Newbie question for the guys: RYN vs. DS..What's the difference?

It's all about what surgery is right for you. There are advantages and disadvantages to each one. I have noticed that my surgeon is performing more sleeves now over lap and rnys. In my support group rny was the majority but gs is now by around a 75/20/5 (gs/rny/lap) margin. The sleeve is aroud 10k cheaper than rny too. Maybe people are flocking to the sleeve because it's cheaper. I still consider rny the 'gold standard'. Hard to 'cheat' with this one now or in the future with the dumping mechanism built in. Some consider that on on complication. I consider it a perk. You also have the malabsorption factor which the other surgeries don't have too. It still all boils down to what's gonna be right for YOU and your lifestyle. Chad...

Since you didn't mention a laundry list of medical complications I assume you can take your time in making a decision.  It really doesn't matter what other people think about one surgery or the other.  I tried to listen to how happy people were with what they had, and I spent all the time I could researching medical literature, asking every doctor I could and scanning the net and reading about failed procedures and failed weightloss.  I chose an open RNY after all that, consults with two different surgeons, and several months attendance at WLS support group meetings.  Several websites (I think Mayo Clinic is one of them) allows you to watch the surgery performed.

In the end, there isn't any rivalry that matters.  There's only living with your decision and your new lifestyle.  My surgery is a week from today (God and the Insurance Company permitting).  I'm ready!

Good luck to you,

Charlie 

Hey Pat... I used to think that there were 3 classes of surgery... 1- lab band, for light weights 2-RNY for heavy weights 3-DS for the 700# people Seems as that is not the case anymore... there used to be a time. when a discussion between lap vs rny would cause a fist fight to break out in the waiting room On the rivelry, everyone has to think they made the right choice, or they fall into self doubt and don;t give it their all... They all seems to have trade offs... this is how I understand the trade offs...and some other people may wanna tweek this list./// 1 -lap band is slow, and it takes follow up (the fills) at $150 a pop...and some of the insurance does not cover the fills...but it is the least invasive of the procedures..it is restrictive only...every calorie you put in your mouth, you have to burn off....(day surgery) 2- RNY - weight loss is pretty fast...especially for the guys....on average from listening to the boards...about a pound a day for the first 100 days....it is restrictive and has malabsorbtion...you eat smaller amounts, and I guess about a 1/3 of your calories are not absorbed, plus the benifit of dumping...(benifit/detrement) that is when you eat something that is to high in sugar or fat, you feel sick/flush.elelvaed heart rate/sleepy...for me this acts a a deterent to eat correctly..so for this to be effective and you not be miserable, you have to change how you eat....maybe not as much, but this is the down side....you dump, and you do have to watch you vitamin levels.... 3-DS - from what I understand, weight loss fast. relatively no restriction...the main thing is malabsorbtion..and it's big on malabsorbtion....the DS people, seem to be very releived that they can eat as much as they want, without the limits...ok here is the trade off...they have wicked time in the bathroom....if you eat something, it comes out fast..no time to hang around and make fat...(our brother from Dallas who has already responded....says he has to go down the street from his office to a convience store to use the bath room...his fellow employees have said he is not welcome to use the bathroom at work anymore....that is a stinky situation...and DS people have higher risk for vitamin malabsorbtion....this is the most invasive of the surgeries.... Other people will tweek this...but this is how I understand it.... Russ

I just wanted to point out that most DSers do not go to the bathroom more then 2-3  times a day...really it's more like one time...but for some reason getting up, and wiping sets off part 2...lol....the 3rd time tends to be occassional in the evening depending on how much fat one eats during the day.   Yes DS BMs can be stinky....but so can RNY ones....any surgery that causes malabsorbtion, causes undigested food to get into the large intestines and colon...which is then attacked by "bad" bacteria...which can cause both gas and stinky BMs.   In additon, anyone who eats a primarily high protien diet (almost all wls patients)...will tend to be stinkier then people with normal diets, because protein causes additonal sulfer...which causes odor. I don't know...I had stinky BMs prior to the DS.....I guess I wouldn't be the best judge of things.....at 500 lbs I was having 5 BMs a day....and they really smelled bad.   I guess that can only say one thing about me....I realize  that my Sh*t stinks....both then and now...lol. Scott

