A lot of thoughts and questions about revision from a VSG to DS.

So... Hello again! Skip to the bottom if you want the simple version, haha.

I was very active on this website in 2011/2012. I had a VSG when I was 15, and at first I was very vocal about it. I wanted to spread information and awareness about childhood obesity, and I had hoped this would help me. I hoped it would be the tool I'd need to finally help me be in the best shape of my life.

Backstory: I was overweight by the time I was 3 years old. I was diagnosed with insulin resistance at 5 years old. On strict diet and exercise regimens at 6. I was a super active kid. Lots of sports and activities. Constantly visiting endocrinologists and dietitians and various other specialists. By the time I was 15 I was fed up, and had heard about weight loss surgery in an ad somewhere? Looked into it, and couldn't find much information on it for teenagers but I found a research study to participate in and well.... I chose a VSG because my doctors told me it would reverse all of my co-morbidities and kind of implied it'd be a cure-all.

I was already the "poster child" for diet and exercise, so they claimed I'd be an easy patient.

Alas, the weight loss never followed the way they said it would. I exercised, I ate protein first then veggies then carbs, drank enough water, etc... I had a lot of complications not necessarily with surgery, but with comorbidities.

I was diagnosed with hypothyroidism around the time of surgery but was never properly treated. I was taken off my metformin post-surgery claiming I wouldn't need it, but I did. There wasn't really an endocrinologist on board for my metabolic issues pre or post-op, so a lot of that wasn't addressed and the weight fluctuated.

With extreme dieting (Example: less than 600 calories a day and close to zero carbs... pretty much only eating string cheese, baked chicken breast, turkey sausage, and eggs for a few weeks) I managed to lose some weight, but then I stalled out doing that as well and just kind of gave up. That was about 3 years post op. I wasn't in a good place mentally. My family life was rough, and I just stopped caring and regained any of the weight I had lost. (Highest weight ever: 285. Day of surgery: 255. Only ever got to 190-ish years out, and i'm 5'3".)

I'm now 8 years post op. Still eat 1200 calories or less most days. 18 months ago I got a very labor intensive job. I walk at minimum 10k steps a day alone at work, not to mention the muscle I've built from heavy lifting constantly. I've been trying the Keto diet religiously for over a month now, while going to the gym for an hour a day five days a week, and I've only lost 5 pounds.

I'm in a much better place mentally. After dealing with anxiety for majority of my life, a doctor finally took me seriously and is helping me treat it. Finally got my hypothyroidism and insulin resistance addressed as an adult. My lab values are almost perfect aside from being anemic. I enjoy working out, I always have, so I feel like going to the gym has been great for me. I feel great about myself when I go, even if I"m not losing anything I can tell I'm getting stronger. The Keto diet has given me more energy, even if I"m not exactly losing much/at all. I got a good job and rescued a puppy, made the decision to go back to college, just bought my first car on my own, etc... Basically, everything in my life is going really well right now. Except my weight. And it's bothering me.

I wanted the DS when I first researched surgery, but no surgeon would perform it on a minor and this research study I did only offered RNY & VSG. So I took what I could get. Now at 23, I'm seriously considering a revision to DS but I'm just worried it will have little-no affect.

I'm currently sitting at 235lbs. I'm re-reading a bunch of research on the DS that I read when I was younger, and everything that has come out since that I can get my hands on. There is a surgeon known for DS that works ten minutes from where I live. I dont' know why I'm so hesitant, I just dont want to go through with an expensive operation if the tool won't aid me.

Sorry for the long-winded post. To summarize: I had a surgery that didn't really help me as much as I would have liked for reasons not entirely in my control. Now that those outside factors are under control, do I go through with a meeting with a doctor about a potential revision?

Questions for those of you who either revised or anyone with a DS:

Do you regret it?

Is there anything you wish you would have done differently in the process or recovery period?

How was the recovery for you personally?

Advice, if i were to go through with this? What's something(s) you wish someone had told you beforehand?

If you made it through this whole post, thank you very much. I really appreciate it!

Ah yes. A fellow superabsorber. I got my first diet when I was 6 weeks old and I was a breastfed baby. I knew the meaning of the word obese at the tender age of 2. Yes, I understand. I congratulate you for doing the best you could at the time but the sleeve is just another diet with a smaller stomach. You knew when you got it that it probably wouldn't do the trick for you.

