VSG to DS revision

[vsgtods]

Good evening,

I am currently being evaluated for a revision of a VSG (performed in 2010- lost 80 pounds, did not make to goal weight, have regained and am 30 pounds higher than when I had the VSG). I am treating at Duke for the revision, and am planning on having the DS.

I have only had one appointment with the surgeon thus far, and during that appointment he mainly just ordered a bunch of tests to review. We really didn't discuss much as he wanted to see the results of my tests before we went any further. I did get the sense though that he doesn't like to resleeve patients when converting to a DS.

I am really nervous that he may not want to resleeve. This is my last shot at WLS and I want to set myself up for as much success as possible. I can eat a normal meal quite comfortably and feel almost no restriction. I cannot binge eat, but I can eat normal amounts during 1 sitting (i.e. a plateful).

So far my testing has been unremarkable and just shown a larger sleeve. No hernias, no complications, nothing you wouldn't expect. Do most surgeons not resleeve when converting a failed VSG to DS? Are people still successful without the resleeving portion?

Is anyone aware of any studies that show revision outcomes with previous VSG patients?

Thank you for providing your thoughts.

 

[DSRIGGS]

You don't want resleeved unless something is wrong. The switch is what will work long term and reserving can really mess up your stomach and create issues like stricture. Plus it shouldn't have stretched out that much anyway and the research shows that smaller sleeves don't result in more long term weight loss.

Good luck and make sure that it is the real DS and not the sadi/sips/loop. I believe one of the Duke guys is pushing the sadi now.....as you saI'd this your last shot so you want the proven surgery that gives best long term ewl.

 

[southernlady]

Welcome @vsgtods
Resleeving unless there is something wrong with the sleeve, not just size, is not necessary. Adding the switch is what helps.

 

[vsgtods]

Thank you both for sharing! No matter how many times I read that the sleeve doesn't really matter, it still makes me nervous. I need to get over that mental hurdle.

My first appointment at Duke (my surgeon is Dr. Ranjan Sudan) was really just them meeting me, glazing over my history, and ordering several tests. I already knew I wanted the DS, and Dr. Sudan strongly supported that choice. I didn't spend much time with him... mainly spoke with a bariatric surgeon fellow. My next appointment is going to be discussing my test results, which as I mentioned have thus far been unremarkable. My last test is an endoscopy scheduled next month with Dr. Sudan.

I definitely don't want any other surgery other than the true duodenal switch. Do you have advice for how to make that clear during my follow up appointment with Dr. Sudan? I don't want to think I'm having one surgery and end up with something else. (If there are other posts that discuss this, feel free to point me in that direction... I don't want everyone to have to reanswer the same questions over and over

 

[southernlady]

Thank you both for sharing! No matter how many times I read that the sleeve doesn't really matter, it still makes me nervous. I need to get over that mental hurdle.

My first appointment at Duke (my surgeon is Dr. Ranjan Sudan) was really just them meeting me, glazing over my history, and ordering several tests. I already knew I wanted the DS, and Dr. Sudan strongly supported that choice. I didn't spend much time with him... mainly spoke with a bariatric surgeon fellow. My next appointment is going to be discussing my test results, which as I mentioned have thus far been unremarkable. My last test is an endoscopy scheduled next month with Dr. Sudan.

I definitely don't want any other surgery other than the true duodenal switch. Do you have advice for how to make that clear during my follow up appointment with Dr. Sudan? I don't want to think I'm having one surgery and end up with something else. (If there are other posts that discuss this, feel free to point me in that direction... I don't want everyone to have to reanswer the same questions over and over

Sudan does the traditional DS. There may be other surgeons in the Triangle that are doing the SADI/SIPS but I have NOT heard of any such thing coming from Sudan's office. Just ask if he does the Hess method and if not, get him to tell you what your limb lengths may be.

I am also in NC but just barely...I can walk to the SC state line if I needed to. Over here in Western NC.

 

[DianaCox]

Make sure the consent papers you eventually sign say "traditional two anastomosis duodenal switch, with a common channel no longer than 125 cm" - you have the right to have that handwritten into the form.

 

[vsgtods]

Sudan does the traditional DS. There may be other surgeons in the Triangle that are doing the SADI/SIPS but I have NOT heard of any such thing coming from Sudan's office. Just ask if he does the Hess method and if not, get him to tell you what your limb lengths may be.

I am also in NC but just barely...I can walk to the SC state line if I needed to. Over here in Western NC.

I am in south Charlotte... I can also walk to SC, haha. My family is from Western NC (closer to the piedmont than the mountains though).

Dr. Sudan didn't mention those other procedures during my appt... SIPS is listed on the Duke website as a procedure that they perform, so I will make sure to clarify.

 

[vsgtods]

Make sure the consent papers you eventually sign say "traditional two anastomosis duodenal switch, with a common channel no longer than 125 cm" - you have the right to have that handwritten into the form.

Thank you for providing that language.... I would not know what phrasing to look for- I will make sure it's in my consent papers.

 

[Larra]

Re-sleeve is a tricky issues. It sounds so simple, but it isn't, and the complication rate is much higher than with a virgin sleeve because the surgeon has to be sure to remove the entire old staple line, otherwise there will be staple lines that cross each other and possibly a small chunk of stomach between staple lines with an inadequate blood supply, which can lead to a leak. So unless you really need a re-sleeve, it's best not to have one.

 

[DSRIGGS]

I am in south Charlotte... I can also walk to SC, haha. My family is from Western NC (closer to the piedmont than the mountains though).

Dr. Sudan didn't mention those other procedures during my appt... SIPS is listed on the Duke website as a procedure that they perform, so I will make sure to clarify.

I lived in Simpsonville, SC for nearly 3 years (2000 - 2002). I used to run a plant that supplied to battery labels to Duracell and their largest volume facility in the US was in Lancaster so I was up there several times a year. Not to far from you from what it sounds like. I miss Simpsonville and the Carolinas.

Best of luck to you

 

[vsgtods]

I lived in Simpsonville, SC for nearly 3 years (2000 - 2002). I used to run a plant that supplied to battery labels to Duracell and their largest volume facility in the US was in Lancaster so I was up there several times a year. Not to far from you from what it sounds like. I miss Simpsonville and the Carolinas.

Best of luck to you

Agreed- the Carolinas definitely have some misgivings, but are a wonderful place to live. Thank you for the encouragement.

 

[DSRIGGS]

Agreed- the Carolinas definitely have some misgivings, but are a wonderful place to live. Thank you for the encouragement.

Oh there are some things that are bit silly going on there now but I still like that area.

You are welcome that is what this place is for...encouragement and information.

 

[vsgtods]

I have completed all of my testing and insurance paperwork. I have a follow up with Sudan on Monday and will hopefully submit to insurance! He did say after the endoscopy yesterday that he will not need to resleeve me.

I am going to ask about the CC length at my OV on Monday. I am so worried that since I don't have a ton of restriction that this surgery won't be successful for me. I don't have crazy goals- I'm about 300 lbs and my goal weight is 200. This is probably my last surgical shot, so I want it to be a good one. I'm hoping he will consider doing a shorter CC on me- around 75 cm. I'm having a hard time finding stories and experiences from people in my situation (higher weight before their sleeve and now having a DS), so I'm not sure what most surgeons do.

 

[DSRIGGS]

Please do your homework and don't be fooled in to thinking that the common channel length in isolation guarantees anything. I had a 125 cm CC done by my original DS surgeon and I became severely malnourished and had to be revised to increase the length of my AL.