Revision of RNY

Question
I'm 15yrs post RNY surgery and lost all my weight and kept it off until 2009 when I began to start gaining again. I had 13 yr of BILE reflux, and was not addressed by several MDs who instead told me I had acid reflux and put me on a myriad of gastric acid reducers and blockers (gaviscon), all of which did little or nothing. I finally found a Gastroenterology MD who did an endoscopy and saw/took pix of the bile and diffuse gastritis of my stomach and esophagus to prove the bile was doing the irritation. I found a surgeon who moved my roux limb lower?? his description not mine, and since that surgery I have had NOT ONE SINGLE episode of any reflux. BUT, now I never feel full, and I now never get dumping from any food that I eat. I have not gained any further weight but can't seem to LOSE any either. I have kept a 6 month diary of what I eat/drink but think maybe the issue is in the gastro-jejunal stoma area. I know that a revision may be what is needed but wonder from you what my options would be to revise the GJ stoma? Also, my surgeon who was in VA has retired since 2007 and I am concerned that no other surgeon will want to take on the revision just because it was RNY (open). Any thoughts are welcome. I am now limited in my exercise routine to walking as I ruptured L1-L2 in 2010 and they tried to repair it...fair outcome, but does limit my recreation and exercise. I DO NOT want to regain another pound even. Thanks!

Answer
Holly,
Bariatric surgeons, including me, are coming to understand obesity as a metabolic lifetime disease that can be *controlled* for some time with the help of gastric bypass but not *cured.*  Thinking about the disease in this way leads to several conclusions:

1)  Many successful patients (but not all) will experience recurrence of the disease over time.  Sometimes there is a particular problem that marks the recurrence (such as your bile reflux), and sometimes it just sneaks back into activity imperceptibly.

2) Most of the time, when the obesity disease recurs it is not because the gastric bypass is "broken" in a way that can be repaired.  It is more common that that obesity disease comes back in spite of normal/intact gastric bypass anatomy.


Although I'm cautious about the potential for benefits of surgical or endoscopic revision, you do deserve a good evaluation by an experienced bariatric surgeon.  It was once true that bariatric surgeons were resistant to seeing patients who had surgery done by someone else, but this is becoming less of a problem with each passing year.  I recommend that you talk to your primary doc and get a recommendation to see an experienced bariatric surgeon in your area.  You will likely receive a good thorough evaluation of your existing anatomy, an opinion about whether there is any benefit likely from additional surgery, and also assistance on bringing your metabolism back into a more healthy balance.

Best of luck!
Dr JP

1. Prev:Lying down for surgery
2. Next:Reversal of lap band procedure