RNY versus DS

Can anyone tell me which gives the best results as a revision from lap band - the RNY or the DS? I didn't have much success with the lap band because I have a sweet tooth, actually I have sweet teeth. 

Well, no WLS is going to help with that sweet tooth.   Simple carbs are absorbed 100% no matter what surgery you have.

With the DS you will malabsorb most of the fat you eat and a lot of the protein so you can always fill up with those but if you have a real problem with sugar you may want to address that first in order to help you have the best chance at success.

Darice, the DS has the best statistics of any bariatric surgery for percentage excess weight loss, for maintaining that weight loss, and for resolution of almost all comorbidities. Of course it's true that any bariatric surgery can be defeated, but the failure rate of the DS is the lowest of any bariatric surgery. It helps a lot that we can eat both protein and fat freely, so we have lots of good food options that you wouldn't have with RNY. But yes, we do still have to watch carbs.

While I've never seen a study compared RNY vs DS specifically for people who are revising from failed lap band, the overall statistics for the DS are superior to those for RNY. That's really all there is to go on. I would suggest you research both options thoroughly, see what post-op diet restrictions, side effects, vitamin requirements, etc fit best with what you can commit to, and then make your decision. Also, if you need NSAIDs (or may need them in the future) consider that with RNY they are contraindicated for the rest of your life.

Larra

Thanks for the replies. 

The DS was created to get past short comings of the RNY procedure most notably maintaining your pyloric valve which eliminates the dumping syndrome associated with the RNY procedure and allows for a more normal digestive process. Today, most or all DS surgeons will recommend a modified DS procedure called a SADi (SIPS or Single Loop) DS which is less risky and offers a longer common channel and thereby reduces negatives effects of the DS, particularly vitamin deficiencies and gas (just reduces, doesn't eliminate). The weight loss appears to be similar and possible better long term than a standard DS, so I would suggest having that discussion with your doctor.

Thanks, jmuldune for the reply.  I will discuss this with the doctor.

Darice, the other poster is happy with her SADI operation, which is great, but she is incorrect about "many" or "most" DS surgeons changing to that operation. A few have, and some offer both, but that's it. What is happening is that some surgeons who have previously offered only gastric bypass are now offering SADI as an alternative to gastric bypass, which is great because more patients will now keep the normal function of their pyloric valve and thus have normal regulation of stomach emptying, and be able to take NSAIDs if needed. Hopefully they will also have a lower long term failure rate than with gastric bypass, which has excellent short term results but a lot of problems with inadequate weight loss and substantial weight regain. But that's not the same as saying that surgeons are abandoning the DS in favor of SADI.

As far as post-op diet, the SADI lacks the selective fat malabsorption of the DS. This should, at least in theory, mean less risk of fat soluble vitamin deficiencies, though long term results are unknown. In addition, these deficiencies are not common with the DS unless the patient is noncompliant. In other words, it's in your hands - if you take your vitamins correctly and diligently and check your labs to make sure you are taking enough, you should be fine.

    On the other hand, without the selective fat malabsorption, the SADI will (again, at least in theory) require a more careful diet than the DS. DS patients don't need to worry about fat content or cooking with fat because we absorb only about 20% of the fat we consume. That's very liberating. It remains to be seen whether the longterm results of the SADI will compare with those of the DS. Short term - fine, but for a chronic medical condition that requires a treatment that will last for life, short term is not enough.

Larra

Larra,

Your comments are not true. First, the SADi is an upgrade to the old DS procedure with the primary difference of maintaining a longer common channel. This minimizes both surgery risk and long term side effects. Both the old DS procedure and the DS SADi benefit from keeping the pyloric valve.

It's really a shame the way that so many people with the old DS refuse to accept the SADi was upgraded 8 yrs ago, and offers a heathier safer option for most people. I guess the RNY patients did the same with the original DS. 

You guys should consider you're trying to talk people out of lowing their risk and long term negative side effects of the standard DS. Also the weight loss so far seems to be as good or better.

I also have a failed lap band... I have had lots of trouble with it and ultimately I discovered that it wasn't optimal for me. I am planning a revision to DS, but I'm still unsure about SADI/SIPS. I already had one failure and I really don't want to fail again and I'm leery of this newer procedure. I'm not sure if the diet for this type of surgery is the same as DS or not - and that's going to be critical, as I know I can succeed on the regular DS diet because it's exactly what I like to eat :)  Is the SADI diet the same except that the malabsorption is less? What about fat absorption? 

The DS SADi diet is the same as the Old DS procedure. The major difference is the SADi procedure itself which is less risky and offers as good or better results so far (8 years since it started). Many of the DS vets on this site don't understand that it has been performed for the past 8 years with stellar results. You will be doing yourself a great injustice if you don't consider it with your surgeons advice.

The SADi is as big an upgrade to the DS, as the DS was to the RNY. It fixes many risks & shortcomings with better results so far in weight loss and post op issues. Just read the posts and you'll notice people are not having many issues with the procedure and the weight loss was about 95% over 3 years studied. On this site, the results for SADi are stellar. 

Also the SADi fat malabsorbtion is consistently misstated. I had the procedure and I mal absorb fat with the same oil slicks for over doing it as everyone else with any firm of DS. Definitely check it out before you have surgery.