Dr: RNY, Sleeve, Lap-Band then DS. WTH?

 I went to my first orientation meeting yesterday and was stunned to hear him say that if he was operating on a daughter or wife (all things being equal) he would pick
1.  Rny
2. Sleeve
3.  Lap-band
4.  DS

Part of his reasoning was based on the limited long term studies of the DS, since (in the medical world) it is a relatively new surgery.  

His comments really took me by surprised since he also admitted that as of now, the DS has shown the most promise of EWL and quoted it somewhere between 80-90%  Thoughts?

Find someone else to do your DS?

Part of his reasoning was based on the limited long term studies of the DS, since (in the medical world) it is a relatively new surgery

What a load of crap! The DS has been aroun a lot longer than the sleeve as a stand alone procedure. Sounds to me like he doesn't actually do the DS. He might even be one of the bait and don't switch doctors. I agree. Find someone else.

The DS has been done in the USA since 1988 - much longer than the sleeve as a stand alone, longer than lap band as well. There are excellent studies of large groups of patients with 10-15 year follow-up showing the superior longterm results not just for weight loss, but also for resolution of almost all comorbidities AND for maintaining good nutritional health as well.
     Longterm results for RNY are available, and they aren't as good as for DS. Longterm results for lap band stink (though there are of course some patients who do well) and the reoperation rate is the highest of any wls. Longterm results for sleeve as a stand alone are simply not available.
     If you would like to see the longterm results of the DS for yourself and not accept the word of someone who apparently hasn't read the medical literature for himself, I would be glad to sent you a couple great articles. Just send me a pm.

And as far as the most "promise", he sort of almost got this right, as the success rate for DS really is about 90% or so. On the other hand, RNY has a failure rate of 30% longterm, and this is with the rather generous definition of success being losing just 50% of your excess weight. There are a lot of people out there with RNY who have lost 50-60% of their excess weight who are counted as "successes". I wonder how successful they feel. Lap band failure rates are even higher. Sleeve short term does much like RNY, and again, longterm, who knows.

Larra

Who's the doctor, do tell?

 The Dr. was McKinlay from the Rocky Mountain Associated Physicians (Salt Lake City).  He admitted that he did not do the DS but assisted on many of them with Dr.s Smith and Simpers.  Simpers is listed on the dsfacts website thingie.

Two other things kinda freaked me out about the RNY surgery.  First, there was another guy in this orientation class who was HUGE!  Turns out that he had the RNY surgery several years ago but "put some of the weight back on."  No ****  He was the size of my car.

Also, my cousin had the RNY done by (you guessed it) Dr. McKinlay and she dropped weight like a rock.  Now 3 years out she is gaining a ton of it back.  

So it was a Twilight Zone experience.  

Last, this was my first post so I appreciate the comments back.

Okay, I can accept him a little bit as a colleague of a true DS surgeon.  Make your next appointment with Dr. Simper.  Keep in mind that the DS is by far the hardest weight loss surgery to perform, and yet is usually the least lucrative to the surgeon per hour of his/her work, especially if accepting insurance for it and not charging extra.  Not a good mix for them to want to perform it. 

For patients who have had an RNY, their malabsorption greatly diminishes after around 2 years (unless the bypass is quite distal, but the majority are proximal, meaning not all that much intestine is bypassed).  Also, RNY patients' stomas often stretch, which means they lose the aid of restriction.  Add to that the reactive hypoglycemia from their RNY not sending food through the pylorus, making them hungrier.  Then, to make matters worse, these patients are usually blamed for their regain.

Ignore him. The RNY data look worse all the time and he should be keeping up on that stuff.

 Let's guess here -- you went to a surgeon that is not on the list of vetted DS surgeons, right?

 
If all other things are equal, and he REALLY performed all four surgeries, he would have said that he'd go with the surgery that a) the patient prefers based on her own lifestyle and tolerance level for life adjustments AND b) that will give the patient the best outcome.  His "unbiased" ranking system will definitely influence the prospective patient's decision regarding the type of surgery she/he wants.

I'd encourage you to use a surgeon who is on the vetted surgeon's list at DSFacts.com, if the DS is the surgery you really want.