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Read the attached link. it states a lot of good info.

http://www.obesityhelp.com/forums/vsg/4497254/Why-VSG-and-on-Roux-en-Y/

You may want to look into and consider a DS as an alternative - The RNY will not help you reach and maintain your goal. You have a restrictive procedure right now - altering your intestines will provide a very temporary malabsorption component but after 18 mo-2years, you will be right back in the same spot with a restrictive only procedure - which...didn't work. The DS will give you much more permanent and powerful malabsorption to help you reach and maintain your weight loss. Just my opinion though.


Before you start cutting again though, I'd highly recommend that you go back over the last two years and be honest with yourself about why you didn't have adequate weight loss - if it was your food choices, a second surgery isn't going to help that. If you tried and did your best and still didn't reach your goal, a revision would be appropriate.

Good luck with your decision!

I agree with the DS option.  Go ask on the DS board and they will tell you everything you need to know.  There are some people that went from RNY to DS.  It would be much better to go with the DS since you already have the first part of the surgery.  Just make sure you go with one of the surgeons they recommend on the DS board.  This is a very complicated surgery and you want someone with experience.  The DS was my second choice for surgery if I couldn't have Sleeve because my insurance covered it and I really wanted my pyloric valve left in tact.  

 I had the sleeve so that I could revise to the DS if I needed to.  Another item in favor of the DS is that VSG evolved as a WLS from the DS.  DS is usually done in two steps; first the sleeve, then the intestinal portion.

You state that you haven't had adequate weight loss but post no stats.  I think acbbrown makes a good point - look at your plan, has it been to liberal?  Are there facets that you could revise to get where you need to be - i.e. a more restrictive calorie or food plan?

Like rhearob and acbbrown - I would first question your parth of the last two years.  If compliance has been an issue, than a revision may present you with more challenges and side effects than success - which would make your situation worse.

Why not tell us more about your story?  We have no metrics here.  What was your starting weight?  How much did you lose?  Did you regain?  What are you eating these days?  How are you exercising?  What lifestyle changes have you employed, etc.

While an VSG to RNY revision is possible, there are a number of things to consider -

Is there a problem with the sleeve itself? The sleeve is not standard and with the rapidly increasing popularity of the sleeve, there are lots of bariatric surgeons out there who are just getting their feet wet doing them, so your sleeve may not have been crafted as well as it could have been - if too much of the stretchy fundus near the top has been left behind, you could have more capacity and less restriction than you should.

The RNY, despite its intestinal rerouting, is still fundamentally a restrictive only procedure like the sleeve any malabsorptive effect on you caloric intake is temporary at best (though sadly, its mineral malabsorption is permanent.) The overall weightloss and regain character of the RNY is similar to the sleeve, so there are doubts as to whether a change between the two would help you much. Further, the RNY is something of a dead end on your WLS journey - revising it to something more effective like a DS is very difficult, with only a half dozen or so surgeons in North America genuinely qualified to do such procedures, and if your RNY was made from a sleeved stomach, that would complicate things further, if not make another revision to a DS impossible.

Revising to a DS is a logical step - the sleeve is the restrictive part of the DS to begin with, so such a revision is fairly straightforward, and some would consider it more of a completion of the DS than a revision, and most any of the qualified DS surgeons can do such a procedure. On average, the DS offers better weight loss than either the sleeve alone or the RNY, and is the only procedure that provides much of an improvement in regain resistance relative to the other WLS. Check the DS board here on OH and also check out dsfacts.com for more info and a list of well qualified DS surgeons.

Good luck in your research and further journeys,

The DS is not an option for me.  I am interested in Bypass.  My sleeve looks to be in tact, it just appears i need the malabsortion component to reach goal.