DS vs RnY
When we first researched surgery, Ted wanted the bypass because of all his comorbidities. When we went to see the surgeon, Dr. Greenbaum, Ted changed his mind. Dr. G explained each of the three procedures to us. What convinced Ted was:
the DS would leave him with a complete stomach, not a pouch
higher success rate of resolving diabetes and diabetes staying in remission longer
lower rate of regained weight
more choices in food selections
I thought he was nuts but I totally supported him and was there with him every step of the way. I saw that he recovered just fine, healed, and began to lose weight quickly. Although he wasn't able to eat nearly the amount he did before, he didn't have to worry about consistency of food very much or how he chewed it or about food getting stuck anywhere. He didn't "dump". And his diabetes went into remission very quickly.
I started discussing my surgery in January 2009. The first thing the surgeon did (it wasn't Dr. G, it was one of the other surgeons in the practice who performed lapbands and bypasses) was tell me he definitely would not recommend the lapband because of the extent of my diabetes. It would be very difficult to have my diabetes go into remission. He suggested the bypass or the DS.
I researched both surgeries thoroughly. In addition to the stuff Ted considered, I also looked at being able to take NSAIDs regularly. I do, for athrtitis and fibromyalgia and other chronic pain. Hey, I didn't want to give them up!
Also, since Ted had already had the DS I figured it would be easier to support each other. And I liked and trusted Dr. G.
So that's why I picked the DS over the RNY. :)
I worked at a bariatric clinic and saw all the bad stuff first hand regarding RNY. The DS does not have any blind stomach issues, or problems with the outlet of the "pouch" (because we don't have a pouch). Thought there for a bit I would be forced to have the RNY because of what my original surgeon told me... but second opinions and support from this forum led me to the right decision for me.
The DS rules!
Come to the Dark Side!!! Band to DS revision 11/09/09.
Learn about the Duodenal Switch at dsfacts.com ! Off site comparisons of the 4 WLS
http://www.thinnertimes.com/weight-loss-surgery/wls-basics/w eight-loss-surgery-comparison.html
http://www.lapsf.com/weight-loss-surgeries.html
RNY – expected weight loss
*50-65% expected excess weight loss (percentage varies in opinion – this is the most commonly seen estimate)
Regain
*Possible regain: more prevalent after 5 years
*50-100% regain of weight has been recorded
*Results may vary
*Must follow “pouch rules" in an attempt to not regain
DS – expected weight loss
*85% expected excess weight loss
*Results may vary
Regain
*Studies show little to no regain (no one recorded as to gaining all of weight back like with the RNY)
*Results may vary
*Highest success rate over 10 year study (78% avg. Excess Weight Loss – EWL)
RNY – have a stoma (stomach made into a pouch – size of an egg)
*Size: 2 oz
*Stretch to average size of 6 oz in 2 years (possible to stretch up to 9-10 oz)
*You can eat more as time goes by
*Average after 1 year is 1-1.5 cups of food
No Endoscopes on blind stomach/remnant stomach that is bypassed
*Doctor evaluation: cannot use an endoscope (to find ulcers and tumors)
*RYGBP construction makes the large bypassed distal stomach inaccessible to standard non-invasive diagnostic modalities. Neither x-ray contrast studies nor endoscopy can assess this potentially important but hidden area.
Stomach: pouch
*Should not take Nonsteroidal Anti-Inflammatory drugs (NSAID).
*NSAIDs are: Advil, Alka Seltzer, Aleve, Anacin, Ascription, Aspirin, Bufferin, Coricidin, Cortisone, Dolobid, Empirin, Excedrin, Feldene, Fiorinol, Ibuprofen, Meclomen, Motrin, Nalfon, Naprosyn, Norgesic, Tolectin, Vanquish
NSAIDs are used for arthritis, bursitis, tendonitis, back pain, headaches, and general aches and pains.
*Taking NSAIDs could develop into a bleeding ulcer and interfere with kidney function.
