RNY compared to the DS

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 intact: 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