What made you pick RNY over DS?

[DianaCox]

The carpenter's maxim is equally applicable to bariatric surgery: THINK TWICE, CUT ONCE.

Read about what people who have had an RNY have to go through to get revised to a DS. It essentially NEVER goes the other way.

You can change you mind until the moment you go unconscious on the OR table.

 

[galaxygrrl]

Thanks everyone for your collective guidance. I really don't think RNY is a bad option for me, given my particular circumstance, but I did send a message to Dr. Ayoola of Denton, TX, advising them of my situation and preference for the DS surgery. So hopefully later this week I'll have a better idea of what my options are, if any.

Have you read about dumping with the RNY?

Dumping syndrome after gastric bypass surgery is when food gets “dumped” directly from your stomach pouch into your small intestine without being digested. ... Late dumping happens 1 to 3 hours after eating. Each has slightly different symptoms, such as abdominal cramping, fast heartbeat, lightheadedness, and diarrhea. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=134&ContentID=107

Between that and the data and long term impact is why I decided to get the DS

 

[Remingtonh]

My understanding is about 30% of RNY patients dump, and dumping can be controlled with proper diet and food choices. It's also considered a good reinforcement against eating fatty foods or foods high in refined sugars.

 

[DianaCox]

I prefer to ENJOY food for the rest of my life, and not ever be on a diet again. I don’t need or want to be punished for eating delicious food - especially high fat food which is the most delicious food. Butter, mayo, dressings, cheeses, fatty marbled meat, eggs, shellfish, avocados, bacon, whole milk products, all my vegetables drowned in real butter, sour cream, chicharrones, roasted bone marrow, etc.

And almost NOBODY is able to avoid foods they like long term, even with negative reinforcement. It didn’t work before your surgery, did it? Don’t buy the bullshit.

 

[Remingtonh]

lol. I too like all those things, and seriously, the idea of never being able to enjoy food again has made me consider aborting the surgery on a few occasions.

I see my surgeon next week on Wednesday. I'm going to take my laptop with me, open to this thread, and discuss some of the points made here. I'll be firm and direct with him that his practice of forcing pre-payment for a procedure that is clearly covered by my insurance is very unusual and see what happens.

Everything I can find online about him indicates he is a quality surgeon, trained at Yale, trains other doctors, etc. I can't wait to see him and see what he has to say.

 

[Remingtonh]

After doing some more research regarding code 43845, I came across some discussions that indicates there may be a difference in coding for the laparoscopic procedure. Also, this document concerns me: https://asmbs.org/app/uploads/2013/02/CPTandICD-9-Codes-for-Bariatric-Surgery-12.19.2014.pdf

It indicates that code 43845 is for "open procedures." Under "laparoscopic bypass procedures", it says to use code 43659 for Lap DS, Lap revisions Lap sleeve gastrectomy - Unlisted laparoscopy, stomach.

Unfortunately this seems to validate the surgeon's reasoning. Maybe it doesn't justify it, but if he's had issues in the past then I guess his concern is at least understandable.

 

[Larra]

Don't you think it's strange, though, that every other surgeon who does the DS doesn't share his "concerns" about the code?

No one here has said anything negative about his technical ability. It's all about you getting the operation you really want, the one that, without question, has the best results for percentage excess weight loss AND for maintaining that weight loss. Weight regain is a big problem with gastric bypass and sleeve. Yes, your surgeon (and every other surgeon who does these operations) can argue that if you stick to the post-op diet you should do well, but let's be realistic, that's a lifetime commitment to low calorie, low fat, low carb. If this were realistic, everyone with gastric bypass and/or sleeve would have great results, and we know that isn't the case. You need to be very honest with yourself about whether or not you can maintain this life long commitment. I couldn't. Can you?

And re: dumping, it has NEVER been shown to be a weight loss tool. It is only a nasty side effect that some people get with gastric bypass, exact percentage unknown. I've seen numbers from the 30% you quoted up to 70%, which just means we really don't know. And for some people it's fatty foods, for some it's carbs, for some it's unpredictable. No one should count on dumping to keep them on their permanent diet.

