Question about revision

on 10/7/11 5:45 am - Shore Area, NJ
from what i've read revisions for RNY lose slower than virgin DS? I have about 150lbs to lose.
Dr Roslin has accepted me as a patient and I am going through the process..however I have some major concerns...a close friend of mine had the DS revision and because it was done lap they did not see that her pervious RNY had cut the atery (sp?) to her stomach...leading to complications after her DS revision, her entire stomach had to be removed due to blood and oxygen lose. this was not seen because of being done lap, it is very rare and I know that I will have additional testing to make sure this does not occur with me.
However for those of you who have had a revision from RNY to DS had the weightloss been enough to justify the risk?

Thank you for all of your responses...the goood..the bad..and the ugly..
I have a 2 year old son and I really need to make the best decision..not only for me but for my family!
on 10/7/11 6:05 am
Revision on 06/21/13
I am a revision, and did not  have any complications. My revision doc was Dr Maguire (he does open revisions only). I think you should share you concerns with Dr Roslin. He has an excellent reputation. His patients do very well from what I have read.  I am not sure if he does lap or open. Who was your friends doc ? A lot of unknowns here.

I am thrilled that I have so far lost about 50 pounds from my revision. Yes it's been slow, but it is still coming off slowly. My job is rather sedentary which does not help as I sit on my arse too much most of the day. There are many times I wish I had a more position.

While I have not YET hit goal, I have not had any regain since the revision. I will take every pound I can get rid of !

Good luck !

 Revision #2 Dr John Rabkin June 21, 2013; First Revision DS - Dr Maguire
  5-18-09; First DS 7-15-2003 Dr Clark Warden = Third time is the charm   



on 10/7/11 6:18 am
I had an RNY to DS revision in August of 09. I had a lot of complications that were eventually solved 18 months later by another large operation. I lost another 2/3rds of my stomach and my pylours. Though I had all sorts of problems and it sucked when I was in the midst of it all....I'd do it again, but not tomorrow () and that is a HUGE thing to say.  Below is my story.

Welcome and congratulations on your jouney from RNY to DS. I've copied and pasted my story below. It's good and bad and ugly at times and went on for 18 months. It's important that you count all costs, and not just financial, before you head out on your journey. None of this may happen to you, but it could. Just use it to educate yourself.

I have been asked a lot why I decided to revise from RNY to DS. Truthfully, it was because I was gaining weight. When I had my RNY in 1999 I weighed in at 430 pounds. 
I really didn't see any possibility of losing 300 pounds or even less than that. RNY was considered "the GOLD standard" and though I had heard about the Duodenal Switch when I asked my surgeon about it his reply was "well, it's just like a distal (now called an eRNY) gastric bypass.  I trusted my surgeon and so I didn't do due diligence and I didn't research it like I had researched RNY. I just went with the RNY. So  I lost 220 pounds and got to 210 and never lost more weight. My weight just stopped and that was it and where I maintained for about four years after which I started gaining weight and from years 4 to 10 I ended up gaining 92 pounds. To put that in perspective I gained about 48% of the weight that I lost.  One thing that the doctor didn't tell me was that Severely Morbidly Obese people gain more like 40-50% of their excess weight loss weight back starting around the forth/fifth year post op. Actually, I was told that I might gain 10-20%. What a lie.  Anyway, I wasn't happy with myself and I hated that no matter how much I dieted I still continued to gain weight. In addition to weight gain I really wanted to not dump, which I did frequently.

Me at 430 and then at 210

The following is from my own RNY to DS revision experience. It's long and it might scare you, but use this information to educate yourself in what can happen. It doesn't mean it will, but it just might.  You need to count the cost of what could happen to you. I think that many people who want revisions walk around thinking that a revision is a walk in the park and for some it can be, but for many it isn't.  Twenty five to thirty five percent of RNY to DS revisions suffer from gastric leaks. That is one in three or one in four people. Revisions are risky and require a skilled and vetted surgeon to perform them.

