RnY revision to DS in Northern KY

[RiaMaleah 0]

Hello,

I am trying to find a DS surgeon here in northern KY who can perform my surgery. The doctors I have found so far do the RnY but not the DS. Does anybody have any suggestion? Thanks.

[pintsizedmallrat 472]

I'm not sure how "northern" in Kentucky you are, but right across the river in Cincinnati there are many options. I had my procedure at JourneyLite in Evendale, OH...I'm not sure if they offer a VSG to DS revision, but you could call and ask. I felt very well taken care of by them.

[RiaMaleah 0]

Thank you for your response. I will definitely call them. I am from Walton KY. I went to St. Elizabeth to have the procedure done. It's only been 2 years since I had the procedure. I was thinking about going to Tijuana Mexico but if I can have it done here then it is best. I just don't know if my insurance would cover it. The covered the gastric bypass the first time.

[pintsizedmallrat 472]

12 minutes ago, RiaMaleah said:

Thank you for your response. I will definitely call them. I am from Walton KY. I went to St. Elizabeth to have the procedure done. It's only been 2 years since I had the procedure. I was thinking about going to Tijuana Mexico but if I can have it done here then it is best. I just don't know if my insurance would cover it. The covered the gastric bypass the first time.

A good clinic should be able to help you navigate insurance and their requirements.

[JanetSS 0]

I was also going to suggest JourneyLite Surgeons in Cincy.

I just had a sleeve done there. I live in Columbus and had to go to their surgery center in Cincy for outpatient surgery. If the DS is outpatient, they require anyone who lives over 60 minutes away to spend the night in a hotle (they pay for it). I didn't love throwing up in a hotel! Just an FYI.

[pintsizedmallrat 472]

2 hours ago, JanetSS said:

I was also going to suggest JourneyLite Surgeons in Cincy.

I just had a sleeve done there. I live in Columbus and had to go to their surgery center in Cincy for outpatient surgery. If the DS is outpatient, they require anyone who lives over 60 minutes away to spend the night in a hotle (they pay for it). I didn't love throwing up in a hotel! Just an FYI.

Hotel is better than the side of the road! I was also an out of town patient (I live in Huntington, WV) and that drive home through those hills was a little dicey at times let me tell you!

[RickM 1,747]

The DS as a virgin procedure is more challenging to perform than a VSG or RNY, which is why relatively few bariatric surgeons offer it, despite its' demonstrably better performance (the RNY is "good enough" for most patients...) That's your first challenge - finding a reliable DS surgeon. Converting a VSG to a DS is straightforward for any DS surgeon, as the DS uses the VSG as its basis, so it's mainly a matter of adding the "switch" part - the malabsorptive part - to the VSG. Revising an RNY to a DS is another, much more complicated matter, and surgeons who can do that are few and far between. It used to be, a few years ago, that there was maybe a half dozen surgeons in the US that reliably did them, and I have seen references to a few more have joined the ranks in recent years. Rabkin and Keshishian in CA have both done them for many years, as has Roslin in NYC. I've heard that someone in Salt Lake has done some, along with some docs at Duke University in NC, possibly Kemmeter in MI.

Some surgeons who don't do the DS will offer to revise to a distal RNY instead - that is a "long limb" RNY that has malabsorption more akin to the DS. However, it does not have a great reputation, and is usually not approved by US insurance as a primary procedure (but often will as a revision under the right circumstances.) My take on why it seems to be more problematic than the DS is that it is rarely done, and the surgeons and their practices aren't all that in tune with its' long term requirements. A DS, and by association the distal RNY, has a quite different nutritional and supplement requirement to the standard proximal RNY, which is well known to those in the DS world, but not all that well appreciated by those in the RNY world. Like with the RNY, and much more important with the DS, is to commit to having annual labs and follow ups for life - with the altered absorption and nutrition/supplement requirements, things can go askew in sometimes if you don't stay on top of them. Those who do stay on top of things typically have minimal long term problems.

I would not go to MX for a procedure like this, as you really don't know what you will end up with. Historically, there has only been one reliable DS surgeon in MX - Gilberto Ungston - who, if not retired, is heading that way. He has trained a couple of others to do the DS, but I haven't heard of him doing the RNY to DS revision. There are, of course, the various horror stories of MX surgeries gone wrong, and in particular of those seeking a DS and getting "something else" (who knows what.) There are great, reputable surgeons down there for the VSG and RNY, but I wouldn't go there for something more complicated like a DS, unless it was someone well vetted in that procedure (such as Ungston,) - the differing legal systems leave one with no recourse is something doesn't go right (and the chances of that happening with something as complex and an RNY/DS revision are high there.)

Good luck - it is a long search for what you need, and be prepared to travel. Being in CA myself, and my wife is a Rabkin DS, we have seen several successful revisions like this from both Rabkin and Keshishian, so it is viable when done by someone experienced with it. It, also, is not a simple outpatient procedure, and Rabkin's standard practice for travelling patients is to remain in town until at least the 10 day post op follow up. Most everything else can be done remotely (and they are set up for doing so.) Keshishian is similar in this regard.