RNY is only choice for me

Sheanie

Well-Known Member
This reference says otherwise...and that it is the length of the Roux limb that is critical

houstonheartburn.com/severe-gerd-after-gastric-bypass-surgery/

"Severe GERD after Gastric Bypass Surgery

Roux-en-Y Gastric Bypass procedure is considered the gold standard treatment for GERD in obese patients. The creation of a small gastric pouch diverts most of the acid produced by the stomach away from the distal esophagus. The Roux limb mechanism effectively prevents bile reflux into the esophagus and promotes esophago-gastric emptying by creating a negative pressure system. Studies in dogs have shown that the Roux limb must be at least 30 cm in length to prevent bile reflux. Measuring the small intestine intra-operatively is not an accurate process since the intestine is continuously contracting and relaxing. Furthermore, there are no studies in humans about the optimal Roux limb length that is associated with bile reflux prevention. Most bariatric surgeons have adopted a 75 cm Roux limb length for gastric bypasses performed for weight loss. The majority of obese patients are reflux free following gastric bypass surgery...."



Re.. "Stick around, experience is enlightening."

Good advice..... for all;)
I am very concerned, George, that your posts are unfairly frightening the OP into an inferior surgery choice. One that, remarkably, you yourself REVISED FROM to the DS.

As previously noted, the OPs surgeon probably can only do the RNY because he/she does NOT perform the DS. This point cannot be ignored.

If the only tool you have is a hammer, every problem looks like a nail.

I do hope the OP gets a second opinion, or even travels for the surgery he needs.
 

Webmommy

Well-Known Member
And I am concerned that in our enthusiasm for a particular choice we made, we may put a person at increased risk for esophageal cancer. Our choice, though great for us , may not be the best for the OP. Their situation is different.


Your situation was different . You had gerd not Barretts esophagus... you were two steps down the risk chain from esophageal cancer ... the OP is one away


Re "One that, remarkably, you yourself REVISED FROM to the DS." You know, I don't really think this type of comment helps advances the discussion. A more thin skinned poster would look at it as approaching an ad hominem attack
It seems like you're missing the overall point here which was that the OP should get a second opinion which is wisdom in any circumstance.
 

Larra

Well-Known Member
Yes, I'm sure. The entire antrum and fundus are separated from the small pouch, thus the acid produced in these portions of the stomach can't get to the esophagus. This is not to say that acid is not still produced, it may well be, it just can't get to the esophagus.
Bile reflux is a separate problem, since bile isn't produced in the stomach, and shouldn't be an issue with a properly performed RNY gastric bypass or a DS. It is a potential problem with the loop DS/SADI/ other names, or with the hopefully rarely performed loop gastric bypass.
But really, my main point is that a second opinion is of great value. I'm not trying to push anyone to any operation. I believe that a second opinion with an experienced DS surgeon will help the OP to learn as much as possible about his options and make the best possible well informed decision. If that turns out to be RNY gastric bypass, so be it. It is inferior to the DS for percentage excess weight loss and also for resolution of most comorbidities, but there may be circumstances where it's the best choice.
 

DianaCox

Bad Cop
1) If the Barrette’s is caused by bile reflux, which is completely different from acid reflux, the DS (NOT SADI!) will permanently divert bile so far downstream as to make bile reflux impossible.

2) A larger pouch (assuming there is a mechanical pressure issue in the reflux) means more volume control by the patient. A person can manage volume control by not eating more than their malabsorption counteracts. A larger stomach and shorter CC can have the same results, except somewhat more need for supplements. I’d go for that over an RNY every day of the week and twice on Sunday. A larger pouch with a stand-alone sleeve is a failure waiting to happen.

3) Similarly, if the reflux is caused by a hiatal hernia, that can be repaired during the sleeve construction.

4) I would consult with a skilled DS surgeon before making the decision.
 

DianaCox

Bad Cop
Of course they didn’t lose a lot of weight - they were only somewhat obese to start with. I recall reading somewhere that they lost about 25 lbs.

I had a 100 cc/3.5 oz sleeve, which was an intermediate size. I still have reasonable restriction almost 17 years later.
 

RainCity

Well-Known Member
OP: I had severe GERD for many years prior to gastric bypass, as well as a family history of esophageal cancer. After my MGB in 2017, acid reflux was resolved but then I developed bile reflux and Barrett’s Esophagus 10 months later. I consulted with Dr Keshishian in Pasadena and he did not convert me to RNY or DS; instead, in July 2018 he repaired a hernia, performed a Nissen Fundoplication, removed an FDA-recalled LINX reflux device (installed in 2015), and he may have done some other magic internally. Result - I feel great, no more Barrett’s, no more reflux (acid or bile), and my BMI (right before surgery with him) has gone from underweight to low normal. Dr K is an expert at DS surgeries, revisions, and complex abdominal issues. I trust and trusted him 1000%. He made the right diagnosis and surgical plan for ME based on my anatomy, medical history, and family history. I still contact him on occasion if I have any concerns and he always answers my questions right away. I highly recommend you consult with him (in-person or virtually) to see what he thinks would be the right bariatric surgery plan for you. Good luck.
 

Jerry

Member
Does your doctor even perform DS?

Trust, but verify.

And fight for the correct surgery.
Yes,that is why
Does your doctor even perform DS?

Trust, but verify.

And fight for the correct surgery.
Hi and welcome Jerry ! It probably would be best to get a consultation with one of the true DS experts who are both very experienced with the DS and with patients who have other conditions. Specifically, it would be worth a visit to like Dr. Keshishian in California.
I chose this doctor because I knew she is a ds dr.
 

Jerry

Member
Not bad advice...Don't let enthusiasm for DS, and I'm an enthusiast, ignore the inceased risk of esophageal cancer for someone with Barrett's esophagus. The VSG part of DS increases the risk of GERD which exacerbates Barrett's esophagus

What it is

"Barrett's esophagus, tissue in the tube connecting your mouth and stomach (esophagus) is replaced by tissue similar to the intestinal lining.

Barrett's esophagus is often diagnosed in people who have long-term gastroesophageal reflux disease (GERD) — a chronic regurgitation of acid from the stomach into the lower esophagus. Only a small percentage of people with GERD will develop Barrett's esophagus.

Barrett's esophagus is associated with an increased risk of developing esophageal cancer. Although the risk is small, it's important to have regular checkups for precancerous cells (dysplasia). If precancerous cells are discovered, they can be treated to prevent esophageal cancer."

Risk factor

."Having GERD that doesn't get better when taking medications known as proton pump inhibitors or having GERD that requires regular medication can increase the risk of Barrett's esophagus."

Vsg/DS RISK

"Longer term risks .... Gastroesophageal reflux" (GERD)

Ref
[URL="http://www.mayoclinic.org/diseases-conditions/barretts-esophagus/symptoms-causes/syc-20352841[/URL]"]www.mayoclinic.org/diseases-conditions/barretts-esophagus/symptoms-causes/syc-20352841[/URL]

thanks for the info.
 

Jerry

Member
I want to thank everyone for their information,I appreciate all of it.
Dr Inman is my dr,I fully trust her.She is at St Vincents in Carmel IN.
The reason I'm going through with the rny.My reasoning is because I trust her,and Im 65 and out of the 6 people in my imediate family,Im the only one that hasn't had cancer.I dont want to take any chances.Thanks again for all of your concerns and info
 
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