Sleeve to loop duodenal switch

1. I had the sleeve done over 3 years ago have gained back 60 pounds. I'm having a loop duodenal switch (sips) done next month. Looking for anyone out there that could share experience in this. Anyone have similar experience??

You might find someone on the revision board or on the DS board. We have one member, I believe who is considering this, so you will probably be hearing from her.

How much weight did you loss with the SIPS? I have had a lot of regain and will be having the sips done. I just can't find a lot of people who have had it done. Can you share a little of your experience with it. Thank you!

Initial results are promising with LoopDS (aka SADI, SIPS, SADI-S), but know that the long term effects remain unknown since this has only been done for a few years (I want to say 5yrs, but only seen it being sold in the mainstream for a few). They need pioneers to get that long-term data. It took 20 years for the DS to finally get respect with the medical community and insurance companies.

In fact, there is no CPT code for the Loop DS. They bill it as a DS and some have been caught after the fact with the insurance company refusing to pay the bill after seeing that it wasn't a DS and the patient is left paying it all by themselves. Just be wary of that if you're looking for insurance assistance. Most slip through without a problem, but it's a risk (and officially fraud) seeking approval for DS with no intention of getting the DS.

Most are looking to the DSers for nutritional information because that is also unknown. I recommend Vitalady.com's DS regimen to get started with. Do it until your first bloodwork is drawn (or longer) and start to adjust the regimen according to your lab results.

I was actually considering this option when I was making my choice so I've done quite a bit of research. First some general science-y stuff, then the SADI/SIPS/whatever stuff.

Val has very valid concerns; the SADI/SIPS is still considered experimental by most insurance. What this means is that if you have this procedure and insurance decides to be a twit if there are complications, they may choose to not cover the resulting care to fix the complications. I am actually not sure when they will have a diagnostic code for it. It is not yet approved as a standard procedure by the ASMBS. That doesn't mean it's bad necessarily...it takes time to approve things, and medical regulation goes at the pace of turtles running a race while they are sleeping - which is a good thing for the most part.

However, you must be aware of and educated about these potential consequences. Also, there's no guarantee that you don't need to follow the DS supplement, protein, and fat rules. Nutritionists are notoriously bad about DS requirements, and will likely give poor advice. You will die, or have severe damage, without sufficient fat and protein. No one likes being on TPN...it's a huge pain in the behind at best.

Also, be sure to get a surgical report when you have your procedure, regardless. There has been much chicanery regarding some DS/SADI procedures, and either way you should absolutely review your report. I will also add that if the SADI is being done as part of a research study, often the aftercare and complications are covered by the research because we must adhere to principals of beneficence for studies.

As for the traditional DS, this is still the #1 gold standard for high BMI individuals. It has the best weight loss statistically. Having said that, I have seen RNY and sleeve peeps do just as well, too. It really depends on a lot of factors, the most significant being your eating habits and behavior.

At any rate, the DS shines for high BMIs for several reasons. One is that by the time we are super obese, we are very insulin resistant. The sleeve does not entirely correct this. The sleeve also does not alter the enterendocrine cells for quite as long as the RNY or DS. This is because an intestinal bypass has a profound effect on the metabolic hormones of the body - the sleeve has a profound metabolic effect too, by the way, it's just not to the same degree, and it does not typically affect the gut cells I mentioned in the same manner. That's really the biggest cause of weight loss for these surgeries. Yeah, the malabsorption helps, but it's the endocrine changes that cause the weight loss and the "honeymoon" period people talk about.

Having said that, the SADI is very new compared to the DS. There are starting to be ten year studies published, as well as several huge reviews of all the literature. Several thousand people have had the SADI at this point. There are two advantages a traditional DS has over the SADI: 1) there is moderate carbohydrate malabsorption with the DS more so than the SADI, due to the fact your common channel is shorter and 2) the SADI has a (minor) chance of causing bile reflux. A DS and an RNY generally cannot cause bile reflux due to the way the alimentary limb is formed.

I don't feel though that the SADI is necessarily inferior in terms of results. At this point the literature says the difference in weight loss is there but less than you might imagine. User error is always going to be the #1 reason for a lack of weight loss for the majority of people seeking surgery. There's also no guarantee that even a DS can get someone to 100% EWL. It does give you the best shot, however it comes with a need to be pro-active, educated, and vigilant about your nutritional needs. Slacking or laziness with a DS or a SADI, or hell an RNY, can get you very sick at best, or dead at worst.

I did not go with the SADI or DS at this time because of a few reasons. I have severe GERD and may not be able to keep part of my sleeve, possibly, due to damage. It was an absolutely heart-wrenching decision as I had my heart set on one of these primarily, but I wound up being advised by several surgeons to do RNY instead. When the pro-DS surgeons tell you to look at an RNY that sure gives you pause, heh.

I was actually going to choose the SADI despite being experimental because I am a...unique...case, and already have malabsorption due to having Celiac. It gets rather bad as it is. So it was ill-advised for me to get, say, a Hess DS. The main reason for the revision is the pathology, though who doesn't want more weight loss?

Anyway that's enough of my rambling >.> You an absolutely do quite well on a SADI weight-loss wise. Just be aware of potential pitfalls you may have, and question the surgeon carefully about them. Don't be complacent with your after-care and nutrition.