Pros/Cons the DS vs. Distal RNY?

I am somewhat confused. Some of the posts here seem so mean spirited and some just downright wrong about those that choose RNY. Now, I'm not trying to get anything started... I'm a newbie, but I don't see the point to putting down a person's decision. I would think that most people who are going for RNY today are doing so because they can't get a DS so I wouldn't want to put them down for it. I had an RNY in 99. For over 4.5 years I was very happy. I liked dumping cause it kept me away from stuff I didn't need, I didn't have to grind my food to mush and I lost from 330-165. However, several months ago I began having acid reflux which I didn't have before. Months dealing with military doctors wasted my time. Finally I flew home and was told I had a hiatal hernia. Also, I discussed my weight gain with my surgeon. I thought it was because I had been less active and taking some meds that made me gain weight. Surgeon says, that RNY's sometimes regain if not careful and that he'd like to do a revision on me. Because I've gone from my 165-240 in 9 months, I am all for it. But then I got to thinking, wouldn't it just be easier to do a distal RNY? Back in 99 and some today at least I've heard, some RNY'ers talk about DS people having bad gas and bile movements. Heck, after RNY I was positively funky and still am. Ozium kills it. I've read that DS's say RNY's must chew forever... not me and my friends. Plus after 2 yrs. you can eat most of what you want... you and your families nose just pay for it. I want what is best. I haven't done a lot of research because I had to make a decision in less than 24 hours. I don't want the fairy tales or the meaness... just truth. Why is DS better? I don't care how bad it may sound, I want to know what I'm really gonna go thru and I want the pros and cons. I really appreciate any help you can give me. Thanks! Ronnie aproverb31wife@aol.com

The pro of the DS rather than a distal RNY is that you would have the normally functioning stomach intact with pylorus valve for better digestion of food. You would also eventually have a more normally-sized stomach rather than having to deal with a tiny pouch. The DS has a high malabsorptive component in the intestines as does the Distal RNY. But the DS would be less malabsorptive for nutrients since you'd have the superior digestion of a functioning stomach rather than a pouch. Yes, it would be easier for the surgeon to go in and just bypass more of your intestines and go from Proximal to Distal RNY. But, do you want what's easiest or what's best? This is the problem we DSers have with a lot of people that choose the RNY. They let the insurance companies dictate to us what we can have by choosing what's easiest rather than what's best. You, yourself state in your post that most people opt for the RNY because they "can't get" a DS. But, MOST people that stand up to their insurance companies end up getting those denials overturned in the long run. I understand many people are too sick to go through this process, and the insurance companies count on it. I also believe many people get the RNY just because that's what "everybody else" had and don't even consider other options, or consider misinformation rather than seeking out the truth as you are doing. Anyway, you answered your own question when you say most people get an RNY because they can't get the DS. IF you CAN get the DS, then you should jump on it! LeaAnn Preebie

Leronica, www.duodenalswitch.com I'm still pre-op but I chose the DS or Nothing. Factual reasons are becuase the possiblity of dumping was nearly eliminated and long term weight loss results are better. In Europe, the DS is used (just the switch part) as a CURE for diabetes. My PCP said I showed early diabetic warning signs (I am 25 and it runs like the plague in my family). Now, correct me if I'm wrong guys, but, 6 months post-op, DSers loose 70% excess weight. There is fewer risks of complications with the DS. Fewer risk of LONG TERM complications with the DS. And my final Factual reaons is; it takes a skilled and dedicated surgeon to learn then perform the DS. Skilled and Dedicated... thats the only kind of surgeon I want working on me. I have lots of other, more "emotionally based" reasons for chosing the DS vs the RNY or any other WLS. But here, it's just the facts, ma'am Good luck with your decision. LeeAnn May God Bless every path you put your feet to

Best wishes and prayers for you on your surgery date for a super speedy recovery

thanks for the info. i understand why a ds is better for someone just going thru wls. however, i wanted to see if it would be easier on my body just to do distal since i am a revision. because of the information i received while searching this morning, i want to go with what is more normal like and if DS is gonna give me that then i'll go for it.

