newbie to the revision forum

I used to hang out on OH all the time, but it's been a while, and now I'm reading the "revision" board.  I developed a new profile after reading something about OH posting things on Facebook...and the fact that I had 1 person who was a friend on here, Facebook (as well as in real life) but have "unfriended" her recently and know if she saw my post would have a field day with "I told you so...I told you so..." (part of the reason I unfriended her).

Anyway, I had RNY in May 2009.  My highest weight was 426 pounds.  I lost about 70 pounds in the year or so prior to surgery to be healthier for surgery.  At my lowest, after surgery in mid-2010, I had literally become 1/2 of my former self at approx 220 pounds!  Around the same time, I met my (now) husband and my mom, who I was sole caretaker of, decided to go on Hospice care.  She passed away in Sept 2010, the day before my formal wedding reception (we had married in Hawaii in July).

At this point, I've gained approx 80 pounds back (though, at my last 6 month check up with my surgeon, I maintained from the previous visit).  So, he's now talking "revision".  Did an endoscopy last week.  He said it was "fine" right after the procedure (maybe thinking I was still kinda groggy...we have a visit scheduled for next week), but the nurse indicated I stretched my stoma.

He briefly discussed 2 procedures...going in and re-pleating the stoma (not stomaphix or ROSE), or going in and bypassing more intestines.  I'm all for both procedures, if that's a possibility.

My husband wants me to get a 2nd opinion with the surgeon who did his DS in 2003.  I unfortunately, got to meet him this summer when I had an emergency hernia with corkscrew bowel obstruction surgery done by him.  He's highly respected in Georgia and is the only GA physician who does DS laproscopically.  I have no problem with a 2nd opinion...it's major surgery.  And I think Hubby's surgeon might be willing to do my revision, if for no other reason as a favor to my Hubby.  I assume, he would suggest the same revision(s) as my surgeon is suggesting.  But what if he recommends the DS?  And no, he's not on that list I've seen posted here of the highly qualified surgeons who do RNY to DS procedures.  But besides that, I've never considered myself a good candidate for DS.  I have autoimmune disease and when originally looking at having surgery, my other docs were happy with RNY not DS. 

Anyway, just looking for other stories, and "what would you do opinions" I guess.  I really think Hubby wants me to use his surgeon because the hospital is much closer (15 minutes from the house vs 30-40 minutes assuming no traffic).  I would only switch surgeons if that is what I'M comfortable with...

Thanks for listening.  I'm not sharing this info with many people at this time...
Lee

Hi Lee, 

I revised my RNY to a DS on Dec 15, 2011. I always think getting 2nd, and 3rd opinions is a good idea, there's nothing quite like meeting a surgeon and seeing their office, hearing what they have to say in person. I do think it's important for people to make their own decision regarding which WLS procedure they think is best for them; from reading what you've said here, your BMI, weight, regain, I have to say I do believe the DS would be the best alternative for you, more comprehensive in addressing the issues of obesity and maintaining weight loss. You mentioned auto-immune disease, but I would think it depends on which particular one you have? So with that caveat, knowing I might not have all the info on your health issues, want to say both the RNY and DS are malabsorptive procedures; with the DS, you are able to eat more, it's designed to succeed best eating protein and fats, which is a very satisfying physically and mentally. You have to take supplements with both surgeries, particulalry iron and calcium; with the DS what additional regimen you need to maintain will depend all on your own labs and how you are responding. 

If your husband's surgeon advises a DS -  and this is key, because what you would be doing is NOT a traditional DS - then you do need to see a surgeon on the list because it's a revision, and the most complex surgery of them all and only the listed surgeons are vetted in this revision. A vetted DS surgeon is not a vetted RNY-DS revision surgeon. The DS has been considered a 'radical' surgery because of the suturing of the duodenum, the tissue is the most difficult in the entire human body. 