I cut and pasted this from the same discussion the DS forum.  I thought it would be helpful for people still in the research phase.  I should note that I could care less which surgery someone has as long as they have all the information in front of them to make an accurate decision.   There are reasons to have the DS, and there are some reasons to have the RNY (yes there are certain precancerious conditions..i.e. bartletes syndrom  that require the RNY over the DS...at least in some doctor's medical opinion)  Scott

RNY compared to DS

 

RNY - expected weight loss

 

• 50-65% expected excess weight loss (percentage varies in opinion – on average estimate)

   

• Results may vary

   

• Regain

   

• Can regain 50% of weight after 5 years

   

• 100% regain of weight has been recorded

   

• RNY must exercise and diet to maintain weight loss after 5 years

   

 DS – expected weight loss

 

• 85% expected excess weight loss

   

• Results may vary

   

• Studies show little to no regain

   

• 20 lb gain from lowest weight has been recorded

   

 RNY – have a stoma (stomach made into a pouch – size of an egg)

 

• Size: 2 oz

   

• Stretch to average size of 6 oz in 2 years  (can stretch up to 9-10 oz)

   

• You can eat more as time goes by.

   

• Average after 1 year is 1-1.5 cups of food

   

• Stoma: blind pouch

   

• doctor evaluation cannot use an endoscope (to find ulcers and tumors)

   

• cannot take Nonsteroidal Anti-Inflammatory drugs (NSAID).

   

• NSAIDs are: Advil, Alka Seltzer, Aleve, Anacin, Ascriptin, Aspirin, Bufferin, Coricidin, Cortisone, Dolobid, Empirin, Excedrin, Feldene, Fiorinol, Ibuprofen, Meclomen, Motrin, Nalfon, Naprosyn, Norgesic, Tolectin, Vanquish

   

• NSAIDs are used for arthritis, bursitis, tendonitis, back pain, headaches, and general aches and pains. This could develop into a bleeding ulcer and interfere with kidney function.

   

• Possible Problems

   

• Ulcers (Doctor’s recommend taking Prilosec to try and prevent the ulcers)

   

• Possibility of a staple line failure

   

• Narrowing/blockage of the stoma

   

• Vomiting if food is not properly chewed or if food is eaten too quickly

   

• No Valves (pyloric valve that opens and closes to let food enter intestines is bypassed)

   

• This means food empties directly into the small intestines and causes dumping and NIPHS.

   

• Dumping: food (most commonly sugar but not necessarily just sugar) enters small intestines and causes physical pain (some people believe this pain enforces good eating habits)

   

• Dumping varies in degree of occurrence and discomfort

   

• Dumping symptoms:

   

• Nausea

   

• Vomiting

   

• Bloated stomach

   

• Diarrhea

   

• Excessive sweating

   

• Increased bowel sounds

   

• Dizziness

   

• Emotional reactions

   

• NIPHS (insulin over production): “the body overproduces insulin in response to food entering the intestines at a point where food would normally be more digested already - this part of the intestine is not used to coping with metabolizing glucose in the condition it arrives after RNY, and it is suspected that the intestine signals the pancreas for more insulin to aid digestion, causing a MASSIVE overproduction.  The change occurs on a cellular level, hard to diagnose.  Treatment: Removal of half the pancreas.  A couple of folks who've had this done have posted on the message boards in the last 6 months.”

   

• RNY stoma that is created allows food to go straight through the stomach into the small intestine unrestricted so it does not control the flow.  Because of that the body reads that it needs more insulin because the food is moving through so quickly and it thinks there's going to be a lot more food.  With the DS, the normal peristalsis works because the pyloric valve is in place and can control the movement of food into the small intestines.  

   

 DS – whole stomach (size of banana)

 

• Whole stomach means the stomach’s outer curvature is removed as opposed to making a pouch/stoma.

   

• Part of the stomach removed is where most of the hormone called Grehlin is produced.

   

• Grehlin gives the sensation of hunger so by removing most of that section; a DSer is not as hungry as before.

   

• Whole working stomach: no blind stomach.  Endoscope can be used.

