RnY "reversal" secondary to non WLS issues, now what?

I had my original Lap Rny in 2004. I did fabulous, going from 305 to 165. I swear, i was the poster child for WLS success. I had some major plastic surgery in 2007 and kept on the right path. I hit the end of 2009 and as I like to say, my liver started eating itself. This had nothing whatsoever to do with my WLS. Essentially, when you have your gallbladder out (which i did in 2002), many years on you can develop something called Sphincter of Oddi dysfunction. In English that means an opening that used to go to your gallbladder and now goes from your liver to your stomach, spasms and causes episodes of bile backing up into the liver and really ******g it off. The only way to fix it is with an endoscopic procedure called an ERCP. Basically a scope is put down you and the the little sphincter is accessed and clipped. Sounds like a breeze right? Wrong! the problem is that little opening is in the part of the stomach outside of the pouch. Bile goes from the liver to the part of the stomach that does not see food, down the small bowel and meets up with your food down yonder. it is not possible to do this procedure without taking down the staple line, and thus undoing the bypass. I made it until 2012 before finally admitting that I had to do this.

My primary reason for gaining all the weight to begin with was that I frankly never knew what full was. I was always freaking hungry. Plus I could exercise until i dropped and diet my way into starvation and maybe lose 3 pounds. Pretty damn discouraging. The RnY gave me a sense of fullness/satiety that I had never had before. I had the energy to be physically active. Life was good!

Fast forward to 2015, I have packed the weight back on. i am now at 250 and rising. As a side note, gaining 80 pounds after a lower body lift is quite painful. And once again, I don't comprehend full. i tried a run at Victoza injections (same drug as Saxenda) because my doc gave me a sample. It actually worked, even at the lower dose that the Victoza is, as compared to the Saxenda. I felt full and dropped about 10 lbs in a month. Problem is, my idiotic insurance won't pay for it (but they'll pay for WLS???)and who the hell can afford $1000 a month out of pocket.

So now my question is where do I go from here? Obviously I am attracted to the idea of a revision (i guess I'd call it that) or rather a redo because i did so well at it. If that is the case, do I go for the RnY again (I did have some minor issues with malnutrition, needing IV iron every couple of years), do I look at the sleeve or what. I am not sure about the Band since I've seen some pretty ugly complications. Even at 250, I meet criteria for WLS but would any surgeon, in their right mind even touch me?

I am sick as hell of people telling me that I just need to eat less and exercise more. Yeah, whatever, if that had worked, I would not have needed the WLS in the first place.

I would appreciate any thoughts that anyone may have. I had my initial WLS at the age of 32. I said it was because i wanted to see my 40th birthday. Now I am 43 and would like to see my 50th birthday.

Go for redo but first place improve your habits. Dear i go for revision from vsg to mini gastric bypass. I know dear where i went wrong n what my problem was. So u forst need to accept where you went wrong than your redo or revision will do miracale for u .beat of luck

Sorry for your troubles. I revised from RNY (2002) to DS in 2012. I got down to 175 gained back to 240 and now at 125 have lost all of my excess weight.

I feel great and know I did the right thing. I went to 3 different surgeons for opinions. THe first Dr wanted to redo my RNY. Why? if it did not work long term the first time.

It is a very serious revision not every Dr. can do it. Research all of your options and do not be afraid to question the Dr. some of them only offer what they can do even though it is not what you want. But it might be.

dsfacts.com is a great place for information.

Good luck

Best

Whit

Here's a curve ball i hadn't mentioned in my original post.....I am an OR Nurse and am exceeding aware of what is done during WLS and also exceedingly aware of the long term damage that obesity does to a person. I am on my feet constantly and a lot of my job is very physical. Pretty hard to do when so overweight.

Interestingly , my hospital was just purchased by a nonprofit company here in Florida, that has a HUGE WLS Center of Excellence thing going. The impression that I have is that they are very pro-healthy lifestyle and understand that some people need some help in the form of surgical intervention to attain that healthy lifestyle. My insurance with them picks up in January. i am hoping that they may cover the cost of the medication I mentioned above. If not, i think I shall investigate the procedures further. I am however prepared to hear that no one is willing to do anything or that it may be unsafe. That would not be what i want to hear, but I would deal with it.

My doctor says lots of doctors won't do bands anymore He also stated that many insurance companies won't pay for fils anymore.

I am in the process of doing a band to either sleeve or by-pass. I failed with the band and gained my 60lbs I had lost back. My dr will not do the band anymore and says it's a better suit for someone that only has 40-50lbs to lose. It is not right for someone with 100+lbs to lose. I am leaning toward by-pass I just don't want to fail it too. Best of luck to you

How has your iron level been since your take-down? The reason iron deficiency is so common after the RNY is that the duodenum is bypassed, and that's where most of your iron absorption happens. If you choose the Sleeve, nothing will be done to your duodenum, so if your iron's good now, it should stay good. If restriction alone will do everything you need, then definitely go with the Sleeve.

If, however, you think you need malabsorption of CALORIES for long-term success, consider the Duodenal Switch. In the DS, only about half of the duodenum is bypassed, which might keep your iron levels okay. The DS has a fully-functional, Sleeved stomach, plus an intestinal bypass that actually causes permanent malabsorption of a significant per centage of the calories you eat. The DS has the very best long-term, maintained weight-loss stats.

The iron levels have been great. Usually an iron supplement is part and parcel of being a gastric bypass patient. My issue was that I could not tolerate oral iron. I will spare you the description of what it did to me.

Because of the division and multiple staplings of my guts, I am not sure more rearrangement of the intestines would be wise or even if it could be done laparoscipically. I'm thoroughly unthrilled with the idea of another open belly surgery. If I cannot get the Saxenda approved by my insurance, I think the sleeve might be an option. Straightforward enough to do given the condition of my insides and a higher chance of being done laparoscipically.

Did you ever try Proferrin? It's heme iron, and much easier on the gut than other irons. Plus, it can be taken with food. Just a suggestion should need it in the future.

So, painful as it was to shell out the obscene cost fro the Saxenda, i did and am now on month 3 of it. My new insurance does pay for it. However, i dropped about 15 pounds and I am stuck. Scale bobs between 236 and 240. Even with as little as the 15 pounds, i do feel better. I am still considering the gastric sleeve. For the Saxenda to continue working, I would have to be on it permanently. i don't relish the idea of injections for the rest of my life. I am going to see a bariatric surgeon just to inquire about the sleeve. Due to the multiple rearrangements of my small bowel, i don't think redoing the RNY or a duodenal switch would be a great idea. Besides, the malnutrition from the malabsorption was one of the things that i had big issues with. Yes it is possible for the malabsorptive effect to be too much to tolerate. We'll see what happens....