Proximal vs distal

on 6/15/19 6:31 pm - tampa, FL

Hello everyone. Looking into a revision and I have a question. I heard my egd done and was told that my pouch wasn't long enough to do the duodenal switch so he would have to do the rny again. My question is has anyone ever been told that and what actual rny was done? What's the difference between the standard vs distal bypass? Getting kind of disappointed now with not knowing if i can do any revision at all.

on 6/16/19 6:40 am
RNY on 08/21/12

RNY to DS is a very difficult procedure, and there are only a handful of surgeons who can do them well. I'd bet money your doc is not one of them.

The length of your pouch has nothing to do with a DS, since the pouch is not used as-is. It involves first putting everything back the way it was originally. Then doing a sleeve, then the switch. That's what makes it so complicated.

I would never do a distal. It really doesn't do much for weight loss, and it creates a lot of bad side effects. Vitamin issues, gas issues, diarrhea, etc.

I would find out who can do a real DS revision and get a second opinion.

6'3" tall, male. Maintaining a loss of 280 pounds.

Highest weight was 475. Consult weight 04/12 was 411. RNY on 08/21/12 at 359 lbs. Current weight 195.

M1 -24; M2 -21; M3 -19; M4 -21; M5 -13; M6 -21; M7 -10; M8 -16; M9 -10; M10 -8; M11 -6; M12 -5.

on 6/16/19 7:47 am
RNY on 05/03/18

As supporting evidence (because I think this is extremely important) here is an article from the official journal of the american society of metabolic and bariatric surgery outlining the procedure used to preform a RNY to DS revision and it does involve first creating a sleeve with the remnant stomach and using that to complete the full DS procedure.

I would be exceptionally cautious using this surgeon for a revision, seeing as how he seems to be completely unaware of how a revision is even preformed. Please go for additional consultations.

25 years old - 5'5" tall - HW: 260 - SW: 255 - CW: 132.0

Pre Op - 5.0, M1 - 25.6, M2 - 15.6, M3 - 14.0, M4 - 13.4, M5 - 10.8, M6 - 13.8, M7 - 9.8, M8 - 7.8, M9 - 2.8, M10-2.4, M11-0, M12-7

Lower Body Lift with Dr. Carmina Cardenas - 5/3/19

on 6/17/19 3:05 pm - tampa, FL

Thx for this article. I thought about this when he told me he couldn't do with my rny pouch. So I'm going for a second and third opinion.

Citizen Kim
on 6/16/19 10:46 am - Castle Rock, CO

A distal has all the lifetime side effects of a DS, (vitamin malabsorption, diarrhea, gas, etc,) without any of the benefits. It's a horrible, lazy (on the surgeon's part) revision and I wouldn't touch it with a bargepole

Proud Feminist, Atheist, LGBT friend, and Democratic Socialist

on 6/16/19 4:34 pm

Take care about this revision.

The procedure is hard.

Think about the causes of regain and you can lost the weight. Your tool RNY is here!

English dont is my first language.

on 6/17/19 2:18 pm, edited 6/19/19 11:04 am - CA

As Grim noted, the RNY/DS revision basically reverses the RNY and then does a DS. It is a very complex procedure with only a handful of qualified surgeons around the country. The ones that have been doing them for a while that I know of are David Greenbaum in NJ, Mitchell Roslin in NYC, Michel Gagner up in Montreal, and Ara Keshishian and John Rabkin out in CA. The guys at Duke that authored the piece that Haley linked - Guerron and Sudan - I have heard of them in the DS world and Duke is reputed to have a good program, but I haven't heard any feedback on how they are on this revision, but they would certainly be worth a call as they are the closest to you.

That said, as with any revision, you should get some second opinions owing to the greater complexity of the surgery involved as well as the reasons for its need. As you will probably be travelling for this anyway, you should certainly talk to several as one may stand out to you in their understanding of your problem and their proposed approach to solving it. Most can do at least an initial consult by phone and email and are used to it owing to the rarity of their specialty.

As others have noted, the distal is not a well thought of procedure (IIRC, it is usually a tough sell to for insurance coverage) and mostly seems to be offered by surgeons who can't do the DS and don't want to refer a patient to one who does do it. As always, there will be some rare special cases where it may be the correct approach (there will still be a few cases where the lapband is appropriate!) - again, second opinions are the rule of the day.

1st support group/seminar - 8/03 (has it been that long?)  

Wife's DS - 5/05 w Dr. Robert Rabkin   VSG on 5/9/11 by Dr. John Rabkin


on 6/18/19 4:47 pm - tampa, FL

Thx for response. I know that this is my

Tool. Not long fir that easy way out