How does one decide?

I apologize in advance for the long rambling nature of my first post. I'm struggling to figure out if having bariatric surgery is the best option in order to help me become healthy, and if it is, which surgery is the best fit. I fully understand that bariatric surgery is simply one tool and won't work without eating right and getting off the couch but I'm having a hard time wrapping my head around why it would happen after surgery, if, I haven't been able to do it before. I've done the starve myself and exercise which worked wonders for about six months but regained all the weight and more. Later, I was able to drop about 20 pounds with good eating and walking but I plateau and again put on more weight. I'm currently at another plateau but worry that again I'll soon see an increase in weight and even if I don't gain more, I'm certainly not happy with my health at this size. I wonder if I simply didn't try for long enough and question why spend the money on surgery, if I can just keep the money and try another round of eating better and moving more given I'd be doing it following the surgery anyway. I'm also worried that having bariatric surgery is going to result in having to pay for revision work every number of years which seems to defeat the purpose.

The second question is obviously if I do go ahead which option would be the best fit. I'm 27, 43 bmi, I don't suffer from any obesity related conditions, but I suffer from bipolar 2. Being bipolar brings medication which from my research basically means if I want to keep my current medication regiment, gastric bypass is not an option. I'm left considering either a DS or a VSG. My wife had the VSG performed a little more than a year ago so I've been able to watch her experiences but I'm also finding a number of individuals who had a VSG, are going back and having the DS performed. If I'm going to have surgery I would prefer to just have it done once and not have to worry that 5 years down the road I have to go back for another surgery which is part of the appeal of the DS. On the other hand, the DS seems to be a more drastic surgery with a higher risk for complications and given my relatively lower bmi, I'm not sure I'm the targeted audience.

Again, sorry for the longish rambling post but I'm hoping individuals who are or have been in my position can provide me with some advice/insight or places I might not have looked at.

If you only want one surgery then the DS is what you want altho it is malabsorptive like the RNY but it is a better long term surgery. I would suggest go to the DS forum and ask questions over there also go to dsfacts.com and check out other social media for ds forums.With the ds you may have to hunt to find a doc that does them but it would be worth your hunt to make sure they have done a good number of them.

Thanks for the response and yeah I have concerns about issues with the DS & medication but I like other aspects. 

The DS is not a "better" surgery than the VSG, regardless of what anyone on here may tell you.  It's simply a matter of which one is the best fit for YOU and what your goals are.  

If you believe that you need the malabsorption piece to get to a healthy weight, then you should go with DS.  You said that malabsorption would mess with your bipolar medication.  Why would the RNY mess with that but the DS wouldn't?  The DS's malabsoprtion piece is for life whereas the RNY's is not.  

The only reason you would need to convert the VSG to a DS is if you found yourself unable to make the lifestyle changes to reach your goal weight.  People aren't converting because the surgery failed them -- they failed their surgery, let's be very clear on that.  Surgeries don't fail, people do.  There are plenty of people on here who had higher BMIs than you who have been super-successful with the VSG.  

Do more research, talk to people who have had the surgeries, and interview the hell out of the surgeons.  Ask how many procedures they've done of each one, what their complication rate is, mortality rate, leak rate, etc.  Through the process you'll get a better feel for which one is for you.  

Thanks for your response. 

Ive vey been getting mixed findings on the impact of medication and the bypass which is partially why I've ruled it out but kept the DS as an option. I've also reaced out to others who have bipolar and had a surgery to see how things went for them. I do agree with you, that, there isn't one surgery that is the best but that it will carry from person to person.

"The DS's malabsoprtion piece is for life whereas the RNY's is not."

Only partially true. Both the RNY and the DS cause permanent malabsorption of certain vitamins and minerals, but only the DS causes permanent malabsorption of calories.

As for " People aren't converting because the surgery failed them -- they failed their surgery, let's be very clear on that.  Surgeries don't fail, people do," I disagree, and more importantly, so do a lot of WLS surgeons. Some people simply require more than portion control.

"...the DS seems to be a more drastic surgery with a higher risk for complications and given my relatively lower bmi, I'm not sure I'm the targeted audience."

Anyone who qualifies for WLS qualifies for a DS. I know people who've had their DS with a BMI below 35, and they've been very successful, healthy,  and happy.

The surgical risk of the DS is pretty much the same as for the RNY/gastric bypass. In the past, the DS was generally reserved for fatter, sicker patients---so the complication rate higher. But when you compare apples to apples---i.e., patients of similar size and health, operated on my surgeons of similar skill and experience---the complication rates are the same.

Basically you need to figure out whether you need malabsorption or not. The VSG is an excellent surgery, if your metabolism is pretty much normal and portion control is all you need. many of us were born with the 'thrifty' gene, and have metabolisms capable of running our bodies on fewer calories than 'normies' burn. Sadly, dieting tends to make our metabolisms ever more efficient, making it harder and harder to lose weight. If you think you have any sort of metabolic issues, then you probably DO need malabsorption.

I don't really encourage people to get the Sleeve thinking "Oh, if this doesn't do the trick, I can go back and add the Switch for a full DS," but that IS an option. It's not really as efficient that way, and you're putting yourself at twice the surgical risk by having two surgeries instead of one, but it's a possibility.

You also need to think about how you want to eat for the rest of your life. DSers have permanent malabsorption of a significant per centage of the calories we eat, especially calories from fat. Since we only absorb about 20% of the fat we eat, we tend to eat a LOT of it---and still have cholesterol numbers around 100. (Any family history of high cholesterol or diabetes?)

Yeah, I've been finding my initial thought of DS to be incorrect which is good to know. I'm not sure why but I never thought to look up a "normal" diet for a duodenal surgery patient but I guess off to google I go. And I believe no history of diabetes or high cholesterol.

Most DSers I know eat 120+ grams of protein a day, all the fat we WANT, and a moderate amount of carbs. 'Moderate' varies---some people are more carb-sensitive than others, and of course while in the losing phase you'll want to keep them as low as you can be comfortable with. We also tend to eat every 2-3 hours, all day long. (*grin*)

I made my decision because while I had been very successful in weight loss in the past, I had never kept it off, and currently my body wasn't cooperating with losing weight. Having surgery meant I had a better chance of losing it and more importantly keeping it off. I don't understand your comment about the medication not being an option with gastric bypass but DS is OK? With both you have malabsorption. I have seen several posts on here were people mentioned being bi-polar, maybe you could do a search and find people who could tell you their experience. Good Luck!