revision from RNY to sleeve

had  a band in 2005 due to issues switched to RNY in 2011. was very success in weight loss with both however now i am gaining weight back. lowest was 157 now i am at 188. I have no restriction..  had scope done and pouch is still fine. My sleep apnea is back in full force, gerds is active again and joint pain all over.. I am also having issues where my blood sugar is dropping very low- this is not what most consider dumping. this occurs an hour or so after eating certain foods.. Have managed to control it for the most part with higher protein. surgeon does not offer band over bypass but is suggesting a sleeve conversion. any thoughts..  Said DS is out of the question.

The only cir****tance I can think of where revision of your RNY to a Sleeve would be a good idea but the DS would be "out of the question" would be if the surgeon doesn't have the skills to do a DS.

If your pouch is "still fine', then what possible benefit is your surgeon telling you revision to a Sleeve would give? It *might* help your reactive hypoglycemia, by putting your pylorus back in play, but it's likely to make your GERD WORSE, especially if he makes a very small Sleeve. (Any chance you have a hiatal hernia? If you do, odds are really good that repairing that would really help your GERD.)

Yes i do have a hiatal hernia however i am told repair for that is very involved. the hernia is partly why the sugeon feels i can eat more is due to the fact my pouch is filling in the abdomen and then filling ontop of the hernia into the chest cavity allowing me more room to eat and food backing up into the esophogus..  I am just not sure  a switch from RNY to Sleeve would be beneficial for frutur weightloss especially since i am currenlty gaining and the sleeve is not a malabsorbtive proceedure

I strongly urge you to get a second opinion. Hiatal hernia repairs are done every day, and they're pretty simple. Also, your hernia shouldn't in any way allow you to eat more, IF your pouch is okay---unless your pouch, or, more likely, your stoma has stretched, then it's the POUCH that gives you restriction.

I agree that switching to the Sleeve isn't likely to help you lose weight. That's another reason to get a second opinion, from a surgeon who actually DOES the full DS. The DS has a Sleeved stomach plus a highly-malabsorptive intestinal bypass. The Ds has the very best long-term, maintained weight-loss stats of all the forms of WLS.

The stretched stoma was my guess as well. The low blood sugar is one of the things I discovered was associated with an enlarged stoma as I was researching endoscopic repairs. I know that certain carbs (like pretzels but not bread) and all-protein meals (bacon and eggs) make me have the shakes within about an hour. Now that I think about it, I wonder why THAT complication isn't listed as insurance approved revision. Since I'm going self-pay (overstitch), probably moot. But if I ever need to go with a DS AND still have low blood sugar, maybe I'll fight that...