RNY to Distal RNY

 I had RNY 7 years ago Aug 8th and come July 30th will be my revision date. The question I have  is Does anyone know or has undergone the revision to a DISTAL RNY  and know it's results? I gained 80lbs back due to bad habits and i've recieve counciling for this so now Im ready again to tackle this whole heartedly. I just want to know if the the weight lose is sucessful cause I can't find a whole lot of information on this because from what I understand this is NOT a DS. And yes I have talked with my Dr. but I feel more comfortable getting experienced feed back from people who have lived it not just seen cases. I do love my Dr. so please don't get me wrong I am bless to have his help.

A distal RNY is most definitely NOT a DS.I don't believe Dr. Boyce does RNY to DS revisions.

I'm trying to find something I read recently by Dr. Roslin, as well-known revision surgeon, about why the distal RNY is not a good choice. I'll post it later for you.

 yes thank you very much i'd love to have more information on it. 

This comes from a question and answer session with Dr. Roslin on another WLS website. The question was "Why do you not include conversion from distal to proximal among your list of options for failed gastric bypass?"  

I think the best answer that I can give to this question is that those that don’t know history are doomed to repeat it. In order to have a distal intestinal bypass, a common channel of 100CM, or 150CM, or a common channel less, then for most patients you have to preserve either the fundus of the stomach or the pylorus. Preserving the stomach is done in the Scopinaro procedure, where the volume of the stomach is about 200-300cc. Dr Scopinaro has trained a lot of Italian surgeons, and actually that was the operation that was used in the most recent trial in the New England journal. All those patients had open Scopinaro procedures, and he does a 100CM common channel and a 200cm alimentary limb. So, the point is in order to tolerate a distal bypass you either have to preserve the fundus of the stomach, or the pylorus. The pylorus is called the gatekeeper.

If you do not have one of those two structures, then what is going to happen is you are going to have a rapid emptying system and basically uncontrollable diarrhea in a subgroup of patients. Obviously there is individuality and certain people can tolerate that. So when people try to do these procedures, the actual risk of protein malnutrition is above 20%. I have not had to, in my DS practice, move anybody more proximal. Occasionally there have been people that have had other ailments like pseudo membranous colitis, and have had diarrhea where I’ve had to institute therapy and then once they got over their acute illness they were able to restore their protein levels. That would be a huge concern if you move standard gastric bypass that’s based on the lesser curvature of the stomach and hasn’t preserved the fundus, if you take it and you move it distally, then you are going to have a 1 out of 5 chance of having protein malnutrition.

So this is a very easy operation, but a very, very, very poor choice and demonstrates a lack of understanding of the sophisticated physiology of the gastrointestinal tract. Again, long term, I would wager to guess that over years the majority of patients that this is done to would have to be reversed, especially if they had another medical problem. And I’ve seen a number of these patients from Brooklyn where they needed reversal 5, 7, or 10 years after it was done, because they couldn’t overcome other medical issues. So I would not recommend this as an approach. 12 hours ago · "}" class="comment_like_391392507586501 fsm fwn fcg">Like

On the flip side I have posted questions about conversion from Proximal RNY to Distal RNY and have come across several people who love thier distal and have no problems. I think it is the same as any other WLS. some have issues and some do not.

Hello,

I am not too sure if I can be of much help to you as I am only just shy of 3 months out from this revision . However, you can check out my journey via My Youtube Channel : https://www.youtube.com/user/ItAintDaEazyWay

 Hi, Im 2mo shy of having "Distal RNY" from Medial RNY...(8 yrs from my original)......basically the surgery is moving the Y Junction down further and you have less intestine and more malaborption (that's what I had - as I understand it).  I've had two bowel obstruction and my colon not functioning properly and it's now moving slowly but moving.  At this point of my journey..I feel disappointed because I feel the same as before everything started.  The dr had told me I would be having 4 bms a day and it would be lose stools. None of that happened or has happened.  I have attempted twice to be non compliant to see if I dump and nothing. I see him Thursday to tell him how disappointed I feel to go through sooo much and feel like I got no where.  Can I say I will not lose weight - NO.  I have lost 21 lbs and if I eat better/correctly and continue to work out - which are the protocols one should continue to follow...then in the end the result of losing weight is what's it's really all about.  I hope u have better results.

Here is a link:

http://www.obesityhelp.com/forums/revision/4521052/WANT-TO-HEAR-FROM-ERNYRS-PLEASE/