Self pay cost for a conversion from a VSG to a loop DS (SIPS). Doctor advice.

About 20k sounds right. Honestly, if you have 20k and change your mind and want the DS, I'd drop it with Dr. K in California, or email the University of Chicago. U of C does a good DS, and they also do the SADI, though it is not advertised as of yet.

There are many surgeons that do the SADI/SIPS/anagram du jour. There are numerous ones here in Chicago, for instance. I would thoroughly investigate it. :) Some surgeons were advertising doing a duodenal switch and really they gave people a SADI/SIPS without their knowledge. I would avoid those on principal, because stuff like that annoys the crap out of me.

At any rate, as for the traditional DS vs. SADI, there is now data on the SADI that is 10 years out. Some is, however, unpublished as of yet. As for malabsorption vs. efficacy, that's going to be impossible to quantify without more details, and is highly variable depending on surgeons. Even with the standard DS, these vary, as some use a procedure called the Hess method, and others use standard lengths for the bypass part of the procedure. I've seen DS patients severely malnourished, and I've seen others have regain. Many more however do quite well with few, if any issues. Forums are replete with the worst...few of us complain if things go well, right? Over all, the DS is a good and proven procedure with high patient satisfaction rates.

Having said that, I am currently mapping the enteroendocrine cells of the small intestine and have worked on a computer model for malabsorption to compare the procedures. While a large component of weight loss, yes even with the DS, is behavioral, excluding that they are, honestly, very close. 5-10% less of weight loss, depending, excluding behavior. I haven't quite finished the modeling yet, though, and I still need to add a few things. I've read every study on the SADI so far, though, and this seems to match the published figures independent of them.

One thing to consider between procedures, is that the DS better accounts for dietary variance, since due to the shorter common channel in particular, you will digest less carbohydrate. Carbohydrates are absorbed throughout the entire intestines, using what is known as "passive absorption."

The SADI will not spare you from the strict vitamin regimen, however, as the first part of the intestines is where many of the issues occur. You will also still need to watch your carbohydrate intake. You "probably" need fewer supplements with the SADI. Most of the patients I've seen take the DS amounts and then, as DS patients do, customize them to their labs accordingly. I would still be prepared to supplement rigorously.

I would also still be prepared to follow a high protein and high fat diet for life. With the SADI, this is still pertinent, and this is where lots of people run into trouble. Just as for the DS, this diet is mandatory for the SADI.

The SADI's other pitfall is that bile reflux is possible, if unlikely. The bypass of the DS makes this relatively impossible. It's also easier for food to go up the bypassed limb, however this, too, is unlikely due to peristalsis.

A larger pitfall is that the SADI is still considered investigational, and some insurance companies will not cover complications related to investigational procedures. Sometimes these happens weeks, or months, after surgery. While I haven't seen any patient with a SADI have this issue, it's good to be aware of it. Also be aware that there was no billing code for the SADI last I was aware; this means they bill it under different procedures, though if you're self-pay that's less of an issue.

I am very pro-DS, myself, as the research firmly supports it. Having said that, the SADI is looking to have similar efficacy and statistics, with only a small percentage of variance. I suspect that the SADI will eventually replace the RNY some day, but time will tell. Honestly, after all my research, I would go for the SADI if I didn't have DS options (literally) right next door.

Thank for you the very detailed knowledgeable post. It certainly sounds like you know a lot about the differences between the two different surgeries. I am still on the fence about it. It's a big decision and an expensive one for me. I don't want to choose the wrong surgery and be angry if it doesn't work or a complication arises years from now.

Perhaps you are right and I should consider the classic DS surgery since i am paying for it.

But the common sense side of me is scared of the extreme vitamin regimen. I hate taking pills as it is. I already take multivitamins, calcium, b12, etc due to my VSG. After speaking with a classic DS surgeon local to me in Philly. I would be required to essentially take 2-3 multivitamins a day and calcium. That's a lot. I am also concerned about the increased level of protein. I'm already getting about 60mg of protein a day which is average for VSG patients. But if I went with the classic DS the nutritionist says i will need 90-100mg of a day due to the malabsorption. I honestly talked an hour with the nutritionist and came to the conclusion that it's going to be really hard to get that amount of protein daily. I don't think i can do it. Which is why i am gravitating towards the loop DS instead of the classic DS because I know if i went with the classic DS, i won't get in that much protein and ill be deficient always. It's not good to be deficient and it could cause health problems, even death. That's what my surgeon said. I honestly am scared about that.

Also since you look to be informed about the surgeries. Do you know what percentage of fats and carbs will not be absorbed , let's say hypothetically i had a common channel of 100cm if i went with a classic DS, vs. something like 250-300cm if i went with the loop DS. How much of a difference are we talking malabsorption wise? That would be something to consider.

I guess i still need to look at the pros and cons of each and make a decision soon. thanks for your advice.

