Switch or Bypass?

RNY is tried and true to FAIL.

with your BMI, the ONLY and BEST option for you to be successful long term is the DS. That's not just my opinion, that's medical fact. 

I belong to a Bariatric revision group on FB...and 99% of the members are RNY'ers with significant regain looking to get their stomas fixed. Everyday there are new people showing up all with the same problem. The stoma has stretched out so much there is nothing to keep food from emptying out of their pouch as soon as they eat it. So they're never full and therefore eat all the time and gain gain gain. I also have a friend from high school who had RNY about the same time I had my sleeve. Her life has been a medical nightmare ever since. She's had numerous hernia surgeries, lives in pain, and has gained back a good bit of weight. 

with RNY, you lose your pyloric valve and have this stoma instead, you have a pouch instead of a fully functioning stomach, you cannot ever take NSAIDS, you cannot drink with your meals, and they have dumping. Also the malabsorption of calories is temporary while the malabsorption of vitamins and nutrients is forever. You couldn't PAY me to have that surgery. It just doesn't make sense to me from an anatomy perspective.

i had the sleeve first and then revised to the DS 3momths ago. No problems here...I'm quite happy with my choice.  

Are there risks and possible complications with the DS? Of course, it's major surgery...but no more so than with RNY.

But really...with your BMI, I would never settle for the RNY. 

The DS has the best statistics of any bariatric surgery for percentage excess weight loss, for maintaining that weight loss (very important!) and for resolution of almost all comorbidities. For someone of your size it is the only choice that makes sense.

Most people with gastric bypass do well at first, but regain is a huge problem. The longterm failure rate with gastric bypass is about 30%, and when you consider that "success" in the world of bariatric surgery means just losing 50% of your excess weight, that's a very high failure rate.

I don't know of any experienced DS surgeons in your state. the best list of DS surgeons is at dsfacts. Keep in mind, though, that you are not the average bariatric surgery patient - I'm not being judgemental here, this is just reality. You need someone experienced with the DS, not someone new to the operation, because you are higher risk and technically a more difficult patient to operate on. You are saying that travel is not an option for you but I hope you will reconsider, because for you to get the operation you NEED, you will need to travel.

Do you every watch the show "My 600 Pound Life"? I hope I got the name right. There are 2 messages I would like you to take away from that show if you see it. First, even the most motivated SSMO patients struggle to lose weight after their gastric bypass, and must stick to a strict diet and do a lot of exercise to succeed. DS isn't a free pass either but it's much easier to life with. Second, some of these people, who are heavier than you are and often very disabled, travel long distances to get to the surgeon seen on the show because they can't find anyone local who will help them. Travel is clearly difficult for them, but they make it happen, and so can you. It's logistics, and logistics can be dealt with, but a failed bariatric surgery is something you will be stuck with for life.

And all of that is aside from the issues others have brought up - living without the function of the pyloric valve, never being able to take NSAIDs again, possible dumping, etc.

Keep on reading and researching. As someone I used to work with often told me, set yourself up for success.

Larra

Monique look me up on facebook. I'd be happy to meet you for lunch and let you pick my brain. Becky Walker Jenks

The only surgery that has a chance of getting your weight down and keeping it there is the DS.

Every day we see people who had the RNY seeking revision to the DS because they either did not lose enough or gained the weight back.  The typical proximal RNY only bypasses a bit of the small bowel and the body compensates for it by the second year or so.  And that's when the regain starts.

You do need a real DS surgeon.  On many sites, OH included, surgeons list the DS when in reality, they do not do the surgery.  Their marketing plan is to get you in the door and sell you the surgery they do.  This is called "Bait and don't Switch".  Your BMI is high and that makes you more of a risk than some.  You can even the playing field with an experienced surgeon.  Medicare will cover surgery out of state.  You just have to make your case and defend your reasons/logic.  And there is plenty of medical literature out there to defend a choice of the DS for anyone who is SSMO.

Best of luck to you!

So for what it's worth. I started the whole process at 552 and had my DS surgery at 464. I picked it for several reasons but a big one was that it had the best chance for me losing all the weight I wanted too and then keeping it off. The fact that I resolved my DIabetes, sleep apnea, and high BP were happy bonuses but not the main driver.

Look, I can't say I had a good life at over 500lbs. I coped but it was getting harder and harder and I really had to change my definitions of a good life as time went on. The chance to change that made it worth the risk. It wasn't an overnight decision either. This was the 3rd time I started down the WLS road but I made up my mind I needed to make a change.

I had a virgin laporscopic surgery out of the Cleveland Clinic. People can say what they want about vetted surgeons but mine wasn't on any list and still did a great job. However, I knew I was not among his first set of DS patients and his reputation as a surgeon was great so I went with it.

I think with your weight your best chance is the DS but there are people that succeed with a bypass. Your chances are just much better with the DS. Surgeons are all different and your high BMI might be an issue. My surgeon talked about a two step DS (VSG for initial weight loss and then the switch part later) unless I lost enough between that appointment and surgery. Happily for me I did. I could always lose weight I just couldn't keep it off - since I just had to make it to the surgery that was fine for me.

I think the DS is your best choice. Statistically there is only a little more risk between the Bypass and the DS. That does depend on the patient and the surgeon though but you can only make your decision based on the facts you have.

Hmmm I've been worried about this one.  As a man and at under 500, I am sure you were big BUT you had some height.  This poster is 5'2 and so she is at least 650 to 700lbs.  Torso can't bee too long and so well lots of fat in a crucial area.  Extremely high risk.  I would go on a medically supervised diet first . . . even an impatient in another state if mine did not have one.  Entirely too risky a weight to begin at for surgery.  I am probably wrong but I would feel that way for me.

My apologies in advance if I am off track.

I wish this poster the best success.

I jumped through insurance hoops for years to have a gastric bypass. But, all that time, I researched the DS and KNEW that it was the right surgery for me. The risks, for me, were worse with the RnY because I may have dumping and there was too great of a chance I would gain my weight back. Insurance would have paid for my RnY 10 miles from my house, but I self paid and went to Brazil for the DS. I would do it again 10 times over.

While there, I met a woman (my switch sister) that weighed in excess of 500 pounds. Sure, it is risky to have surgery at that weight - even for tonsils. I know she is mobile and living a good life.

When the DS was experimental (before it was approved by Medicare as an acceptable surgery), it was usually given to the SMO patients.

This is your decision but for me, I am glad I had the DS 9 years ago!

Dianne