On August 10th, 2009 (Monday)  I underwent revision surgery from an RNY to a DS. There were issues immediately after my surgery. My heart rate was out of control and for some reason my normally low blood pressure was in outer space. I was heavily drugged on pain medication and placed in the critical care unit following my surgery. I was given medication by a cardiology specialist which after a day did bring down my BP and heart rate to more normal levels.  My husband brought up to the CCU nurse that my heart rate and BP seemed high. Though nurses had been in and out of the room no one was checking my vitals. I think were it not for my husband checking my vitals I might have had cardiac arrest.  After my heart rate and BP were normalized I was sent for an upper GI the next day. I repeatedly failed the GI. The gastrograffin contrast did not exit into my stomach, but rather remained in my esophagus. The next day my bariatric surgeon, Dr. Greenbaum came to visit to me to tell me that I needed to have another operation.  I knew something was wrong because I was throwing up old blood, saliva, and the gastrografin contrast. Basically, the contrast nor anything else would go down into my stomach and would remain only in my esophagus I was told and that there was an area in my stomach that had been necessarily over sewn because it was a weak spot along the old RNY staple-line. That area got very swollen and as a result the contrast from the upper GI was not going into my stomach, but rather backing up into my esophagus. The next day (Wednesday) I had a second operation. Sutures were released and my pylorus, which seemed not to be working had to be stretched. I was returned to CCU and in the end I spent 9 days there. I was moved to a regular room on a Wednesday and was to be discharged 2 days later on that Friday, but my incision got red and hot and started leaking sero-sanquenous fluid and had to be opened in two places even though I had two JP drains. My incision was packed daily and dressed. Due to the draining of my incision I was not allowed to leave the hospital until the following Wednesday making my first stay at the hospital 17 days. I came home with a PICC line, a J-tube and home health care nurses to assist with the enteral feedings and thrice daily IV antibiotics as well as dressing changes. I was not allowed to eat anything (NPO), and only allowed small amounts of water and or ice. I was not allowed to eat and allowed only small amounts of ice and water. I had been NPO the entire 17 days I was in the hospital and would continue to be NPO for a total of 55 days. The days that followed my return home the arm I had the Picc line in started to hurt like hell and by Sunday night (home only 4 days)  my temperature went up to 102.6. We knew that something bad was going on so I called Dr. Greenbaum's office. His answering service connected me directly with him. He told me to pack a bag and get back to the hospital. It turned out I had a subclavian blood clot (a DVT) caused by the PICC line. The PICC Line was also superficially infected and was removed, but because I needed IV antibiotics at home I had to have another one put in my other (left) arm. I was put on Warfarin and Lovonox while in the hospital. I spent another week in the hospital and was discharged. I came home on Warfarin and again started to settle in. In total I was on blood thinners for 3 months. Four days after I got home I got a visit from the visiting nurse so she could packed and dress my wound. I went to bed later that evening my husband came up a few hours later to hook up my enteral feeding (I had a J-tube) to discover that my night shirt was soaked. He took the dressing off of my incision and discovered white viscous ick (gastric stuff) everywhere.When I raised my head to look ick would come bubbling out of a hole in my incision. Once again I called the doctor the next morning and back to the hospital I went. I ended up getting a gastric leak in the area that had been previously swollen and operated on previously. This in turn caused a fistula which was draining out of the open incision. I spent another week in the hospital again. I came home with a Wound Vacuum pump. Total time in the hospital over Aug. and September was about 27 days.

For 60 days I wore the wound vac pump while it sucked out ick from my stomach and helped close my incision. In mid October the J-tube was  removed and I was put on full liquids. The PICC line was removed at the beginning of October. I had been moved from being NPO except water to clear liquids to full liquids to actually eating. Unfortunately when I did eat anything that wasn't pudding or yogurt consistency I threw up. From October to April 10 I was moved back and forth from full liquids to soft foods. I had a lot of food intolerance. Most meats were impossible for me to eat. Most of my protein came from cottage cheese, Greek yogurt, and protein drinks. 

