Thoughts on revision surgery

Hi

I just saw my bariatric surgeon yesterday to discuss some of the issues I've had with multiple anastomotic ulcers after my RNY (2009). This last one was really bad, appearing in Oct. 2013, and still not completely healed. The only lifestyle risk that we can determine (PCP, GI MD, and Bariatric Surgeon), is my level of stress related to my job. The GI & Bariatric MDs suspect some physiological abnormalities, but more diagnostic testing will be needed. My last EGD was recent, and am waiting to set up some radiology testing appointments. The surgeon candidly discussed the options for revision surgery.

The thing is, although I have had some rebound weight of about 20-25 lbs, it is the marginal ulcer issue that concerns me the most. I just wanted to ask those people who have revised to the VSG how they have done. I am looking predominantly looking at VSG, but may decide to add the malabsorption component if the risk of marginal ulcers can be diminished. I'd really like to hear the opinion of others on this matter, along with possible suggestions for other options.

Thanks

Lisa

Revising to a Sleeve or a DS will completely eliminate marginal ulcers, because you will no longer have a stoma. The stoma is a prime spot for ulcers, because stomach contents are acidic and intestinal contents are alkaline. Since the stoma is also open, intestinal contents can back-flow into the stomach, and this constant change in pH promotes ulcer formation.

HOWEVER, there are very few surgeons who can do a true RNY-to-DS (or Sleeve) revision. Be very careful on choosing your surgeon.

Thanks for your reply, MsBatt.

I can honestly say that other than the marginal ulcer issues, I have been happy with my RNY choice back in 2009. I am seriously thinking VSG to avoid the ulcers in the future, as they have become debilitating. Not sure if converting to DS is an option for me, as I would still have the Y-connection seen in the bypass surgeries. I do know of the newer procedure, VSG with single loop duodenoileal bypass (SIPS procedure), though I am not sure that this is the direction I want to go. Regardless of my choices, surgical or no, I do not want to wind up with complications that might result in a feeding tube or TPN. Unfortunately, I see these types of complications in my work more frequently than I'd like to. 

I am confident that my current surgeon is very competent, and would prefer not to change, but it would be helpful to have suggestions from others about surgeons who are proficient in revision surgeries such as I am interested in. I live in the Raleigh area in North Carolina. I also work for the University of North Carolina health systems, sharing my time between UNC and Rex hospitals as the Post Acute Nurse Liaison for home-based Post Acute services. There are a few surgeons that I would not consider due to their prevalence in post surgical complications, but I am open to names that I can research. Any suggestions will be much appreciated.

Thanks

Lisarn