Dr. David Geller? Lapband or Gastric Bypass? Do "fills" hurt?

Hello there!  Since you're early along in the process, I want to be sure you've researched the duodenal switch.  Many people have surgery without knowing the DS exists as another option.

Like RnY gastric bypass, DS combines restriction which allows you to lose the weight with malabsorption to keep the weight off.  Instead of disconnecting the stomach and creating a pouch, DS simply reduces the size of the stomach to create restriction leaving  you with a fully functional, but smaller stomach.  The second part of the DS is an intestinal bypass which creates malabsorption, and keeps the weight off.  Of all the weight loss surgeries, it has the best statistics for the greatest amount of weight lost and kept off long term.   You may have seen from the boards that weight regain is a huge issue with gastric bypass AND lap band - not so with DS, because we only absorb 20% of the fat we eat, and about 60% of the protein and complex carbs we eat.  We can eat larger meals than lap band and RNY - what amounts to a normal, but smaller, meal.  Finally, for me, it had the most attractive  postop way of life with NO dieting, NO counting fat or calories, NO dumping, NO vomiting, NO foamies, NO fills and unfills, NO "port" under my skin, NO stuff getting "stuck" and NO chewing food into mush.  DS has the best resolution of comorbidities like diabetes, sleep apnea, etc.,  An added bonus is that the portion of the stomach that is removed is the portion which produces most of the hunger hormone, ghrelin, so you are less hungry postop!! 

The keys to DS are these few, very critically important rules:

1.  You must eat at least 90 grams of protein every day;
2.  You must take your vitamins and supplements every day;
3.  You must drink at least 64 ounces of water every day; and
4.  You must get regular lab work to make sure you are taking enough vitamins.

Most of us watch our carbs during the weight loss phase because we absorb 100% of simple carbs like sugar and it can slow the weight loss.  Most of us also can't go hog wild on carbs after we reach goal, but no food is off limits in moderation, as long as we have no individual intolerance to it.  Many of us get stinky gas when we eat certain carbs, like those with white flour such as bread and pasta.  However, gas is certainly an issue with RnY also.  And our poop smells pretty bad, but whose doesn't? That's pretty much it. Sound too good to be true?  That's what I thought too, but the DS is the best decision I ever made!

I think it's important to caution you that if your surgeon does not perform the DS, he/she is not likely to give you fair or accurate information about it.  On the DS forum, we have heard story after story after story of doctors that do not offer DS trying to scare people away from it, simply so they can retain a paying customer.  Fortunately, you have one of the very best DS surgeons in the world right in your own backyard - Dr. John Husted in Somerset, KY.  He is truly brilliant, very talented, and a super caring surgeon. 

Check out www.dsfacts.com and www.duodenalswitch.com for more information, and hang out on the DS forum here on OH to ask any questions you have.  Also be sure to check out the Revisions forum here on OH.  You'll see there lots of folks revising to DS from other surgeries.  There are NO folks revising FROM DS to anything else.  I think that speaks volumes.

Here's some reading material for you:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=13 60120

http://nyp.org/news/hospital/884.html

http://www.springerlink.com/content/u11438757w123722/

http://www.duodenalswitch.com/procedure/1998hess/1998hess.ht ml

http://www.duodenalswitch.com/procedure/clinical_data/Annals DS042303.pdf

http://cat.inist.fr/?aModele=afficheN&cpsidt=19374425

http://www.springerlink.com/content/w812n693rq8v83m0/fulltex t.pdf

http://www.duodenalswitch.com/baltasar.pdf

http://www.ncbi.nlm.nih.gov/pubmed/19093625?ordinalpos=11&it ool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_ DefaultReportPanel.Pubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/18752029?ordinalpos=19&it ool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_ DefaultReportPanel.Pubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/11589248?ordinalpos=2&ito ol=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_D efaultReportPanel.Pubmed_RVDocSum

http://bariatrictimes.com/displayArticle.cfm?articleID=artic le110

http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=136012 0&blobtype=pdf

http://www.empireblue.com/medicalpolicies/policies/mp_pw_a05 3317.htm  (this is empire BCBS guidelines for surgery it has EXCELLENT reference materials in there about the DS, etc)

http://www.medpagetoday.com/MeetingCoverage/ASMBS/14874

http://www.springerlink.com/content/363065077k025330/fulltex t.pdf  (start on page 5)

In the Empire one there's lots of good studies listed in the references section look up the following #'d peer reviewed pubs:  5, 7, 11, 19, 28, 47, 63, 91<- good one for diabetes resolution, 92, 103, 104

If you'd like more articles/ peer reviewed studies/ medical publications, PLEASE do not hesitate to ask!  All my best to you in your decision!!
 

THanks Maria, I am now very interested in the Duodenal Switch...Lots of options out there...I just know that I need to lose weight, and I want to do it safely and I want long term positive results as well as short term...

I am SO thrilled to hear it!  You will not regret researching it.  What are you doing this Saturday?  A group of about 10 DS post-ops are getting together for tubing at Great North in Indiana.  You should join us!  We'll fill you in at lunch afterwards.

