Sleeve to DS - Questions for Doc (X-Post)
Just thought I would share my list in case it might help someone else. Feel free to share anything I might have missed. I also welcome your answers and feedback if you've already been through a revision or have a DS. I'd love to have a robust list before my consultation. (This is a X post on the revision message board as well.)
Surgeon
How many surgeries have you preformed?
How many Sleeve to DS revisions have you done?
How often do you perform the DS?
Which surgery option do you perform most?
How many two-stage duodenal switch procedures have you performed?
When is the second stage typically performed?
How many laparoscopic DS procedures have you performed that needed to be converted to open? What were the reasons for that?
How many DS procedures have you started but were unable to complete? What were the reasons for this?
Complications
What percentage of your revision patients had complications?
What are the possible complications?
What is the most common complication?
What has been the worst complication with your patients?
What do you think caused these complications?
How many of those patients died due to post-op complications?
What can I do to help avoid complications? Lose weight pre-op?
How many patients of yours have needed follow-up surgery to help with the complications?
Costs
What is the estimated cost?
Do you have financing for any portion of the expenses that insurance will not cover?
Do you require a deposit? If so, how much?
Procedure
If a liver biopsy and removing the gallbladder is not approved by insurance, will those need to be done anyway?
How will the incisions be closed (staples, stitches, glue)?
Do you stitch over the stomach staples?
Can you possibly go in through the same spots from my Sleeve procedure?
Is there a weight loss unit at the hospital?
What size is the stomach with the DS compared to with the Sleeve?
How do you determine common channel length?
Does the length have an impact on GI issues?
How do you determine alimentary limb length?
What pre-op and post-op tests do you conduct (leak tests)?
Surgery Options
How many pre-op appointments are required before surgery?
At what point is it truly necessary to consider a revision? And the DS in particular?
Does my non-surgical weight loss affect your opinion on me needing the surgery?
Which surgery would be best for me (why, laparoscopic)?
What is my normal weight range and what is the expected weight loss?
When will the weight loss start? Why don’t you recommend the other surgery options for me?
Post-Op
What happens to the unused portion of the intestine?
What is the best thing for dehydration?
What can help with bowel issues (probiotics, avoid carbs)?
What percentage of vitamins, protein, sugars, carbs and fat are absorbed?
Will the hospital staff give me something for nausea after surgery?
Will the scars be any worse than the ones from my Sleeve?
What are the details of recovery compared to the Sleeve (time, pain, etc.)?
How often and what type of follow-up care will there be (labs, doctor visits)?
What are the long-term medical needs (vitamins, medications)?
What percentage of people regain weight?
Is there nutrition, psychological, exercise, etc. support after the surgery?
How long should I avoid pregnancy?
Should caffeine be limited post-op after the healing process?
Vitamins/Medicines
Will I need to crush my vitamins and medicines at first?
When will I start the vitamin regimen?
What are the most effective birth control methods post-op (depo shot, a ring)?
If my gallbladder isn’t removed, will I be on Actigal post-op to help prevent stones?
Do iron levels drop post-op? What helps prevent or slow hair loss?
Surgeon
How many surgeries have you preformed?
How many Sleeve to DS revisions have you done?
How often do you perform the DS?
Which surgery option do you perform most?
How many two-stage duodenal switch procedures have you performed?
When is the second stage typically performed?
How many laparoscopic DS procedures have you performed that needed to be converted to open? What were the reasons for that?
How many DS procedures have you started but were unable to complete? What were the reasons for this?
Complications
What percentage of your revision patients had complications?
What are the possible complications?
What is the most common complication?
What has been the worst complication with your patients?
What do you think caused these complications?
How many of those patients died due to post-op complications?
What can I do to help avoid complications? Lose weight pre-op?
How many patients of yours have needed follow-up surgery to help with the complications?
Costs
What is the estimated cost?
Do you have financing for any portion of the expenses that insurance will not cover?
Do you require a deposit? If so, how much?
Procedure
If a liver biopsy and removing the gallbladder is not approved by insurance, will those need to be done anyway?
How will the incisions be closed (staples, stitches, glue)?
Do you stitch over the stomach staples?
Can you possibly go in through the same spots from my Sleeve procedure?
Is there a weight loss unit at the hospital?
What size is the stomach with the DS compared to with the Sleeve?
How do you determine common channel length?
Does the length have an impact on GI issues?
How do you determine alimentary limb length?
What pre-op and post-op tests do you conduct (leak tests)?
Surgery Options
How many pre-op appointments are required before surgery?
At what point is it truly necessary to consider a revision? And the DS in particular?
Does my non-surgical weight loss affect your opinion on me needing the surgery?
Which surgery would be best for me (why, laparoscopic)?
What is my normal weight range and what is the expected weight loss?
When will the weight loss start? Why don’t you recommend the other surgery options for me?
