Comparison of DS and rny - good info if you're trying to decide...
DS - stomach cut up and down like a bananna
rny- stomach cut horizontal size of an egg
DS- can eat a normal sized meal post op. Initially your sleeve will be swolen, but it will stretch to be able to eat bigger portions. Keep in mind a NORMAL meal is not 3 fill-up trips to the Chinese buffet. Normal means 3-4 oz meat, a veggie, and a starch. This is what we should have eaten in the 1st place so we wouldn't have gotten so fat.
rny- will eat tiny portions post op, a few oz
DS- unused portion of stomach removed from your body and disposed of.
rny- unused portion of stomach stapled off, but left in - can get ulcers, cancer, etc in the remaining "blind stomach" and not know because it's just hanging in there.
DS- no dumping syndrome. I eat sugar, in moderation (may cause gas in some people, but I have a good tolerence)
rny- if you eat anything high sugar you likely will dump, and it is a miserable feeling the way it's described
DS- very malabsorbtive- have to take vitamins for the rest of your life
rny- malabsorbtive, but not as much, still have to take vitamins for the rest of your life
DS- need to eat 90-100 grams of protein every day. Good thing is you have a bigger stomach, so you can fit more meat into your diet.
rny- need protein, but not as much as DS.
DS- highest success rate of weight loss 90-95% excess weight lost
rny- 2nd highest success rate of weight loss
DS- pyloric valve left intact
rny -pyloric valve sectioned off into blind stomach and does not function
DS- can work with surgeon to customize sleeve size to control how much or little you will be able to eat post-op (bougie size), and how much intestine is bypassed (common channel). A longer common channel generally means less malabsorbtion and sometimes less gas, and loose bowel movements post op. A good DS surgeon will work with you to get the right fit for you.
rny-??? not sure if they just do a standard pouch or not???
DS- malabsorb 75% of fats you eat
rny- fat malabsorbed but only at about 30% by most estimates
DS- large part of your stomach that produces ghrelin, the hormone that causes hunger is removed.
rny-not sure, don't want to give you the wrong info???
DS- less revisions of ALL the other surgeries
rny- revision more likely due to blind stomach, weight regain after pouch stretches, ulcers, etc.
DS - can take NSAIDS - inportant if you have arthritis or other inflamatory ailment
RNY - can't take NSAIDS
DS- may have intolerence to refined carbs like white bread, pasta. I don't have any reaction to rice, potatoes, corn, etc. but white flour products sometimes cause gas. Can be controlled with prescription Flagyl, beano, gas-x, or a probiotic.
RNY- some gas, but not as much as some have w/ DS.
DS- can drink with meals. I have trouble drinking with cread. pizza, pasta, but can drink with everything else. This differs from person to person.
rny- can't drink while you eat- you may throw up! (Actually, you won't necessarily throw up. There are some RNYers who do drink with meals against the "rules". My understanding is that you are not supposed to do this because without the pyloric valve, the food gets pushed through and flushed out of the pouch making you hungrier sooner.)
DS- highest liklihood of co-morbidities cured. NO diabeties, slep apnea, high blood pressure, pcos... Life is good girl!
rny- 2ns to DS in cure rate
DS- very expensive! many insurances will not cover it
rny- 2nd priciest in comparison to band and sleeve and DS
DS- you can lose too much weight and need to supplement with extra calories or get switch revised (rare)
rny- same
DS- continues to work the rest of your life!
rny- stops working after you stretch your pouch out. You need to caredfully watch your diet for the rest of your life.
DS- not very accesible because not many wls surgeons do DS. It takes surgeons longer to learn to do the DS and the operation takes longer to do, so it is not as profitable for them. They can do 2-3 rny in the time it takes them to do 1 DS.
rny- most popular wls. There is a rny surgeon on every corner. It is very likely you will find a local surgeon and will not have to travel.
DS- operation takes about 4 hours. Surgons normally do only 1 of these a day.If you are super obese 500lbs up you may not be able to go under anesthesia that long. The surgeon can do a 2 stage procedure with the vertical sleeve 1st and add the intestional switch later after you lose weight.
rny- takes about 2 hours. Surgeons can do many of these in 1 day.