Maria,

I read your post about your experience with your DS -- that you had a leak that took a month to heal and had to find an American surgeon to take care of it after having surgery in Brazil. WOW, your a brave woman. Did you have a hard time finding a surgeon to take care of you or did you just go to a local ER and expect that someone will take care of you? I know complications do happen, but there just arent that many DS done and everything I read said the complication are higher -- not only higher chance of leaks in the immediate post-op period like you had, but high risks of nutritional problems long-term because of the extreme amount of malabsorption. These are not minor problems. These are complications that can kill you. Did you have to pay your hospital bill since the complications occured from a surgery that isn't covered by your insurance? I think Dr. Hess, who has now retired, is known as the father of the BPD-DS, but he only described the procedure less than 20 years ago. I guess there is a reason that most surgeons aren't performing the BPD-DS and it only makes up a few percent of all weight loss surgeries. I read your email with all the links (a lot where dead links) and I am wondering how you made the commitment to go out of the country to have surgery and to have the BDP-DS done?

Holly

Hi, Holly.  I hope I can clear up a few misconceptions you seem to have about DS.

I went to Brazil because my health insurance excluded ALL weight loss surgery for ANY reason.  However, I would have gone to the ends of the earth for my DS, whereas you couldn't pay me to have RNY or lapband, for all the reasons I put in my previous post.

I did not just show up in the ER when I had a complication.  Dr. Husted wasn't seeing patients yet, so I went to an experienced bariatric surgeon, who does not perform DS but is certainly educated about it.  He had been recommended to me by my sister-in-law, who is an endoscopic nurse and had worked with this surgeon before.  He handled my case without hesitation, and my health insurance covered the entire bill.   In most cases, patients with complications either return to their surgeon, or their surgeon coordinates by phone with a doctor the patient chooses close to their home.  DS surgeons are quite accustomed to working with other doctors long-distance.

 The rate of complications with DS is no higher with DS than with RNY.  In the old days, DS was performed only on patients who had BMIs over 60, which places them in a much higher risk category no matter what type of surgery they have.  Now that DS is being performed on folks with all BMIs, including "lightweights", the complication rate is about the same. 

DS has been performed for over 20 years in its current form.  However, the sleeve portion has been performed since the 1800's for various stomach ailments such as cancer and ulcers.  And the intestinal portion is performed in other countries exclusive of the sleeve portion solely for the successful treatment of diabetes.  Medicaid and Medicare have covered it for several years.  Why?  Because it works.  It is not considered "experimental." 

The reason most surgeons don't perform DS is simple - money.  It takes several months of proctoring under another surgeon to learn to perform DS because it is a much more complex procedure to learn, and most doctors don't want to put their profitable practices on hold for that.  In addition, a doctor can perform 2 RNY surgeries or 3 lapbands in the time it takes to do one DS, so they earn 2 or 3 times as much money doing those surgeries.  Plus they don't make all the money on the fills and unfills that they do with lapband.

As for follow up care, it's true that if you don't take your supplements, your health will suffer, but that's the case with any weight loss surgery.  Since there is a greater amount of malabsorption with DS than RNY, you'll get into bigger trouble and faster with DS, but if you don't intend to follow up and take care of your health by taking supplements and getting regular labs, you have no business getting any WLS.

I made the commitment to get the DS no matter what it would take, because I knew it would offer me the greatest chance to lose the weight, and keep it off forever.  I have personally seen several women *****gained all their weight with RNY, or just never lost it at all with lapband.  I knew if I had to live on a diet for the rest of my life, which is required with the other WLS, that I shouldn't even bother with surgery because if I could do that, I wouldn't need surgery at all.  DS doesn't require me to count calories or fat grams.  I eat whenever I am hungry, rich and satisfying foods, until I am satisfied, several times a day.  I wi**** could be this way for everyone, including you, Holly.  Best of luck with your choice.

Hi Holly

Not sure wIhat got your knickers in a wad, if you don't like Maria - if you don't like DS or if you have a problem with people who go out of the country to have surgery. 

1. Maria is a good girl, a smart one and a right cute one in her size 4 snowsuit this weekend

2. Maria is a smart girl, she did her research, discovered that there was another option besides RNY or lapband and decided that option was for her.  She also knew there were surgeons here in KY and closeby in IN who could help in the event of complications.  BTW all surgeries have complication rates, might be something you wanna check into

3. The DS is performed by more than one surgeon in the country, it is a more complicated surgery and there fore requires a more skilled surgeon than your run of the mill lap band.  If you were interested at all in knowing these things there are links on OH that could lead you to all the surgeons who perform the DS.  You don't need to rely on the man who developed the surgery there are many more options out there

and

4. There are so many people on these boards who have gone out of country for surgery no matter what type it is.  American doctors and hospitals are so expensive they make going out of the country a very attractive alternative.  There is another young lady in our surgery group who went to Mexico.  Care to take a few pot shots at her too?

This is supposed to be a support forum.  Wanna go slinging ugliness around here there are few who will take it so take your ball and go home.

Come meet with us anytime - we'll tell you anything you wanna know!  PM if you have questions too!