Possible Problems
*Ulcers (Some doctors recommend taking prilosec for 6 months to 1/2 years in an attempt to prevent the ulcers)
*Possibility of a staple line failure
*Noncompliance: simply do not lose enough (even with following the rules)
*Vitamin Deficiencies
*Narrowing/blockage of the stoma
*Vomiting if food is not properly chewed or if food is eaten to quickly
*Dumping syndrome, NIPHS, Hypoglycemia
No Valve (pyloric valve that opens and closes to let food enter intestines is bypassed) which means food empties directly into the small intestines and causes dumping and/or can cause NIPHS or Hypoglycemia
Dumping: food (most commonly sugar but not necessarily “just" sugar) enters/dumps directly into small intestines and causes physical pain (some people believe this pain enforces good eating habits)
*Dumping varies in degree of occurrence and discomfort
*Dumping symptoms:
Nausea
Vomiting
Bloated stomach
Diarrhea
Excessive sweating
Increased bowel sounds
Dizziness
“Emotional" reactions
NIPHS (insulin over production): “the body overproduces insulin in response to food entering the intestines at a point where food would normally be more digested already - this part of the intestine is not used to coping with metabolizing glucose in the condition it arrives after RNY, and it is suspected that the intestine signals the pancreas for more insulin to aid digestion, causing a MASSIVE overproduction. The change occurs on a cellular level, hard to diagnose. Treatment: Removal of half the pancreas."
*RNY stoma that is created allows food to go straight through the stomach into the small intestine unrestricted so it does not control the flow. Because of that the body reads that it needs more insulin because the food is moving through so quickly and it thinks there's going to be a lot more food. With the DS, the normal peristalsis works because the pyloric valve is in place and can control the movement of food into the small intestines.
*NIPHS, Hypoglycemia is deadly if not corrected
DS – whole stomach (size of banana)
“Whole working stomach" - meaning the stomach’s outer curvature is removed as opposed to making a pouch/stoma.
*Part of the stomach removed is where most of the hormone called Grehlin is produced.
Grehlin gives the sensation of hunger so by removing most of that section of the stomach a DSer is not as hungry as before.
*Whole working stomach: no blind stomach. Endoscope can be used.
*Can take NSAIDs
*Do not need to take Prilosec to prevent ulcers.
*Valves are in tack: no Dumping Syndrome or NIPHS
RNY – Eating
*Eat protein first
60g of protein a day
*Recommended to chew food to liquid consistency (pureed, soft, thoroughly chewed)
This is more important for people early out (new pouch stomach will stretch out with time).
Food is thoroughly chewed to prevent blockage (the hole/path leaving the stomach and into the intestine is roughly the size of a dime).
To get food unstuck, patients drink meat tenderizer mixed with water.
*Low carbohydrates
Carbohydrates can slow weight loss and lead to possible regain
Avoid sugars in particular (to prevent dumping syndrome)
*Low fat
Foods high in fat may cause Dumping Syndrome
Fatty foods can lead to slow weight loss or possible regain
*64 oz of water
Stop drinking within 15-30 minutes of a meal
Do not begin drinking after a meal for 1-1.5 hours
Some doctors do not encourage the use of a straw (pushes food too quickly through the stomach and can cause gas/discomfort)
*Water Loading
15 minutes before the next meal, drink as much as possible as fast as possible.
Water loading will not work if you haven’t been drinking over the last few hours.
You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.
Disclaimer: this is a practice some people use to feel “full" and lose weight. Not a requirement.
DS – Eating
*Eat protein first
80-100g of protein
DS patients can on average eat more food than any other type of weight loss surgery.
*Low carbohydrates
Carbohydrates can slow the weight loss and lead to possible regain
No dumping syndrome from eating sugar (or fat)
*Eat high in fat
DS only absorb 20% of fat (do not need to eat low fat)
If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or RNY absorbs ALL 20g. (this is just an example, measuring absorption is not an exact science)
*When experiencing a “stall" (slowed weight loss/plateau) a DS patient commonly increases fat consumption to resolve
*64 oz of water
Can drink with meals
Can use a straw
RNY – Possible Issues
*Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
Common vitamin deficiencies found in vitamins B12, iron, and zinc
Calcium must be supplemented for the rest of your life
*Bathroom issues
Gas
Constipation
Dumping in the form of loose stools
*Reversible procedure (Reversals of any surgery is very complicated)
Revision often performed instead of reversal
Revising to a different type of surgery is possible.