What will a revision do for you? Well, it's not likely you will get down to a size 6 but it will make your issues easier to manage for a longer period of time. Chances are you will be able to eat and exercise more like a normal person. Will you lose weight? Probably some. My best guess would be 50lbs or so but you will have to work at it to stay there. Health wise, you will most likely be better off and you will benefit from the metabolism reset the DS will give you. I would be looking for the most extreme surgery I could get with the shortest CC. This also means you could be looking at deficiencies down the road. Make sure you can afford all the supplements you will need. And you may need iron infusions at some time in the future. At your young age you will have to manage that DS for a long time. And postop you need to lose as much as possible as fast as possible because chances are your surgery will run out of gas sooner than most. Every carb you don't eat is a victory. Most likely you will be able to get off the metformin.

I wanted a 50cm CC. My surgeon wanted to do 100. Supposedly we compromised on 75. But who knows. I wasn't awake when he did it. I have never had a single deficiency. I had surgery in 2003. After all this time, it is probably safe to say I still absorb plenty. I have to diet, low carb, pretty consistently to stay under 200lbs. And I work out too. Right now I am in the 170's. Still fat but an average looking old bag. And just like almost all women on the planet, I am still trying to lose weight. I will probably never see that elusive normal BMI.

My DS was open and the recovery was easier for me than what I was expecting. YMMV. Regrets? Oh hell no! It made my problem manageable. I would probably be much worse off if I had done nothing. I do have a hernia that needs to be fixed, probably next year.

I would encourage you to do some serious surgeon shopping. You need to find someone who actually understands your problem and is willing to do the surgery you want. In other words, don't settle just because they are down the street. That was my big mistake. I would have gotten a better DS if I had had a different surgeon who was willing to do the shorter CC. Be really careful. Many surgeons are pushing hybrid, look alike, surgeries. So far the research says, and there has NOT been enough done because these procedures are experimental, the patients lose too much malabsorbtion of fat too fast. And what that should tell you is these folks are going to have a harder time fighting regain.

My best recommendation would be that you consult with Ara Keshishian in California.

We see new people wanting/needing to revise from VSG to DS all the time. While your situation is more extreme in terms of your metabolism from hell, you are definitely not alone.

I think the DS will allow you to lose some weight with a much more normal level of effort. It will help with a lot of your metabolic issues (the VSG doesn't do this, and gastric bypass helps to a much lesser extent). It's the logical next step for you.

As for myself, I've lived with the DS since 2006 and have absolutely no regrets. I do take a bunch of vitamins and minerals every day. It's not difficult, it simply becomes part of your daily routine, like brushing your teeth. I get labs done once/year and adjust my vitamins and minerals if needed.

I agree with Patty - make very sure you are consulting with a surgeon who does the real, standard of care DS and given your struggles, get the shortest common channel you can get. The non-standard operations are experimental, and involve a much longer common channel, which, in your case, is the last thing you need.

Larra

I started dieting pre-puberty, but despite also being athletic, I still gained. My mom and I were doing diets together since I was 8, on and off. I still gained. I understand your plight. I also understand a surgeon being hesitant to do a DS on you at such a young age, despite it is likely the only thing that will give you success.

You're older now, wiser, and they can now believe that you are perfectly willing and capable of doing what is needed to be healthy. I concur with everything the two before me said.

The terms for the hybrid versions that surgeons (that never EVER did a real DS) are peddling are called SIPS, SADI and Loop-DS. We are already seeing revisions from these to regular DS, and the last thing you need is a 3rd procedure, right?

Questions for those of you who either revised or anyone with a DS:

Do you regret it?

No regrets, not for a millisecond!

Is there anything you wish you would have done differently in the process or recovery period?

No. The surgeon and her staff were quite thorough, and the hospital program is top flight!

How was the recovery for you personally?

I had a rough patch due to dehydration at week 4, but got it turned around and did fine.

Advice, if I were to go through with this? What's something(s) you wish someone had told you beforehand?

RELAX! The process is not easy, but there's no need to stress because you are being watched very carefully for any sign of trouble.

Do you regret it? no

Is there anything you wish you would have done differently in the process or recovery period? no

How was the recovery for you personally? easy

Advice, if i were to go through with this? What's something(s) you wish someone had told you beforehand? I wish I had looked for a sugeon that performed the Hess method