The DS is being dissed! Sic 'em!

This article points out the exact reason why a study such as this would never take place in the United States. It is MALPRACTICE plain and simple.

Let me preface my comments by stating I am a duodenal switch patient. I am also a board-certified physician (not a surgeon) and a major proponent of the duodenal switch.

There are major flaws with this study:

1. The length of the study is inadequate and leaves open-ended statement about not knowing what will happen over time. There are other studies in existence already that have results spanning 15+ years.

2. The participating surgeons admit they are inexperienced DS surgeons; therefore, intraoperative risks as well as postoperative complications are more likely for patients in the DS arm of the study.

3. The malabsorptions for DS vs RNY are completely different. The vitamin supplementation prescribed could have permanently harmed a DS patient because it violates standard of care. Since DS patients malabsorb 80% of the fat they consume, the risk of fat-soluble vitamin deficiencies (A-D-E-K) is substantial. Not only do the authors not supplement at the proper levels, but they do not indicate which form their vitamin supplements were dispensed. If those vitamins were dispensed in a oil base, then the patients were getting very little supplementation at all. Finally, any physician should check labs on bariatric patients frequently and adjust their supplements based upon those results. These patients were placed on an inadequate regimen to begin with and no such adjustments were made. Any permanent damage to patients in the DS arm as a result of this negligence should be grounds for a malpractice lawsuit.

4. The study clearly shows more weight loss with DS vs. RNY; furthermore, it shows more improvement in cardiovascular risk factors. It also clearly states that patients had equal quality of life regardless of procedure, yet it deemed DS inferior due to a short form that patients completed showing 1 out of 8 subjective symptoms ("bodily pain") appeared to be more improved in RNY patients.

5. The only reason malnutrition only showed up in the DS arm is the ignorance on the researchers' behalf in regards to supplementation needs to begin with.

Dr. Livingston is not a DS surgeon. His bias toward DS is understandable. Where are the viewpoints from a surgeon who does perform DS? There is no balance in this article and it is serves as a major disservice to the DS procedure.

DS is referred to as the platinum standard of weight loss surgery. I treat my obese patients naturally, medically, and am quick to refer for bariatric surgery when necessary.  I have nine patients in my own practice undergoing DS in August and September of this year alone. My decision to recommend DS is based on data collected since this procedure was first offered in the US in 1988.

DS cured my diabetes. My preoperative weight was 342 lbs and my present weight is 164 lbs. I am normal weight and take no prescription medications. My labs are perfect because my supplementation regimen is adjusted based upon my labs which are done on a scheduled basis. My diabetes was completely resolved within two weeks of my surgery even though I still weighed 330 lbs. This alone indicates that my diabetes was not obesity-related, but also based on metabolic and hormonal abnormalities as well that DS corrected. I am not slowly dying; on the contrary, I am living life to the fullest for the first time in a long time.

My diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea were killing me. I no longer suffer from any of those comorbid conditions. Conventional diet and exercise failed in my case. I did not "LET" myself go preoperatively out of choice. My obesity was not related to an eating disorder or an emotional disorder. There is more to obesity than overeating and there is more to weight loss than "eat less and exercise more". Type 2 diabetes is highly prevalent in my family (over 80% in my immediate family alone). I would be on an insulin pump by now with a dramatically decreased life expectancy if not for DS. Suggesting that DS no longer performed is the equivalent of signing an early death certificate for me.

This article should be retracted in its entirety. To suggest a procedure that provides a 99+% cure for type 2 diabetes be discontinued because of blatant physician negligence/incompetence in the referenced study is completely unfounded. DS should be making headline news for its scientifically-proven benefits.

Having DS is one of the best decisions I have ever made. I will continue to recommend it to my patients. I hope others will do their own research regarding this remarkable procedure rather than accept this article at face value.