 

[Remingtonh]

So the insurance company BRS (bariatric resource services or something) nurse called this morning for a different issue, and I asked her about this. She said Lap DS is absolutely covered by my insurance and there is a code for it (unfortunately she didn't know it off the top of her head). Hopefully that will help in my conversation with the surgeon next week. I'm still conflicted on which surgery to get though (mostly about a concern for GERD). I don't see many DS revisions, but I see quite a few sleeve to RNY revisions because of reflux.

 

[Larra]

Interesting. My big concern was about losing down to a normal or near normal weight and keeping the weight off permanently. We have lots of good meds for GERD, nothing much to help you if your bariatric surgery doesn't provide the results you need.

 

[DianaCox]

A skilled surgeon should be able to (1) address whether you need to have a hiatal hernia repaired concomitantly with your sleeve, to address the GERD (not a guarantee that it will resolve the GERD - I had hiatal hernia repair and my GERD stayed the same - still under control with meds 15 years later, and not progressing); and (2) how to construct a sleeve that is good enough without being overly tight, especially since as I recall you are not SMO, so you're going to get the most benefit from the long-term malabsorption anyway.

The whole "RNY is better for GERD" mantra is rarely true, with the exception of when the sleeve is too tight. It doesn't need to be. I had a reasonable 3 oz sleeve, and 15 years later, I still have significant restriction, although I can eat quite a bit more at a meal that I could early out.

 

[southernlady]

The whole "RNY is better for GERD" mantra is rarely true, with the exception of when the sleeve is too tight. It doesn't need to be. I had a reasonable 3 oz sleeve, and 15 years later, I still have significant restriction, although I can eat quite a bit more at a meal that I could early out.

And I know, in person, RNYers who suffer from GERD now, when they didn’t have GERD before they had the RNY.

 

[k9ophile]

My understanding is about 30% of RNY patients dump, and dumping can be controlled with proper diet and food choices. It's also considered a good reinforcement against eating fatty foods or foods high in refined sugars.

I understand that not everyone dumps. On another site, a woman posted that the Jell-O was labeled as sugar free, was not. This happened in a hospital cafeteria, where that should NEVER happen. Of course it's your decision, but this is another factor just in case you're in that unfortunate 30%.

 

[galaxygrrl]

I still don't get your reasoning. The Data says people with the RNY might gain their weight back. You can eat a pretty normal diet with the DS. Those things are not true with a DS. I wanted one operation and be done with this problem. It worked. It works for everyone. RNY does not.

 

[Remingtonh]

I don't disagree that it seems DS is the better surgery, my surgeon said as much the last time I discussed this with him. I just wonder if you hear/read many more stories about people regaining with RNY, simply because there are *far* more RNY patients than DS patients. The body will adjust and regain it's ability over time to absorb nutrients with either surgery.

 

[hilary1617]

I don't disagree that it seems DS is the better surgery, my surgeon said as much the last time I discussed this with him. I just wonder if you hear/read many more stories about people regaining with RNY, simply because there are *far* more RNY patients than DS patients. The body will adjust and regain it's ability over time to absorb nutrients with either surgery.

I think, in large part, that the significantly better DS long term weight loss results are due to (1) reduced hunger from removal of excess stomach in DS, rather than retention of blind stomach that does not receive food, but still is active in hunger, hormone, and acid generation; and (2) the ability of DS'ers to eat real food in satisfying quantities - I think the pouch construct causes hungry RNY'ers to tend to consume high calorie liquids and "slider" foods to try to satiate the hunger.

Main deciding factors for me in DS over RNY were (a) I wanted to continue to use my pyloric valve; (b) I didn't want a blind stomach; (c) best long term results; (d) didn't want the risks or costs of second "revision" surgery i.e. cut once; (e) best resolution of comorbidities, particularly diabetes - I didn't want diabetes and had signals it was just a matter of time before I would have it; (f) no foreign bodies (lapband was a no go); (g) dieting never worked for me (sleeve was a no go) and (h) I wanted a normal life for both me and my family - which meant I wanted to be able to eat with them.

DS was the best decision for me. Make the best decision for you! All the best!