RNY revision options

[desperateandconfused]

Hello everyone, I am 12.5 years post-op from a RNY. I do not know if it was distal or proximal. I am just starting the process of researching options for a potential revision. I have regained 120 of the 170 lbs I lost post surgery. I kept the weight off for ~8 years and then had 2 children and my weight spiraled back out of control.

Could someone point me to a link or information on what options there are for RNY revision outside of DS? I am quite concerned about the potential for complication from the DS. Could a balloon insertion or something along those lines help or is that not viewed favorably?

I can afford to self-pay if necessary (it would kill my husband but I could do it).

 

[Larra]

Hi and welcome!
As you will see if you do a lot of reading here (which I highly recommend, there is so much good info to be found) most of the people on this website are very much in favor of the DS, though people with any operation or no operation are welcome as well.
For you, the options are very limited. RNY to DS revision is a complex operation with significant risks, and you are right not to take it lightly. Because of the difficulty and risk there are only a few surgeons who do it (there is a list here somewhere). Sometimes insurance will cover it, not always, depends on your policy and possibly on your appeals rights.
what else is there? Well, not a balloon, which is experimental under any circumstances and which I haven't heard of being used for someone who already has gastric bypass. All a balloon does, if anything, is lower the capacity of the stomach, and you should already have a low capacity pouch.
the only other option would be ERNY (the E stands for extended) which goes further distal than a distal RNY. Going from proximal to distal RNY has never been shown to be helpful. With ERNY you get the worst of both worlds - the pouch issues of what you already have, with the added potential nutritional issues of significant malabsorption. It's not a good combination. One of the reasons the DS was created as a modification of the old BPD is that the BPD worked great for weight loss but had serious problems with nutrition. The only advantage of ERNY would be that the surgery, while still major surgery, would be lower risk than RNY to DS revision. Once you get past that, though, you would have greater risks of nutritional problems.

Keep on reading and researching. This is not a decision to be made lightly. There are people here who have had this revision, some with excellent results, some with serious complications. You will have to weigh the risks vs benefits, keeping in mind that remaining MO also carries significant risks, they just aren't as immediate as the risks of surgery. Not to mention your quality of life as well.

 

[desperateandconfused]

Thanks Larra, appreciate the welcome. I will keep reading and learning, it seems like a great group of folks here.

 

[galaxygrrl]

Yep, read and learn and there are a bunch of people on this board who have done a RNY to DS. Also, for self pay, if it comes to that (hope it does not), you might consider Mexico. One Dr there does it and is about 1/3 of the price.

 

[southernlady]

Welcome @desperateandconfused Just keep reading and asking questions.

 

[Larra]

@galaxygrrl my understanding is that Dr. Esquerra does not do RNY to DS revisions, and I wouldn't recommend any other doc in Mexico for an operation with this degree of risk. Sorry!

 

[KathrynK]

Have you visited your original surgeon? Have you had tests to see why the surgery failed? It is not necessarily what you are assuming and some RNY problems can be fixed without revision to another WLS method. Did your original surgeon tell you the complications of a DS conversion were too dangerous? You might need an opinion from another surgeon. The balloon cannot be used in people who have already had bariatric surgery, unless it was a failed l band that has been removed, according to the FDA's approval. It seems like it would only further ruin your pouch, as food stretches it when the balloon is there and removal of the balloon would leave you with an even bigger pouch. maybe that's why the FDA didn't approve it for weight regain after WLS. As for insurance, I have heard that many will pay for only one procedure in a lifetime, but the insurance experts here will give you better info. As others have said, keep reading.

 

[galaxygrrl]

@galaxygrrl my understanding is that Dr. Esquerra does not do RNY to DS revisions, and I wouldn't recommend any other doc in Mexico for an operation with this degree of risk. Sorry!

Oh, I did not know that. Thanks for the correction. My bad.

 

[DianaCox]

Keshishian, Rabkin, Ayoola - and - um - in some circumstances Greenbaum? What is our current vetted RNY to DS list? (Roslin is off, because he's a SADIst (or SIPS or whateverthefuck he's self-promoting this month).)

 

[southernlady]

Actually there is a list of revision surgeons here: http://bariatricfacts.org/threads/current-list-of-known-rny-or-lapband-to-ds-surgeons.1403/

 

[Kristaz]

I was RNY to DS - I had regained weight but I also had MAJOR dumping. This isnt an easy surgery however I would do it again in a heartbeat and wish I had done it sooner! Do your research, ask questions. It is a totally different surgery and different from almost every rule you were taught as an RNY. It was a harder recovery than the first and maybe partially because I am 10 years older or my memory is foggy but the best descion I made. I used Dr Keshishian and would without a doubt recommend him. He's not cheap if your ins Dosent cover. I believe it was about 24k cash pay.

 

[Jen2016]

...As for insurance, I have heard that many will pay for only one procedure in a lifetime, but the insurance experts here will give you better info. As others have said, keep reading.

I'm getting an RNY to DS revision with Dr. Keshishian in December, and I was recently approved by insurance, despite the issues I list below.

Everything depends on your policy. I was worried that I would be denied (see below). Most importantly, try to get approval anyway.

My BCBS policy stated that they would cover a revision, but you could not have lost more than 50% of your excess weight after the first surgery. I lost 100% of my excess weight after the first surgery, and gained it back. So I thought I was going to be denied.

Additionally, I was supposed to go through a 6 month physician supervised weight loss. Kristina at Dr. Keshishian's office helped me so much! She told me to start the program and do everything else and we'd submit even though I had only completed 3-4 months of the weight loss program.

Bottom line: We submitted and it was approved the first submission!

So read your Evidence of Coverage, work with the doctor's staff, and try to get insurance approval. You may be pleasantly surprised!