   

• Can take NSAIDs

   

• Do not need to take Prilosec to prevent ulcers

   

• Valves are in tack: no NIPHS

   

 RNY – Eating

 

• Recommended to chew food to liquid (most important early out)

   

• Foods need to be thoroughly chewed to prevent blockage (hole leaving stomach and into intestine is the size of an eraser).

   

• To get food unstuck, patients drink meat tenderizer mixed with water.

   

• 64 oz of water

   

• Stop drinking within 15-30 minutes of a meal

   

• Do not begin drinking after a meal for 1-1.5 hours

   

• Not encouraged to use a straw

   

• Low carbohydrates (carbohydrates can slow weight loss)

   

• Avoid sugars (in fear of dumping and slowed weight loss and/or weight gain)

   

• Eat protein first

   

• 60g of protein a day

   

• Water Loading

   

• 15 minutes before the next meal, drink as much as possible as fast as possible. 

   

• Water loading will not work if you haven’t been drinking over the last few hours.

   

• You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.

   

 DS – Eating

 

• Daily intake of 80-100g of protein

   

• 64 oz of water

   

• Can drink with meals

   

• Can use a straw

   

• Low carbohydrates (carbohydrates can slow the weight loss)

   

• No dumping syndrome from eating sugar

   

• Only absorb 20% of fat (do not need to eat low fat)

   

• DS patients can eat more food than any other type of weigh loss surgery.

   

 RNY – Possible Issues

 

• Vitamin deficiencies: Must follow a vitamin regime for the rest of your life

   

• Common vitamin deficiencies found in vitamins B12, iron, and zinc

   

• Calcium must be supplemented for the rest of your life

   

• Bathroom issues

   

• Gas

   

• Constipation

   

• Reversible procedure but complicated

   

• Revision often performed instead of revision

   

 DS – Possible Issues

 

• Vitamin deficiencies: Must follow a vitamin regime for the rest of your life

   

• Common vitamin deficiencies found in vitamins A, D, and iron

   

• Water soluble/ water miscible / dry vitamins absorb best (in other words get vitamins that are not fat/oil based)

   

• Calcium must be supplemented for the rest of your life

   

• Bathroom issues

   

• Stinky gas

   

• Loose stool

   

• The intestinal bypass is reversible for those having malabsorptive complications

   

• Stomach portion removed is obviously not reversible

   

 RNY - Diabetes

 

• RNY does not cure diabetes but puts it in remission.

   

• Can come back in two or three years--even if the patient maintains most of their weight loss.

   

• Even a small weight gain long-term can cause a diabetes relapse.

   

• 85% cure

   

 DS – Diabetes

 

• A 98 percent cure rate for type II diabetes.

   

 DS – Myth or Fact Skin color turns yellow or pallor = Myth / Not True

 

• Patients who follow their regular vitamin regime (keep up with blood work) do not turn pallor

   

• If someone looks pallor, they could have a vitamin deficiency

   

• Vitamins and blood work must be monitored for life.

   

 The DS is “experimental and investigational” = Myth / Not True

 

• Medicare approves the DS

   

• Many insurance companies  are starting to cover the DS.

   

• DS has been performed since the 1970s

   

 The DS is only recommended for the super morbid obese (bmi over 60) = Myth / Not True

 

• To be eligible for ANY type of weight loss surgery, a person has to be 100 lbs. over weight or have a bmi of 40 or more.

   

• BMI’s under 40 have also been approved (usually require a comorbidy/health problem - an example is sleep apnea).

   

 DSers may need to wear a diaper = Myth / Not True

 

• That is silly

   

 Dser will have a problem when they become old = Not True

 

• We wont need to eat as much when we are older b/c our bodies will adapt

   

• The little hair-like villa grows to adjust to the new digestive system.

   

 Dser’s gas stink = true

 

• The gas does smell.

   

• There are products called air fresheners that a person can buy.

   

 Dsers will have a heart attack from all the fatty food they eat = Myth / Not True

 

• Cholesterol levels lower after having the DS. 

   

• 80% of the fatty food is not absorbed – so it the fatty food is healthier to eat as a post op than a person without surgery.

   

• Normal person eats a fatty meat that has 20g of fat, they absorb 20g of fat. A DSer absorbs 4g of fat from the same fatty meat.

