VSG to RNY without bowel shortening

[RTL1234 99]

Hey all! I had a revision from VSG (2020) to a bypass without bowel reduction on 11/28. It’s been going fine, recovering is good and I’m tolerating food fine. However, since we did my revision for severe GERD and a large hernia, the surgeon told me that my bypass was minimal in terms of removal of bowel. Since I’ve basically maintained my weight loss since my sleeve, he did not want to create a situation where I would be malnourished so he did not remove bowel like a typical bypass. All that to say, I’m super hungry which is surprising since they did mess with my pouch, and I’ve lost a little weight which is fine too, but it’s like I cannot tell when I’m full.

I’m on soft foods, so not full solids yet but have been eating real meals basically (soft foods allows canned veggies and some fruits on my plan). With my sleeve I could easily tell when it’s time to stop. Now it’s like I could just keep going. I haven’t had any nausea or vomiting caused by over eating, and I’ve been measuring because I’m nervous but it’s like I’m still hungry.

I was hopeful leaving the bowel would help me not experience dumping as much (which I have no idea if that’s legit or I’m just telling myself that), but I’m also so worried about eating too much.

On a happy note - I have only ate tums once since my surgery, and I guess now won’t have to continue to keep tums in business anymore. LOL! That was the goal, so far so good, still on protonix but I’ll take it over misery any day!

[catwoman7 10,867]

They don't actually remove any bowel - they just bypass part of it - but the two parts meet up again about a foot from the stomach. He may have just made the "Y" shorter than usual - as in had the two parts meet up sooner.

I'm not a revision patient, so there are probably others on here who know more than I do, but you may not be feeling full because of nerves being cut during surgery. If so, they regenerate fairly quickly. Plus you're eating soft foods, also. I didn't really start feeling restriction until about a month out when I started eating solid food.

lastly, only about 30% of bypass patients dump. I never have - and know lots of others who don't, either. If you turn out to be a dumper, though, you can prevent it by not eating a lot of sugar or fat at one sitting (which we shouldn't be doing anyway...). I never worried about dumping (although at times I wish I DID dump since I have no problem eating tons of sugar at one sitting, unfortunately...)

[RTL1234 99]

Thanks for the explanation! Thats actually really helpful. To be honest, I was very much like ‘just help me get rid of GERD’ and the rest he took care of. I didn’t research much on bypass myself.

Thanks for the reassurance with the restriction, or lack there of. It’s such an odd thing being how easily I felt it before, and now nothing. Like you said, perhaps I just need more time and well, more solid food.

I am also very bubbly, such a weird statement, but I never really experienced that with my sleeve. I feel like almost gassy but not gassy. Not burping, not tooting, just bubbly.

[ChunkCat 675]

12 minutes ago, RTL1234 said:

I am also very bubbly, such a weird statement, but I never really experienced that with my sleeve. I feel like almost gassy but not gassy. Not burping, not tooting, just bubbly.

I had this post op. I'm 6 weeks out from a DS surgery which reroutes the small intestines as well as a sleeved tummy. I swear for about two weeks everything gurgled. It wasn't gas, I wasn't gassy, it was this literal gurgling, bubbling feeling in my tummy. Sometimes when I drank Water I'd hear this sound that was like water going down a drain pipe that was narrowed. I could feel water displace air. I suspect my stomach was so swollen inside I had this narrow tunnel for things to flow through and the Fluid would get backed up and slowly funnel down. LOL It gradually went away after a few weeks, but the sound effects and body sensations were really funny!

[RTL1234 99]

On 12/16/2023 at 23:51, ChunkCat said:

I had this post op. I'm 6 weeks out from a DS surgery which reroutes the small intestines as well as a sleeved tummy. I swear for about two weeks everything gurgled. It wasn't gas, I wasn't gassy, it was this literal gurgling, bubbling feeling in my tummy. Sometimes when I drank Water I'd hear this sound that was like Water going down a drain pipe that was narrowed. I could feel water displace air. I suspect my stomach was so swollen inside I had this narrow tunnel for things to flow through and the Fluid would get backed up and slowly funnel down. LOL It gradually went away after a few weeks, but the sound effects and body sensations were really funny!

Yes same! Such a weird feeling. I don’t remember having that experience with my sleeve. I’m just like bubbly. 😂😂🤷🏼‍♀️

[RickM 1,747]

The thing to watch out for when doing a minimally malabsorptive RNY is the prospect of bile reflux instead of the acid reflux that you had with the sleeve. When I was looking into this for a non WLS reason (it's has long been used for maladies such as gastroparesis and gastric cancer,) was that one of the most common problems reported on the patient sites such as Facebook was bile reflux. Talking to the surgeon about it, he said that as long as he keeps that roux limb at (IIRC) 80cm or more, it's not a problem; it seems that many surgeons going for minimal weight loss for such patients go overboard on shortening things. The extreme of this would be the "mini bypass" that attaches the pouch directly into the intestine without the roux limb, and that is well known for bile reflux (and why it was never adopted here in the US as a mainstream approved WLS.

However, there are also definitions and standards of care wrapped into the CPT codes that the docs use for billing, that define these things depending upon usage. I know this came up in one of the support groups with my wife's surgeon, and he noted that when he did the RNY, which he rarely did preferring the DS, he liked to make it as malabsorptive as the codes permitted. So there are standards that the surgeons are obliged to follow if it is to be a WLS procedure, and it doesn't seem to be a problem with most RNYs that we see as WLS, but could have been for what I was contemplating (but never proceeded with.) There's always an up side as well as a down side with anything we do.

[Arabesque 6,481]

I gurgle all the time with my sleeve. I say it’s my poltergeist cause it literally groans & moans & whines too. It’s just a noisy digestive system. My young nieces & nephew think it’s quite amusing, I’ve never been able to burp so I think that adds to mine.

And yes I agree not feeling your restriction is likely from your nerves being cut during your revision restricting messages getting through just like after your initial sleeve surgery. Remember to keep to your recommended portion sizes until your signals can get through to ensure you’re not accidentally impacting your healing & recovery.

All the best.

[Noemik 0]

i just had a revision from a sleeve to roux en y and yes i can hear everything. i also feel things moving through. Has anyone else had this experience?