SIPS Surgery - Anyone?

Hi!  Had my final surgeon appointment today and I thought we were all on board for RNY, but instead she really tried to convince me that SIPS would be more appropriate.   I will be a revision from the sleeve.   Does anyone have advice or info?   I had turned down the DS option because I didn't want to worry about malnutrition or frequent BM bathroom trips!  Do I need to take more vitamins with the SIPS than I would with RNY?   Those are my main questions right now, but I would love to hear anything about this.   Thank you!

I don't know anything about SIPS but I would guess to start with an RNY-like vitamin regimen and then keep a real close eye on frequent labs. You can adjust the vitamins once your labs start showing trends. Keep us posted and good luck!

--gina 

I would talk to the DS patients about this for sure.

SADI/SIPS will still have significant malnutrition issues due to the small intestine that is bypassed.  We are not quite sure what adequate supplementation is, as there is little research on it.  The regimen is likely similar to the DS in the long run (by long run I mean 10+ years out).  Far more intestine is bypassed than the RNY, so you will still need miscible/water soluble ADEK and such which you do not with RNY, for instance.  You will also still need to eat high fat, which you do not with the RNY.  We also do not know the degree to which the malabsorption lasts.  Bear in mind most programs have horrible nutrition advice for the DS which has been done since, what, the 1980's?   Never mind the SIPS which is newer.  

The frequent bathroom trips are minimized following a correct DS diet - high protein, high fat.  I have spoken to 2 dozen or more DS patients in detail, and 3-5 years out of they eat correctly they have no issues.  

I think that the SIPS is better than RNY if you have a higher BMI.  If your starting BMI was 50+ for the original sleeve, statistically the DS is still better by a wide margin, not just a small one.

BTW, you can still get severe vitamin deficiencies on the RNY.  You will need to be just as vigilant with that.  It is in many ways, not necessarily easier than the DS or SIPS regimens.  Additionally, your malabsorption will only last about two years before the body adapts, yet you will retain the inability to absorb as many vitamins.  I've also seen RNY patients with more bathroom issues than DS patients, too.  A lot of that results from food choice or "user error," as I call it in my case.

I am also revising from the sleeve - likely the DS.  If I had no other option I'd do the SADI/SIPS, possibly, over the RNY.  I'd still get the RNY if it's the only option, however RNY is no guarantee of fewer complications by any stretch.

Hi Donna,

Thank you so much for taking the time to share all of that with me.  I didn't realize that SIPS would require high fat as well as high protein.  I don't think that will be a problem!  But these are the kinds of things that my surgeon didn't share with me.

One more question for you... my surgeon is young and tells me that she has done "less than 5" of these and would require an additional surgeon in the room with her.  Would this deter you?  I'm realizing that I'm getting anxiety over this.   I'd prefer a very experienced surgeon!

 

 

If you look at the way that the SIPS bypass works, it becomes very clear it also needs higher fat and protein.  I also would make the argument that for most surgeries a low carb/high fat diet is optimal on a biochemistry-level.  It helps keep insulin low which accelerates and maintains weight loss.  Even if you don't have the DS it's likely a good idea.  The one exception might be RNY because of "dumping," however that's less common than people realize.  You must understand: most surgeons do not even teach DS requirements correctly.  Some good bariatricians and nutritionists are aware, but many are not.  There is a whole mess of crappy politics as to why.

As for two surgeons: I had two very skilled surgeons do my sleeve at once.  Both were experienced general and bariatric surgeons.  My surgery took less than an hour, actually.  It's a way for new surgeons to get experience while preserving patient safety.  This happens all the time.

A "young" surgeon is like in their 40's.  So I guess it depends what you mean by young?  Most surgeons practice up to early 60's at most only.  If a surgeon is 40 they probably have only 20 more years of practice, and already have 10+ years of practice via residency.