   

 Dsers don’t need to exercise = Myth / Not true

 

• DSer’s are aware of the benefits of exercise (body and soul).

   

• Exercise helps in losing weight and maintaining goal weight

Hey Scotty.... I know that you cut and paste that article, and some of the facts are a little tilted.... Like the Nsaids....I doc perscribed Nsaids for me day 1 post RNY, and the diabetes curing....I don;t know how having your stomach reworked can make your pancrease start producing insulin... but like I said before, everyone has to love their surgery in order to get the max benifit When we get to see a pic of your thin self...you have been dropping liek a stone ..congrats Russ

There has been a recent shift with some surgeons regarding NSAIDs and the RNY.  For a long time, NSAIDs were a no no...because of their tendency to cause ulcers...even in normal people with regular use.  Now it seems that some surgeons are suggesting that there is little more risk for RNYers in general...but that it depends on an individuals reaction to the drug.   While this is the case, still a majority of RNY surgeons do tell their patients not to use Nsaids.....for the record I  don't use Nsaids regularly (even though I have a back issue) because preop they use to irritate my stomach....at least in the dosage I would need to take them to be effective. I'm not sure how I feel about the word curing in relationship to diabetes.  I've never had the disease but I have  about 7 close relatives who have had it, and 2 that have died from complications from it.  DSers sometimes debate the terminology, and question if saying the word "cure' should be replaced with remission or something to that effect.  In Europe they are doing the intestinal part of the switch without the VSG to put diabetes in "remission" because it has such a high rate of putthing the disease down.    I'm not sure why it works, doctors aren't sure why it works (at least  not totally)...but it  does often gets a person off insulin and returns their fasting glucose levels to normal...and changes their own insulin response to consumption of sugar.   I should note this is TYPE 2 diabetes and not type 1.  Is it a cure?  I think time will tell.   Scott PS if you want to see pictures...all you got to do is ask...lol.  I have them on my profile, just add me as a friend.....I tend to keep them private.

OK, let's clarify. Neither DS or RNY "cures" diabetes T2.  OTOH, both can quickly eliminate or greatly reduce one's need for medicines to keep one's blood sugar in line. Staple line ruptures:  A risk in both surgeries. NSAIDs:  If they bothered you before surgery, they'll probably bother you after surgery.  Wouldn't recommend taking them in the first few months following either surgery.

Nutritional deficiencies:  Risk for both surgeries.  DS bypasses more intestine than RNY, so more risk, but still controllable.  Both surgeries require lifelong supplementation. Weight Regain:  Possible with both.  That is to say, once you learn what your new plumbing will tolerate, you can 'eat around' either surgery, and consume a LOT of calories. In the US, RNY is generally considered the "gold standard"  weight loss surgery, but I believe that is mostly the result of having good and consistent long-term results, as supported by a large statistical population of RNY patients.  Since RNY is the most-frequently-performed weight loss surgery in the US, the track record is strong. However, that does NOT mean that RNY is the "BEST" surgery - only the most documented.  The "best" surgery  for anyone is highly subjective, and highly personal. We're all heading for the same destination.  We needn't all take the same road.        

I think the word you may be looking for is "Control" the diabeties.... The way I understand the teaching...there is no "Cure" for diabeties, just control...cure would come it the stem cell stuff they got going on.... We really need to chat more often...we have some good exchanges...\ you know the mental game is so important in this process...I had a chick...she had the vbg convert to rny and then DS, and she lost a total of 40 pounds....she was non compliant as hell//// The way I look at this...you have a mountain in front of you....you can climb over it, or dig a tunnel threw...both are lots of work and there is no free pass.... ok my dumping keeps me honest....with an iron fist.... how much self control, does the GI stuff take to get under control....? I still get in very respectible calorie count, and not dump...but lactos...stay away....danger will robinson..not explosive...just bloated... Russ

You know it's one of those things where surgeons are saying "cure" and everyone else is saying "controlled".  I like the word remission, because it puts the sense that the disease was there, and it's not there currently....but again  tomato/tomaato. Yeah we're lucky as men...we can eat and eat and eat..and not regain...some of the women ...unfortunately 1 slice of cheese too much and they're gaining weight like crazy. I added ya as a friend, so we can chat more. Scott