Revision from RNY pouch to Gastric sleeve due to anemia and B-12 deficient

Old member... Back again from 2002 open RNY lost 130 lbs.. Able to maintain weight thru first pregnancy after second in 2010 I can not lose the 50 lbs I have gained back. I have been on iron pills since surgery 2002 but they are not longer working and now go monthly for infusion and B12 injections. Has any other member had this problem? I now have a hernia in the small bowel loop so they have mentioned a revision of a sleeve over a RNY... has any member had this type of revision and please give details. thank in advance. 

Hey everyone It was suggested I try also posting over here as well.. I would be going from a RNY pouch to a gastric sleeve. 

thanks

You might want to check in the Revision forum.

I don't menstruate, but I become anemic app 2 years post RNY.  Tried increase iron pills, but they make me sick, and not do anything on my iron levels.  I got a series of iron infusions in 2011, them 2012, then eventually in 2014...  I get weekly B12 injections. That works best for me. 

I also got tested for food allergies and intolerancea. I removed gluten, and grains from my diet. Also dairy and soy (allergies). Plus I stop eating any food that I tested allergic to. 

This somehow helped my iron. This year blood work show high level of iron, and mid normal ferritin. My ferritin stayed stable over 8 months... 

That is a very unusual (and complicated) revision.  

Even though you have gained 50 pounds, are they going to remove ("take down") the intestinal bypass in order to fix the hernia and eliminate the vitamin issues you are having?  If not, you would just be exchanging your pouch for a sleeve of about the same size, so I would have to wonder what the point of the revision is, and whether it is really worth the myriad of potential complications. (Taking down the bypass is a more difficult procedure than creating it, and most surgeons aren't specifically trained to do it (but may "wing it", anyway.  If he is going to take down the bypass, please ask him how many times he has done it.  You do NOT want to be the first!)

Have you really discussed with your surgeon the actual procedure he is recommending and the potential complications of it?  In order to create a sleeve, the surgeon will have to either 1) remove your pouch (which means either separating it from your esophagus and completely removing it from your body, and then using your remnant stomach to create a sleeve and attaching the end of the sleeve to your esophagus) OR 2) attaching your pouch back to the remnant stomach (so there is enough to create a sleeve from) and then cutting away part of the pouch to create the long slender sleeve.  One significant complication of the first option could be the formation of excess scar tissue at the esophageal connection point.  Strictures are bad enough when they are at the stoma (the opposite end of the pouch from the esophagus), but having your esophagus partially close up and have to be dilated (as they do with stoma strictures) would be a real problem. At least when someone gets a stricture at the stoma site, the food and liquids they try to eat just get stuck in the pouch. If you end up with the stricture of the point of connection to the esophagus, food and liquids are going to back up in your esophagus!

is there a reason that he is recommending a sleeve rather than just cutting away some of your pouch to make it smaller?  There are risks with that (which is why it is only rarely done), but I would think the risk of that would be less than replacing a pouch with a sleeve.

I assume that you've already tried taking different types of iron (since we absorb some kinds better than others)? 

Definietly do yoru research and make sure you know exactly what the aurgeon is planning to do (and why, and what the potential complications are) before you decide to go ahead with it.  You should also be sure that your insurance will pay for such a revision.  Some policies don't cover revisions at all, and some may limit the type of revision.

I wish you well.

Lora

I am thinking an adjustment to the Roux Limb might be a better option to aid in absorption rather than going through a surgery that is most likely next to impossible.  Tearing down the pouch and reattaching the pyloric and sphincter valves to create a sleeve that will make the pouch the same size seems unnecessary.  In addition, her origional surgery was done in 2002. No telling what a surgeon might find once she is on the table and if the valves would actually become fully functional again. She needs the advice from an experienced revision surgeon to find out if it's feasible. 

Agreed!  

Thanks for all your input,  I feel the same way I would rather not go through another surgery.  I feel if I could get my levels normal not be so tired, cold, short of breath side effects of low iron I could start walking and lose weight.

i have tried several iron pills and was on RX iron 325 2x a day before doing the infusions.

i am in Michingan not a small town, I have had one surgeon at a local hospital only perform a few repairs on hernias on Gastric Bypass so I don't feel .  When I called The Barix center and Dr Pop would perform.. Excellent doctor who has done several.. But due what I am being to my old stuff can not absorb anymore. I have young kids taking that Risk..concerns me.. I did post on the revision site the sent me over her and again thanks so much for your help...

why do you need infusions weekly? 

are you still menstruate? if yes - do you plan to have any more children? if the answer is "absolutely not" or "my tubes are tied " - if you are losing a lot of blood every month- having uterine ablation - can reduce or eliminate the blood loss.  

If you think you may want more children on day - IUD - or 3-4 months pills cycle may be an option. (talk to OB GYN) 

Not bleeding heavy.. Tubes are tied.. OBGYN sáys no reason for ablation  due to the loss not from there.

i am no longer able to absorb.  My apt today update is weekly B-12 injections for a month then monthly for 6 months.  I also am depleted like the test of the population of D. My iron will be re checked again next month.  

i have been taking sublingual b12 and D.  I will keep you posted if your intrested of my decision. 

What type of Vit D have you been taking? (D2 or D3? Dry or in oil?) It significantly matters after a RNY. The dry D3 gets absorbed much better.  Also, how much are you taking?  Sadly many doctors (and even bariatric surgeons) don't understand how high a dose of certain vitamins some of us can need after surgery. For instance, it is not uncommon for RNYers to need 50,000 units of dry D3 2 or 3 times per week, so it you have only been taking a few thousand units a day, it probably isn't that you aren't absorbing at all, it is probably just that it isn't enough after the bypass.

The type of iron can also matter. What type and how much have you been taking? Again, some RNYers need large doses.

Same thing with B12... How much are you currently taking and how low are your levels?

Lora