DS – Possible Issues
*Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
Common vitamin deficiencies found in vitamins A, D, and iron
“Water soluble"/ “water miscible" / “dry" vitamins absorb best (in other words get vitamins that are not fat/oil based)
Calcium must be supplemented for the rest of your life
*Bathroom issues
Gas
Loose stool (Most common in the first few weeks of surgery. Generally food related)
*Reversible procedure
The intestinal bypass is reversible for those having absorption complications revision: lengthening common channel (to stop losing weight and/or to absorb vitamins)
Stomach is obviously not reversible (part of stomach was removed)
RNY - Diabetes
*85% cure rate
*RNY can put diabetes in remission.
Diabetes may come back in two or three years--even if the
patient maintains most of their weight loss.
Even a small amount of weight gain, long-term, can cause a diabetes
relapse.
DS – Diabetes
98 % cure rate for type II diabetes.
DS – Myth or Fact
DSers will have a heart attack from all the fatty food they eat = Myth / Not True
-Cholesterol levels lower after having the DS.
-80% of the fatty food is not absorbed – the fatty food is healthier to eat as a DSer than a person without surgery.
**The fat therefore does NOT enter the bloodstream**
If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or a person with the RNY will absorb ALL 20g. Good meal for the DSer. (this is just an example, measuring absorption is not an exact science)
The DS is only recommended for the super morbid obese (BMI over 60) = Myth / Not True
-To be eligble for ANY type of weight loss surgery, a person has to be 100 lbs. over weight or have a body mass index (BMI) of 40 or more.
-BMI’s under 40 have also been approved (usually require a comorbidy/health problem - an example is sleep apnea).
The DS is “experimental and investigational" = Myth / Not True
-Medicare approves the DS
-Many insurance companies are starting to cover the DS.
-DS has been performed since the 1970s
DSer will have a problem when they become old = Not True
-We wont need to eat as much when we are older b/c our bodies will adapt
-The little hair-like villa located in the intestines grows longer to adjust to the new digestive system (grows longer to increase absorbtion).
DSer’s gas stink = true
-The gas does smell. (This is true for the DS and RNY)
*Most people see no difference in gas smell but more in the way their poop smells.
-There are products called air fresheners that a person can use.
-Controllable by diet (stay away from trigger foods)
-May take Flagyl or fish zole
DSers may need to wear a diaper = Myth / Not True
-That is silly
Skin color turns yellow or pallor = Myth / Not True
-Patients who follow their regular vitamin regime (keep up with blood work) do not turn pallor
-If someone looks pallor, they could have a vitamin deficiency. This applies to any type of weight loss surgery. For both RNY and the DS.
-Vitamins and blood work must be monitored for life. For both RNY and the DS.
Dsers don’t need to exercise = Myth / Not true
-DSer’s are aware of the benefits of exercise (body and soul).
-Exercise helps in losing weight and maintaining goal weight
*Some practices may not be used by all patients. Some recommendations will differ depending on a person’s surgeon. Possible issues are just that, “possible," and may or may not occur.
5'10", HW: 326/SW: 280/CW: 181/Goal: 165
Here is a message I posted sometime ago to a similar question. Let me know if I can help in any way.
