8 years RNY post op, need a revision, Options?

I'm 8 years post op from RNY and definitely have a problem. Either my pouch has stretched or stoma has stretched, I'm not sure. I have an appointment with my surgeon on May 13th to discuss my options, but I don't even know what my options would be. What are the options? 

Also, how likely is insurance to cover a revision? 

Any advice is much appreciated.

Thanks!!

Why do you think your pouch or stoma has stretched?  Have you lost restriction and are able to eat a lot?

The first thing to do is find out if that is the case.  If it is then your surgeon will discuss options with you.  A few things I would recommend you don't consider is a lap band and a procedure like the Stomphix or the ROSE procedure, or something, I think it may be  sclerotherapy, to try to tighten the stoma.  I have heard of no one having any kind of longer term success with those procedures.  Some have done ok with the band but that comes with it's own set of problems.

I have heard some surgeons are able to redo the pouch.  My surgeon told me (in 2010) that the RNY they were doing then was far different from the one they were doing even 5 years earlier.  I don't hear a lot from those revisions but a few have posted here.  I hope they speak up.

Some surgeons will also suggest making your bypass more distal, meaning you will have more malabsorption.  The people I have spoken with who had this done weren't happy with the results.  They had all the problems of a pouch with the added issues of malabsorption, more vitamins and bathroom issues.  

You could also see about having a revision to another surgery, mainly your options would be to have a sleeve or DS.  The sleeve is part of the DS without the malabsorption.  The DS is the sleeve with a lot more malabsorption then the RNY and where the RNY loses most of it's malabsorption by about 2 years the DS never does lose that much.  The downside of that is more supplements, more protein and more follow up lab work.  It can be expensive for some.  Some have bathroom issues, especially if they eat white carbs.  The other problem is finding an experienced surgeon who can do the RNY to DS revision.  It is the most complex revisions and only a few surgeons have the skill and experience to do it.  Some may say they can give you  a DS but what usually happens is they wind up with an ERNY, which is basically a RNY with more malabsorption, like I talked about.

Look into the DS and if you decide that is your best option do not cut corners and find a very experienced surgeon to do it right.  You may have to travel.  Two of the best revision surgeons are in California.  And you will most likely have to pay more because the surgery is so difficult and insurance usually doesn't compensate well, many of the experienced surgeons have program fees on top of what insurance pays.  Don't go for the cheap.  You get what you pay for and considering this is your life and health we are talking about, you want the best.

WOW!! This is amazing information and insight. THANK YOU!  Yes the reason I feel I need a revision is that I can basically eat a full meal + and not really feel full anymore. The only time I ever feel full is if I eat carrots or brussel sprouts, and I suspect that is because those are bigger and can't easily go down the stoma. I plateaued for a long time with my weight loss, now I'm starting to go back up and I will not let it get out of control. I'm anxious to see what the surgeon says. VERY useful information, again I thank you!!

I had RNY in 2005. I originally lost 140 and have gained about 60% of that back.  According to what I read, this is not atypical for RNY at 9 years.  I have just started looking at a RNY --> duodenal switch (DS) revision.  This is the most complex of the revision surgeries.  I'm fortunate that my original surgeon is also one of the few that do RNY --> DS revisions (Dr. Simper).  This seems like the best option for me, because I feel like with this weight regain that my life has shrunk to a not-so-great place.

As for insurance, I am hoping.  My BMI is 37, under the 40 number for a good possibility of approval.  But, I am fairly certain that I have sleep apnea.  I know I have borderline hypertension, with a family history of stroke.  These comorbidities aid in approval when BMI is under 40.  Right now I'm just waiting to hear back from the surgeon's office.  It's been a week, and I'm getting antsy.  

I'm seriously considering self-pay, though, if insurance denies me.  I'll do at least one appeal, but am saving money for the possibility of that $25K hit to my budget.  

I revised from RNY to DS in December of 2012 (Original RNY in 2002). It was a very complicated surgery I had complications and ended up in the hospital for 3 weeks and out of work for 14 weeks. I have lost all my excess weight and now have a BMI of 19.5. I feel pretty good. I am still dealing with food issues. But I am glad I did it and wold do it again in a heartbeat. 

Insurance covered my revision. I had Access BCBS and Tri-Care Standard. It was deemed Medically necessary.

Good luck 

Whit.