I think in your case you'd be better off with the DS because of your renewed acid problems, if for no other reason! I'm not saying that no one ever has acid reflux after the DS, but it's rare. For example, my surgeon puts all his patients on Protonix (an acid blocker) immediately following surgery. His DS patients are on it for two months, but his RNY patients are on it for TWO YEARS. That alone tells me something. (*grin*) I also echo LeeAnn's points about nutrition. While the DS has the greatest malabsorption of any form of WLS currently performed, it's 'selective' malabsorption. Recent results of long-term studies show that DSers have fewer problems with malnourishment than do distal RNYers, due mostly to the fully-functional stomach and the retention of some of the duodenum. This allows DSers to absorb calcium, iron, B-12, and protein better than with the distal RNY. It's also this high degree of malabsorption that gives the DS such great long-term maintainence of weight loss. As for the potential bowel issues from the DS---I find that they're exaggerated, and much of the info out there about this actually refers to the old BPD/Scopinaro procedure---which was basically a large-pouch, extremely distal RNY. No pylorus, no functional duodenum. I suspect your intestines have adjusted to, perhaps even overcome, the proximal bypass of your first surgery. The body really *wants* to heal itself of the 'damage' WLS inflicts on it, and it often grows more intestine to replace what's bypassed. (Both more length and more villi, the little thingies that actually do the absorbing.) The DS is going to give you a LOT more malabsorption, with a correspondingly lesser chance that the body can *ever* regrow enough intestine to short-circuit it. Yes, it would be 'easier' to just increase your degree of bypass---but would it be as effective?

http://www.dssurgery.com/aboutus/Research/safeoperation.pdf This has some good information about revisions from VBG and RNY to DS.

Here is some more info on Distal RNY vs. DS -- this is from Anthone's 2003 paper (Annals of Surgery 238(4), 1-10 (2003)): "A modification of gastric bypass, by lengthening the Roux limb, has been proposed for patients with more extreme degrees of obesity or when the routine Roux-en-Y bypass has failed. This "Long-Limb" or distal gastric bypass has been associated with significant metabolic and nutritional complications that have been inappropriately assumed to occur with the duodenal switch procedure.27-29 The hypoalbuminemia and other nutritional deficits observed in patients with a long limb gastric bypass may be secondary to the combination of extreme gastric restriction imposed by the procedure along with a malabsorption component. In contrast, the duodenal switch procedure allowed patients to ingest approximately two thirds of their preoperative dietary volume without specific food intolerances, and more than 98% had a serum albumin within the normal range three years after surgery." References 27-29 are: 27. Sugerman HJ, Kellum JH, DeMaria EJ. Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity. J Gastrointest Surg 1997; 1:517-524. 28. Murr MM, Balsiger BM, Kennedy FP, Mai JL, Sarr MG. Malabsorptive procedures for severe obesity: comparison of pancreaticobiliary bypass and very very long limb Roux-en-Y gastric bypass. J Gastrointest Surg 1999; 3:607-612. 29. Brolin RE, LaMarca LB, Kenler HA, Cody RP. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg 2002; 6:195-203.

You might want to talk to Michelle Curran about the distal RNY. She has one and is a health care professional. She answers questions all the time. She seems to be very reasonable in her advice to others. With distal you still have the protein and vitamin requirements. But, you can't eat enough to meet them with food. Michelle has said distals must rely on protein shakes for life. A distal RNY still has less bypassed than a DS. A DS person can eat pretty normally and still lose weight. We can eat enough to meet our protein requirements. Good luck whatever you decide to do!

wow! protein shakes for life would definitely not be for me. also, i like the idea of getting my vitamins absorbed better. i really appreciate this info. i don't think i need to even consider the distal any longer. i will be on the table longer, but who cares i think this will solve things... and i certainly don't want more acid problems. yuk. thanks everyone.