questions

What exactly in done with the DS? Is part of the colon removed? What is the common channel? Believe it or not I'm almost 13yrs out and I still don't know exactly what was done to my insides. I'm still quite happy with the results.

While watching MY 600lb Life I saw Dr. Now remove part of the stomach for the sleeve. At first he was only doing the stomach stapling.Do you think he'll start doing the DS also?

DS has two parts, a sleeve gastrectomy (partial stomach removal) and also a diversion of how food goes through the intestines.
Part 1: The gastrectomy part involves removing the curved side of the stomach, leaving a stomach that is shaped like a tube holding between 1 cup and 1 1/2 cups. (It was described to me as banana-shaped but now they compare it to a sleeve, but I guess it's the size of a toddler's sleeve!). The gastrectomy part of DS preserves the "pylorus", the natural opening of the stomach that regulates the flow of food into the intestines.
Part 2: the DS surgeon creates a "diversion" in the small intestine. The diversion separates the small intestine into two smaller "limbs", one for the food and the other from the pancreatic digestive enzymes and bile (that's the reason"biliopancreatic diversion" is in the name of BPD-DS). The diversion changes the usual way food is digested. The reason it is called duodenal switch is that the diversion starts at the duodenum, the first part of the small intestine.
Why it works: With DS, two thirds or more of the intestine is bypassed, leaving only a few feet of intestine where food and digestive enzymes meet. The "common channel" is the length of the intestine after reconnection, when food and digestive juices are brought back together. My common channel is 100cm, about 3 ft.
By keeping food separate from bile and digestive enzymes for all but a small section, the DS significantly reduces the intestinal area available for digestion of food and particularly fat (so a lot of calories go through without digestion), but it also gives less access for vitamin and mineral absorption. Darn it, but sugar and carb calories are the best absorbed!
At 13.5 years out, I am sure my stomach has stretched a bit and the intestines are getting more adept at digesting food, but I still weigh almost exactly half of what I weighed on my surgery day.

You touched a sore spit with me about Dr Now. DS is the most effective procedure for anyone who weighs 300 pounds, let alone 600 pounds. It is unconscionable that he continues to do a less effective procedure for these people. DS is a long and difficult surgery that isn't easy to learn, and maybe he can't or isn't willing to learn it. I won'****ch the show because I end up yelling at the TV and I can't endure the public humiliation and fat shaming that is part of the show.

The DS is a very complicated surgery and not every surgeon has the experience to successfully perform it. I have never watched this show so I don't know what his skill level is. Also, doing the DS on someone over 600 pounds is probably not a good idea. There are usually other health issues with someone of that size so keeping that person under anesthesia for 4-5 hours is not a good idea. Most skilled DS surgeons would probably want to do the DS in two parts (the sleeve first, and then the switch).

Now for your questions. Eliza did a great job describing the DS. Please learn this because it is something you should know. I also carry a medical emergency card with a picture of the DS along with a brief description so that if I'm every in a situation where I can't describe what my insides look like, someone can see it (for example an EMT).

Did you ever get a copy of your operative report? That should tell you everything that was done. How are you labs?

Skilled DS surgeons almost routinely do the whole DS in one OP on very heavy patients. I met a patient in my surgeon's office who was over 800lbs on his surgery date. The whole 2 OP thing came about when 1 surgeon started pushing it. And writing papers. It meant more money for the surgeons and a lower skill level. Occasionally the 2 OP thing is valid. But usually it's an indication of the surgeon's skill level.