DS- will stay in hospital at least 3-4 days, maybe more
rny- will likely go home next day
DS- return to work 2-6 weeks
rny- return to work 1-2 weeks
DS + rny -will need to walk, walk, walk, drink, drink, drink, post op. Will need to get in protein and vitamins, will need to follow up with surgeon or pcp for the rest of your life to get labs, etc.
The best thing I think about the DS is, most people with it are very happy. The true measure of this surgery can be found on the regrets and revision forum. You rarely see a DS'er wanting a revision. But, you DO often see rny or lap band patients wanting a DS because their surgery has failed them or they have serious complications Do you want to have surgery again in 5-10 years??? Your insurance is likely only going to pay for 1 wls. Pick a wls that will last a lifetime and won't have any complications or massive weight re-gain years down the road.
I am 3 months post-op. I feel like I have a normal life now. I am not burdened by my pre-op need for massive amounts of food to get me full, but I can still eat a normal sized meal. At the OH conference Saturday, I sat at a table with rny, sleeve, and band patients. They were shocked! that I could eat a full plate and went for seconds. They had a few bites of this and that and were stuffed. I LOVE FOOD! I can't see me spending the rest of my life eating two forkfulls of food. To me that is not normal, and would lower my quality of life. I think God put food on Earth for us to enjoy (in moderation) and we should. Taking away your ability to enjoy a normal meal is taking away the gift of good food God gave us.
Yes, this is a biased post in favor of the DS. Naturally I am 110% in favor of the DS, otherwise I would not have gotten it. I have OH buddies that have lost 100+pounds with the rny and they are happy. I also have rny friends that have gained all their weight back. I never heard of a DS patient gaining all their weight back! Some re-gain is possible, but you will likely NEVER be anywhere close to where you started. DS regain may be 20-25 pounds max. RNY regain may be 100 pounds.
It was so critical to me that I get the DS and not the rny, that I drove 5 hours to Nashville and committed myself to a lifetime of follow-up in Nashville, just so I could get the right surgery for ME. We DS'ers are getting together Saturday for a movie and coffee at Stonecrest Mall in Lithonia. You should come hang out with us.
rny- if you eat anything high sugar you likely will dump, and it is a miserable feeling the way it's described
Actually, only about 30% of RNYers dump.
rny -pyloric valve destroyed
The pyloric valve is not destroyed, but it is sectioned off in the remnant stomach, so it isn't used.
rny- fat not malabsorbed
Actually, RNYers do malabsorb some fat, but only about 30% by most estimates.
rny- revision likely due to blind stomach, weight regain after pouch stretches, ulcers, etc.
I think calling revision "likely" with an RNY is probably stretching it. There are certainly a number of RNY revisions, but I've seen no evidence that this is the most likely outcome.
RNY- some gas, but not as much as some have w/ DS.
I have seen so many threads on the RNY board about gas, I'm not entirely sure this is true. My friends with RNY certainly have their share of gas issues.
rny- can't drink while you eat- you WILL throw up!
Actually, you won't necessarily throw up. There are some RNYers who do drink with meals against the "rules". My understanding is that you are not supposed to do this because without the pyloric valve, the food gets pushed through and flushed out of the pouch making you hungrier sooner.
DS- you can lose too much weight and need to supplement with extra calories or get switch revised (rare)
This can happen with RNY too.
rny- stops working after you stretch your pouch out. You need to caredfully watch your diet for the rest of your life.
In fairness, although that is a common problem, it is not true for all RNYers.
RNY – expected weight loss
*50-65% expected excess weight loss (percentage varies in opinion – this is the most commonly seen estimate)
Regain
*Possible regain: more prevalent after 5 years
*50-100% regain of weight has been recorded
*Results may vary
*Must follow “pouch rules" in an attempt to not regain
DS – expected weight loss
*85% expected excess weight loss
*Results may vary
Regain
*Studies show little to no regain (no one recorded as to gaining all of weight back like with the RNY)
*Results may vary
*Highest success rate over 10 year study (78% avg. Excess Weight Loss – EWL)
RNY – have a stoma (stomach made into a pouch – size of an egg)
*Size: 2 oz
*Stretch to average size of 6 oz in 2 years (possible to stretch up to 9-10 oz)
*You can eat more as time goes by
*Average after 1 year is 1-1.5 cups of food
No Endoscopes on blind stomach/remnant stomach that is bypassed
*Doctor evaluation: cannot use an endoscope (to find ulcers and tumors)
*RYGBP construction makes the large bypassed distal stomach inaccessible to standard non-invasive diagnostic modalities. Neither x-ray contrast studies nor endoscopy can assess this potentially important but hidden area.
