DS approved! but questions remain.

A little background...I had RNY in 2001 and dropped from 417 to 195!  Unfortunately like many others by 2010, the stoma stretched and dumping syndrome was out of control along with weight regain to 270 and the silastic ring (fobi pouch RNY eroding into the pouch).

So, in 2010 I was approved to have revision to DS with Dr. Gagner in Montreal.  Surgery went well but only the first stage could be completed and I was left with a VSG.  The restriction gave me some early weight loss of about 50 lbs.  I was not able to go back to complete the DS as we lost our insurance coverage.  With no malabsorption I began to put weight back on and I am now at 295 with the return of sleep apnea, diabetes, High blood pressure etc.  Also, along the way I had an anal fissure from constipation and had to have a lateral internal sphincterotomy which has left me with slightly diminished sphincter control.  I also have daily bloating from small intestine bacterial overgrowth from a blind loop left during the revision along with moderate IBS.

So, I now have a great surgeon who is experienced in all WLS procedures and an advocate of DS and my insurance has approved the completion of the DS.  In light of all of the above he has suggested that the bowel issues of the DS maybe too much and leave me in a bad situation, so he has suggested that we consider the SIPSS procedure (loop DS leaving 3m) if insurance will cover it or go back to the RNY.  So, can those of you with the DS please let me know what you think.  Thanks.

I had the SIPPS procedure and only lost 12 additional pounds in a year , and that was with being well on plan with carbs less than 20 grams a day. It also caused bile reflux, different from acid reflux , but just as bad and I had to convert on to the full dS. 

Weight loss has been good and bile reflux Is gone

Hi Hollykim, thanks for your response.  So, did you convert initially from RNY to SIPSS?  How have bowel issues been with the DS?  I work in sales and spend hours on the road and doing seminars each day.  The doctor seems to think the bowel issues may preven me from doing that.  What has your experience been?

no I converted from a VSG to what I thought was going to be a dS but in fact a SIPPS was done instead. After 2 years, I began having the bile reflux and found out the SIPPS was actually done. I converted to a true dS then. That was about 15 months ago. 

I only have loose stool if I eat bread or white flour items. I will have stinky gas from them also. I have one sometimes two stools in the morning and am good to go. I give myself plenty of time in the mornings to get that done then o don't have any problems.

Thanks for the follow up.  So, you have not had issues of wondering if you could control your bowels or flatulence in public?

I am totally not incontinent. my bowel habits totally depend on my eating habits. In fact, if I am 100%on plan, with little to no carbs, I will become constipated , just like I would with the VSG alone. agree with your other posters in everything they said. I have traveled an flown with no problem as long as I monitor what I eat. 

I can control gas and bowels in public but there are restrooms everywhere.  But again correct eating is key for me.

SIPS is experimental.  If they code it as the DS, there may be problems.  99% of the time, insurance will not pay for experimental procedures.  Next, SIPS is experimental...  A few have had results like Holly Kim, and there are some with good results.  But long term, no one knows yet.  Like I said, it's experimental.

So why do docs like SIPS/SADI?  It's an easier surgery.  They can do more per day and make more money.  Always follow the money.  SIPS has less malabsorbtion than the true DS and on top of that, they want to give you a 300cm CC?  I would be running out of the office screaming NO at the top of my lungs.  The body adapts to whatever we do to it...that's why DSers quit losing.  Just for example, I have a true DS and my CC is 75cm.  And I still have to diet!  Your body will adapt too and when it does, you won't have enough malabsorbtion to keep the weight off.

You already went through hell getting rid of the RNY.  And you already know it doesn't work.  You have the sleeve and the next logical move is the DS.  I wouldn't even consider repeating a surgery that didn't work in the first place.

It's a shame Gagner did that to you.  And you are not the only patient who had this problem with him.

Me personally, I would hold out for the whole DS.  Best results and it cures type 2 over 90% of the time and the cure is not dependent on weight loss either!  I had mine in 2003.  It does take a few weeks to adapt to your new normal.  Whenever I got diarrhea, I treated it.  Imodium is your friend!  Since 2003, I have traveled the world and pretty much live a normal life.  Poop is very predictable.  I go twice in the morning while I am getting ready for the day and occasionally once in the evening if I eat poorly.  In the past 14 years, I have pooped in a public toilet maybe 10 times.

I hope you think really hard about this!

Thanks, I really am thinking very long and hard about this and truly appreciate your input in this very important decision.  I realize I am truly blessed after all of this to be in a position of having a great surgeon close to home and benefits to cover the DS.  I agree that you can usually follow the money to see the motivation behind which procedure is recommended, but in this case the surgeon has extensive experience and is an advocate of the DS.  It was his first recommendation, but when I mentioned the IBS and sibo he said the sips might be worth considering but his position is that the true DS is the best choice for long term weight maintenance.  Another surgeon who took care of me in Florida following my revision in Montreal is the one who says I should not consider the DS at all as it will ruin my quality of life and possibly leave me incontinent.  He has no financial motivation here as he would not be doing my surgery either way, as a matter of fact he would not even charge me for aftercare when he took care of me after my last revision.  He didn't even ask for insurance either.  I believe he has good intentions, and he has done thousands of wls procedures. so I have to consider his opinion.  That being said, he has never lived the life of an obese person and may not truly see just how important it is for us to be at a normal weight.  It amazes me that they still consider me to be a "success" story as I have kept off 100 of the 200 I initially lost, even though I am nearly 300 lbs again!  It's pretty crazy!  

I'm glad you mentioned travel as it's one of the things I enjoy most.  So, you have been able to travel without trouble in airplane restrooms etc?

Travel...promise, dealing with the DS is easier than coping as a fat person.  And I'm talking real traveling.  I kayaked the Amazon, rode a horse across Mexico, and took up rappelling.  Normal travel too!  Like Spain and Tahiti.  No fear, no worries!

You didn't mention diabetes and I hope you are thinking hard about that too.  It is progressive and only gets worse.  I would get the DS for the diabetes alone!  It's the number one cause of adult blindness and amputation other than accidents!

I'm in the process of getting my vsg turned into the full ds. I went from 310 to 250 while training for a half marathon and now I'm back up to 300. I have been informed by my surgeons office everything that comes out the back end is what you put in the front end. No matter what surgery you have or don't have this is true. I'm sorry you suffered good luck in your journey.