Rny to DS

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Jojobanana27

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Hello everyone, I am new here and I am seeking any advice possible. I had rny in 2015 and now researching how I can obtain revision to the traditional DS, it is possible but I am having issues getting a referral for an approval for my insurance (medical with IEHP, I live in San Bernardino,CA) any help or suggestions would be great. I had medical with Kaiser and they denied me, filed a grievance, got denied, took it to DMHC and got denied, I filed again and filed for a state hearing too. I now switched to IEHP as I said above thay I have but idk how to get this surgery approved. Pre surgery rny 341lbs, surgery weight was 331lbs, got down to 230lbs and now 6 years later I am at 308lbs feeling really discouraged at this time about it all so please be kind, thank you in advance.
 
Hi and welcome Jojobanana27 ! I had a traditional DS, for which I will be forever grateful. I had quite a battle going through hoops with insurance. It wasn't a revision, so I can't comment on the rny->DS procedure, but hopefully some of the revisionistas will chime in with their experience. Wishing you all the best!
 
Dr Keshishian operated on me a few years ago at Huntington Hospital (in Pasadena) and it was covered by insurance. It wasn’t WLS or RNY to DS revision, but was a different GI surgery to resolve some complex abdominal issues. I was very happy with my care and results.

Dr K definitely does RNY to DS revision surgery for the right patient.
 
These are now several years old, but supports the DS as a revisional procedure for RNY.


Management of Failed Laparoscopic Roux-en-Y Gastric Bypass - PMC

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has emerged as the gold standard for the management of morbid obesity. Accordingly, patients who fail to lose weight after LRYGB present a difficult problem for the bariatric surgeons. A ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

Weight regain after gastric bypass: etiology and treatment options - PMC

Roux-en-Y gastric bypass (RYGB) is one of the most common operations performed for the patients with morbid obesity. Weight regain (WR) is a complication that may decrease efficiency of the surgical treatment and demand further interventions. ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

More recent paper, not about DS as a revision procedure, but showing efficacy:

Long-Term Outcomes After Bariatric Surgery: a Systematic Review and Meta-analysis of Weight Loss at 10 or More Years for All Bariatric Procedures and a Single-Centre Review of 20-Year Outcomes After Adjustable Gastric Banding - PMC

Durability is a key requirement for the broad acceptance of bariatric surgery. We report on durability at and beyond 10 years with a systematic review and meta-analysis of all reports providing data at 10 or more years and a single-centre study of ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
See especially this chart:

Table - PMC

Durability is a key requirement for the broad acceptance of bariatric surgery. We report on durability at and beyond 10 years with a systematic review and meta-analysis of all reports providing data at 10 or more years and a single-centre study of ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov


A newer paper on revisions:

Weight Regain and Insufficient Weight Loss After Bariatric Surgery: Definitions, Prevalence, Mechanisms, Predictors, Prevention and Management Strategies, and Knowledge Gaps—a Scoping Review - PMC

Some patients experience weight regain (WR) or insufficient weight loss (IWL) after bariatric surgery (BS). We undertook a scoping review of WR and IWL after BS. We searched electronic databases for studies addressing the definitions, prevalence, ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
“A systematic review (799 studies) assessed the revisions of RYGB for WR, including two conversions (to distal RYGB or BPD/DS) and three revisions (revision of gastric pouch and anastomosis, revision with gastric band or with endoluminal procedures) [100]. The review found that the mean percentage excess body mass index loss (%EBMIL) at 3 years for these five revisional procedures was 52.2%, 76%, 14%, 47.3%, and 32.1%, respectively [100]
 
I am sorry my story is a bit long but you might be interested in my revision experience. I had a revision from RNY to DS revision with Dr Keshishian.

My highest weight was 430 lbs. My low weight with the RNY was 228 lbs. I did not realize the malabsorption with the RNY was not permanent and over time I regained to 360 lbs. I originally investigated the DS but at the last minute I allowed concerns about the hospital (Mt Sinai in NYC) to change my mind. I felt like I had ruined my chances to achieve a healthy weight. Then I started reading on a weight loss board about people who had RNY revisions to DS.

