Self Pay Revision from Sleeve to DS - Questions

[KirbHTX]

Hello All! I have been lurking for a few days now after finding this forum through a Facebook group (I think.)

I recently found out that my insurance (BCBS of TX) has a bariatric exclusion so I am now looking into affordable options. I was just about set on a revision to RNY with a Dr. in Mexico who has thousands of fans and happy patients but I had a couple of people warn me that RNY might not be a good option and encourage me to educate myself on DS instead. So here I am.

I have searched through the forums and read quite a bit on people who have revised from RNY to DS but not a whole lot who were sleevers that then completed the DS. Since budget is quite tight and I will likely have to save and borrow to make this happen, Mexico is looking really attractive. I see Dr. Esquerra seems to be the only one mentioned but again, most people I have seen went RNY to DS.

Here are a few questions I hope some of you might be able to answer or provide insight on:

1. Does anyone know the approximate cost of Sleeve to DS revision in Mexico? (I saw $11k in the forum but seems like that was for RNY to DS. I would imagine sleeve to DS being less since it is fairly simple operation but I could be wrong. I am certainly no doctor.)

2. Is the main reason people encourage DS over RNY as a revision due to the likelihood of regaining again? Or is there something else I am missing?

3. As a two-part DS revision, is it realistic of me to expect to lose 50-60lbs to reach my goal weight or is that a lofty goal? (32 / F / 5'2 / HW: 240 LW:165 CW: 195)

Thanks in advance everyone! Glad to be here and have this wealth of info for guidance!

 

[DianaCox]

1) Even if your insurance covered bariatric surgery, you would likely not qualify. You’re not morbidly obese. Do you have type 2 diabetes?

2) You’ve only gained back 30 lbs. What have you done to modify your diet?

3) The DS is the most powerful and effective surgery, but also has drawbacks with respect to lifelong, non-negotiable dietary/supplementation requirements. For 30-60 lbs without comorbidities, it’s extreme, I think. Especially if you have regained because you didn’t control your diet, or weren’t compliant.

 

[Susan in Tennessee]

If you have a sleeve already, I couldn’t understand going with RNY. You’re halfway to a DS already (if I am understanding your post correctly). I went to Mexico and had virgin DS with Dr. Esquerra and have been extremely happy. That was in June of 2016. I paid I seem to recall $10,500.00 so yes, the switch part only should be less, seems like at that time it was 7 thousand maybe. With passage of time I’m sure costs have gone up. I’ve heard Dr. Esquerra does not do the surgeries now but another Dr. who is very experienced, Ungston maybe. Others here will know better than me. I wish you the best. Please read everything here you can, ask questions and research well. If you email Nina who is the office person liaison she’ll be able to tell you costs.

 

[southernlady]

Welcome KirbHTX
Mexicali Bariatric....Dr. Ungson, Esquerra, and Wilhelmy all practice there.

 

[hilary1617]

Hi and welcome KirbHTX! I wouldn't recommend a RNY to anyone because I think the pyloric valve is important and dumping and regain are real probabilities. The only revisions I would recommend would be re-sleeving - if your sleeve has streatched out or is unusually large - or DS later on if your weight increases significantly despite dietary changes. As Diana pointed out DS is pretty extreme way to achieve a 50 pound loss, so you will want to think very carefully if you are willing to handle the lifetime requirements of vitamin and protein supplementation and testing in exchange for that loss.

 

[aaa]

Hello.

 

[KirbHTX]

Hi and welcome KirbHTX! I wouldn't recommend a RNY to anyone because I think the pyloric valve is important and dumping and regain are real probabilities. The only revisions I would recommend would be re-sleeving - if your sleeve has streatched out or is unusually large - or DS later on if your weight increases significantly despite dietary changes. As Diana pointed out DS is pretty extreme way to achieve a 50 pound loss, so you will want to think very carefully if you are willing to handle the lifetime requirements of vitamin and protein supplementation and testing in exchange for that loss.

Yes I think my first step needs to be checking to see if my sleeve has stretched or is too big. I feel like I can eat quite a lot more than a lot of people who also have the sleeve and also feel that my restriction even in the first year or two wasn't super severe. If that's the case then I agree it might be best to do a re-sleeve to reach my goal. I never had any issues with reflux so hopefully that wouldn't change.

 

[KirbHTX]

1) Even if your insurance covered bariatric surgery, you would likely not qualify. You’re not morbidly obese. Do you have type 2 diabetes?