Stomach: pouch
*Should not take Nonsteroidal Anti-Inflammatory drugs (NSAID).
*NSAIDs are: Advil, Alka Seltzer, Aleve, Anacin, Ascription, Aspirin, Bufferin, Coricidin, Cortisone, Dolobid, Empirin, Excedrin, Feldene, Fiorinol, Ibuprofen, Meclomen, Motrin, Nalfon, Naprosyn, Norgesic, Tolectin, Vanquish
NSAIDs are used for arthritis, bursitis, tendonitis, back pain, headaches, and general aches and pains.
*Taking NSAIDs could develop into a bleeding ulcer and interfere with kidney function.
Possible Problems
*Ulcers (Some doctors recommend taking prilosec for 6 months to 1/2 years in an attempt to prevent the ulcers)
*Possibility of a staple line failure
*Noncompliance: simply do not lose enough (even with following the rules)
*Vitamin Deficiencies
*Narrowing/blockage of the stoma
*Vomiting if food is not properly chewed or if food is eaten to quickly
*Dumping syndrome, NIPHS, Hypoglycemia
No Valve (pyloric valve that opens and closes to let food enter intestines is bypassed) which means food empties directly into the small intestines and causes dumping and/or can cause NIPHS or Hypoglycemia
Dumping: food (most commonly sugar but not necessarily “just" sugar) enters/dumps directly into small intestines and causes physical pain (some people believe this pain enforces good eating habits)
*Dumping varies in degree of occurrence and discomfort
*Dumping symptoms:
Nausea
Vomiting
Bloated stomach
Diarrhea
Excessive sweating
Increased bowel sounds
Dizziness
“Emotional" reactions
NIPHS (insulin over production): “the body overproduces insulin in response to food entering the intestines at a point where food would normally be more digested already - this part of the intestine is not used to coping with metabolizing glucose in the condition it arrives after RNY, and it is suspected that the intestine signals the pancreas for more insulin to aid digestion, causing a MASSIVE overproduction. The change occurs on a cellular level, hard to diagnose. Treatment: Removal of half the pancreas."
*RNY stoma that is created allows food to go straight through the stomach into the small intestine unrestricted so it does not control the flow. Because of that the body reads that it needs more insulin because the food is moving through so quickly and it thinks there's going to be a lot more food. With the DS, the normal peristalsis works because the pyloric valve is in place and can control the movement of food into the small intestines.
*NIPHS, Hypoglycemia is deadly if not corrected
DS – whole stomach (size of banana)
“Whole working stomach" - meaning the stomach’s outer curvature is removed as opposed to making a pouch/stoma.
*Part of the stomach removed is where most of the hormone called Grehlin is produced.
Grehlin gives the sensation of hunger so by removing most of that section of the stomach a DSer is not as hungry as before.
*Whole working stomach: no blind stomach. Endoscope can be used.
*Can take NSAIDs
*Do not need to take Prilosec to prevent ulcers.
*Valves are in tack: no Dumping Syndrome or NIPHS
RNY – Eating
*Eat protein first
60g of protein a day
*Recommended to chew food to liquid consistency (pureed, soft, thoroughly chewed)
This is more important for people early out (new pouch stomach will stretch out with time).
Food is thoroughly chewed to prevent blockage (the hole/path leaving the stomach and into the intestine is roughly the size of a dime).
To get food unstuck, patients drink meat tenderizer mixed with water.
*Low carbohydrates
Carbohydrates can slow weight loss and lead to possible regain
Avoid sugars in particular (to prevent dumping syndrome)
*Low fat
Foods high in fat may cause Dumping Syndrome
Fatty foods can lead to slow weight loss or possible regain
*64 oz of water
Stop drinking within 15-30 minutes of a meal
Do not begin drinking after a meal for 1-1.5 hours
Some doctors do not encourage the use of a straw (pushes food too quickly through the stomach and can cause gas/discomfort)
*Water Loading
15 minutes before the next meal, drink as much as possible as fast as possible.
Water loading will not work if you haven’t been drinking over the last few hours.
You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.
