might have to have a RNY stomach?

Question for those in the know.... I had another consult today with my surgeon -- he wanted to review my last surgeon's notes from when the band had to be removed to see what exactly happened. He had mentioned this in my first consult, but re-iterated that my risk is higher than a normal patient (because I am a revision technically although the band is gone).  He feels that I may have too much scar tissue up where the band was (and eroded) that he might not be able to give me a DS stomach and might have to take the pyloric valve (thus really creating a RNY stomach).  He said the risk is small, but that he will feel freedom to do whatever he has to in order to give me a safe surgery. Ok...safe is good. I like safe. Why would this really be though?  Let's say there was scar tissue at the top of my stomach, why not just leave more stomach up there, but still do the banana shape that leaves my pyloric valve intact?  Then the stomach would look like an upside down pear (bigger at top where the esophogus is), but ending with my pyloric valve? Color me confused. Also color me happy - I got a date -- March 10th.

congrats on the date!

Did your doctor present this as a real possibility, or simply conjecture? I dont see how having a band would effect the phyloric valve, if anything it would seem a RNY stomach would have a higher risk of complications.

I know someone on the VSg board had her band removed, and the surgeon was unable to do the VSg due to the stomach being thin and with scars. But, he said to let it heal and he will be able to do the VSG in a few months.

He said it was just a possibility and no way to know until he got in there.  Small possibility, but he wanted to tell me up front. A 2 stage process won't work for me -- I am self-pay, but that'd be $30K twice. Ain't happening! jayme

How long ago was your band removed? It should be healed by now

Removed 20 months ago.  But here's what he said: When they removed the band, there were small holes in the stomach (because of the erosion)...so they take fat (some fancy o word was used) and that patches the holes.  Works great he says.  He also said that part of my DS surgery will be to remove that fat patch partly because the liver is so attached to the stomach that's already a weakening of the stomach muscles. Jayme

Hmmm... I really don't know how to answer your question.  BUT!  I do want to say this.  From what I have read on these boards, Dr. Anthone is one of the best and I don't think he would lead you astray.  I'm sure that giving you the VSG is really not going to be a problem, but he needs to know before you're under anesthesia how you feel about alternatives.  Lyndia was a revision from a VBGB and she ended up with a DS stomach with a dual chamber.  Our surgeon never got a chance to confer with Lyndia about what to do b/c she was already on the table.  Lyndia's surgery was Oct. 3rd and she has still not healed from the complications with a leak and an abscess in her stomach.  I'm not blaming the surgeon, just that the surgeon didn't have really any other choice than to give Lyndia the BPD/DS that she had requested.  I DON"T know how this would've turned out for Lyndia had they spoken about these issues up front, but it sounds like your surgeon wants options while he's faced with a decision on the operating table. I'll be interested to see what others say.  I wish I had more for you!

I'd still have the DS intestines, just more of a RNY stomach. I think he's being overly cautious in case it has to happen, then I don't wake up freaked out when he tells me.

He still thinks he'll be able to give me a DS stomach and keep the pyloric valve.  But, like a good boyscout: always be prepared. jayme

Technically, you've already had 2 surgeries (which puts you in a similar category as me).  Dr Antone told me the same thing, and it wasn't an option I was willing to live with.  Dr Baltasar pretty much told me straight out, an RnY stomach, and my surgeon (Dr Buckwald) just wouldn't go near my stomach at all.  I did have an additional issue, in that my VBG band was made of Marlex, which is hard to remove and causes plenty of issues with scar tissue.  Anyway . . . the more times they mess with your stomach, the more 'thin skinned' it gets?  He said it gets like wet tissue paper and can so easily tear.  The reason they have issues with doing the sleeve is because scar tissue acts like cement/glue and plasters your liver to your stomach. In order to do the VSG stomach, they have to remove the liver from the stomach to cut the stomach - it's like trying to unglue an envelope, and the 'tissue paper' stomach can rip too easy.  Soooo, staying away from the top part of the stomach is the goal (if there is evidence that it's a problem), so sometimes the RnY stomach is the only option. What the odds are in a lapband to DS revision, or in your particular case - sorry, can't help ya there.  But I hope I explained why the issue is the issue!

Yeah, he did...but you explained it better.   Sigh... jayme

I'm with Michelle on this one-- I have an RNY gut and longer bypass, and I can eat literally anything, in smaller amounts. You can't count on that, but it's not necessarily as damning as you might think: for many of us the pyloric valve is kind of a non-issue. (I think the fancy word for fat you're thinking of is "omental fat".)