Sleeve or DS??

I am researching WLS and am very confused. I was diagnosed with type 2 diabetes approximately 6-7 years ago. It is not out of control...recently A1C was 6.4 and my average fasting is about 128.

Besides the weight loss, my main focus of WLS is resolution of diabetes. I know the DS has the best resolution percentage, but it also comes with the most potential problems. The clinic I am talking to believes the sleeve will be sufficient. It certainly seems to have fewer risks and complications, but, still, I want the best chance to resolve the diabetes.

Any suggestions?

i dont know what the DS is but i had the Gastric bypass ruen Y procedure 5 years ago and it was a total Nightmare for me. I am now completely disabled from all the complications and my stomach is now paralyzed. I have heard that the sleeve has had good results with alot less risk than the gastric bypass ruen y  procedure. All i can say is Talk to your surgeon . Make sure that HE is the one doing surgery . I was fooled . i felt comfortable with MY surgeon but because of where it was done and it being a teaching hospital my surgery was done by aonther surgeon in training and over seen by my actual surgeon who told me HE was going to be the one doing the surgery. I was never informed of this untill i had emergency surgery 1 year later to save my life and i had to get copies of my medical records. That is where i read he never did my surgery like i was lead to belive. But according to laws in texas it was ok for them to do that and not tell me because it was a teaching hospital. Check into that one first . Join a good support group in your area and talk alot to them. This is NOT and easy surgery wichever one you decide to go with. Good luck with everything hope it all works out for the best for you .

I am so sorry to hear of all you have experienced. I really appreciate the sharing and the information. You have provided excellent food for thought.

Are you absolutely positive the surgeon you've consulted with even performs the DS? Most bariatric surgeons do NOT perform the DS so they try to deter patients from getting it (i.e., losing their business to another surgeon).

I had only been diagnosed with type 2 a year before my surgery. I specifically chose the DS in an attempt to obliterate my diabetes. Due to drama unnecessary to bring up here I ended up with a VSG plus only a little bit of malabsorption; my common channel is about 4 TIMES as long as that of a "normal" DS.

So, I can tell you with certainty that the VSG alone would not have been enough for me because this surgery I ended up with still wasn't quite enough. Now, don't get me wrong - my diabetes is WAY easier to control, and if I went to a new doc tomorrow, they would not diagnose me as diabetic based on my current A1C and fasting values. However, I still know I am diabetic because if I have something full of fast-acting carbs (like a milkshake or a pile of mashed potatoes), my post-prandial levels will still spike well into the 200s, sometimes over 250. Normal people don't see those numbers. Also, if I don'****ch my food intake and get lazy about limiting my carb intake, my fasting values will creep back up. When I'm diligent about eating low in carbs, they're happily in the mid 70s to mid 90s. But just a few weeks ago, I checked and had a fasting of about 115 (which helped kick my butt back into gear about limiting my carbs).

I am off of all meds. Pre-op, I was up to 2500mg metformin and 500mcg sitagliptin (Januvia), and I don't take any diabetes meds now. I was cut down to 1000mg metformin when I left the hospital from surgery, cut to only 500mg a few months later, and cut completely free of meds by 6 months (my PCP was more conservative than others and didn't want to cut me from everything cold turkey right away). My A1C at my 1 year post-op labs was 4.8. But, like I said, I know it's still in there...

I found a study recently that provided these figures for type 2 resolution at 1 year post-op with the VSG:

Starting BMI averaging  54.4: 69%
Starting BMI averaging  45.5: 88%

So, a lower starting BMI will provide better chances of resolution with the VSG. With the DS, I have many, many studies that show type 2 resolution exceeding 90% regardless of BMI.

Also, one thing that has not yet been proven with the VSG is the long-term resolution rates. Not having diabetes at year 1 is great, but what about year 5? Year 10? Year 20? I don't know how old you are, but I had my surgery at 26 and wanted the best chances of KEEPING the diabetes away. Studies are now showing diabetes returning a few years after RNY for some unfortunate folks, whereas with the DS, this doesn't happen. The VSG as a stand-alone WLS procedure has barely 5 years of research behind it, whereas the DS has more than 20.

I keep a running thread of studies and articles here on this board and in my profile if you'd like to read up.

I'm curious what you mean by that the DS comes with "the most potential problems." Between the VSG and the DS, that is true, but I have to say the RNY scared the crap out of me, and I was RELIEVED when I found out about the DS! I never considered the VSG for myself since kicking diabetes was my primary objective, and the reconfiguration of intestines plays a pretty major role in that. With the DS, the biggest complaint I see consistently is that eating lots of carbs can cause gas. This is true even for me - sugar doesn't bother me at all, but starchy carbs (pasta, potatoes, breads, rice, etc.), and I know I'm in for some gas bloating and pain later on. I see more DSers battling constipation than diarrhea. And I hope no one has tried to tell you that DSers end up with a foul body odor (I have heard this one before and have yet to meet a DSer in person who has this problem, and I've probably met more than 50 DSers in person so far).