Red
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When I was first exploring the possibility of WLS I went to an RNY support group meeting. The things that the people said about their post-op life were very upsetting to me. But at that point I did not know about any other surgery except Lap Band, and I was sure I did not want that. Next, I went to a different surgeon's information session. When I left that meeting, I told my husband I did not think I could this. Plus, I have a dear, dear friend who had the RNY and has not been able to eat a piece of meat since his surgery. This is a man who is 6'8" tall and loved beef, chicken and pork. Now all he can eat is seafood and some vegetables. Oh, about the RNY surgeon. After that meeting I took his list of pre-op tests to my PCP to get the tests ordered, but that morning I had a terrible headache. So my PCP ordered a CT of my brain. We found out I have a little brain thingy (venous angioma) and a spot next to it that they call a small ischemic change. This put everything on hold until we could find out about these things in my brain. Also there was a hold-up with the surgeon scheduling an insurance class that I had to attend before they would submit my paperwork and give me an appointment for the consult. Well, before I knew it that surgeon's office called and told me they would not be performing any WLS for several months while they found a new hospital. The surgeon then lost his license because of high complication rates and law suits. Then one night when I was on the OH website I saw a post from Diana Cox and she invited anyone who wanted more information about the DS to contact her. I did, and well I guess the rest is history. But even then my insurance up and decided not to cover the DS anymore. I decided to wait it out because what I knew about the RNY scared me. Eventually I found a way around my insurance issues and went to Omaha for a consult with Dr. Anthone. On the plane trip home I developed a blood clot in my leg. But the office went ahead and submitted my paperwork. And I was approved for surgery. However, at that time I was on coumadin for the blood clot, so we knew I would have to wait at least three months till I came off the coumadin. However, before I came off the coumadin, the hematologist did genetic testing and found I had three genetic clotting disorders. When I had an upper GI done and the radiologist saw my IVC filter and asked me about it. I told him I felt like a blood clot probably saved my life. His response to me was –" it probably did, you would have probably died on the table." I shudder to think what could have happened! First off if I had gone with a bad surgeon and then if I had not had that life saving blood clot. I have always heard the good lord takes care of children and fools and I ain’t no kid!
Now every time I have the opportunity to tell anyone about the difference in the two surgeries I tell them. I tell them about having a fully functional stomach and not a pouch. I tell them about being able to eat just about any food in moderation. I tell them to do their homework and research the surgeries independent of their surgeon. I remind them that their surgeon no matter how well intentioned has a vested interest in what surgery they have. I am now three and half years out and down 140#. When I had the DS I had been researching the procedure for some time. I will try to tell you a little about it. You see there is an awful lot of misinformation floating around about the DS.
The DS has been around for many years. Dr. Hess, surgeon who is credited with perfecting the technique has a patient that is something like 21 years out. The man is alive and kicking and doing just fine. You can find some of Dr. Hess's papers at http://www.duodenalswitch.com You will also find lots of other information and a message board totally dedicated to the DS. It is a great site and I encourage you to go there and study the information and post questions there too. There are many who participate on that board that do not post here who are several years out. I would also recommend that you look at http://www.dsfacts.com There you will find a great surgeon list and a lot of reliable information.
The DS is two parts; the restrictive part and the mal-absorption part, it is similar to the RNY in that way, but that is where the similarly ends. The restrictive portion of the surgery is accomplished through a vertical sleeve gastrectomy (VSG). The VSG removes ½ to 3/4 of the stomach. Now, yes this does seem drastic and scary. But what is accomplished is that you get a much smaller fully functional stomach and the portion of the stomach that produces gherlin a hunger producing hormone is greatly reduced.
How does this compare with the RNY pouch? Well, first off there is no blind stomach. You see normally our stomach is about the size of a football. With the RNY all of that stomach remains in your body producing gastric juices. However, once it is stapled off or transected the only way to see what is going on inside is with another operation. You cannot scope the blind stomach. The DS stomach is completely accessible. Plus because it is a whole fully functional stomach one can still take NSAIDS and many other medications that are not permissible after the RNY. Then there is the connection. Since there is a natural connection between the stomach and the intestine the chance of marginal ulcers is practically eliminated. The DS retains a good portion of the pyloric valve so the food is regulated going into the intestines -- hence, no dumping. The DS also retains most of the duodenum this aids in the absorption of iron and B12.
Yes, the DS does produce the most mal-absorption of the WLS. But it is this mal-absorption component that makes the DS so effective at long-term weight loss and maintenance. According to many, the DS has the best record for long term maintenance of weight loss.
