Picture ten McDonald's Quarter Pounder sandwiches. That is what you could have stuffed into your old stomach at every meal before your sleeve was done. After VSG, half of a Quarter Pounder would have been a huge meal. Even with your stretched out sleeve, you probably could not eat more than one sandwich at a meal. Going from somewhere between 28 and 40 oz stomach to a 2 or 3 ounce stomach was a huge change.

If your sleeve is now 6 ounces, putting it back to 3 ounces would not have made any noticeable change in capacity. We all learn how to eat smaller amounts of food more frequently.

It is probably amazing that we learn how to use our tiny stomachs to hold enough food to gain back our weight. But about half of weight loss surgery patients have regained 50 pounds by five years after surgery. It is normal to regain about 10% of the excess weight. That happens even with careful diet and exercise.

I have regained and lost several times in the 14 years since my surgery. I have told myself that I am on a diet for life. I can eat a lot of food at one time, if I let myself do it. Just because I can do that does not mean that I should do it. Every day, I make a commitment to track my food, to weigh myself, and to get in my exercise.

I am 73. I joined Weigh****chers and became a lifetime member in 1973. I would get to my goal, stay there for about a week and a half and then start gaining again. That happened over and over again. I could not figure out why I could not lose and stay there. For me, the final solution seemed to be weight loss surgery. That was wonderful for about three years. But when I started to gain again, I went back to Weigh****chers.

Even with surgery, a diet plan, and an exercise plan, I am overweight, but no longer obese. I am currently struggling with 12 pounds over my goal weight. And it is a struggle. Surgery does help and you now have malabsorption of fat that will last a lifetime. Carbs will still be absorbed and used by your body.

The important thing is not the size of your sleeve, it is what you put into that sleeve. If he had tightened up the sleeve, I think a few cheat meals would have stretched it back out and we all have cheat meals. You should discuss your concerns with the surgeon and get his take on what he did. Perhaps he should refund part of what you paid for, but that is something you would have to take up with him.

I has the duodenal switch surgery on October 15 th, I had the gastric sleeve 6 years ago . I had regained roughly 50 lbs in last two years. When I spoke to my surgeon he said when we done the DS switch he would resleeve me also , along with removing my gallbladder. However he decided not to resleeve me while in surgery . I paid out of pocket for my surgery, and I kind of feel slighted, and just wondering , or wanting to know if I have a reason to be upset . My stomach had definitely stretched out some and I'm kind of scared I wasted all this money , and can still eat more than I had in the beginning

The proximal RNY is the standard gastric bypass that most people here (at least in the US) have, where everything is performed on the upper, or proximal, part of the intestine. The 75 cm referenced may be either the biliopancreatic limb, from the remnant stomach to the anastomosis, or the roux limb from the stomach pouch to the anastomosis, with the remainder of the 20-30 feet of small intestine being the "common channel" in DS vernacular. These upper limbs can be varied by surgeons' preference, usually between 50 and 150cm. The distal RNY is more comparable to the BPD/DS in that the surgeon will measure from the lower end of the small intestine (the "distal" end) where it joins the large intestine, typically leaving a DS like 100-150cm of common channel, with the remaining 20-30 feet of intestine above being split between the two upper limbs. The distal is rarely done in the US (from what I have seen, most insurance doesn't approve it as a primary WLS) and is mostly used as a revision from an earlier proximal RNY, or another WLS where the BPD/DS isn't appropriate or the surgeon doesn't know how to perform it.

In short, (so to speak..) comparing limb lengths of the DS and proximal RNY is an exercise in futility as they are quite different procedures that work in different ways. Likewise, the SIPS/SADI/"Loop DS" is a very different procedure from the BPD/DS, so limb and common channel lengths don't directly compare. You say that you have seen some with long CC who have done poorly - do they have the BPD/DS or the SIPS/Loop DS which typically has a longer CC. As the SIPS is a newer procedure that is not as standardized as much as the BPD/DS or RNY is, there is going to be more variation in patients' results with that, as surgeons are doing them with greater variations as they figure out what really works with that configuration. I certainly wouldn't let someone's poor results with a long CC SIPS influence my view of CC length in a BPD/DS. Make sure that you are comparing apples to apples.

Reiterating what I indicated above, I would talk to several BPD/DS surgeons and get their take on the issue. I understand your concern about long term weight maintenance and regain resistance, which is the strong suit of the BPD/DS. There are several here on this board who are around 20 years out and maintaining well, likewise, my wife and I have dinner with a largely DS support group, most of whom are in the 20 year range as well, and maintaining as relatively normal people - sometimes one gains a little and has to cut back for a while to bring it back in line - like a "normal" person. Which is basically what we are looking for in our WLS.

I can see and argument that because you are on the young side, that you may not need a particularly short CC to maintain effectively, as your metabolism may not be as damaged as a similar person who started this process when older. This is something to discuss with the surgeons and draw from their experience, as they are the ones who have done hundreds or thousands of DSs and have a lot of insight into what works best for what kind of patient. As the DS is still a fairly niche procedure, most DS surgeons are quite used to dealing with patients who travel to see them, and are used to doing remote consults, at least the initial ones, so it can be well worth it to consult with several of them and get some consensus on this.

Good luck, there's lots to absorb here,

Hey! We're on the move again! Just weighed and another 2 pounds down!!!

Barbara

Proximal RNY? What does that mean? I don't really know much about the RNY, I was asking about the DS. For me, being that I am 24, keeping as much weight off after the surgery as possible is a priority for me. So I don't want a longer common channel then I'm struggling with regain down the line. I'm glad you were able to find some success though, and yeah, health is important.