I also had never heard of it before deciding to have WLS.  When I initially decided to get WLS, my thought was to have the lap-band, but once I went to the info seminar of the MeritCare Bariatric Center, the dr told us that they were moving away from doing to bands in favor of the RNY b/c of high long-term failure rates/ failure to lose or maintain at least 50% of their excess weight.  That spurred me to start reading the research on WLS's.

I think that there are definitely people who are successful with thhe RNY, but the long-term stats are better for the DS, especially once you get into the 5-10 year post-op range.  At 10 years post-op, 20% of those who had an RNY have regained at least 50% of their excess weight that they had either never lost to begin with or had lost & then regained.  Only 5% of those who got a DS have regained at least 50% of the weight (or never lost it - HIGHLY unusual) by 10 years post-op.  The main reason for this is that the RNY has A LOT of restriction due to the pouch size & regulating stoma and it has some malabsorption.  Over time, it is expected that the pouch will stretch out some & that puts more of the responsibility of regulating food intake on the person, hence they fall back to dieting.  I'm really successful at dieting & always gain the weight back.  I do have instances where I eat way too much food in one sitting.  I know I do & I also think that most obese people fall into that category/habit.  Why the DS works better for long-term success for the average person is because it has some restriction (3/4 of stomach is removed), but it has A LOT of malabsorption.  Fat is absorbed at 20%, protein at 40%, complex carbs at 60%, & simple carbs/sugars at 100% - so you still can't eat sugary crap all day long & expect to lose.  You'll lose some, but not that much, if you eat sugary crap all day.  However, due to the high malabsorption feature, that is why the long-term stats are better b/c that doesn't change, unlike the RNY's pouch expanding.  I also like the fact that you can eat more.  There seems to be a good bit of variability by patient for this, some people can eat a lot 3-5 years out of surgery & others typically eat like a normal 2000 calorie per day person - neither of whom tend to gain weight.  There are exceptions, but it's very rare & difficult to mess up with the DS - I LOVE that.  I would feel devastated having lost all of this weight & then regain it back.  Horrible, unacceptable.

The 1/4 of stomach that is left with a DS (sleeve) also stretches some with time - this just is a normal process.  At least the stretchiest part of the stomach is the outer curvature, which is the part that is removed, so it doesn't stretch quite as much.  The hunger hormone ghrelin is also mainly produced in the portion that is removed.  I understand that ghrelin production decreases with RNY patients b/c the stomach isn't being used, but some is still produced by the stomach b/c the stomach's still there. 

One huge advantage of the DS is that all of the food intake & outtake regulating portions of the stomach are left intact, specifically the pylorus valve is left intact, which is removed with the RNY.  Because this valve is remvoed, food passes in an uncontrolled fashion out of the pouch directly into the small intestines - that's what causes dumping symptoms in many of those who have the RNY.  DS patients never - none of them - experience this, at all.  This also means that you can take whatever medication you need to that has anti-inflammatories with NO risk of marginal ulcers b/c it's dissolved in your stomach before hitting your intestines b/c the pylorus valve still regulates food passage into the intestines.  Both rheumatoid & osteo arthritis run in my family completely independent of weight (they're normal weight) & I already have joint pain in several locations & I'm only 31, so I'm likely to need to take NSAID's.  My dr already advised me to start taking OTC anti-inflammatories.

The more I read, the more my reaction was, well holy **** why isn't this done more???  It's a very complex procedure & not that many surgeons know how to do it, so of course, if someone goes to the typical WLS surgeon, they're not going to coo about the positives of the DS when they can't do it!  It would be like convincing their potential customer to go elsewhere.  Sadly, I have heard of a # of surgeons who know about the DS purposely spread factually incorrect information, which I think is unethical, such as your body will literally smell or that you will poop 10-20 times per day - both are not supported by research or the many, many people on the DS boards.  I've also heard the rumor that you need to wear a diaper - not true.  Generally, people do have some awfully smelly farts & poop, but air freshener works.  Aside from that, people on the DS board state that it's typically things that have white flour & processed sugar (not fruit) that causes gas, so people usually just avoid eating much of those things while out in public.

BC/BS would pay for an RNY for me, but not the DS b/c they will only do that if your BMI is 50 or higher.  The "catch-22" is that Dr. Fabian, who is in network for BCBS is reserving doing surgeries on those with a BMI up to 45 until he gets more experience (which makes sense), but he's also the only one in ND who has been physically trained in how do them.  So, that's why I'm forgoing my paid RNY for the DS.  I don't want to risk being a failure when I have a much better chance of success with the DS, I want to have a fully functioning regular stomach where I can eat regular normal-sized people amounts of food, I don't want dumping, & I want to be able to take anti-inflammatories.

With all that said, I know that there are RNY people who are successful & I certainly wish anybody who goes through WLS success.  It really saddens me that there's so much misinformation out there & people who don't even know it's an option b/c data shows that there's going to be people who aren't succesful with the band or the RNY who would have been successful with the DS - not all of them, but most.