Help me understand

I am 4 year out from vsg surgery and very frustrated. I had lost 95 pounds but have gained back 30-40 of it. I originally had a lapband for 2 years that I had revised to a vsg. I have been researching DS  for the last couple of weeks, but I had a consultation today with my Dr and am now frustrated and confused. He has done DS surgeries in the past but is not a big fan and wants to convert my sleeve to a bypass instead.  He doesn't like DS bc of the possible electrolyte and vitamin problems and side effects of diarrhea and gas. 

He is not a quack. He and his son were on the TLC show big medicine and are very reputable Drs. They happen to be big fans of bypass.

Some things that he said that I would like people to comment on:

If the DS is such a wonderful surgery why in such a big city like Houston are there not More drs that perform the procedure?

The malabsorption from bypass does not go away after 2 years. And the pouch is cut smaller and not out of the fundus so less chance of stretching like when they were first done.

Does anyone have links to medical journals or articles that support DS?

No hating please! I am just trying to answer questions that he brought up. I am still leaning toward DS but am wondering if I am going to be able to find a expert Dr in Houston that will be able to do the surgery!

 

Dr Davis is relatively new to the DS, and from what I've read, kind of a hyper-health nut, believing we don't need protein, or much of it anyway. I think he lets a lot of his personal ego get in the way but that's just my take from reading from others that work for him or had surgery with him.

Many surgeons are wary of the DS because of patient compliance issues, thus the issues with vitamin deficiencies and the bowel issues. Some surgeons want to make the most money they can from patients and the DS is not a surgery where they make a lot of money. Insurance only pays for the DS as they would the RNY, which would be not enough to cover the DS OR time. So, they might do the DS 1/4 or 1/8 of the time they do other more profitable surgeries. Plus, they may have never taken the time to learn how to do the DS in the first place. They may "bait and don't switch" patients just to get them in the door but sell them on another surgery.

There are a couple of good articles and studies but I don't have them bookmarked any more. Perhaps Southernlady has them and will chime in.

--gina 

Thank you for the honest and informative input. Do you (or anyone out there) know how long the second part of the surgery takes?  I have a sleeve already so they would just have to do the intestines. I did a quick barium swallow in the office today and my sleeve looks pretty good. Still pretty small, just a small area toward the top that is dilated a little ( which I kind of figured since I have a lot of reflux issues).

I don't know how long the second part takes alone but a total DS done lap can take about 5 hours.  If there is a bulge at the top, I hope they can fix that at the same time. 

I'm in Houston, almost 8 yr post DS and would be glad to message with you. Email me

[email protected]

I live in Boston area, the medical mecca of the world. But I can't find a dr. To do weight loss DS surgery unless you are 55bmi and over. That said look up http://health.usnews.com/health-news/news/articles/2012/09/17/comparison-of-obesity-surgeries-turns-up-surprising-results, Several long term results.

Go see Dr. Ayoola in Denton.  There are no experienced DS surgeons in Houston.  There are a few who have done some some but not a lot.  Denton is only about 5 hours from you.  There used to be a big support group in Houston but I'm not sure they are around anymore.  My sister in Houston is a DSer but she went to Spain for surgery.

Yes, the majority of the malabsorbtion from a normal proximal RNY does go away after 2 years.  Your body adapts and does everything it can to get back to where it used to be...fat.  It happens with all malabsorbtive procedures, no exceptions.  DSers lose some too but we have so much bypassed the body can't compensate.  That's why so many of the RNY folks start gaining in the 2 to 3 years post timeframe.

I had my surgery about 11 years ago.  10 people in my office had surgery about the same time as me.  I was the only DSer.  And guess what?  I am the only one who still looks pretty normal for my age.  All the RNY folks gained back every last pound.  Plus!  I do have to watch what I eat and I can gain.  Just like a normal woman.

Research, research, research!  If you can find anything that works better than the DS, get it.  Check out dsfacts too!

Dr. Davis may be an excellent surgeon and has certainly had publicity, but is known to be negative about the DS. I have also heard that he favors vegetarianism, which doesn't always go well with the DS because of our protein requirements.

Regarding nutritional deficiencies, the longterm studies on the DS show that the rates are very low, though higher than for RNY. But we are talking 2% vs 1%, so not high for either, and with both operations, the problems almost always are due to noncompliance. Not always, but almost always. In some cases they are caused by patients being given poor information by their surgeons and nutritionists, who often give the same post-op instructions for RNY and DS even though the needs are different. If you have good information and follow it, eat plenty of protein and take all your supplements, and follow your labs to adjust supplements as needed, chances are very strong that you will do just fine.

I'm over 8 years post-op with the DS. No deficiencies yet! I can eat normal meals and drink liquids with meals. I can eat any cut of meat, not just lean meat (I'm sure Dr. Davis would frown on this). I can use any cooking method. I can take NSAIDs, which are contraindicated for the rest of your life with RNY. I don't know what comorbidities you have, so will just mention that the DS has the highest rates of permanent resolution of type 2 diabetes, high blood pressure, sleep apnea, and high cholesterol of any bariatric surgery - not to mention the highest percentage excess weight loss.

You may need to travel further for a DS, but remember that YOU are the one who will live with it, not Dr. Davis. Be a well informed patient and make the decision that YOU can live with for the rest of your life. Dr. Ayoola in Denton has an excellent reputation. At the very least, get a second opinion. Or, hang around here and other websites devoted to bariatric surgery for awhile and see how many people are looking to revise from RNY to DS - which is a very difficult and high risk operation, but these people are desperate, either because they have regained a lot of weight or because of side effects that are making their lives miserable. No operation is perfect, including the DS, but the results and quality of life with the DS are the best available.

Larra

Don't be defensive. Your doing just what each of us has done in the past. Research, discuss, and reach the best decision you can. Of course we are mostly pro-DS here, after all it validates our own decisions but that doesn't mean it has to be your decision. Just a few opinions on your questions.

   I think you misunderstand the whole point when you call it a "wonderful" surgery. There is no WLS surgery that can be called wonderful... Statistically it is better than the bypass but certainly not a panacea. I love what the DS has given me but believe me if they invented a pill tomorrow to accomplish the same thing no one would have it done.

    Why aren't there more surgeons doing it? It's a harder, longer surgery. As a procedure it has a shorter, more checkered history than the gastric bypass. It requires more patient commitment and support. This is an area that surgeons are often not comfortable with. It's fine to say the majority of people with problems are not compliant but I think part of that goes along with patient pre-screening and followup. 

    A surgeon might easily rationalize doing bypasses instead of the DS, and not just for money. It isn't like everyone with a bypass regains and for those that do we are just starting to learn that there may be weaknesses inherent in the surgery that cause some of the regain. However, I would bet that most surgeons put it down to a patient failure not a procedural weakness.

    I'm happy for you that you have an opinion of a reputable Doc but if you think anyone goes into it without their own leanings affecting their opinion - I just don't believe it.

     Just some pro's to finish up. Sorry I rambled on.

• Statistically better outcomes with regards to weight loss (not perfect)
• You get a stomach with a pyloric valve instead of a pouch
• More ability to use NSAIDS
• More malabsorption - this can cut both ways but I've regained enough times to see this as a plus.

Good luck on your decision. Whatever  Ihope it works well for you.

Pete

Those side effects depend greatly on the patient and how they choose to live and eat.  Same for nutritional deficiencies.  Knowing enough to take care of yourself right out of the gate (and sadly, you don't get a lot of good advice from doctors) and hooking up with people who have been there done that is a great start.