For me, once I heard about the DS I knew it was the surgery for me. I did not think I could live with the restrictions of the RNY. When I went to that RNY support group they were happy with their weight loss but other than that all they talked about was dumping and throwing up. One lady kept saying if she put one grain of rice in her mouth she would throw up and she was like 18 months out. These people were miserable. Are these extreme cases, probably, but it was enough to scare me. I went to a support group meeting for the DS, it was held in a restaurant. The DSers were actually happy. They were happy with their weight loss and happy with their eating. There were no stories of throwing up, food getting stuck or dumping. They all still eat their protein first – but there was such a difference in attitude. It was easy for me to decide which way to go.
I have no bowel issues. That is one of the myths about the DS. I too had what I think was IBS pre-op. I would go days without a bowel movement at times and then other times I could not get to the bathroom fast enough. And the cramping was so bad at times I thought I would pass out from the pain. All of that is gone now. Before I had the surgery I asked Dr. Anthone if it would cure my IBS and he got a sly look on his face and said he could not promise that it would go away, but if it did, he would take the credit for curing me! You gotta love a surgeon with a sense of humor.
When you go for your surgical consult be sure that you go to a surgeon that really does the DS. There are many surgeons listed here on OH that claim to do the DS but in fact do not. We have learned through the feedback we get here that many of these surgeons do not tell the truth about the DS. Also there are those surgeons who will tell you they do the DS and then when you are in their office will try to convince you to have the RNY or Lap Band. The web site I listed above has the most reliable list of DS surgeons on the internet. Each of these surgeons have been vetted or checked out by the owner of the site. Also, the owner of that site does not accept ads nor does she receive any sort of remuneration from the surgeons listed. Hence, it is a very objective list.
You asked about complications. Yes, I did have some complications. First let me say my surgery is perfect. I have had many CTs and MRIs since surgery and there is not a staple out of place. I had to be hospitalized a few days after my discharge (from surgery) for pancreatitis and something to do with my kidneys. Then I had a very hard time eating and drinking for many months. I think part of the problem was that I had thrush and everything tasted nasty and part of the problem was that I had no appetite. I also think the anesthesia really played havoc with me emotionally and I was very depressed. But, around the six month mark I started feeling more like my old self.
As I mentioned I have genetic clotting disorders and take coumadin. When I first told my hematologist about my plan to have WLS - he said absolutely not -- no way. You see, his fear was that I could develop an ulcer and because of taking the blood thinner I could bleed out before anyone would know what was wrong. He told me he had a couple of patients who had gastric bypass and he had seen this problem with ulcers and bleeding. I told him I was not having THAT surgery and explained that the risk of developing ulcers is greatly reduced with the DS. I then gave him my surgeon's contact info and asked him to call Dr. Anthone. He left the room and called him right then. They spoke for probably ten or fifteen minutes and the hemo doc came back in the room and said this sounds good and, oh, by the way, I have a good friend who is a hematologist in Omaha who can follow you while you are out there. I will give him a call. How is that for support.
I had an open procedure. My incision was a work of art. In fact I teased my surgeon by saying he could moonlight as a tailor the stitches were so neat. I did not feel a great deal of pain and after my discharge I rarely took any pain medication. My surgeon only does the DS open. He feels it is the best way to do the surgery and since my bikini days are behind me and I have other surgical scars-- it was a non- issue for me.
No, the DS is not a magic bullet or pill. It is still work. You have to take your vitamins and get your lab work done. But you have to do that with the RNY. But I think the DS gives you the best chance at not only getting the weight off and making it to goal – but keeping it off. I would be very happy to send you more information about the DS if you will send me your email address, I cannot send an attachment through this system.
Artificial Intelligence is simply no match for Natural Stupidity.
I was unable to eat good protein sources. I wound up anemic, and pretty miserable. I revised to the ds this past December because of many of the reaons people have listed above. I am already able to eat steak and chicken, something I haven't been able to do well since 2003.
