Traditional DS or SADI loop
Hi, everyone! I know this is a controversial topic but would appreciate advice and input. I am finally committed to having WLS, and after initially thinking I wanted to get the sleeve, then thinking the gastric bypass would make the most sense, I am now very interested in the DS after doing a lot of research. My insurance has a "one WLS per lifetime limit" and I want to get the surgery that will give me the biggest chance of losing (and keeping off!) my excess weight.
Went and saw a surgeon last week, and he says he only does the newer loop procedure (per him, because of less chance of malabsorption and bad diarrhea). Said he wouldn't do the regular DS on me (BMI is 45) but said maybe one of his colleagues would, so I have a consult with him tomorrow.
The lack of long-term success data on the loop concerns me. I've taken medication since I was 12 years old and am not concerned about being able to comply with a vitamin regimen. I also like the idea of being able to eat with somewhat less restriction on variety with the DS. And finally, I do suffer occasionally from heartburn and am worried about the increased likelihood of that with the loop due to the "gravity-defying" principles.
On the other hand, I know the loop has been done for a good while in Europe and they seem to have their act together, healthcare-wise. :)
Would love to hear some objective arguments for either one or the other (I know this is a topic people have strong feelings on). I really want to get the surgery that will actually work for me and don't like the idea of having to "convince" my surgeon but it does just seem like this is becoming popular because it's easier to perform, not because it works as well as the traditional DS.
Thanks! Happy Thanksgiving!
You are very wise!
Yes this is a touchy subject and I don't want to offend anyone. On the positive side, at least your surgeon was honest about what he wants to do. We have seen other people *****quested the DS, insurance paid for the DS, and what they got was a SADI being called "the DS". Whatever the merits of this newer operation (or lack thereof), it is NOT the same as a DS.
The DS has been done in the USA since 1988 and is a standard of care bariatric surgery for anyone who meets the usual criteria for medical necessity, as you do. The long term results are well documented - it has the best statistics of any bariatric surgery for percentage excess weight loss, for maintenance of that weight loss, and for resolution of almost all comorbidities. It allows for the most normal diet, allows you to take NSAIDs safely (unlike gastric bypass), and the risk of nutritional problems is actually very low and in most cases due to noncompliance, though of course there are exceptions. In other words, if you are willing to make the lifetime commitment to eating plenty of protein, taking all your vitamins and minerals daily, and regular lab work, you should be fine. anyone not willing to do this should not have any procedure that includes any component of malabsorption.
In addition, not only do you face the "one surgery per lifetime" idiotic policy, the SADI can't always be converted to a DS - it depends on technical details of how the operation is done. I say idiotic because there is no other medical problem where insurers make this regulation and get away with it. The AMSBS has recognized that revisional surgery is often necessary due both to complications and substantial failure rates of some operations. That's a bit off topic of DS vs SADI but that regulatiion really chaps my hide.
So bottom line, all the reasons you mentioned for wanted a real DS and not a SADI are excellent reasons, and my recommendation is that you stick to your guns. Go to a different surgeon if necessary. Travel if necessary - the temporary inconvenience will be well worth it for something you will live with for the rest of your life.
Larra
There is nothing that works better than the DS. Period. There are decades worth of statistics out there that agree with me.
Some day there will be something better but not yet. I personally am hoping for a pill!
You have one shot at it. Take the one that is proven to work or take the one that MIGHT work. It's a no brainer to me!
I really don't have an opinion on the SADI procedure. My surgeon is actually one of the first surgeons in the country that started performing it. I highly respect him, but know that the DS has decades of statistics behind it, the SADI does not.
I always thought that there will be an improved version of the DS at some point, surgeries evolve and get better- but only time will tell if the SADI is that procedure.
From my experience- I am very happy with the DS. I have maintained a very large weight loss without much effort on my part. I eat a LOT, my wife actually comments that she has never seen anyone eat as much as me....but that is how I was before surgery too. I know there is an element on this board that believe that you can "change" ...but the research shows that with other surgeries the failure rate is much higher than the DS.
With that said, I needed a lot of malabsorption, probably more than most. I was super SMO, and needed the best chance to get to a normal weight. I had that with the DS. I have the stomach that allows me not to feel deprived when I eat, and the malabsorbtion that keeps the weight off. With more absorption i highly doubt I would have been able to maintain my weight loss so effortlessly.
Scott
I'm not discounting progress...however, I don't think we can discount proven long term success either.
Scott
"My surgeon is an expert at Mount Sinai in NYC and only perform the bypass, DS and SADi DS. He refuses to do the band or RNY any longer because he perceives the other 3 are much better options."
Huh? He performs the bypass but not RNY? Usually those two terms mean the same thing.
Laura in Texas
53 years old; 5'7" tall; HW: 339 (BMI=53); GW: 140 CW: 170 (BMI=27)
RNY: 09-17-08 Dr. Garth Davis
brachioplasty: 12-18-09 Dr. Wainwright; lbl/bl: 06-28-11 Dr. LoMonaco
"May your choices reflect your hopes and not your fears."
It is a very controversial topic, although you'll find everyone here is well intentioned. Ultimately you should do as much research as possible and go with your gut feeling. The health care providers and all of us WLS patients are biased based on our own experiences, and I'm no exception.
I would highly recommend the SADi DS as the first choice for nearly anyone. I had it done in Nov 2014. It has been performed for 9+ years and the results are staggeringly positive but there is more limited research than the standard DS. You will have less malabsorbtion, take less vitamins, eat whatever you want for the most part (although I gave up soda and substantially cut down sugar). My surgeon prefers it over the standard DS for the reasons above and due to lower surgical risks.
My surgeon is an expert at Mount Sinai in NYC and only perform the bypass, DS and SADi DS. He refuses to do the band or RNY any longer because he perceives the other 3 are much better options.
To my knowledge, everyone that has the SADi DS by a qualified surgeon (that's a real important distinction) will do better long term. The only published research I've seen is a 3 year study that shows the avg SADi patient loses 95% of excess body weight after 12 months and keeps all of it off after 3 years. I have not seen any research that shows years 3+, so that's your risk. I personally lost more than 100% of my weight and have been working on gaining back weight thru fitness training over the past 6 months. I am glad to look very fit and be the thinnest guy in the room for once.
In my view it's like buying a 1996 car versus 2016. They both can work fine for you but sometimes the advances in research are worth using to your benefit.
Any decision you make that helps you go from morbidly obese to much healthier is a plus so you'll get support form all here regardless of your decision.
Jim
the bypass and RNY are the same thing.
