you are the one who will live with the results of this operation, not the surgeon.
     It's true that revision to the DS would be a higher risk operation than just going to distal or ERNY. On the other hand, as so many others have told you from personal experience, their results with ERNY were not worth any risk at all, and in some cases even made their health worse, not better. There is no risk free alternative here, and you must decide how much risk and what type of risk you are willing to take. With distal RNY, it has never been shown to achieve better results than the original proximal RNY that you have now. You would have to go to ERNY, which is where the increased risks of protein malnutrition and/or vitamin deficiencies come in.
    And you mentioned that your problem is something to do with your esophagus and pouch. If he isn't going to touch the pouch, how will the surgery fix your problem?
     I can't tell you what operation to have, but I would strongest suggest that at the very least you get a second opinion from someone who does do RNY to DS revisions. Dr. Roslin in NYC is probably closest to you. Don't give up just yet.
Larra

Suzanne, as someone who had a revision with Dr. Greenbaum and also as someone who used to have a distal bypass (ENRY) may I strongly suggest that you do not subject yourself to a distal bypass. I did have a full RNY to DS revision by Dr. Greenbaum and though I had many post op complications I am now 165 pounds. I started at 302. I used to weigh 430 and even with my distal RNY I only lost to 210 pounds and never a pound more. I ended up gaining to over 300 pounds and by the time I had my revision.

Think twice, cut once. If you want an RNY to DS revision then get one. Do not get something that the doctor says is an A- because in my personal opinion a distal RNY is more of a D- option. If you have been approved for a DS by your insurance company then I doubt you will have trouble getting approved a second time around. Please seek a surgeon who will give you what you want.

I have no personal issues with Dr. G. I find him a fine surgeon, however, I do not fully agree on the surgery route he is going. I no longer refer people to him for revisions as I do not agree that a distal is better than a DS.

Feel free to PM me if you would like more information, or I can send you my phone number if you want to talk.

Maddie.