Seeking Revision from VSG to RNY

[Thecurlymanifestor]

Hello,

My name is Shannon.

I have started the process of undergoing a revision to RNY. This is covered in my plan.
My starting weight date of surgery was 283lbs and my lowest recorded weight was 244lbs. I am currently 258lbs. Last month I had an EDG and upper GI. It came back that I suffer from moderate GERD and I have a technical surgical failure which is dilation of the pouch. According to my policy with BCBS IL I meet all of the requirements for a revision. However, my patient advocate felt inclined to tell me that it was not likely that BCBS IL would approve my surgery because it is very rare that BSBC IL approves revisions. Has this ever happened to anyone? This has me really down and discouraged. VSG was not a good surgery for me and unfortunately, I did not get to experience the weight loss bliss that most do.

 

[southernlady]

Welcome Thecurlymanifestor

Before getting rid of your pyloric valve, PLEASE look into going the DS revision route which adds malabsorption to your VSG.
With the RNY, your chances of keeping weight off long term is very slim. At 5 years out, many have regained a considerable amount of weight if not all plus more.
With the RNY, you can NEVER take NSAIDS again.
With the RNY, you still need a boatload of vitamins.
With a RNY, your chance of dumping (not shitting but a glucose reaction that is miserable), can increase to around 30% but no guarantee if you want that as a way to modify bad eating habits.

The DS, once healed, allows for keeping the weight off the rest of your life as long as you follow the DS rules of protein first, fat second, and limited carbs.
With the DS, if you can use NSAIDS now, you can afterward, once the insides heal.
Yes, you need a boatload of vitamins based on your labs with a full lab work up at a minimum of yearly.
The chances of dumping with a DS is the same as a non WLS individual which, I’ve seen quoted as about 5%.

Understand that most of us here are die hard DSers. Several have revised from the RNY to the DS but in the almost 9 years of being on forums and social media, I know of only ONE person who revised from the DS to the RNY.

Please read as much of this board as you can.

 

[Larra]

First, I can't agree more strongly with what southernlady said. You're already experienced one failure, and please understand that you are far from alone. We see new people here (and on other sites) looking to revise from VSG to something better all the time. Some people are successful with it, a good number are not. But at this point, you need to fully research all your revision options, and almost everyone here would recommend the DS as your best choice. The DS has the best statistics of any bariatric surgery not just for percentage excess weight loss, but also for maintenance of that weight loss, which is crucial, and the best statistics for permanent resolution of almost all comorbidities. It is also much easier to live with than gastric bypass, as dumping (which is NOT a weight loss tool, just a very nasty potential side effect) is rare with DS, we can safely take NSAIDs, and we can freely eat both protein and fat. With gastric bypass, your permanent diet is low calorie, low fat, low carb. IMHO that's one of the reasons the results just don't compare to the DS.
Ignore the patient advocate and get your EOC (evidence of coverage, a 100 or so page document that spells out your coverage, essentially a contract) and read it for yourself. Find the criteria not just for bariatric surgery but specifically for revisions. That's what you need to know. It will also spell out your appeals rights, if any. You also need to make sure your potential surgeon does revisions, and again, does the DS. Many surgeons don't do the DS, and some surgeons won't do any revisions at all, so don't waste your time with them.
It sounds like there may be something wrong with your sleeve, too, and the sleeve can be revised along with a DS, so don't let that stop you.

 

[hilary1617]

Hi and welcome Shannon Thecurlymanifestor ! I had DS at U of C with BCBS IL - it wasn't a revision, and there were a bunch of silly hoops that I had to go through prior to approval, but it was approved. I echo the above comments, but would add since VSG is half the way to DS, converting a VSG to RNY really doesn't make sense to me. Anyway I wish you the best on your journey!

 

[JackieOnLine]

Hello, Shannon, and welcome.

do you want to revise to a RNY or are you assuming that is your only option?

 

[Spiky Bugger]

So...the RnY and DS are very different surgeries. With the sleeve, you already have half of the DS. I'm curious as to why you would "abandon" the option to complete the DS (some patients have the DS in two parts...the first part is the part you've already done) and go for a really different procedure.

