RNY 21 years ago looking to revise

[Karen Dean 17]

I had my gastric bypass in 2000, I was one of the first to do it in the UK. 21 years later and some non weight related illness I have regained half of the weight I lost. I was 300lbs and went to 140lbs. It's only in the past 5 years the regain has really started. I am looking at having a minimizer ring fitted. Has anyone here done this? What was the outcome. Is it like day one after your original surgery? Any information would be greatfully received. Thanks x

[Sunnyway 345]

Hi Karen, I had RNY Gastric Bypass in 1990, which failed after 6 months. I had lost about 75 lbs when I stopped losing. I regained it over the next 7-8 years, returning to my high set point of around 315 lbs, where I stayed for over 20 years despite frequent diets. I did not know that a revision was possible until just before the pandemic hit.

My revision will include reducing the size of the pouch and anastomosis, separating the stomach (which was not done 30 years ago), and removing most of the fundus of the remnant stomach. The protocols and techniques have much improved over the years.

I've been in my bariatric clinic's program for 7 months and am scheduled for revision surgery on December 21. In the meantime I've been on a high protein/low carb liver reduction diet, cutting out all sugar, flour, rice, potatoes, and processed food. it's been very successful, but I'm going ahead with the revision because I'm still over 100 lbs overweight. I don't expect to achieve a "normal" BMI, but should get out of the morbid obese category. My surgeon thinks I can lose another 60 lbs. (I'm hoping for more.)

I had never heard of a "minimizer ring". but it looks sort of like a "lap band" technique which is rarely done in the US anymore. I don't think the minimizer ring is used by surgeons here. Have you had an EGD yet to determine the state of your pouch and anastomosis? That would determine if you are a candidate for that procedure.

[Karen Dean 17]

Hi Sunnyway

I shall watch with interest how you get on post op! I am just researching at the moment to see what my options are. I have been in touch with a surgeon who wants to do the tests you mentioned, which should tell me where I am and what can be done.

Thats so sad that your bypass failed and you had to wait so long to find a resolution to it. Mine was successful until I was diagnosed with Ehlers Danlos and then all the running I did and exercise just stopped. Depression hit and bam regain!! Like you I have tried many diets of the past few years and they work for around 21lbs and then nothing. Not sure if its because of the lack of movement or an altered digestive system. Who knows?! As we both know weight is a very complex and frustrating subject.

Good luck for the 21st, let me know how you get on.

[Guest]

Just curious; is nobody suggesting the mini gastric bypass (or other primarily malabsorptive procedures like BPD-DS, SADI-S etc.) for revisions? Results in scientific studies are very promising specifically on revisions.

Edited December 12, 2021 by Guest

[Karen Dean 17]

Not sure I can have another procedure I had a full open RNY, so I guess a mini bypass would not be a thing? As for the other surgeries you mention, never heard of them!

[Guest]

1 hour ago, Karen Dean said:

Not sure I can have another procedure I had a full open RNY, so I guess a mini bypass would not be a thing? As for the other surgeries you mention, never heard of them!

I'm definitely not qualified to know what's better for you, you and your surgeon are. I was just curious if malabsorptive procedures were even considered. I know the UK does a lot of mini bypass these days.

[Karen Dean 17]

I had a full gastric bypass which I think is the next level up from yours? So I think any further malabsorptive procedures would not be possible as the intestinal routing for a full bypass is more aggressive. But I will look into the other suggestions with my surgeon.

[Guest]

Just now, Karen Dean said:

I had a full gastric bypass which I think is the next level up from yours? So I think any further malabsorptive procedures would not be possible as the intestinal routing for a full bypass is more aggressive. But I will look into the other suggestions with my surgeon.

In terms of weight loss on average, the mini gastric bypass is more aggressive (the name comes from it involving less re-routing of the intestine; it's not a great name to be honest ).

Weight loss from primarily malabsorptive procedures seem more durable in the studies, too, which is why I wonder why they don't look into it more when it comes to revisions, specifically.

[Karen Dean 17]

Oh! I see! As my surgery was 21 years ago I am hoping that there is something that can be done. I have to have some tests to see what size my pouch and anastamosis is after all this time! I would say for sure it stretched, I can eat a normal sized meal on occasion two courses. But I know if I dont do something I will be back to 300 lbs in another 5-6 years.

[Guest]

Just now, Karen Dean said:

Oh! I see! As my surgery was 21 years ago I am hoping that there is something that can be done. I have to have some tests to see what size my pouch and anastamosis is after all this time! I would say for sure it stretched, I can eat a normal sized meal on occasion two courses. But I know if I dont do something I will be back to 300 lbs in another 5-6 years.

I honestly commend you for taking your health so seriously, and not just letting things get worse. I hope to be as honest with myself if/when I run into trouble at a later stage.

Definitely ask about your options, I guess. There's so much that has changed since you had yours, and all of it for the better for us patients. Let us know how it all goes, ok?

[Karen Dean 17]

Thank you. Oh, I think you will be, but hopefully you will be sensible and not have any issues!

I will be posting on here to learn, as you said so much has changed since I had mine, which hopefully there will be a solution for me. 👍

[Sunnyway 345]

9 hours ago, Karen Dean said:

I shall watch with interest how you get on post op!

I think it will be a piece of cake compared to my 1990 RNY. It was open surgery. I have a scar from below my sternum to my belly button. I was in ICU 2-3 days and in hospital for a week, then off work for another 4 weeks. I was given no nutritional advice or counseling. I saw the surgeon once before surgery, on the day of surgery, and two weeks later for him to check the stitches and remove the drain tubes (3 weeks of drain tubes!). In ICU I had a nasal gastric tube and IVs--nothing by mouth. On returning to a regular room I got Clear Liquids for a couple of days, pureed/soft for a couple of days and, get this: I was given solid food within 7 days of surgery. I was given a one-page low calorie diet and told "don't throw up".

No wonder I blamed myself for the failure of the procedure. For 30 years I assumed that I ruined the RNY because I had thrown up too often. It was not until I had an EGD that I learned that the staples dividing the pouch from the stomach gave way due to peristalsis of the stomach. My surgeon told me that around 75% of the bypasses done back then failed for this very reason. He specialized in bariatric revisions during his residency and 1/3 of his current surgery is for revisions. He's reassured me that the new laparoscopic incisions and robotic assisted protocols are far superior, that the possibility of staple failure and leaks are minimal and would be found quickly. Because of my age (73). I'll stay two nights in the hospital instead of the usual 1 night. I think I'll be in good hands and make a rapid recovery. I have every intention of driving to my 2-week follow up visit.

[Sunnyway 345]

10 hours ago, Karen Dean said:

I was diagnosed with Ehlers Danlos and then all the running I did and exercise just stopped.

If you have difficulty exercising due to Ehlers Danios, here is a mobility device that can get you back running again. I got one because bad knees and my weight prevented me from doing any serious walking. Another woman in my area has one too. Neither of us are actually disabled, just limited by pain. I can walk and run easily with no stress on my joints or back. We always draw a lot of curious attention wherever we ride.This past week my friend rode hers on the track at the local YMCA, and will use it to attend a dog show out of state. She is flying and will gate-check it.

I won't kid you, it is expensive ($2500 US) and there is a learning curve but it's worth both the expense and the effort. There are users who run races with it. There are also crowdfunding and rent-to-own programs.

It's called an Alinker, a three-wheeled walking bike. See alinker.com for videos and more information.