Oh, no! Dr. has left the choice to me?!?!

I had my surgical consultation yesterday - seeking a revision from my lap band.  I was soooo sure that I wanted the DS - now I don't know between that and the RNY.  The surgeon said he would do whichever one I want him to do.  He said that I'm going from the most minor of WLS to the most major - if I choose the DS.  He also said that I would be the "smallest" patient he's ever done a DS on.  I asked if either was safer or had a quicker recovery than the other, in my case, and he said "no" to both.  He said that the DS is considered the "sledge hammer of WLS", because it's the most drastic.  I was sooo hoping that he would suggest one over the other, to relieve me from having to make the decision; however, I'm impressed that he laid all the facts on the line and is leaving it up to me, as well.  I just don't know what to do.  The things steering me away from the RNY are the number of people that gain much of or all of their weight back, and the fact that I have yet to come across one person that has said they regret their DS - but many that say they regret their RNY.  I want this to be my last WLS EVER, so do I choose the "sledge hammer"?

Any advice anyone could give would be great - although I know that, ultimately, the decision is mine.  (it's just such a huge decision - I'd like any and all input I can get my hands on) 

p.s. my BMI is "only" 39
p.p.s.s. I frequent the DS and RNY forums, also

thanking you in advance - Stephanie

You are the one that has to live with this surgery type so it's good that he's not making the decision for you.  Give your doc a hug and tell him good job!

Stephanie,

This decision really does need to come from you, and any surgeon that wanted to make the decision for you outside of medical reasons, I would find suspect.

If you aren't familiar with lightweight DSers, you may want to consider getting to know some of them.  There are many people that I know of who had a BMI between 35-40 when getting their DS, and recommend it highly.  You can find Gina (MajorMom) on the DS or Lightweights forum most days.

Personally, I wanted the best chance I could give myself of losing as much of my EW as possible, and I never wanted surgery again, thus the DS.  That said, I don't see how being a lightweight will necessary guarantee you success with a RnY.  The potential post-op life of a RnYer is what scared me away from it the most though.  Most I know still  'diet'  and have too many dietary restrictions for what I wanted for myself.

As you consider your choices, also remember that you have some say in the size of your sleeve and common channel with the DS.  I don't think that enough people do their due diligence on researching WLS options, let alone what can be customized with each procedure.  Volume eater and want to consume less?  Get a smaller sleeve.  Malabsorption of the DS is holding you back?  Consider a longer common channel.  Don't want to lose that fast or that much, and want to eat more than you would with a standard size stomach?  Consider a larger stomach / bougie size.

Potential DSers should do an honest assessment and consider their diet history (lose easy but can't maintain, etc...), consumption habits (grazing, volume, etc...), and determine if adjusting the sleeve or common channel from the standard (or what their surgeon considers standard) would be appropriate.

Good luck in your decision!  You know what I would tell you -- the DS is the only way!!

Stephanie:

Consider yourself lucky.  Remember, only you know the answer.  Be honest with yourself about what you liked/disliked about the Band... and how you live your life now and want to live it post-op.  There are plenty of Lap-Band to RNY and Lap-Band to DS patients you can talk to... and you know what??: Pretty much everybody is happier than they were with their Band. :) :)

You'll do fine.

Just take a breath.... and maybe lay out the pros/cons for you.

I'm assuming your surgeon would do a longer common channel on you because of your BMI.  Is that true?

My doctor also left it up to me. And rightly so because the surgeon and the surgery will only take you so far. From that point on it is up to you to make it happen. 

So check around, educate yourself, and go for it.

Keep in mind that if he thought one of them wouldn't work for you he would tell you that. Apparently though he thinks either one will work for you. 

Whichever you choose, know that all wls surgeries have miles of success stories behind them. 

                                                    
                                            

 IMO, what you need to look at is your BMI before you had the lapband put in.   If that lapband helped you lose to a BMI of 39 before you had complications, then you may be able to get away with just a restrictive procedure alone - get a "sleeve" - the first part of the DS and then you can always add the malabsorptive portion later.   They two portions work synergistically when done together, resulting in the highest proportion of excess weight lost, but you may not need the full "whammy".