Also read as many accounts as you can about RNYers *****vised as you mentioned. You shoud have as much information as you can before you make a decision. I also suggest visiting the new board for more DS/RNY feedback, the veteran DS people are there mow; also read DSfacts.com. All of this will help further educate you about  the RNY too, so you can make the best decision possible. To me, after all I went through with my RNY - big complication, second surgery, more complication, hernia a year later, for a net weight loss of 70 lbs no matter what I did (I was a 'lightweight' at 270 for surgery), and I worked hard at my diet and exercise - I wanted one surgery that was going to truly going to give me the tool I set out to have with the work I was willing to put in. 

I definitely agree about 2nd and even a 3rd opinion when it comes to surgery.  This is a major undertaking and I need to be aware of all my options, all the benefits, all the risks, etc.  So, I have no problem consulting with Hubby's surgeon.  He's a good guy with an excellent reputation (my current surgeon is also a good guy with an excellent reputation) and he did a fine job fixing my emergency hernia back in June.

I just want to make sure I do all the research I can to make the most appropriate decision for me.  Thank you for suggesting the new board to get more feedback.  I'm checking that out next. 

I don't really think I want a DS procedure, but I do think I want more of my intestines bypassed.  Maybe some sort of "hybrid", not quite DS procedure?????  We'll see where my research and doctor opinions/advice takes me...

Thanks again for your input, I truly appreciate it.

Having more of your intestines bypassed would be giving you an extended or distal RNY---something I would think long and hard about before doing. Talk to Vitalady---she's been living with one for 16-17 years now, and I've heard her describe it as the worst of both worlds---in other words, you can't eat much, yet neither do you absorb nutrients well from your food, so there's a LOT of supplementing to be done.

Thanks about reminding me of Vitalady.  I will look her up.

The supplementation part doesn't bother me in the least.  Vitamin supplimentation has never been a problem for me, so if I have to add more into the regimin, I'm okay with that.  I'd rather have an extra multivitamin or two than the blood pressure pills (which have been gone since late 2009 and haven't come back) or the CPAP machine (which I had been able to get rid of for a while, but now am using again 8( ).

But yes, I will look her up and see what she has to say as well!

Hi Lee, you're welcome! Yes, definitely take the time, you're on the right track. There really isn't a 'hyrbrid' of the DS :-) Bypassing more of the intestines is called an ERNY or 'distal'. The VSG (Gastric Sleeve) is "half" the DS procedure - the stomach is made into a sleeve - 70% removed - so you have your own stomach, not a pouch - but the intestines are not re-routed. In your case, a revision, they would be put back as they were.

I think when we're dealing with chronic obesity, we definitey need the malabsorption. Here's 3 links to papers my surgeon published, that he also shares on his website, dssurgery.com, about the ERNY, the size of the stomach, and the length of the common channel. Again, this is not to try to 'sway' you to the DS; if anything, they will help you formulate questions to ask re: the potential success of the ERNY, or, a band over bypass. For me, getting the DS also made me really re-examine my RNY, understand the mechanics of both surgeries. Things have changed a great deal in technology and these surgeries since my RNY 2002, so it was a whole new learning process. Wishing you luck, hope to also see you on the other board. Page back through posts, especially on the DS and RNY boards. The revision board unfortunately is not quite as active yet, but I'm hoping that will change when the site moves to it's permanent host home.

Length of the Common Channel

http://www.dssurgery.com/newsletters/length-of-small-bowel.p hp

Does Size Matter (Stomach)

http://www.dssurgery.com/newsletters/does-size-matter.php

Duodenal Swtich and Distal Gastric Bypass (ERNY) more different than similar

http://www.dssurgery.com/newsletters/duodenal-switch-and-dis tal-gastric-bypass.php

Thank you for the links.  I'll take all the info I can get!  I'll be reading them momentarily...and asking more questions, I'm sure!

Have a great day!

I'll post more as I come across them;  let me know if you were able to join the new board or not, if you wanted to try. I know the woman who runs it is heavily backlogged, she's doing it now as a volunteer, and by herself. Otherwise, I'll continue to share info/links here. Ask all the questions you must!