SIPS Surgery - Anyone?

I've been on this forum and others devoted to the DS for years now, and in almost all cases, when people are complaint about diet and supplements they have few, if any, of the issues you are concerned about. There was a large study by Dr. Hess, who did the first DS in the USA, where they followed up on almost 1,000 DS patients, and the rate of nutritional problems was about 2% or less, and in almost every case the patient was not complaint about protein and/or vitamins. In other words, if you are willing to emphasize protein and take the necessary vitamins and minerals, with your lab results guiding you on how much to take, you should be just fine.

    Same idea for bathroom issues - eat DS healthy - should be fine. Eat lots of carbs - not so fine.

SIPS is controversial. It is not a "standard of care" bariatric surgery at this time. Maybe this will change at some future date, I can't say. The fact that less small intestine is bypassed with SIPS compared with DS is both an advantage and a disadvantage - advantage in that, at least in theory, there should be less issues with nutrition and BM's - though again this is really largely under YOUR control with the DS - disadvantage in that there will be less malabsorption, especially less fat malabsorption, which means you have to be more careful about your diet. With the DS we can eat fat freely, which means any protein is healthy for us, not just lean protein, and any cooking method is ok, not just low fat/no fat cooking. This makes for a much more normal diet.

For me, the biggest issue with SIPS is that the long term results are not known. Studies are going on, but that doesn't help you right now. For me that would not have been acceptable - I wanted the operation with the best documented long term statistics both for percentage excess weight loss and also for maintaining that weight loss, and that was, and still is, the DS. For you, you have already had one bariatric operation that failed you, do you want to take a chance on another? You have a substantial amount of weight to lose, and your VSG has already shown you that restriction was not enough, you need metabolic changes and malabsorption, and the operation with the most of these is the DS.

I do think SIPS will prove better than gastric bypass, which has failure rates far greater than most pre-op's realize. But I don't think it will prove to be as effective and durable as the DS. Plus, with gastric bypass you have the risk of dumping (which is NOT a weight loss tool, just a very unpleasant side effect some people have), you can't safely take NSAIDs again for the rest of your life, a laundry list of foods you are never supposed to eat again - and results that don't compare to the DS. You are fortunate that your surgeon is having you consider other options.

Larra

Good Morning Larra,

Your comments are so valuable to me - thank you for taking the time to write me.  You're right that I am worried that SIPS is just too new to know enough about.  That makes me nervous.  In some ways, VSG was like that when I had it done.  It wasn't as new as SIPS is, but since my surgery, I've heard of studies showing that VSG is not nearly as successful as they originally hoped it would be.  

You're also right about restriction not being enough for me.  I guess I was kind of sticking my head in the sand the last 6 months, ignoring the facts that RNY has a fairly high failure rate.  And ignoring the fact that dumping would be as horrific for me as the BM issues.  

For me job, I have to attend a lot of meetings, many that it would be unacceptable to get up and step out for a bathroom run.  I also teach a day-long class once a month.  For those reasons, I immediately ruled out the DS because I won't have a BM at work as it is!  And I certainly don't want to have several.  And then I've heard stories about the smells.  I would be traumatized!  LOL   BUT, you say that doesn't have to be my reality if I eat correctly.  If that's true, my reservations would be mostly removed.

Thank you for helping me to think through this lifelong commitment/decision.  Hugs!

I am a corporate trainer, 11 years post-op DS, and I can assure you that I've never had to excuse myself from a class for a BM.  I also eat very strategically when I'm teaching (i.e. no experimental foods that I cannot predict results with).  As long as I eat what I'm supposed to, I have a giant BM first thing in the morning and I'm done for the day.  It's really not a big deal at all.

SIPS, SADI, Loop DS, are all the same thing and if you call your insurance company and ask if they cover it as it is, they will say it's not covered.  However, the medical office peeps have figured out to bill for two procedures that are covered for reasons other than WLS, and it passes right through.  This is fraud no matter how you put it.  The DS was still considered experimental for 20 years before it got any respect from insurance companies, and surgeons who never did the DS before are doing it.  It baffles me.  

Really?  I'm surprised that insurance doesn't catch on?  2 reasons, nothing to do with WLS?  Yeah, I'm so nervous about all of this.  I thought I was sold on SIPS yesterday, and today I am wavering again, back to DS.   Good to know another trainer that has handled DS just fine...   Thank you for your message.

You already have half the DS.  Why not just do that?  It's the best WLS out there.  More weight lost and less regain.  Go read the revision boards and learn.

SIPS is probably better than the RNY but not as good as the DS.  Time will tell and SIPS just hasn't been around long enough.

Thank you Patty!

If it was me I'd go with a "real" DS rather than SIPS. I'm just not a big fan of being a guinea pig. That being said I'd definitely go SIPS over RNY (if I had no choice) I've never met someone who had long term success with RNY. Perhaps you should look for a doctor that will revise you to the actual DS.

Do you think that the SIPS is much easier to do than DS?   My surgeon says she has done about 20 DS surgeries, and "less than 5" SIPS... which could be 0 or 1!   

Although everyone is well intentioned, most of the commentators on this site had the original DS, and there is a heavy bias against the SADI / Sips procedure. I had the SADi done more than 2 years ago by one of the best WLS surgeons on the east coast. He now recommends the SADi for most patients looking for a DS procedure, as I was. The SADi leaves about a 400 cm common channel resulting in less malnutrition and much fewer vitamins than a typical DS. It also leaves your pylori valve in tact which elongates the dumping syndrome of an RNY. It take 1 stitch to close the surgery so there is a lower risk is surgical complications.

In my case I wanted guaranteed long term weight loss, lowest possible surgical risk and limited side effects. I lost all the weight in 9 months (150lbs) and have kept it off easily. I eat normally and consume about 3k calories a day. 

For me, a DS would have risked malnutrition and if I lost any more weight, I would be anorexic. This was a big concern also prior to surgery so I'm very grateful for the SADi option.

Definately please find a very qualified surgeon for whichever procedure you choose.

Best of luck!