Disclaimer: this is a practice some people use to feel “full" and lose weight. Not a requirement.
DS – Eating
*Eat protein first
80-100g of protein
DS patients can on average eat more food than any other type of weight loss surgery.
*Low carbohydrates
Carbohydrates can slow the weight loss and lead to possible regain
No dumping syndrome from eating sugar (or fat)
*Eat high in fat
DS only absorb 20% of fat (do not need to eat low fat)
If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or RNY absorbs ALL 20g. (this is just an example, measuring absorption is not an exact science)
*When experiencing a “stall" (slowed weight loss/plateau) a DS patient commonly increases fat consumption to resolve
*64 oz of water
Can drink with meals
Can use a straw
RNY – Possible Issues
*Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
Common vitamin deficiencies found in vitamins B12, iron, and zinc
Calcium must be supplemented for the rest of your life
*Bathroom issues
Gas
Constipation
Dumping in the form of loose stools
*Reversible procedure (Reversals of any surgery is very complicated)
Revision often performed instead of reversal
Revising to a different type of surgery is possible.
DS – Possible Issues
*Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
Common vitamin deficiencies found in vitamins A, D, and iron
“Water soluble"/ “water miscible" / “dry" vitamins absorb best (in other words get vitamins that are not fat/oil based)
Calcium must be supplemented for the rest of your life
*Bathroom issues
Gas
Loose stool (Most common in the first few weeks of surgery. Generally food related)
*Reversible procedure
The intestinal bypass is reversible for those having absorption complications revision: lengthening common channel (to stop losing weight and/or to absorb vitamins)
Stomach is obviously not reversible (part of stomach was removed)
RNY - Diabetes
*85% cure rate
*RNY can put diabetes in remission.
Diabetes may come back in two or three years--even if the
patient maintains most of their weight loss.
Even a small amount of weight gain, long-term, can cause a diabetes
relapse.
DS – Diabetes
98 % cure rate for type II diabetes.
DS – Myth or Fact
DSers will have a heart attack from all the fatty food they eat = Myth / Not True
-Cholesterol levels lower after having the DS.
-80% of the fatty food is not absorbed – the fatty food is healthier to eat as a DSer than a person without surgery.
**The fat therefore does NOT enter the bloodstream**
If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or a person with the RNY will absorb ALL 20g. Good meal for the DSer. (this is just an example, measuring absorption is not an exact science)
The DS is only recommended for the super morbid obese (BMI over 60) = Myth / Not True
-To be eligble for ANY type of weight loss surgery, a person has to be 100 lbs. over weight or have a body mass index (BMI) of 40 or more.
-BMI’s under 40 have also been approved (usually require a comorbidy/health problem - an example is sleep apnea).
The DS is “experimental and investigational" = Myth / Not True
-Medicare approves the DS
-Many insurance companies are starting to cover the DS.
-DS has been performed since the 1970s
DSer will have a problem when they become old = Not True
-We wont need to eat as much when we are older b/c our bodies will adapt
-The little hair-like villa located in the intestines grows longer to adjust to the new digestive system (grows longer to increase absorbtion).
DSer’s gas stink = true
-The gas does smell. (This is true for the DS and RNY)
*Most people see no difference in gas smell but more in the way their poop smells.
-There are products called air fresheners that a person can use.
-Controllable by diet (stay away from trigger foods)
-May take Flagyl or fish zole
DSers may need to wear a diaper = Myth / Not True
-That is silly
Skin color turns yellow or pallor = Myth / Not True
-Patients who follow their regular vitamin regime (keep up with blood work) do not turn pallor
-If someone looks pallor, they could have a vitamin deficiency. This applies to any type of weight loss surgery. For both RNY and the DS.
-Vitamins and blood work must be monitored for life. For both RNY and the DS.
Dsers don’t need to exercise = Myth / Not true
-DSer’s are aware of the benefits of exercise (body and soul).
-Exercise helps in losing weight and maintaining goal weight
*Some practices may not be used by all patients. Some recommendations will differ depending on a person’s surgeon. Possible issues are just that, “possible," and may or may not occur.
Not every surgery will be right for everyone. Not every surgery will be covered by insurance. Good luck to everyone and thank you for reading my comparison chart. Hayley F.
5'10", HW: 326/SW: 280/CW: 181/Goal: 165