2) You’ve only gained back 30 lbs. What have you done to modify your diet?

3) The DS is the most powerful and effective surgery, but also has drawbacks with respect to lifelong, non-negotiable dietary/supplementation requirements. For 30-60 lbs without comorbidities, it’s extreme, I think. Especially if you have regained because you didn’t control your diet, or weren’t compliant.

Yes someone else suggested a re-sleeve so I'll probably look into that first. The biggest factors in my regain have been a spinal injury that has halted my workouts. I was doing CrossFit and HIIT 2-4x per week before I hurt myself so the sudden halt in activity definitely contributed. Plus, I didn't compensate for the loss of working out by drastically reducing my calories so it snuck up on me for sure. I have gone back to the basics of sleeve eating but the scale won't budge and I just can't starve myself. I am hungry ALL the time it seems.

 

[southernlady]

Unless it is way too big or make incorrectly, I wouldn’t resleeve. Having a larger sleeve actually helps down the road getting in your protein. And most of us who have tiny sleeves wish they were larger.
Plus, sleeves are meant to stretch some after surgery.

Plus, I didn't compensate for the loss of working out by drastically reducing my calories so it snuck up on me for sure. I have gone back to the basics of sleeve eating but the scale won't budge and I just can't starve myself. I am hungry ALL the time it seems.

Okay, for a DS we do not count calories, count grams. How many grams of protein, fat, and carbs are you eating. JackieOnLine is a successful sleever. She doesn’t always see it that way but she is.

As for being hungry all the time, eat protein about every 2 hours. It will help keep you full.

 

[Georgepds]

Re "3. As a two-part DS revision, is it realistic of me to expect to lose 50-60lbs to reach my goal weight or is that a lofty goal? (32 / F / 5'2 / HW: 240 LW:165 CW: 195)"



I did it

Vsg may 2018 314 - 264 lbs 50 lbs lost
Ds may 2019 264 -174 lbs 90 lbs more lost

The two step surgery works, and at 6 years out, works just as well as the original ds+vsg. In my case I lost almost all my excess weight (96%)

I stalled at vsg only, and the comorbidites did not resolve. After revision, cholesterol, blood pressure, blood sugar and sleep apnea problems are gone.

There's a study on Keshisian's site that shows revision Vsg to DS works, and just as well as doing both together at the two year point. My experience is not unique

Cant find the figure I'm looking for, but here is a start

Duodenal Switch As A Revision Surgery - Duodenal Switch

Studies addressing Duodenal Switch as a revision surgery for other failed weight loss surgery procedures. Is biliopancreatic diversion with duodenal switch a solution for patients after laparoscopic gastric banding failure? Poyck et al. Sept 2011 PubMed Abstract BACKGROUND: Weight loss failure...

www.dsfacts.com

 

[Georgepds]

Found it

"They concluded that “Second-stage DS is an effective option for the management of suboptimal outcomes of SG, with an additional 41% excess weight loss and 35% remission rate for type 2 diabetes. At 3 years, the global outcomes of staged approach did not significantly differ from single-stage BPD-DS; however, longer-term outcomes are still needed.”

Sleeve Gastrectomy Failure - DSSurgery

There is a subset of patients for which Sleeve Gastrectomy will be inefficient/ineffective. Second-stage duodenal switch for sleeve gastrectomy failure"

www.dssurgery.com

 

[KirbHTX]

Hmmm... looks like it may not work so well if substantial weight gain has occurred after the vsg

I found this comment on another forum


" It is a little more subtle than that, as what you describe is more of a revision from an unsuccessful VSG rather than a preplanned staged DS. When discussing this with my surgeon - the prospect of a "plan B" revision if I didn't do well enough with the VSG alone - he explained that the two stage DS works best if you do the second stage before any substantial regain occurs (just like if it was planned that way.)...

Another factor of the "success" level is that the two stage DS is usually only done on the very high BMI patients, who are unlikely to see as high of an excess weight loss (with any procedure, including a single stage DS) as more "moderately" obese patients. A further wrinkle is that with a fully planned DS, the sleeved stomach is usually larger (typically a 56-60 Fr bougie rather than a 32-40 for a VSG) so that works better as a "team" with the malabsorption and has less chances of side effects such as severe GERD.)




"

Interesting. I have regained 30lbs since I had my sleeve 4 years ago so I wonder if it would be a good choice for me. I set up a consult for a couple of weeks from now so I will definitely be bringing these things up to the surgeon. Thank you for all the info !