Duodenal switch VS Gastric bypass

Hello everyone,

I am new here and i really need your help plz. My height is 5'6", i weigh about 350lbs and bmi is 56. i have HBP, cholesterol and herniated disc in the lower back, not diabetic. i have been on the waiting list for a barriatric surgery for more than 2 years. I had a call from the barriatric clinic a month ago to attend an information session and was given an appointment to meet the doctor 3 weeks later. I didnt have the chance to meet the doctor himself, instead i met another doctor in training working under his supervision, he asked me abt the surgery i prefer to have, i said DS, i tried to know his opinion and if i did the right decision but with no result, he replied nothing to me, he just mentioned something like this surgery is made sometimes in 2 steps and the doc will decide later only during the surgery. Then I met the nutritionist, she tried to convince me to change to the bypass procedure because it's safer in the long term. I left the clinic without being confident that i chose the right surgery for me.

Since i chose DS i have been trying to educate myself more and more abt it and honestly i am so scared of what i heard abt malnutrition, deficiencies, anemia, bone problems and other high risks and complications. I want to be slim but healthy also..

All these complications and others make me very confused abt DS surgery and prefer Gastric bypass, it is more popular and most surgery complications and risks are known by all doctors but the biggest disadvantage that i dont lose more then 65% of excess weight and there is a big percentage to regain weight after 3 years.

I really appreciate all ur answers that can help me to take a decision

Cheers

Adam it's a hard question to answer because the decision is a personal one. One key advantage of the DS is long-term weight loss. You chances of regaining weight with the DS is much less than any other procedures. Not all DS surgeries are done in two parts. A lot will depend on the skill of the surgeon and obviously the overall health of the patient.

You can experience deficiencies with any WLS. Are the chances of deficiencies higher with the DS, I suppose so. Malnutrition is primarily when the patient doesn't eat properly. Deficiencies can be mitigated by regular labs and adjusting supplements and vitamins accordingly. Do deficiencies happen. I have been dealing with iron deficiency anemia for almost 12 years. I get regular lab work and if the need is there I get iron infusions. No big deal (for me). I have osteoporosis but I'm also 60 years old so it could be because of the DS or it could be genetics.

The DS requires diligence to vitamins, labs, protein, and overall health. It takes work but for me personally it's totally worth it, but only you can make that decision for yourself.

Thank you very much for ur reply and i am sorry to hear that u r dealing with anemia, osteoporosis and minerals and vitamins deficiencies. This is actually what scared me the most of doing this surgery!

It means that no matter what minerals and vitamins supplements we take after DS, we still in high risk to have anemia, osteoporosis and other deficiencies related complications? What if i eat properly, pass lab tests in time and take all required supplements, will i be safe? i like to hear answers from patients that did the DS surgery long time ago n they continue living their life healthy with no serious related deceases.

My bmi is 56, is it very big to be a good candidate for a bypass surgery? i saw some before ant after photos here, some of them did very well and lost more than 200 lbs? so what's the point of doing DS if i can loose all my excess weight by doing a bypass surgery which considered more safe? but again when i read abt bypass surgery complications, there is again vitamins to take for life and some risks for minerals and vitamins deficiencies in long term, so how this surgery is considered more safe?

I noticed that as much as i read abt surgeries as much as the decision and choice become harder. I really want to lose weight but i dont want to spend my life in hospitals :(

To be honest, i feel more confident abt DS, i like the idea of having a smaller stomach instead of just a pouch n not to mention the calories malabsorption that can be a great tool to not regain weight later.

Thank u once again

Adam - even with all the problems, I still would not change anything. My BMI was exactly what your BMI is now. I was very lucky that one of the best DS surgeons in the country was 10 miles from home. He didn't blink twice about doing the DS in one step. There is no way to predict what will happen down the road. For me, personally, the decision was a no brainer. Had I not done something I truly believe I'd probably be dead now (or close to it) and having absolutely no quality of life.

Maybe my decision was easier because we didn't know as much about the DS 15 years ago as we do now.

I am very glad that u feel good, happy n confident no matter what.. i am still very confused here..

