RNY to DS recent changes?

I was seen a few years ago, and told that since I had an RNY done, there was nothing else that could be done. As I've been reading through various forums and such, it appears that isn't the case. I have listed a few questions below. Unfortunately most of the topics that I found by searching the DS, and rev forums were a couple years old.

1.) Has there been an evolution in the technique that has allowed it to become more acceptable?

2.) Has anyone done this in Ohio, Indiana, or Kentucky? Dr. Suggestions?

3.) Are there special scenarios from an insurance perspective? I have BCBS, and there is a BMI component which I am above, along with comorbidities.

4.) Potential Complications?

Thanks for any additional help. I appreciate it!

Revision from a RNY to a DS is possible but it is only done by a handful of surgeons.  It is a technically difficult surgery and should only be done by a surgeon experienced in this type of revision.  Many surgeons may tell you they can give you a surgery "like" the DS but mainly that would be to revise you from a proximal to a distal RNY.  That adds more malabsorption to the mix but can cause more problems than it helps.

The reason the DS isn't done by more surgeons isn't because it is a bad surgery.  It is one of the best as far as weight lost and maintained and resolution of comorbidities.

It also is very high maintenance with strict monitoring of vitamin levels and supplements.  Many surgeons have seen so much lack of compliance in their patients that they are reluctant to perform a surgery that has such requirements and dire consequences to those who cannot comply.

That is why the VSG is so popular.  While it has many post op requirements, too, the consequences aren't as severe for noncompliance.  

As for the surgery itself, many surgeons are doing variations of the DS such as the SADI.  These variations are too new to have much long term data regarding results.  You might want to do a search on the SADI to learn more.

Revisions are very serious and riskier than first time surgeries.  It is very important to follow through and find out if your original surgery has failed for mechanical reasons.  If the reason for the failure has to do with overeating than it is important to address those issues before having more surgery.

The DS and distal RNY mainly cause malabsorption of fats and proteins.  Many people have weight problems due to overeating refined carbs, things with sugar and flour.  There are no surgeries currently that can help in that area.  Simple carbs are absorbed 100% no matter what surgery you have so if that is your problem it is important to work on that before you have more surgery.  You may find that the tool you have is enough to help you make changes to your eating.

I'm not understanding the 'difficulty' in a good Bariatric Surgeon doing RNY to DS. Do you know what the big difficulty is in doing the surgery? Is the aftercare and the patient? I see many posts on here about this subject and 'only a very few Surgeons able to do the RNY to DS', but as a medical professional myself, a surgery is a surgery is a surgery. If you cannot do ALL of them, I personally don't want you cutting me at all. I am being worked up now for such a surgery and my Surgeon does DS on people with BMI's of 70-80-90 which are the Super morbidly obese. He should be able to do the RNY to DS without any problems.I'm just trying to figure out if I should be seeking another surgeon or not.

I'm not understanding the 'difficulty' in a good Bariatric Surgeon doing RNY to DS. Do you know what the big difficulty is in doing the surgery? Is the aftercare and the patient? I see many posts on here about this subject and 'only a very few Surgeons able to do the RNY to DS', but as a medical professional myself, a surgery is a surgery is a surgery. If you cannot do ALL of them, I personally don't want you cutting me at all. I am being worked up now for such a surgery and my Surgeon does DS on people with BMI's of 70-80-90 which are the Super morbidly obese. He should be able to do the RNY to DS without any problems.I'm just trying to figure out if I should be seeking another surgeon or not.

Ladytazz,

Thank you for your information with the forum.