Help needed regarding Duodenal Switch

I started out at 450 lbs and had Gastric Sleeve surgery 5 months ago. i have lost 102 lbs so far (counting the pre-surgery weight loss). Things have gone very well and I haven't had any problems other than the fullness feeling in the chest if I overeat (if that's what you want to call it because I barely eat anything now) and occassional stomach cramps. No vomiting and not much diarrhea either.

My surgeon wants to go a step further and perform a duodenal switch down the road. I was wondering if anyone who has had this procedure can give me details and experiences. I have read it is a much more invasive surgery, takes alot longer and that the recovery and after life regimen can be more difficult. Although I am ready and kind of excited now for surgery now that i have survived the Sleeve procedure but since it is somewhat new I would appreciate any advice, reassurances or even warnings you can offer.

Thanks.

You are very fortunate to have a surgeon who has made a great suggestion for you, instead of telling you that the sleeve is the be all and end all for you. And if you think the DS is "somewhat new", you are very much mistaken (unless you meant that it was a new idea for you). The DS has been done in the USA since 1988 and is recognized as a standard of care bariatric surgery since, I believe, 1991. The sleeve as a stand alone is far newer, though it is gaining in popularity because it avoids the many nasty side effects of gastric bypass. And we are seeing people asking about revision from sleeve to DS all the time. Sadly, many who don't get the results they hoped for with the sleeve get revised to gastric bypass instead, not because it's better (it isn't) but because that's what their surgeons do.

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. You already have the sleeve portion of the DS, adding the "switch" part would give you metabolic changes and malabsorption that you don't have now. Given where you started, the chances are good that you need these advantages to get you to or near a normal weight, and to resolve any comorbidities you may have.

I hope you will consider your surgeon's advice with an open mind and learn as much about the DS as you can to make an informed decision.

With all that Larra said, I'd like to add that you learn all you can about our nutritional needs.  it's going to take some serious commitment to keep healthy, but once you get the hang of what specificially YOUR body needs, the rest is just good habits of taking your supplements and checking your bloodwork annually.

Congratulations on your progress!  It is addicting isn't it?  To me it looks like you are thinking forward and already starting to plan how to keep the progress going.  I say super good for you!

A really good video for anybody already familiar with the different surgeries but just needs to seem they all laid out is https://youtu.be/Z5JPrZPBzag.

I hope the VSG does the whole trick for you, but statistics say something like 65% of excess weight will be lost.  Extraordinary compliance might add another 10% or so, but I wouldn't expect much beyond that.  Perhaps that is a weight/life you can be happy with?  Only you will be able to decide. 

The DS is rated for about 75% of excess weight lost and again, extraordinary diet and exercise can bump that up a bit too.  Of course with both these numbers, YMMV.  Your surgeon can make decisions that would greatly affect that percentage or you might have complications or what ever... 

The biggest difference is the malabsorption after you get the DS.  It is a huge blessing, ~80 to 90% of the fats you eat do not get digested!!!  That means you will be on high fat diet, if you can call eating as much fat as you can lay your thin, beautiful hands on "a diet".   But it is also a bit of a curse, because you also don't absorb all the protein and vitamins/minerals you need, so daily supplementation becomes your religion and that actually gets rather old, but is certainly doable. 

I had a full virgin DS and VSG getting close to two years ago.  I met my goal weight four months ago.  Daily supplementation is starting to get routine and blood work is a just an annual chore, not a big deal.   I have ZERO regrets.  I would do it all again just the way I did without a moments thought.  I was self pay in Mexico and I'm beyond happy that I had only one surgery, one full focus diet phase and that it is all over now except a brand new awesome life. 

But if I were in your shoes, I might wait out the VSG and see how far I can take it and be happy.  I'm not sure the extra ~30 lbs is worth the life time supplementation and high fat/protein diet.  That is, it might not be worth it if my VSG worked really well and I was happy enough being on a restrictive diet for ever.  

I doubt I would have said that at the start of my WLS journey.  I had to get skinny to become mentally sound around the idea of not being skinny.  Now I see that it isn't everything and that ~30 lbs would probably make my deflated balloon like bag of skin look a lot better and that I miss not always having to a small background worry about protein/fat/vitamins. 

I guess what I'm trying to say is that you probably had WLS to become happy and healthy, not to become skinny, but it really easy to forget that. 

Good Luck!!

I'm glad the DS worked out well for you, I had the VSG & what I kept in my mind when going for it is that I was not a statistic, that I could work this tool to the best of my ability, but I can understand that for some people its not enough.

I don't feel that I had to do anything extraordinary to get the weight off, so I don't think only 75% of ewl is all that I or anyone has to look forward to. It's ultimately up to the individual where they'll end up. Statistics be damned!

I agree! 

I also think we forget that the reason why people grow to be morbidly obese is not as simple as "too much junk food and not enough exercise."   Or maybe it is for some people, but not for the vast majority.    When they measured my short intestine to calculate what my channel length should be they realized that my short intestine was almost long enough for the record books and hence my primary problem.  Some people can absorb calories in their colon, but thankfully they guess that is rare.   They know so little about this and most of what the believe isn't backed up by science.   Of course our experiances are going to be all over the board.

Good luck!

So, the VSG is the first part of the DS so your half way there. Some Docs do it in two stages because they want the person to be a little healthier for the switch portion.  That was something I discussed with my surgeon. He gave me a weight loss goal to hit where he would do the whole thing other wise I was looking at 2 stages - VSG then the switch. I hit the goal so I didn't have to go under twice. I started out at 464 so I have agood idea where you are coming from.

While I believe you can rock any WLS surgery I do think at your weight the DS is probably a good option for you. It had the best stats against regain and gives you an extra tool for the weight loss.

I could always lose weight by restricting my intake but always ened up gaining more than I lost. If your weight loss history is like that I would consider adding the switch part.

I think it's kind of funny. You already have the physical changes that were the biggest problem for me post-op. The restriction from the VSG. I knew I had to do vitamins, and protein, and hydrate but physically that was the biggest sign I had surgery (OK that plus the healing laporscopic incisions). 

While it is more invasive (rerouting the connection to your stomach) I don't think the recovery time will be any worse than what you had for the VSG. The post-op adjustments may take longer but that is nothing that stops you from living your life while figuring  out how to accommodate the vitamins, protein, and liquids.

Best thing I ever did and at 3 years out I can hardly tell that I am living my life different because of the DS. Mostly, there are just things that I do and then go and live my life.

Good luck,

Pete