If you were converting from sleeve to DS, would you resleeve?

there are numerous variables when it comes to weight loss.  the weight loss window you are talking about is due to early on the restriction portion of the VSG and it takes the body about 18-24 months for the body to adapt to the bowel shortening etc.  Once intestinal adaptation occurs then the body gets much better at absorbing with the shorter bowel, it will never absorb the same pre op, but the body is an amazing thing and it will do everything it can to absorb more.  when you see a short weight loss window that is what is is in reference to, there are no free rides ...lose all the weight and I would suggest going a little under, since you will have a bounce back.  and yes for sure I would be resleeved

Some are all for the Hess method.  But I have seen successes with the cookie cutter approach too.  I don't think it makes all that much difference unless you are one of those rare folks with a much shorter, or longer small bowel.  I know one person who ended up with the shortest CC ever, 40cm, because of the Hess method.  It served her well and she is just fine.  Have you ever had your hands in guts?  They move like earthworms kind of.  Honestly you could put 1 patient in an OR and have the 10 best DS surgeons in the world measure the CC and they would all be different.  It's really a best guess scenario.

I think a little ancient history will help you here.  The DS and really all WLS began from soldiers who were gut shot and with the availability of antibiotics, began surviving.  In the beginning it was pretty much thought if you lost a part of your digestive tract, you would eventually die.  They found out they were wrong.  We have more guts than we need to survive and the body will adapt as much as it can to it's altered anatomy.  That's important.  It's one of the processes that stops your weight loss.

Unusual but true.  Occasionally a CC grows.  This has been documented a couple times.  More likely to happen if you are very young when you have your DS.  I hypothesize it's probably not that unusual for a CC to get a little bigger over time.  Plus, the small bowel of a DSer usually has more concentrated villi than a normie.  Homeostasis.  The body is always trying to get back to where it used to be.  It's safe fat happy place.  This is also why I believe RNY folks start gaining at around the 2 year mark.  That's when the body has adapted to the small amount of malabsorbtion delivered by the standard proximal RNY.  DSers have too much bypassed for the body to ever adapt completely.

So it follows if you absorb more over time, you will also stop losing weight.  And there is the DS bounceback as well.  That's why I tell people to go 10% under their goal if they can.

I wouldn't do the resleeve if I were you. I'm a big believer in less is more and limiting risks & complications.

I'm a guy with similar presurgery stats and think a 9 oz steak following a plan with the help of malabsorption will get you closer to your full weight loss goal than you think. I had surgery in Nov 14, and I'm down 110% of excess weight. 

No matter what surgery you have, you can always savatage yourself so it's up to you to stay within reasonable guidelines for long term success.

I'm in the same boat as you.  I just can't decide what to do.  I was going to do rny but my doctor feels I won't lose that much with it.  He feels resleeving  might be a good option but that I should also look into sips which is like the ds.  I really like the sleeve but I don't want to worry about gaining weight in the future.  Do you have any thoughts on what you may do?  

I had the SIPs in Nov 14 and highly recommend it. 

I would get resleeved for sure.  You will need all the tools at your disposal to get as much weight off in the 18 months after surgery. Especially since you seem to be metabolically resistant in the first place and secondly, you have gone through one WLS already.  I would hazard a guess that you will have to work hard to get past 55% EWL.

Restriction isn't the key component - malabsorbtion is.  But it really helps you curb the intake that first 2 years and makes you more comfortable with what little you do eat.  It will stretch out again, but at least you will have had good momentum when you started the weight loss and you can ride it to the finish line before your body adjusts and becomes more efficient at absorbtion.  Because it is a race to get the weight off before the 1.5-2 yr mark.

Good luck.  I know everything will go smoothly.

I would leave the sleeve as it is. 

Depending on how long your common channel will be, DSer's need  more food than RNY's to maintain, because you will be malabsorbing 50-60 percent of whatever you eat in protein and complex carbs.  80% of fats are malabsorbed, simple carbs and simple sugars (white flour, white sugar, brown sugar) are the only foods that will be absorbed 100% . Your surgeon should measure for the correct food and biliopancreatic  channel lengths using the Hess Method (although some surgeons do one length for everybody), taking your sleeve size into consideration. 

I've read that VSG's are slightly smaller in capacity than a sleeve done with the full DS would be, because VSG's still have full intestinal absorption. 

It would depend upon my surgeon.

IF he/she was one of the best, like Ungson or that guy in SF. CA, then I would re-sleeve. 

If it was just some local yokel, then no.  Actually, then I wouldn't do a DS but JUST another re-sleeve.

The DS is a demanding surgery and not all surgeons can even do it.  My advice is to go to one of the top 10 DS surgeons in the world and go for the whole shebang.  Every surgery is a risk, if you are going to take the chance, then make it count.  IMHO.

Thank you one and all for your replies and counsel.  Unfortunately, I'm not getting much consensus!  But, I have been given food for thought...

Continued replies are welcome....

Thanks again, MM

Actually, one more question for everyone:

I’m still a little confused about the magical weight loss “window.”  I get the part about the body adapting to the malabsorption and that, once it does, the weight loss will slow or stop.

But once the body adjusts, won’t it find its new body weight regardless?

I mean, sure, if I were resleeved I could lose more during the first couple of years, but, since 90% of the long term weight loss comes from sustained malabsorption, within 5 years wouldn’t I eventually get back to wherever I was meant to be, regardless of being reseleved or not?

I’m deeply confused about this.  If you can provide some clarity, pleas chime in.