Is 2 surgeries standard for a DS?

My doctor told me I can choose any of the surgeries I wish. I do not think they realize how confusing and awesome of a task that is for people. There is so much info, good, bad, misinformed opinions to waddle through. It is all becoming very stressful!

i am leaning towards the DS. But last night I just read that it is sometimes performed in 2 surgeries because it is too big of a surgery? First a sleeve then the intestinal by pass year or two later. This can be a deal breaker for me. If sips can be done in 1 surgery, why can't this? I would change my mind and go rny or sips then I guess. 

So a question for all that read this. did your DS take 2 surgeries or 1? If it did take the 2, for what reasons was the second half postponed?

Thanks in advance!

SOME surgeons do not feel comfortable with doing a virgin DS on someone who is SSMO. However, the best DS surgeons have no problems doing it in one stage for their patients who are in good enough health to go into surgery ANYWAY.  (examples of two who do a virgin on SSMO are Dr. Rabkin and Dr. Keshishian both in California).

I do understand that it is POLICY for the DS to be done in two stages in the UK for some reason.

Mine was one surgery...best way for you to find out is ask your surgeon. Assume it's gonna be one surgery unless he tells you different, then move forward from there by either insisting on ONE or find a new surgeon.

My DS was done in one surgery as a virgin DS, no revision from any other surgery.

I'm guessing in the UK the thinking is if the VSG, which is the top half of the DS works in getting and keeping the weight off, there's no use in having the patient deal with the daunting (to some) task of all the vitamin and mineral supplements necessary because of the malabsorption the full DS brings with it.  Sometimes, the surgeon feels that the patient is too heavy to endure the complex surgery all at once, so they will stage it - VSG first, then after weight loss, go back and do the DS.   Many times, the patient has lost enough to have the DS portion Laparoscopically.  Mine was open, because my surgeon didn't do LapDS on anyone with a BMI above 50.

Folks who don't take care of their DS can and *will* suffer vitamin deficiencies and protein calorie malnutrition quickly, and once nutrition tanks, it's hard to recover. Many who don't follow the protocol, or don't get the correct protocol end up on TPN if they can't master the protein and vitamin requirements.  That is why the lab checks are so huge for DSers. Some medicos still try to lump the nutritional needs of DSers into the same category as RNY's, but DS nutrition is way different.

I'm not a UK doctor, or a USA doc for that matter...just a person living with a DS...emphasis on *living*, because had I stayed at 405 ( and likely more), I probably would have been in a nursing home or dead by now. 

I just turned 57 this month, hypertension and sleep apnea gone!

The DS is usually (read almost always) done in ONE surgery. There are exceptions for people who are either extremely SSMO or who, for other health reasons, need to be off the OR table as fast as possible. Some revisions are also done in more than one stage. But in general, any experienced DS surgeon can do the DS in ONE operation on almost all patients.

However, the surgeon you have listed does not do the DS. He has begun doing the SIPS, or SADI, or whatever name he is using for it. This is not the classic DS, it is a much newer variation for which long term results are unknown. It does not provide the selective fat malabsorption that the real DS would give you. Whether he's doing it in one stage or two, I have no idea.

I would strongly recommend that you have a consultation with another surgeon who does the real DS and does it in one stage. If you then decide to go with SIPS instead that is your choice, but you will be making a much better informed decision. Personally, I would not be willing to have an operation where the long term results are not known when there is an excellent standard of care operation like the DS that DOES have well documented, excellent long term results, but that's me. You may feel differently.

Larra

just curious....Where did you get the information that he does not do the real DS and just does the sips?

He has a good reputation (from what I know reading here) as a gastric bypass surgeon and recently began doing the SIPS. This info comes from his patients who post here occasionally. I have no personal experience with him. However, I have not yet heard of him doing the standard DS on any patient here or on any other DS related website. If someone knows otherwise I hope they will inform us both.

    This is not to say that he's not a good surgeon. He may be terrific at what he does. It's just that what he does isn't the DS. I do think SIPS is far, far better than gastric bypass so if he's doing SIPS instead of gastric bypass, that's great. It will spare many people from losing the function of their pyloric valve, from dumping, from not being able to take NSAIDs for the rest of their lives...but that doesn't make it a DS.

Larra

Happy to report Dr. Enoch's does perform both the traditional ds, and the new sips procedure. I am scheduled to have my traditional DS done on March 2! 10 days to go! Excited beyond words. Just because a doctor doesn't advertise all the different procedures, doesn't mean they don't do them. They simply put the most popular. Goal is to have patients do their research and really know what they want and why they want it, and then ask for it. The DS is not something someone should enter into without knowing the risks. dr. Enoch's has done many traditional ds procedures and sleeve to ds convertions. Yes, He likes the new sips procedure Because he believes in it, but it is not the only thing he does.

That's great news! I hope he will inform potential patients of this on his website. I agree completely that every patient should do his or her research and be well informed about all the options and their potential benefits and complications, but it makes sense to me that a surgeon would make known all the bariatric surgeries he or she does so a patient interested in a given operation will consult with them.

Best of luck with your upcoming surgery!

Larra

Unless you are in REALLY bad shape the DS can be done in 1 surgery by a real DS surgeon.  My surgeon did it on an 800+ lb man.  I actually met him once.  Baltasar and Rabkins did the DS on 600 lb patients...even LAP.  Usually the surgeon is telling you about HIS/HER skill level.  And if the surgeon is not skilled enough to do the whole op at once...well they shouldn't be doing the whole op at once.  Plus it's a money maker for the surgeon while the patient has to be traumatized twice for the convenience of the surgeon.

The next problem with the 2 surgery approach is getting insurance approval for the second stage.  This has proved to be a real issue.

Bottom line.  Don't accept the 2 surgery thing unless you know you are in dire shape.  Find a real surgeon.

Do a lot of research.  You have to live with choice.  Your surgeon does not.

I was just getting my info from all the people against DS. They are the ones that out it in my head that it is a 2stage operation. My bmi is floating just above 40, I am actually afraid to lose any weight and be turned down last minute.  

Pro DS, anti DS, pro sips anti sips....a lot of fiery debate and misinformed statements. i can't wait to be over all of this!