Were you aware of the option to "complete" the DS?

 

[Thecurlymanifestor]

So...the RnY and DS are very different surgeries. With the sleeve, you already have half of the DS. I'm curious as to why you would "abandon" the option to complete the DS (some patients have the DS in two parts...the first part is the part you've already done) and go for a really different procedure.

Were you aware of the option to "complete" the DS?

I have GERD and my surgeon recommended to help with GERD.

 

[southernlady]

I have GERD and my surgeon recommended to help with GERD.[/QUOTE
Even RNYers can get terrible GERD. That is not the long term cure they want it to be. The resolution rate is about 80% which means you could end up being in the 20% that doesn’t resolve or even gets worse. GERD is manageable with the right meds and eating habits.

Your Surgeon is recommending the RNY cause he doesn’t do a DS.

 

[Thecurlymanifestor]

My surgeon does in fact offer and perform DS. He gave me that as an option but reccomends RNY for my GERD. Lol

 

[Thecurlymanifestor]

Hello, Shannon, and welcome.

do you want to revise to a RNY or are you assuming that is your only option?

I want to revise to RNY.

 

[southernlady]

We haven’t seen a DS surgeon in Missouri. We’d love one there but the nearest one we know of is Bernstein at Tallgrass in Kansas.

Ask him several questions.
1) Does he use the Hess Method? (That will tell us right there, yes.)
2) If he doesn’t, how long does he make all the limbs and the common channel?
3) Who did he proctor with to learn the DS. My surgeon, Dr. Boyce, proctored with Dr. Dennis Smith and had no issues answering these questions.
4) How many has he done of the DS.

 

[southernlady]

My first surgeon gave me the same song and dance about my GERD, but I knew my GERD was nothing compared to my need then and even more so now to proper pain relief of NSAIDS. The kind of pain, Tylenol doesn’t touch. He said, well, you’ll just have to see a pain doc for opioids. I fired him. I got the DS. Yes, I still have GERD but use less of a PPI than I did preop. But I also can take NSAIDS daily for my osteoarthritis in my knees and hands and the Ankylosing spondylitis arthritis in my spine.

 

[JackieOnLine]

I want to revise to RNY.

I don't blame you if that's what your surgeon thinks is best. We just don't agree with him.

the DS veterans here know that many, many surgeons officially "offer" the DS but don't actually do it or don't do it often enough to be good at it. it takes a lot longer and, frankly, they make less money. Also, they can be badly misinformed about it!

I hope you can read some of the posts and at least consider your surgeon might not know what is best.

we want you to have successful weight loss and control of your GERD.

The DS has the best statistics of any bariatric surgery not just for percentage excess weight loss, but also for maintenance of that weight loss, which is crucial, and the best statistics for permanent resolution of almost all comorbidities. It is also much easier to live with than gastric bypass

quoting Larra for truth - the DS is a better surgery than the RYN

just like the VSG is a better surgery than gastric banding. I only found that out from reading people posting on the internet - not from my doctor!

did you notice this board doesn't have advertising? because nobody is here to make money. we are here to tell the truth about weight loss surgery.

 

[JackieOnLine]

for some reason I can't edit my post, so let me just say that I have a VSG, not the DS.
(keeping in mind it is the VSG is the first part of the DS)

but my doctor really thought I should get a lap band instead and I am so glad I didn't listen to her!

 

[Thecurlymanifestor]

We haven’t seen a DS surgeon in Missouri. We’d love one there but the nearest one we know of is Bernstein at Tallgrass in Kansas.

Ask him several questions.
1) Does he use the Hess Method? (That will tell us right there, yes.)
2) If he doesn’t, how long does he make all the limbs and the common channel?
3) Who did he proctor with to learn the DS. My surgeon, Dr. Boyce, proctored with Dr. Dennis Smith and had no issues answering these questions.
4) How many has he done of the DS.

Well that is interesting because my surgeon performed 2 of my family memebers Bariatric Surgery which were DS and they have had great success. He also specializes in revisions. His name is Dr. morales and he is based out of St. Louis.