2-3 multivitamins will NOT be adequate for either surgery. If you are that pill and protein averse, the DS and SADI are not a good choice for you. You will end up malnourished and sick. PERIOD

I take 32 vitamins a day FYI

um. wow. that's a lot of vitamins. i can certainly take a few more supplements a day once i figure out which DS surgery i want to get, even though it's not ideal. i guess it's the trade-off in getting surgery. but wow. that's quite the regimen you got there.

I'd say most people who actually watch their own labs are in the 20-30 per day range. I lost 275lbs and consider vitamin taking a small price to pay to be healthy.

I'm new here too but just wanted to add my 2 cents - for what it worth.....

I'm only three years out from having my VSG converted to a BPD-DS. Due to noncompliance for multiple reasons I managed to malnourish myself twice in two years. Eventually I was hospitalized and had my common channel lengthened.

If during your decision making process you already know you can't commit to the daily intake of protein and vitamin regimen, don't kid yourself.

The REAL DS requires a high level of lifetime committment from its patients. There is no "work around" for meeting the DS requirements.

I am sympathetic to your situation because I too was a self pay patient. I paid $30,000 to have my VSG revised. I thought I was committed to the regimen but I was fooling myself.

I realize this is your decision to make so I urge you to make an informed decision.

$15/$20/$30k is a lot of money to waste. Educate yourself on the process.

I wish you the best of luck in your journey. I know you'll make the right decision.

Queenbee

great advice. and it really hits home. i believe i can meet the vitamin and protein requirements. i talked a great length with my nutritonist. i already do 60mg of protein a day. i can switch a protein bar i eat daily to a protein shake instead with higher protein in it and i think i can def. get to 90. it's a challenge for sure, but i think i can do it.

That sounds great. If you like Greek yogurt some of them have 18 to 20g of protein in a single serving. You can even turn it into a dessert if you like sweets by adding sugar free no carb no calorie Skinny Syrups or Truvia Nectar Honey sweeteners.

If you drink coffee you can add protein shake (liquid or dry) with 30g of protein and sweeten with half and half and Splenda.

All little extra tricks to get in large amounts of protein. I didn't have this information during my struggle with anorexia.

You could meet your daily requirement for protein intake by lunch time. ?

How soon do you plan to have surgery?

Where are you located?

You are going to have to take the same vitamins for the SADI, because the vitamin malabsorption that causes supplementation needs is typically in the parts of the intestine that are bypassed. It is better to over supplement and adjust according to labs than to under supplement and do damage.

I mean, I'll be revising to the DS with a very small sleeve and I have no issues eating 120g of protein a day. At worst I have to involve protein powder. One 4oz meal of meat is 30g of protein, nearly, though... it's really not as bad as one might think. You will have to make yourself eat with either surgery, though. The protein needs for the SADI are still going to be steep.

If I got the SADI I would follow the DS regimen for fat and protein. Being short protein long-term is very bad, because eventually the body begins to cannibalize muscle for its needs. It takes a long time to get to that point, and if you have ample fat stores that makes it take far longer, as ketosis will drive energy needs for the brain until then.

The SADI has roughly the same protein and fat malabsorption. What is different is that the DS absorbs less carbohydrate because the time food is in contact with the intestines is less. There is less protein and fat malabsorption with the SADI, but not by much. The carb component to the DS is helpful because none of us got obese eating steak - it was the twinkies, chips, etc. The SADI has inefficient carbohydrate malabsorption at best. That is something I don't have data on, as carbohydrate is absorbed at all points in the intestine, where fat and protein or not. I'd argue that's one of the biggest strengths of the DS that gets overlooked by people who don't understand the surgery. It's not true malabsorption in a sense; it's more that the food just does not get a chance to be digested - hence the GI distress with too many carbs that some have.

Common channel size varies greatly for the DS. Weight loss surgery procedures are only quasi-standard, as all anatomy varies. Some DS common channels are under 100 and some are 150-200. The ideal way to form one uses something called the Hess method (all intestines are actually different lengths, and this customizes it for the patient); others always use a standard measurement. It varies greatly by surgeon. 100cm is 39 inches or therabouts, so you will be absorbing significantly more carbohydrate, and slightly more protein and fat, with a SADI. Is that a problem? We don't know. It might be? I've seen people lose 200-400 pounds with a bypass and keep it off for ten years. It really depends.

I would absolutely call Dr. K - he's known for working with people who self-pay, and he is one of the best in the country. Dr. Prachand in Chicago has also done over a thousand DS procedures, and many have been at very high BMI rates.

Thank for you the very detailed answer about differences between fat/carbs malabsorption between the SIPS and the classic DS surgery. A lot to consider. I think i am now leaning towards the tried and true DS. I think the best option for me is getting it done by Dr. Esquerra in Mexicali as he is experienced at doing the DS surgeries as well it is affordable. Average DS costs in the US is 20k-30k. Some even quoted me $50k. That's a small fortune. Also who is Dr. K? Maybe ill contact for pricing info.