Revision advice

[Brianna]

hi everyone! I had VSG surgery in May 2015. My starting weight was 267, bmi of 52. Despite getting pregnant 4 months later (accidentally), I managed to get down to just under 180. From September 2017 to this past August I went to an intense nursing program and realized after graduation that I had put on a lot of weight. The stress and being so busy led to feeding myself and my family fast easy options and a drop off in exercise. I'm now at around 225 pounds. I started putting effort into losing the weight right after graduation in August. I've been calorie counting religiously and going to planet fitness at least 3x a week with a friend. I've only managed to lose 9 lbs. I feel stuck again!
I have an appointment with my surgeon on Wednesday to discuss revision. My doctor is Dr Onopchenko at Atlanticare in southern NJ. Now, I would really prefer to go with the DS as I want the best chances for sustained weight loss. However, I also have very bad acid reflux and keep reading that the RNY is the option to fix that. I have NJ FamilyCare insurance, specifically the Horizon NJ Health plan. They did not pay for my first surgery as I was covered by Private Cigna insurance at the time. I'm worried about being denied. I would so appreciate any and all advice on my situation.

 

[Munchkin]

Does that doc do the DS? The real DS? NOT Loop/SIPS/SADI? Make sure!

Here's the real scoop. The sleeve is just another diet with a smaller stomach. If diets don't work for you then you already know the sleeve is not going to solve your problem. A smaller stomach plus malabsorbtion is the best answer available today. A standard RNY does not bypass enough to keep the weight off. The body adapts as best it can and by the time you are 2 years or so postop the malabsorbtion from the RNY is gone. The DS bypasses so much more that the body can't adapt. Plus you already have 1/2 the DS done. All you would need is the switch.

Going back to the 2000 time frame, I worked in an office full of fat women. 10 of us had WLS. 1 DS, me. 1 Band. And 8 RNY. Fast forward to today and I am quasi normal as is 1 of the RNY people. The band person never lost a pound. And 7 of the RNY folks now weigh more than they did before surgery.

 

[Brianna]

Thanks so much for responding. I'm fairly certain Dr O does the "traditional" DS. Here is the websites explanation of the procedure:

"What The Procedure Involves

• Removal of 85% of the stomach including the portion that is responsible for producing an appetite stimulating hormone (Ghrelin). Since this portion is removed, patients tend to feel less hungry than before surgery and yet the functional part of the stomach remains. Formation of the new stomach “sleeve”, which is shaped like a very slim banana which measures from 1-5 ounces. By reducing the size of usable stomach the patient feels full with lesser amounts of food.
• The small intestine is reconfigured and then reconnected to the remainder of the stomach so that not all of the calories that are consumed will be absorbed, producing the greatest amount of weight loss of all bariatric surgical options"

Do you know if the DS helps with acid reflux? Mine is pretty bad. I've woken up a few times with stomach acid burning my throat and nasal sinuses.

 

[southernlady]

Welcome Brianna

The small intestine is reconfigured and then reconnected to the remainder of the stomach so that not all of the calories that are consumed will be absorbed, producing the greatest amount of weight loss of all bariatric surgical options"

That is NO guarantee he does the traditional DS. That same verbiage can apply to the SADI/SIPS/LoopDS.

When you see your surgeon
1) Ask him to draw the DS and then compare that to a picture of the DS.
2) Ask him if he does a Hess method DS. If he does, it IS a DS. If he doesn't then go to step 3.
3) Ask him how long he will make each limb. (If he mentions a common channel of over 250 cm, it's likely NOT the DS)

Who is your surgeon?

Many people are getting the SADI/SIPS/LoopDS THINKING they are getting the real DS. For many, it's been okay but for many others, it's been a disaster. Read this forum for an understanding of why we don't recommend the SADI/SIPS/LoopDS but we will recommend THAT one over the RNY any day.

 

[Brianna]

Thank you so much for the info! I will ask him at my appointment and let you know his response. My surgeon is Dr Onopchenko at Atlanticare in Atlantic City nj. Before my I initial surgery I researched him and his reputation seem to be very good. AtlantiCare was also named as a bariatric center of excellence which I think is good, right? The only thing was I did all my preop requirements with the plan of getting the switch to begin with. Then at my final appointment he said he would prefer to do the sleeve only because he was concerned about absorption of one of my medications. Since then I have done research and I don't think that particular med would have been A problem, I think it was more of a stigma and doctors not having much experience in dealing with it. The medication is an immediate release liquid and the prescribing doctor can adjust it if needed. So I'm hoping he doesn't give me a hard time with that again.

 

[Larra]

First, the DS won't make your reflux better except in that weight loss does help with reflux. How much it will help you, you won't know til you get there. Also, if you happen to have a hiatal hernia, your surgeon could and should fix that at the same time, and that will help also. On the positive side, you already have your sleeve, so going to the DS won't make your reflux any worse.
I have a funny feeling that this guy will try to talk you out of the DS again, either because of his lack of familiarity with your medication (I already posted on your other thread) or because he does gastric bypass more often and is more comfortable with it. You have already had one operation that failed you (note - YOU didn't fail, the operation did), and you deserve to have the operation with the best chances for meaningful, permanent weight loss, and that's the DS. If this surgeon balks, i.e. tries to find some reason not to do it, vote with your feet and get yourself to another surgeon. You are the one who will live with the results of this operation, not him.

 

[southernlady]

AtlantiCare was also named as a bariatric center of excellence which I think is good, right?

Only if your insurance requires it. Otherwise it means absolutely nothing. It’s a marketing ploy.

 

[Charris]

If you already have a Vsg natural progression for insufficient weight loss is the 2nd half of the surgery.....DS.