Today i went to one of a barbaric support group to meet people n ask them abt their experience.. everyone told me abt his/her surgery n how happy he is.. i saw good results in all categories.. i met someone who lost 230lbs on gastric sleeve n other lost only 30lbs on RYN.. results r very variant.. it depends on many factors other than just surgery type i guess. My visit made me more distracted n confused btw surgeries..

I really appreciate every advice and every message here.. it's very important for me, it may change my life.

I had gb over 12 years ago, I have gained a most of my weight back over the past couple of years. I am looking into getting the ds now. I had a friend who had ds the same time I had bp and she is still skinny and we eat about the same amount. If I had known about ds back then I would have gotten it. My mother had open gb a couple of years before me and she had a problem with iron off and on since surgery, but no big deal I would either give her iron shots once a month for a couple months (10 years ago) or take her to get about 3 iron infusions (1 per week) 2 years ago, in between she would take over the counter iron pills.

i strongly agree with u.. DS seems to be the best surgery to lose weight n not to regain it back..

Malnutrition and malasbsorption can happen in both bp and ds surgeries .. the most important is to pass the labs in time and take ur vitamins and minerals.. i know that it is more intense with DS but who takes 6 pills per day after bp, he / she can take 11 pills after ds

Adam, I think it's very sad that you had to wait 2 years, THEN didn't even get to speak with the surgeon, and THEN had someone other than a doctor try to talk you out of the DS.

The statistics are real. The DS has the best statistics of any bariatric surgery for percentage excess weight loss, for maintenance of that weight loss, which is crucial, and also for permanent resolution of almost all comorbidities. Other advantages include that dumping (which is NOT a weight loss tool but rather a very unpleasant side effect) is rare with the DS and much more common with gastric bypass, and that we can safely take NSAIDs, which are contraindicated for life after gastric bypass. NSAIDs are one of the most commonly prescribed and OTC drug categories, and even if you don't need they today they may well be part of your future.

Yes, we can develop nutritional deficiencies, BUT long term studies, involving large groups of patients, have shown that the rate of these is much lower than you might guess and that most of the time (though not always) the problem is due to noncompliance. And after years on these boards, I can also tell you that many times the patient is trying their best to be compliant but getting poor advice from the surgeon and/or his nutritionist. With proper education, compliance, and attention to lab results, most people do just fine.

As far as risk of surgery goes, higher complication rates have been seen because some surgeons and clinics "reserve" the DS for their heavier, sicker patients. Of course their risks are higher. If you compare similar patients, the rates of surgical complications are almost identical, while the weight loss and improvements in comorbidities are much better with the DS, and the difference in results only becomes greater as the years post-op go on.

I hope you'll have the opportunity to speak with an actual surgeon about your concerns. The DS works well for anyone who qualifies medically for bariatric surgery but is especially valuable for people with higher bmi's, so instead of trying to talk you out of it, they should be trying to talk you into it. It may be that the surgeon is more comfortable doing what he's used to doing, which is his problem, not yours. Make your own decision and stick to your guns.

Larra

Thank u very much for ur reply.. it was very good said. U mentioned many points i was thinking abt. it is very important for me to be able to take NSAIDs in the future because i m allergic and intolerant to many medications such like paracetamol, penicillin, sulfa and others.

Yea it was a big frustration that i couldnt meet the surgeon, i prepared a big list of questions to ask him abt but it went very wrong with me. I will call the nurse next week and will try to explain to her how important to meet the doctor before the surgery day. Some words from him may change everything and give me some relief. By the way I heard he is very good in DS, he did it many times.

After i said to the doc in practice abt the surgery DS, he left me and went to the doc surgeon to tell him, so when he came back he told me yes he can do it for u but u should be on liquid diet for 4 weeks instead of 2 because ur bmi is slightly high for this type of surgery. He didnt say no or try to convince me to change my mind.

Sounds like the surgeon you're looking at might not be comfortable with the DS, so they push the easier and faster RNY. Also not a big fan of "he will decide during the surgery" - if I were you I'd look for a different surgeon.

I'm 3yrs out, lost 275lbs, 25-30 below my original goal, zero complications, and great labs. You gotta stay on top of your vitamins because doctors don't have a clue.