It really depends on the surgeon.  Do you mean the DS or SADI?  For the DS, experience matters.  Not necessarily DS replication (though important), but intestinal and duodenal surgery.  You want them to clearly explain how they measure all the bowel lengths, as well, since some methods are considered superior to others.  

Consider that WLS is not just rearranging organs, though.  Even with the sleeve, there is a lot of structural dissection that goes on around the stomach.  The same for the duodenum area.  Reconnecting small vessels is difficult and precise work.  Ask: Who is the other surgeon?  Are they a DS surgeon?  How experienced are they?  That I would want to know too.  This is part of the may complex reasons there are not more surgeons that do the duodenal switch, though.  Not everyone is going to be on Dr. K's level, for instance.  I am not saying you should jeopardize your health.  I would consider speaking to other patients of your surgeons and other DS patients who may be familiar with her though.  

I am... unconventional, in that I would be willing to let an extremely skilled and experienced surgeon perform the DS *if* they had excellent training and were familiar with it from residency, and if I was not near a more experienced DS surgeon.  I live near the University of Chicago so I'm quite fortunate.  I'm also a weirdo who enjoys being on the cutting edge of things, and am a medical history dork. (I've participated in medical research twice in the past).  Bear in mind, I also have a medical background and I can easily vet health professionals through channels others may not have.  Many people travel thousands of miles to get the DS done correctly though, and there is often a good reason for that.  I am not saying other people should do this.  What I am saying is that it, like having surgery to begin with, is a calculated risk I'd be comfortable taking if the context was right. 

Surgeons have to learn to do the DS somehow, too, you know?  If no one sees the inexperienced surgeons, then no more surgeons will learn it.  That's just how medicine works.  Even counseling is like that way.  I am a very young counselor (40) and I am inexperienced compared to a 50, 60 70 year old counselor.  I make more mistakes.  I also have supervision and the level of care is very similar to having my supervisor do it, because everything I do is vetted. Still, people have reservations - which is totally understandable!  Because of this I am more lenient towards new practitioners.  Please be mindful my bias colors my choices!  Not everyone is comfortable with this and that's 100% okay.

Bottom line: don't ever do any procedure you aren't comfortable with, excluding emergency life-saving stuff.  WLS will happen, and it's always better to get something like the DS done correctly.  If you have reservations, absolutely discuss it with your surgeon.  Vet their experience.  Find out who trained them and drop a note to that doctor and ask about their trainee's skills.

 

 

Super helpful... again!  How would I go about researching (or vetting) my surgeon.  Or any chance I can give you her name?

Ask the surgeon if you can speak with some of her patients who've had the DS.  Talk to other DS patients here and elsewhere - many are more knowledgeable on the surgeons than myself.  

If your surgeon in Illinois I am more helpful as I have associates I can ask for impressions.  Outside of that, you can search for doctor's malpractice claims in most states through their department of licensure regulation (each state has a different name).  NPI numbers and license numbers are typically public information.  Search for malpractice claims, etc.  Check reviews.  Consult as many local WLS groups as possible.  Ask the surgeon who taught her the DS and where she learned it, then write that institution and inquire.

Edit: my general advice is that you should always solicit an experienced surgeon.  In my case I am okay with making a very educated choice to select one that may be "off the beaten path," somewhat.  One must consider though, that a superior DS surgeon will be very skilled at many kinds of surgery and not just the DS.

Thanks so much Donna :)

Also, I know surgeons as well as professors who have had the DS themselves.  They frequently are in positions where they cannot use the bathroom for hours at a time - if not all day.  They also have no issues as long as they eat and supplement correctly.

I wouldn't let a surgeon touch me for a WLS unless they've done at least 100 of these surgeries. They are complicated...it's not just a removal of an organ (like an appendix surgery), there is a lot of room for error. My surgeon did over a 1000s of WLS before he did my surgery. I'm sure that a surgeon with less than 1000s of surgeries under their belt can do the job...but I do not think I'd want to be one of the first 10....just sayin'.

Scott