Post-Op
What happens to the unused portion of the intestine?
What is the best thing for dehydration?
What can help with bowel issues (probiotics, avoid carbs)?
What percentage of vitamins, protein, sugars, carbs and fat are absorbed?
Will the hospital staff give me something for nausea after surgery?
Will the scars be any worse than the ones from my Sleeve?
What are the details of recovery compared to the Sleeve (time, pain, etc.)?
How often and what type of follow-up care will there be (labs, doctor visits)?
What are the long-term medical needs (vitamins, medications)?
What percentage of people regain weight?
Is there nutrition, psychological, exercise, etc. support after the surgery?
How long should I avoid pregnancy?
Should caffeine be limited post-op after the healing process?
Vitamins/Medicines
Will I need to crush my vitamins and medicines at first?
When will I start the vitamin regimen?
What are the most effective birth control methods post-op (depo shot, a ring)?
If my gallbladder isn’t removed, will I be on Actigal post-op to help prevent stones?
Do iron levels drop post-op? What helps prevent or slow hair loss?
That's a VERY comprehensive list. (*grin*)
One or two things caught my eye. First one, re the stomach size---in a 'virgin' DS, the stomach is usually a bit larger than in a stand-alone Sleeve, so unless yours is really large, I doubt your revision surgeon will touch it.
Secondly, re the 'unused' portion of the intestine---it's not really 'unused', just 'bypassed'. It's still attached to the common bile duct, and carries bile and pancreatic enzymes down to the common channel. Here's a pic:
See how much longer the bypassed (bilio-pancreatic limb) portion of the intestine is, compared to the alimentary (food-carrying) limb? (Surgeons who use the Hess method measure the whole small intestine, and divide it 60/40.) This is why DSers absorb so little fat. Fat can only be absorbed after it's been emulsified by bile.
One or two things caught my eye. First one, re the stomach size---in a 'virgin' DS, the stomach is usually a bit larger than in a stand-alone Sleeve, so unless yours is really large, I doubt your revision surgeon will touch it.
Secondly, re the 'unused' portion of the intestine---it's not really 'unused', just 'bypassed'. It's still attached to the common bile duct, and carries bile and pancreatic enzymes down to the common channel. Here's a pic:
See how much longer the bypassed (bilio-pancreatic limb) portion of the intestine is, compared to the alimentary (food-carrying) limb? (Surgeons who use the Hess method measure the whole small intestine, and divide it 60/40.) This is why DSers absorb so little fat. Fat can only be absorbed after it's been emulsified by bile.
MsBatt,
This is great info. My sleeve is a 36 French but it has a stretched area (like a balloon) that might need repaired. Not sure if repairing it is necessary though.
So food isn't mixed with bile until the very end instead of along the entire bp limb. That makes sense now. And because of that short length, food is basically expelled before it's completely digested....I think that's a good assumption.
One more question (as if I don't have enough) - Is the digested food that's expelled (aka poop) different because it's less "digested"?
Thanks again for your info! I'm a bit scared to undergo a revision (had complications during my sleeve operation but really none after). The more informed I am, the better I feel about the whole thing.
This is great info. My sleeve is a 36 French but it has a stretched area (like a balloon) that might need repaired. Not sure if repairing it is necessary though.
So food isn't mixed with bile until the very end instead of along the entire bp limb. That makes sense now. And because of that short length, food is basically expelled before it's completely digested....I think that's a good assumption.
One more question (as if I don't have enough) - Is the digested food that's expelled (aka poop) different because it's less "digested"?
Thanks again for your info! I'm a bit scared to undergo a revision (had complications during my sleeve operation but really none after). The more informed I am, the better I feel about the whole thing.
Some absorbtion does occur along the alimentary limb, since the food does mix with digestive enzymes secreted in the stomach, but most absorbtion does happen in the common channel, and ALL fat absorbtion happens there. On average, DSers absorb about 50% of proteins, 60% of complex carbs (everyone absorbs nearly 100% of simple carbs, alas!), but only about 20% of fats. This is one big reason we don't eat reduced-fat or artificially fat-free foods. When fat is removed from foods, something has to take its place, and it's usually carbs.
And yes, malabsorption does cause some changes in our poop. The smell is different, more---well, scented like the foods we've eaten, or at least that how it seems to me. I won't say it's stinker than before, just---different. And because it is less digested, there's a greater chance of getting our intestinal bacterias out of balance. (This is true with the RNY, too, BTW.) This is why many of us take probiotics.
And yes, malabsorption does cause some changes in our poop. The smell is different, more---well, scented like the foods we've eaten, or at least that how it seems to me. I won't say it's stinker than before, just---different. And because it is less digested, there's a greater chance of getting our intestinal bacterias out of balance. (This is true with the RNY, too, BTW.) This is why many of us take probiotics.
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