Which surgery?!?!

Thank you NYMom222! Those are great reasons. It's a tough decision, and I appreciate you taking the time to share your story! 

Your surgeon probably doesn't know how to do this surgery, which is why he hasn't mentioned the duodenal switch.  It's got a 98% permanent cure rate for type 2 diabetes and the diet is much easier to follow than RNY.  VSG does give you some control over the diabetes, if only because you will get your weight under control, but the other two options are definitely more powerful.

I've read and was told my surgeon that the duodenal switch is very rarely used, has high chance of complications, and us often used for extremely obese people. We agreed that wasn't the right surgery for me. Thank you for your input, Valerie! 

I don't care what surgery you select, but want to clarify some things as many people read this post while researching.

The DS is certainly not rare.

According to studies, the incidence of complications for DS statistically are the same as for RNY. Studies also show that DS is better at treating t2 diabetes than the other weight loss surgeries (as well as resolving other co morbs like high cholesterol).

While the DS is in fact more effective for the extremely obese, it is more effective for all BMI's and is commonly done on lightweights as well.

The guidelines for WLS quilification are a BMI over 40, or BMI over 35 with co-morbs, for RNY, DS or Sleeve. 

Getting information about a particular surgery from the surgeon, if it's one they can't do, often yields inaccurate information. 

I was in kinda the same boat not sure what surgery to have I decided to go with the vgs the reason was if it works I wont have as many complications as with rny and if it don't you can always revise to rny

  My surgeon explained tha. Studies have shown less complications less vitamin supplement and less regain.  I hope this helps Good luck.

Thanks so much for your thoughts! I appreciate it! My surgeon did explain this, but I'm not sure I want to go through, but mostly pay for, two surgeries! 

Duodenal Switch.

It's THE form of WLS for resolving Type II diabetes ANd high cholesterol. It has a Sleeved---i.e., fully-functional---stomach, plus a very determined intestinal bypass that will cause you to malabsorb a significant per centage of the calories you eat, FOREVER. It has the best long-term, maintained weight-loss stats of ALL the current forms of WLS, and pretty NON-restrictive post-op diet. All forms of WLS require a post-op diet of protein FIRST, but the DS also needs a lot of fat---and fat is what makes foods tasty and satisfying.

Thank you MsBatt. Another person mentioned this, yet I've read very little about this procedure. Why do you think there's not much information about it? 

Several reasons.

It's a more complex surgery that requires a higher level of skill than the other forms of WLS. I'm not a surgeon, but I have friends who are surgeons. Intestinal tissue isn't easy to sew, but the duodenal tissue---the uppermost part of the small intestine---is considered THE hardest to sew. I've heard it compared to sewing wet tissue paper. As a seamstress, this makes me shudder. (*grin*)

It takes longer to learn to do a DS, so---that's more time a surgeon has to take from earning money in the OR doing Sleeves, RNYs, or Bands. (Although, thank goodness, very few are doing Bands these days!)

Less so now, but back when I had my DS, getting insurance coverage for the DS was more difficult. Since the DS is more difficult, and takes more OR time, IT COSTS MORE. Insurance companies prefer to spend as little as possible. (IN the past 4-5 years, this has been changing, as insurance companies are learning that it's cheaper to pay for ONE, effective surgery, but...some have decided to just limit each patient to 'one WLS per lifetime', no matter WHICH insurance carrier paid for the first one.)

While the DS has the very best long-term, maintained weight-loss stats, it ALSO requires the highest level of patient...well, I hate to say 'compliance', because with the current level of surgeon-driven post-op education, strict 'compliance' is likely to kill you. What the DS requires is post-op patient self-education, and a dedication to monitoring one's own vitamin and mineral intake and lab results. ALL forms of WLS can lead to malnutrition, but because the DS causes the highest degree of malabsorption, it also requires the highest degree of self-awareness about diet and supplementation. Some surgeons have shied away from the DS because of poor patient compliance, but *I* think much of that problem is due to poor surgeon-driven EDUCATION about HOW to be healthily compliant. (If you want to know more about this, PM me.)

I had my DS in Dec. of 2003. I'm still in touch with many of the folks who had their DS around the same time I did, and 95% of us are still very healthy and happy with our surgery. BUT we mostly learned the hard way, and we had to fight VERY HARD to get a DS in the first place. Compared to what was easy to find back then, there's a wealth of good, sound DS info out there today. (And, sadly, a bunch of BS, too.) If you'd like to learn more about the DS, I suggest you visit www.bariatricfacts.org, and join some of the DS-specific groups on Facebook. Duodenal Switch Patients is a good one for solid info, but not so much for hand-holding or blowing smoke up your butt. (*grin*)

Finally---back when I was looking into getting a DS, there were 52 surgeons in the ENTIRE WORLD who did it. Today, there are a couple of hundred in the US alone who do. No matter what some people may tell you, the DS is growing in popularity by leaps and bounds.

I just got my approval for revision from lap-band to RNY today.  I'll tell you why I decided to go with RNY instead of VSG:

• I've got PCOS, which combined with the lap-band, has shot my metabolism to pieces.  I wanted a procedure that also had a metabolic element to it, to give my metabolism a boost.  I already had a "restriction only" procedure (twice, actually, since I had to have my first band replaced due to a massive slip) and wasn't happy with the long-term results. 
• I simply don't trust the results of the VSG yet.  It's simply not been performed as a stand-alone procedure long enough to have really long-term data.  I made the mistake once of having a procedure done that was touted as being the next big thing in weight loss surgery, with projected long-term results that were as good as or better than RNY.  Yeah, that didn't turn out so great.  I'm not taking the risk again.  This is my third time around (remember, I had to have my band replaced, too), so I wanted something that has the best chance of success (the DS is not an option for me for various reasons).  I don't want to do this again.
• I have had extremely bad reflux with the band, only getting some relief when I have no fluid in it.  Since one of the major side effects of the VSG can be reflux, I'm steering clear of that procedure.  Reflux isn't something to be fooled around with, since it can cause tooth decay, vocal chord damage, and even cause damage that leads to cancer.  Plus, it's hell to have to sleep sitting upright and STILL wake up choking on stomach acid.