I researched doctors doing the revision. I found a doctor in New Jersey who was doing these revisions. I live in New York so this was convenient. I contacted the surgeon sent him my medical records completed all the required medical testing. I went for the initial consult.

This doctor required DS patients to take a test about the DS requirements to be sure they understood the DS requirements. I passed the test with a perfect score and received a surgery date. I was then scheduled for my pre op visit. At my pre op visit the doctor told me he was NOT revising me to a DS but to a distal RNY. I was devastate. When I expressed my displeasure the doctor said “Me and Ara are your best options for revision surgery what are you going to do go to California?”

I knew he was referring to Dr Ara Keshishian in California. I went home, cried, and posted how upset I was to the weight loss board and the next week I contacted Dr K and started the process with him.

I currently weigh 247lbs. I gained 20 lbs during the pandemic. It has been so much easier to maintain this weight with the DS. When I lost the weight with the RNY I went to the gym everyday no exception. I worked very hard and I still gained weight. I don’t feel like a true success because I never made it to onederland or even out of the obese category. I am grateful for my improved mobility and health. I am happy because I know if I increase my protein and reduce my carbs I will lose the extra 20 lbs. I am grateful because my DS let’s me control my weight and stops my weight from controlling me.
 
MsVee I would like to talk to you. I just now became a new member and made my first post. I am considering having a RNY revisional surgery to DS by Dr K. Can you tell me your experience with DrK etc. thank you
 
MsVee said:
I am sorry my story is a bit long but you might be interested in my revision experience. I had a revision from RNY to DS revision with Dr Keshishian.

My highest weight was 430 lbs. My low weight with the RNY was 228 lbs. I did not realize the malabsorption with the RNY was not permanent and over time I regained to 360 lbs. I originally investigated the DS but at the last minute I allowed concerns about the hospital (Mt Sinai in NYC) to change my mind. I felt like I had ruined my chances to achieve a healthy weight. Then I started reading on a weight loss board about people who had RNY revisions to DS.

I researched doctors doing the revision. I found a doctor in New Jersey who was doing these revisions. I live in New York so this was convenient. I contacted the surgeon sent him my medical records completed all the required medical testing. I went for the initial consult.

This doctor required DS patients to take a test about the DS requirements to be sure they understood the DS requirements. I passed the test with a perfect score and received a surgery date. I was then scheduled for my pre op visit. At my pre op visit the doctor told me he was NOT revising me to a DS but to a distal RNY. I was devastate. When I expressed my displeasure the doctor said “Me and Ara are your best options for revision surgery what are you going to do go to California?”

I knew he was referring to Dr Ara Keshishian in California. I went home, cried, and posted how upset I was to the weight loss board and the next week I contacted Dr K and started the process with him.

I currently weigh 247lbs. I gained 20 lbs during the pandemic. It has been so much easier to maintain this weight with the DS. When I lost the weight with the RNY I went to the gym everyday no exception. I worked very hard and I still gained weight. I don’t feel like a true success because I never made it to onederland or even out of the obese category. I am grateful for my improved mobility and health. I am happy because I know if I increase my protein and reduce my carbs I will lose the extra 20 lbs. I am grateful because my DS let’s me control my weight and stops my weight from controlling me.
Click to expand...
I sent you a post but Idk if you received it. My name is Christy Porter. I just made my first post. Wanting to know your experience with DrK. Also considering Dr Ayoola had RNY wanting revision to DS thank you
 
Sorry just saw your post. Dr K was wonderful. He answered all my questions and explained that I did not fail the RNY it simply was the wrong surgical option for me. I trust him because of his knowledge. I was comfortable with him because of his compassion.
I traveled from Long Island NY to California because I wanted the best medical care I could find. I do not regret my decision at all. I spent more money doing so. It was worth it to know I was giving myself the best chance at being successful. I did not achieve my goal weight but I managed to lose and keep off 200 lbs for approximately 9 years. I know if I clean up my diet I could easily drop another 25 to 30 lbs.
During the pandemic I have been less active and unfortunately snacking more than usual. Dr K is an excellent choice for revision surgery.
 

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