Reasons for RNY revisions
Hello. I am just a couple weeks away from getting a revision from band to bypass. Of course I am hopeful that this will be the right choice for me and the right surgery for me to be more successful in my weight loss and health. I am fully aware of all the reasons to get a revision from lap-band. I have been living it for 7 years! If someone was to ask me about the ugly side of lap band, I could explain it well. But now, i can't help but wonder about the RNY. There are many people on this site that are looking to revise FROM the RNY TO something else. Now, I need to know what the reasons are for revision from RNY, specifically. There are a lot of things I wish I knew BEFORE getting the lap band. I want to know BOTH sides of RNY surgery BEFORE I do it this time. Thanks
There are basically two classes of why a revisions from an RNY would be necessary.
The first is mechanical failure. This would be something like an over-large stoma, or a fistula. There are several options here, including repairing the fistula, or attempting or reduce the size of the stoma. Unfortunately, reducing the size of the stoma seems to be pretty hard to do---procedures like the ROSE or Stomaphyx haven't proved very effective. The latest procedure, the Apollo Overstitch, will hopefully be more effective. There's also the option of placing a LapBand over the pouch, but---well, you already know about the Band. The most effective, but also most complicated, option is a complete take-down of the RNY and conversion to a DS/duodenal switch.
The second situation would be when the patient's metabolism simply needed more help than the RNY could give them, usually due to metabolic issues. In this case, conversion to the DS is the procedure of choice in most cases.
I'd advise you to research the VSG/Sleeve and the DS as well as the RNY. Right now you have a fairly intact stomach, so all three procedure should be equally accessible to you. After an RNY is done, your stomach will be MUCH harder to do more work on.
Thanks for that information. It is pretty helpful...but now I have to find out what a fistula and over-large stoma are! The sleeve, they say that wont be helpful to me because it is purely restrictive and no absorbing help so I was advised not to go that way. I am scared of the DS. That leaves the bypass. I am praying that I will be a success story, and not another revision.
Why, exactly, are you scared of the DS? Malabsorption? Both the RNY and the DS cause permanent malabsorption of certain vitamins and minerals. Some RNYers take more vitamins than some DSers---it all comes down to how YOUR body reacts to surgery. With either, you'll have to get regular blood work done to ensure you're taking everything your body needs.
On the other hand, the malabsorption of calories is temporary and fairly minor with the RNY, but permanent and pretty significant with the DS. This is probably why the DS has the very best long-term, maintained weight-loss stats.
To be honest, I am scared because of stories that I have heard about people having serious conditions due to not absorbing vitamins. Also worried about being very stinky, another story I have heard about. Also, I don't have anyone in my area that does the DS and so It's not really an option for me. I guess I could go into the city (NYC) but that is a huge obstacle. Sometimes I think I should have gone for the DS. But its more of an extreme surgery so I guess that is also what scares me.
The DS is more demanding that you take your vitamins and that you get regular blood work done. This is also a requirement of the RNY---it just takes longer for the RNY to kill you. (*grin*) I know RNYers who take more vites than I do, and RNYers who take less. It really depends on your labs.
I fear that most RNYers don't get adequate emphasis placed on vitamins. (Well, that's true for most WLS patients, sadly.) The bottom line is that the majority of the receptor sites for most vitamins and minerals are located in the duodenum and ileum, the upper parts of the small intestine. ALL of the duodenum is bypassed in the RNY, as is ALL of the lower part of the stomach. (That's where intrinsic factor is produced, which enables us to absorb B12. RNYers tend to have a lot more trouble with B12 than DSers do.) DSers still use part of the duodenum, but we do use less of the ileum. (RNYers use most of the ileum, because they're bypassed so much less.) This means that while it's not necessarily the SAME vitamins and minerals, both the RNY and the DS can have some serious absorption issues when it comes t0 vites and minerals.
By "being very stinky", I assume you're referring to gas and BMs. This is a side effect of malabsorption---which both the DS and the RNY cause. Go to the Main board or the RNY board and do a search for "stinky gas" and you'll find just as many stories about paint-peeling gas. For MOST people, no matter their surgery type, it's eating carbs that causes excessive, painful, and, yes, very stinky gas and BMs.
Most people who get a DS do have to travel. I know people who've traveled half-way around the WORLD in order to get their DS! 99% of them think it was totally worth it.
I guess "extreme" is in the eye of the beholder. I figured that my morbid obesity was pretty extreme, and I was willing to take extreme measures to defeat it.
Just be happy and confident about whatever surgery you ultimate choose. I'm convinced that most people can lose a lot of weight with any form of WLS they choose. For most of us, keeping it off long-term while being happy and compliant with what our surgery asks of us is the hard part.
A fistula is when the pouch grows a little tunnel to connect it with the remnant stomach, allowing you to eat more than you should. An over-large stoma is when the stoma stretches out, allowing food to pass through the pouch too quickly, again allowing you to eat too much.
As for the Sleeve not being helpful for YOU---that depends on YOUR metabolism. Long-term the Sleeve and the RNY have almost identical maintained weight-loss stats.
Hi Catalina,
I am wishing you well on your decision for the RNY. I am currently considering the lap band and I have had no previous surgeries. My surgeon recommended the sleeve but I am not 100% comfortable with that idea. I am not 100% comfortable with the lap band surgery either and so I thought I might reply to you and ask you about the "ugly" side of the band.
Part of me thinks that I can just loose this weight on my own.. without any surgery.
Anyway- thanks for any help that you can give and I wish you luck with your revision to RNY. Its not easy to make these decisions so I am right there with you
Please please do not get a lap band they are horrendous I only know of 2 people who have had great success with them. The band sounds good but the biggest problem is you can start out great for the first few years BUT after awhile scar tissue builds up between the band and the stomach and this causes tightening which continues damaging the stomach. It can't be seen on any tests so the docs will just tell us we are crazy there is nothing wrong, until the band ends up slipping or eroding into the stomach or nearby organs like the liver. Then you are looking at some serious emergency surgery. Plus having the band getting tighter damages the esophagus causing horrible heart burn that sometimes lasts forever even after removing the band.
Not to mention the constant fill and unfill that usually goes on as the band tightens and if you have to pay for those fills it gets expensive. Many like myself never did find a so called sweet spot I was always either too tight or too loose. Plus they say it dampens your hunger but it never did mine. If your insurance changes then you can easily lose bariatric coverage like I did and when the problems started I had to pay for everything including removal of my band. I simply could not handle the pain another day, it had to come out and I was fortunate enough to not have an issue with vomitting like many others do. Many folks have lost teeth because they vomit so much the enamel is gone on their teeth!
All these problems and there is no guarantee you will lose any weight at all because the harder it is to eat the more you turn to slider foods to get something to eat. Cookies, chips and ice cream go down just fine. Only 50% of bandsters lose any weight at all and that can be as little as 5#, that is considered a loss, you may never get to goal weight or you get there and 2 yrs later the band gives you problems and you gain it all back, that has to be so disappointing. I never lost much to begin with so it wasn't that big a deal for me. I'd say go with any of the other surgeries but listen to your doc, he knows what he is talking about. These things happen to the majority of people who get a band, it is not an isolated thing. Good luck to you but please for your own sake do not even think about getting a band!
