Looking to go from sleeve to either bypass or DS

[Megxelizabeth91 2]

I got the sleeve in 2011 and I lost about 100 lbs after.. since then I have gained about 60 back. I had a many complications with the surgery and had my staples pop and had to have follow up surgeries. Since then I have found an amazing doctor who I trust and he spoke to me about a revision surgery for weightloss. He recommended the DS but apparently their was not a surgery code to bill it yet * this was last January 2020 * . He then recommended the bypass. I agreed and started everything with hopes of getting the surgery by June 2020 before he retired. Due to covid my surgery got pushed indefinitely and he retired. In august when they started to do elective surgeries again a Doctor from his group reached and said that my original doctor asked this new Dr. to take me on as a patient moving forward with the surgery. I had decided that I did not know him that well and would not proceed at that time. Well I am still struggling with weight loss. A huge amount it is effecting my daily life I work in trauma and psych in the hospital and I am in nursing school and having issues keeping up due to my energy and weight. I have recently made the decision to continue with the pre op tests and get my chest xray and labwork redone to see if I can fast forward this surgery and get it by end of march beginning of april. I was just wondering for people who have had the revision surgery --- sleeve to bypass or sleeve to ds - how it ended up for them. I doubt I will be able to get the DS even though that is what I want due to the insurance issues so bypass is the way it looks. Also recovering times and everything else please. I am doing this one solo only 1-2 friends will know I am having the revision due to so much stress and people giving me their opinions about the situation the first time I do not feel like dealing with again.

[RickM 1,747]

For treating a regain problem, I prefer the DS as it is stronger metabolically than either the VSG or RNY - the RNY is too close to the VSG in strength to reliably offer a significant improvement in weight loss, from what I have seen over the years. Figure maybe 20lb loss on average - about what one would expect from going through all the intense dieting associated with going through surgery again. (There are some who do significantly better, bit it seems to be more a function of their determination to "make this work" or "not screw it up again" than the actual surgery itself. Call it something like a surgical placebo, lol.)

By your surgeons not finding the codes for the DS implies that they are talking about the newer SIPS/SADI/"loop DS" which is a single anastomosis adaptation of the traditional BPD/DS (biliopancreatic diversion) which has been routinely covered by US insurance and Medicare for the past 14-15 years, but is a more complex procedure that relatively few bariatric surgeons perform. Some practices that do the SIPS/SADI use the BPD/DS billing codes which is technically insurance fraud, but if they're comfortable doing it, that's their concern.

Revising the VSG to a DS, of either flavor, is straightforward as each use the VSG as its basis (some don't even consider it a revision, more a "completion" of the ultimate configuration.) The strong point of the BPD/DS is its regain resistance - regain is possible as it is with any of these procedures, but it is harder. I know many with the DS who are 10-20 years out (my wife included) who are still maintaining a healthy weight; some are up a bit more and working on losing their "Covid 19" - just like "normal" people but major regains are relatively uncommon. The SIPS/SADI type of DS seems to fall somewhere in between the VSG/RNY and the BPD/DS - I have seen a few in the various forums who have had it and seem to be doing well with it, but it doesn't have as long a history.

Any of these procedures - the RNY, DS or SIPS - will be somewhat fussier and less care-free than your VSG when it comes to supplements and follow up; the RNY is maybe a bit less so, but one can get into some serious trouble with any of them if one slacks off. If keeping up with supplements and annual labs is not an issue with you, then any of them should be fine.

[aug62012 27]

I am going from sleeve to gastric on 2/8. Had sleeve in 2012 and am a bit nervous for Monday.