Biliopancreatic-DS and Distal

Hello, to make a long story short, I had the RNY in 2009 and currently in the process of getting approval for revision. I'm hoping for the Biliopancreatic, but the doctor was talking about the distal bypass. I've read so much my head is spinning. Can anyone in "dummy' terms tell me the difference. I also have hypertension and Type II Diabetes. Thanks in advance for any kind of simplicity!!

Very simple. These are 2 completely different operations. Distal bypass keeps everything the same as what you have now except more of the small intestine is bypassed. Going from failed proximal bypass (what you have now) to distal bypass has not been shown to provide much additional weight loss UNLESS you go to ERNY, with the E standing for extended, which bypasses even more of the small intestine. This creates what many of us believe to be the worst of both worlds, where you keep all the disadvantages of your gastric bypass - can't take NSAIDs, possible dumping, malabsorption of certain vitamins - and add to that the increased malabsorption of vitamins of the DS. Some people do make this work, others get into trouble.

The DS is completely different. For a surgeon (not the one you are consulting who has probably never done a DS and that's why he's suggesting distal bypass) to revise you to the DS, he would first completely reverse your entire gastric bypass back to the normal anatomy and THEN create the sleeve stomach that is part of the DS (not the pouch you presently have) and then do the "switch" part that bypasses roughly half of your small intestine. The advantages is that this restores normal stomach function with use of the pyloric valve, ability to take NSAIDs safely, dumping rare or nonexistent, much improved weight loss, best resolution of any bariatric surgery of most comorbidities, including type 2 diabetes and hypertension. The disadvantage - and it's significant - is that it's a complex and challenging operation to revise from RNY to DS with few surgeons do, with higher risk than distal bypass would be.

I would suggest that you contact one of the few DS surgeons who does this operation for another opinion. Depending on where you are you may have to travel but at least initial contact can be done with email. Then you can sort out what option seems best for you.

Larra