I post on both the DS ad VSG boards since I ended up with this sort of in-between surgery. I can tell you that I've seen more than one VSGer get all the way to their weight loss goals but still have symptoms of their diabetes. I know of at least one who was considering a revision to add the "switch" part of the DS solely to help with her diabetes even though she had reached her goal weight.

I'm not saying the VSG can't/doesn't/won't work for you, just that the DS works for more people than the VSG does and has stood the test of time. Good luck with your decision!

Thank you so much for all of the fabulous information. You are correct in that my surgeon does not perform the DS. I wonder why so few WLS surgeons do this surgery though?

I don't think my research is through yet! This can be so confusing!

The DS is a more complex procedure than the VSG or the RNY, so it takes longer to learn, whereas I have heard of surgeons learning to do RNY in a weekend seminar. So, fewer surgeons go that extra mile to take the extra 1-2 YEARS to master performing the DS (and quite frankly, not every surgeon is skilled enough to handle it). It also takes longer to perform in the OR, yet insurance only reimburses about the same amount as for an RNY, so it is substantially less profitable than quicker  procedures such as the band, VSG, and RNY.

And then there are some surgeons who are honestly fed the same misinformation or outdated information based on the old BPD procedure that many patients hear from non-DS surgeons - that the DS is only for super morbidly obese folks (very high starting BMI), that DSers end up with a disgusting body odor, that DSers have excessive bowel movements on a daily basis (this topic comes up on the DS board somewhat frequetly - most common anser I see is 2 poos in the morning and that's it - there has even been a study that concluded that there is no statistically significant difference in the amount of bowel movements between RNYers and DSers), that DSers will have diarrhea for the rest of their lives (I don't  know many people who can take calcium and iron sulements like many of us do and not be constipated!), that DSers will have uncontrollable peel-the-paint-off-the-walls gas every day (again, a topic that often comes up, and the most common answer is that gas is very easily controlled by watching what you eat)...the list goes on. Some of these are possible side effects, but they happen to VERY few DSers, and they are not afforded to DSers alone (for example, I recently saw a thread on the VSG board asking if they sold Gas-X strips at Costco).

Not that you asked for my personal opinoin, but here it is anyway: The VSG and the DS are the most logical WLS procedures available today. I hope that someday, they outrank the band and the RNY as the most commonly performed procedures (though I doubt it since the band is so easy to install and is backed by millions on marketing $$, and the RNY is so much easier to learn and perform than the DS). So hopefully either way you go, you'll be happy with your decision. Just keep doing your research, and you'll find what makes the most sense for you.

Thanks so much! I really appreciate all the information you have provided. It has really opened my eyes to some things. All of the "issues" you have listed are all of the ones I saw  (and heard) from other websites.  Even from our local health care facility. So I almost immediately dismissed it. Glad I didn't! It has certainly eased my mind quite a bit to know these issues aren't necessarily true for everyone.This forum (and the people on it) are fabulous and it is so wonderful to have this resource.

I haven't made a decision yet other than to narrow it down to either VSG or DS. I plan to continue research, research, research so that I find what I feel is right for me. I do know that to do DS I'll probably have to go out of town. I'm certainly willing to do that for the right procedure done by the right person. Thanks!

Don't be afraid to wander around the DS forum here on OH or even post a thread asking about these types of side effects. If you'd like a source for more information (including a list of "vetted" DS surgeons), check out www.dsfacts.com (non-profit site created by a Canadian DS patient, not affiliated with any surgeon or hospital or anything like that).

I'm only about a month out from my RNY but it has put my type 2 diabetes into remission and I feel great.  I find the threat of dumping from eating sugars and simple carbohydrates and great deterent.  RNY has a great % for putting diabetes into remission.  This is the reason I had WLS.  Just make sure whatever procedure you choose, the doctor has performed it successfully on a lot of patients.  I also don't buy that doctor's are learning the RNY in a weekend.  Give me a break.

On December 10, 2010 at 8:54 AM Pacific Time, Lucycat wrote:

I also don't buy that doctor's are learning the RNY in a weekend.  Give me a break.

Research it. Why would I make it up? It's certainly not ALL RNY surgeons, and they are still SURGEONS when they learn the procedure (as in, have gone through medical school and all that jazz), but it does happen. Regardless, the fact remains that the RNY is easier and faster to perform then the DS, which is one reason more surgeons choose to do the RNY and not bother with the additional time investment required to learn the DS.

The RNY does have a "great % or putting diabetes into remission." However, the DS has an even greater %, and the LONG term DS % is much better than that of the RNY. I hope you are in the percentage whose type 2 does not re-surface a few years after your RNY.