RNY -vs- DS

Now I'm sure this has been discussed/debated plenty of times in the past, but as a newbie I'm not entirely sure.  Perhaps someone can link me to a previous thread?

In my readings on DS and RNY, it seems as if there is a bias (on paper) toward DS mainly due to the fact that the lower valve is left intact (avoiding dumping syndrome) and ulcer frequency is greatly reduced by removing the unneeded ~75% of the stomach.  There is also talk that gastric illnesses in the bypassed portion of the stomach (in RNY patients) may go undiagnosed because they are not seen during an typical endoscopy.  The readings make DS out to be a no-brainer choice over RNY.

So, my question is this, why does RNY seem to be the more "popular" choice over DS?  I know eight people in my little world that have had WLS, five of them had RNY and three picked the band.  Some would argue that dumping keeps you "honest", and that RNY surgery is entirely reversible worst case, but is that enough to sway doctors and patients to RNY over DS?  Some clinics and hospitals (like Barix for example) refuse to perform DS, won't even discuss it.  It just seems odd given what I read.

Your thoughts...

I would love to hear an answer to your question, the docs i have talked to refuse to talk of DS, and there are very very few out there who do the procedure............


i just don't understand

I am going to try and honestly answer your questions.  If you find a ton of people (DS women) come on to this board...I won't post further on this subject.  Also if a lot of men (who don't normally post here on the Men's Forum come on) I'll just drop it.  DSers are pationate for their surguery (saying it kindly).  So sometimes trying to hold a normal conversation is nearly impossable with many of them.
Over the years many Doctors and insurance companies didn't do the procedure (DS) and would not insure the procedure.  Some call the DS expirmental...which it is not anymore.  Because of these two things many surgeons never learned this procedure.  The DS is a more difficult procedure to do (perform and learn...major surgery).  This is one of the reasons doctors chose not to do it.  To get it done you may have to travel hundreds of miles for the procedure.  This may require going out of state for many people.
I am now going to list the positive and negative aspects of both procedures...(The DSer will flame me) but I will try and be as honest as I can.  DS positive: Greater weightloss over the years.  Greater reduction of the amount of diabetes "cured".  Can eat most foods without dumping.  Can eat large large amounts of foods...this may be good or band...the jury is still out on this one.  No issues with strictures.  No issues with sugars.  Less issues with dehydration the first few months.  Now the negitive:  Possibly more issues with malabsorption...including iron and Vitamin D.  These can be supplimented, but if you ever got into an issue of lack of food for some reason or not have the ability to gain access to vitamins...DSers could be up the creek without a paddle...Same with RNYers but differnent malabsorptions in different locations.  DSers may have problems with many starches post op.  This can come out in the form of smellier poop.  DSers would say I was wrong...Don't flame me...the exact words from my surgeon...also his partner...and many DSers on their board.  We don't know what the outcome of either DS or RNY will be 10-20 years down the road.  With the malabsorption issues, problems could arrise in both procedures.  I worry about the malabsorption of DSers over the years...just me.  I also might be concerned when DSers can say they eat "everything they want".  Just wonder about the heart and colon years down the road with that one.  I didn' like the idea of most of my stomach being tossed into the garbage can and I wouldn't have access to it if I needed it years down the road for some reason.
Now to the RNY...again these are general thoughts.  It is performed everywhere.  Many doctors know the procedure (your PCP).  It is effective in major weightloss.  There is a difficult learning curve starting out...but it gets easier over the months.  There can be issues with strictures...but they can get resolved with a simple outpatient procedure.  RNYers have to take certain vitamins too...Iron, calcium, B-Complex, B-12. There is an issue with dumping.  But it can aid in the weightloss...You cheat major...you dump.  Dumping usually happens the first few months or first year for most.  It becomes less and less of an issue for many people...while others have to be concerned with it the rest of their lives.  RNY is effective for these things; major weightloss (men lose it quickly), IBS, diabeties (sorry not a good speller here...don't want to look everything up here...just type), bloodflow (if you get my drift), harder exercise becomes an option for both surgeries, both usually reduce the need for blood pressure meds, weightloss in both procedures can reduce joint pains.  I know I am missing a ton of stuff, but I'll stop now.  I could type for hours on this subject...Brian  

Well, I thank you very much for your reply.  Your post was informative to say the least...