Make note that once you construct the pouch portion of the RNY it makes it very difficult (some surgeons say impossible - incorrect, but they say it) to change it back into the working stomach of the sleeve.   Also, if you get the sleeve, the surgery cuts away and removes the greater curvature of the stomach where Grehlin, the hunger hormone, is produced.   The reduction in this hormone is a another issue which adds to the success of the DS and sleeve procedures..  

With the RNY, your entire stomach is left in your body, so that you will still be churning out Grehlin and be as hungry as before, only you will be left with a small pouch, so, at first, you won't be able to get much in.   Once your pouch stretches, if you cannot adhere to the post WLS eating rules, you may gain a good portion (sometimes all) of your excess weight back. 

You only need look at the revisions board to see how many RNY'ers are on here seeking conversion to the DS because this is what happened to them.    Sometimes it's in 3 years, sometimes as long as 8-10, but a good proportion of RNY patients do gain their weight back.   And, once they do, the procedures which are most available to them as revisions are the lapband over the pouch to regain restriction or the ERNY which adds even MORE malabsorption than the DS and (just from what I have read here) is hard to live with because of the potty, vitamin and body odor issues.   Some have complained of the same symptoms as those who had the Scopinaro surgeries years ago.  (For those who don't know, the Scopinaro was the first version of the DS and was fraught with problems and is not being done anymore.  Most, if not all, who are complaining about DS side effects have had the Scopinaro, not the modern DS with the sleeve stomach!).   

Another thing to consider are all of the possible complications of the RNY surgery.   It recreates your anatomy and renders your stomach unusable for food.   The organ still stays in you, yet is considered "blind", because there is no way to easily examine it.     From the research, the RNY people seem to have many more complications several years out than the DS patients.   The DS doesn't change your stomach anatomy except to make the stomach smaller.   It still works as it did before the surgery.   The remainder of the stomach is REMOVED completely so it is not still in you, churning out Grehlin 24/7.

The choice would be a "no brainer" to me.  The sleeve or the DS is the way of the future.   The research on the sleeve is saying that it's just as effective as the RNY in the long term (and it is a safer operation because there is no intestinal malabsorption).   The DS is even more effective with less weight gained back several years out.    Your surgeon should be able to tailor your common channel length to take into account your BMI of 39.   Just make sure you are getting "sleeve" stomach and not the old Scopinaro pouch.   And, there are differences in the size of the sleeve stomach with regard to the eventual success of the operation, so do your research on that and make sure you get the correct size for your situation.  

It's great that your doctor performs both procedures and is giving you a choice without trying to make it for you.   He is to be commended.  A lot of doctors hope for the best and really do think that the patient will be able to adhere to the post WLS rules and completely overhaul their lifestyle and eating habits.     They lead patients to believe that it's a "one shot" deal, and frequently it's not.   How many times have you read on someone's profile. "that's 100 lbs, gone forever", only to see them on the revisions board a year because they've gained back 50 of them?   The DS is stronger "tool" to help you achieve your goal.   The greatest danger during any surgery is going under the anesthesia and risking bleeding out from any complications which arise during the procedure.   Do you really want to have to do that more than once?

Best of luck to you whichever you choose!

I can't thank you all enough for all of the great facts and advice you've offered.  As you all know, it's such a huge decision, but having you pitch in with your knowledge helps immensely.  I'm still really leaning toward the DS. 

Dr. Kemmeter didn't get into channel length or anything like that - probably because I couldn't tell him for sure that the DS was the way I was going to go. 

And, as far as my BMI - it was a 39 when I had my band put in also.  My weight never varied more than +/- 5 pounds in the almost 2 years it's been in!  I can say, for sure, that a restriction only procedure was not for me - I need some of the malabsorption as well.

thanks again as I'm off to "weighing" my pros and cons!

Stephanie

You know that with the RNY, after around 2 years, the body will adjust with the result that you will hardly malabsorb any calories any longer, don`t you? The DS may be the "biggest gun", but if you want lasting malabsorbation to avoid regain, there seems to be no alternative. The RNY doesn`t bypass enough of the intestines to make a lasting effect for most people. Some will losse like crazy and never regain anything, but for the majority, reality after serveral years out looks differently.

DS all the way.  It can be tailored to your particular size and needs -- longer common channel, longer alimentary tract, larger sleeve, to ensure adequate but not excessive weight loss.

Gosh, I cannot thank everyone enough for their time spent responding to my post.  Your advice is absolutely priceless.