For a total of 17 months I dealt with the now chronic gastric leak and fistula. In the end I had internal and external fistulas (5 in all). In April I was put on TPN (IV nutrition) and made to go NPO once again. This was only supposed to be for a couple of week, however, it it's turned into 6 plus months.  In June I got sepsis from the tunneled PICC which was in my jugular vein and being used to infuse the TPN. That PICC was removed and a Groshong cath was inserted into my subcavian vein just above my left breast and was there from June to December. In September I underwent a Enterocutaneous Gastric plug procedure. The plug was supposed to plug up the fistula and the gastric leak, however, it the procedure failed and didn't work for me. Frankly, at this point and knowing what I know, the plug never had a chance since I had so many internal fistulas. In October I went back to the GI surgeon who I had been referred to by Dr. Greenbaum. He said that surgery was the next step, but told me that I potentially could come out of the surgery without a stomach. Even though the potential outcome could mean a total gastrectomy I decided to have surgery.  December 15th, 2010 I underwent another surgery to excise out the gastric leak. While the surgeon was inside of me he discovered three additional blind fistulas. One that went from my stomach to my colon, which had to be repaired as well. The other two were tributary fistulas and were causing internal abscesses which had to be cut out. I had two external fistulas (fistulas that went from my stomach to the outside of my body) that were cut out as well. I ended up having a lot of strictures around the lower portion of my stomach that was causing poor blood flow to my lower stomach. I had a stricture around my pyloric valve that was so tight that the tip of a pen could not have penetrated it. This was why I was throwing everything up that wasn't pudding consistency. In the end I lost another 1/3 of my stomach. I sadly lost my pyloric valve and had to go back to having a pouch. Some of my intestine had to be cut out however, my intestines are still a DS configuration.

As a revision I am an anomaly, but you should know that sometimes things do not always go the way we think they will.  You must count the cost of having a revision. It bears repeating; think twice, cut once.

So, in the end I have lost (this time) 145 pounds so far. I'm close to being at my goal of 150 and close to being at my surgeons goal of 140 pounds. 

Me at 302 on the right and now around 160.

I'm able to eat now and rarely throw up anymore. I have no more medical appliances in my body. It's been a long year and a half and there were times when I wondered if I was going to make it to the next day, however, I'm finally at a place where I am enjoying my DS. 



                   HW (pre RNY) 430 HW (pre DS) 302 / SW 288 /
                          Lowest weight 157 / CW 161
GW 150
                "I'm just one stomach flu away from my goal weight"
on 10/7/11 7:19 am - OKC, OK
Revision on 12/15/10 with
Welcome. I had a RNY to DS revision last December with Dr. Keshishian. He only does revisions open and I wanted him to be able to see what he was doing. I have had no significant complications and, yes, my weight loss has been very slow.

Would I do it again, YES because I no longer have diabetes, hypertension, and reactive hypoglycemia. I feel better than I have I years and have regained my life. I am currently right about where my weight loss Stopped with my RNY and I'm hoping to go lower.

Good luck with your journey.
SW  257    CW  169  GW  165
Shavonne P.
on 10/7/11 8:25 am
I am 4 months post op RNY to DS revision with Roslin.  Like  the previous poster said he has a great reputation.  Just talk to him about your concerns.  I had no major complications.  Only issue I really had was at 3 weeks post op I had reflux so bad I couldn't really drink at all for almost a week - thankfully I didn't get dehydrated.

I am down 66 lbs in 4 months - which I think is pretty good for a revision. *knock on wood*
Nothing feels better than being able to go into ANY store and fit their clothes!
Jennifer D.
on 10/7/11 10:13 am
I had a conversion from RNY to DS this past August. I believe I am losing slower than a virgin DSer but I am definitely losing. My conversion was done laproscopically by Dr. Gagner in Montreal on A Wednesday. I was discharged Friday, travelled home Saturday and was back at work Monday. Everyone's experience varies.
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