Just so it's stated guys, I have no intention of "rocking the boat" here, or in this case, "rocking the forum".  And I certainly don't want to be the reason that anyone stops posting on any subject for any reason.  I am here to learn 

As always, I thank everyone for their responses!

ditto for me, thanks...very balanced......i just can not seem to get any balanced infor on the DS board....

cheers

    There is a deep dark secret of all bypass surgeries that we never talk about ant it explains the second reason many doctors will not do DS. The secret is that with all malabsortion surgeries, there is a risk, though I consider this risk small,  of irreversible malnutrition. The more extreme the bypass, the greater this risk is. Doctor's malpractice insurance rates are influenced by the actuary tables the insurance companies use. Right or wrong, these figures can and do control the actions of many doctors. 
     But this does bring up a more directly impacting factor for us, in that vitamin and nutritional deficiencies are a real threat to post operative health with any WLS and continual, rigorously scheduled testing and verification of our blood  chemistry is essential. More RNYs are done so more doctors, (not all by a long shot), and more hospitals have an understanding to the nutrient and vitamin need of RNY patients. Being able to get accurate follow-up care without a journey that will be costly, and thereby tend to be more likely to lengthen intervals between follow-up care, is a factor I considered in my decision. 

The DS attempts to solve two possible problems with the RNY, as I see it. 

There are problems with having a pouch without a pyloric valves.  Not only can you get ulcers and strictures, but there are issues with stretching and a loss of restriction.

There are also problems with the malabsorbtion not being aggressive enough and people regaining after their newly routed guts adjust to the surgery.  Weight gain after 1 to 2 years on RNY is not unusual.  Dumping often goes away, allowing patients to go back to carbs. 

The possible problems with DS is that it's a higher risk surgery, and as others have said, you don't know how the more aggressive malabsorbtion is going to affect you long term.  

Offtopic, but I'm getting VSG because I don't want malabsorbtion if I don't need it.  i can convert to RNY or DS later if needed. It's lower risk and less expensive, which is important to me because my insurance has a rider explicitly denying coverage of all WLS procedures. 

Jay, I think each has its pros and cons.  I know what worked for me, and I stand by it.  Check out my profile, you'll see why.  Good luck to you.

John (3 years/4 months post-op)

At this stage of WLS technology, there is insufficient data to say which surgery is 'best,' and yeah, we don't know what the 20+ year outcomes are.  But we do know that in 5-10 years we would all be dead or permanently messed up without WLS.

In my case, Dr. Kim felt that I didn't need malabsorption, only restriction (I weigh 280 or so).  So the question was then between the Lap Band and VSG.  I decided that I wanted the VSG so I wouldn't have to deal with the return doctor visits.  I also wanted a "permanent" solution that forced me to change.  I know the Band works great for many people and I'm not slamming them -- it's just not for me.

My guess is that there are similar considerations in deciding between RNY and DS.  Is restriction important to you and your doc?  Do your doc and insurance company have issues with either surgery?

Based on some of your other posts, Jay, restriction sounds like something you want/need.  Maybe your doc sees this too and wants that aspect of RNY for you.

If you trust your doc, go with his recommendation.  It is ultimately a personal choice.

Thank you for your thoughts...

Yes, both my PcP and I feel I will get the most long term benefits for WLS that includes both restriction and malabsorbtion.  Since RNY and DS both "accomplish" that, I was wondering why DS was so unpopular and physicians shy'ed away from the topic.  It seemed odd, hence the post.