RNY-RNY and RNY-DS Revisions - What are they? Which has the best longterm success rate?

Hi Everyone!

I've been looking for answers to two questions but can't seem to find it through the posts. If I may, please allow me to ask them here. If you have already answered these questions, I apologize.  I am going through major depression about my weight. I had RNY surgery in 2002. I was almost 300 pounds at that time but I dropped to 170 and couldn't seem to move beyond that despite my efforts. I bounced back up to 270 and here I remain even after trying every diet imaginable. I am so depressed. In any event,  I am thinking about having Revision Surgery and as possibilities I might consider RNY to RNY Revision and the RNY to DS. I know very little about any of the two and wonder if you can direct me to where I can find solid information on both possibilities. I intend to post to the Florida forum but in the meantime, I'd like to know if anyone here has ever sought approval for revision surgery though United Healthcare Community Plan [Medicaid]. I am just beginning my revision journey, so I'd be grateful if you can provide any information. I humbly ask your understanding and your assistance. 

Best,

Shay

There are two other options, although one I wouldn't even consider.  If a doctor tells you that you need a band over you bypass, run.  The lap band has proved to be poor surgery choice and having that on top of a RNY is only adding fuel to fire.

The other option is a revision to a sleeve.  The sleeve is part one of a DS.  The stomach would be put together the way it was and then it would be cut along the curve, preserving the pyloric valve, which is bypassed with the RNY.  That gives you restriction.  The DS part is what gives your malabsorption.  Malabsorption is great if you eat a lot of fats and protein as those are malabsorbed the most.  It is useless if you eat a lot of simple carbs as those are absorbed 100% no matter what WLS you have.

And unfortunately most of us got here because of the carbs, bread, pasta, crackers, candy, cake, etc.  Sound familiar? If it does then dealing with food issues should be your first priority before a revision or you will be right back where you started.  Again.

A RNY to RNY revision would most likely be to make your pouch smaller and your surgery distel, which means you would have malabsorption was well as restriction.  Most people who have had this done say it is the worst of both worlds.  I am pretty much in that group.  I have a lot of restriction and malabsorption, which means I can't get in a lot of food and part of what I do eat is malabsorbed.  The biggest issue with malabsorption is that along with fat and protein we also malabsorb vitamins.  And because of the protein being malabsorbed we require a lot of protein to stay healthy.  I get in at least 100 grams a day and my levels are in the lower end of normal.  To get in that much protein without a lot of room means that I still rely on shakes even at 4 years out.

Fat soluble vitamins like E, D, A and K are also malabsorbed and must be supplemented, along with a lot of other vitamins.  I have been diagnosed with osteoporosis and anemia in spite of supplementing.

That is why a lot of surgeons are pushing the sleeve.  It gives a lot of restriction and little chance of problems due to deficiencies.

If you do want a DS revision you will have to travel as there are few qualified surgeons who have the skill to do this complicated surgery.

But, before you subject your body to any more surgery I suggest that you get evaluated and find out the status of your current surgery.  If you are able to eat a lot then it is possible you have a mechanical defect, either your pouch has stretched or you stoma, which is the connection from your pouch to your intestines.  Since your natural valve, the pyloric valve, has been bypassed this is what keeps (or doesn't keep) the food in your pouch, giving you the fullness sensation.  If the stoma is stretched the food passes through quickly leaving your hungry soon after eating.

However, certain foods go through easier the others, like carbs and ice cream, non dense foods.  That is why it is recommended that you eat protein first.  With a small pouch a few ounces of meat should fill you up and leave you satisfied.  That makes it easier to pass on the foods that aren't doing you much good.

If you do have a mechanical defect then you can discuss revision with your surgeon.  If things are intact then you owe it to yourself and your body to try and make the surgery you do have work for you.  Don't subject yourself to major surgery before you know you have done all you can with this one.

If you come to accept that you have a problem with food then by all means do what you can to address that issue as well.  If is very possible with help that you can be successful even at this stage.