Is VSG enough after succesful band weightloss?

Can I ask a silly question?  Your doctor put in for a two-part DS for you... but he doesn't even do the DS (according to his OH profile).  What is the plan if you need a DS?  Will your insurance cover you having the surgery with another, experienced DS surgeon? Or would you be stuck being his first?

My doctor has done the DS, I definitely would not be his first. When you click his name, his page shows 10 open and 20 Laproscopically (not sure how often they update those numbers, but I'm sure its more now). He does them, but doesn't recommend them because its a very high risk surgery (more than the RYN) and so many people end up with malnutrion problems and even kidney problems. He wants me to atleast try with the sleeve alone first. Since the insurance did approve me for the DS, atleast I will have that as back up...but I do not want to have to go through another surgery again! :( I'm going to see him Saturday, so I am going to ask more questions.

Sounds like a typical RNY doc who knows nothing about the DS.  DSers are not more likely to end up with malnutrition issues (that's a myth)  and an increased risk of kidney stones exists for both RNY and DS patients.

Sounds like  your doc is not keeping up with the research, so if you do need a DS, you might want to check out somebody with more experience.  If he's done anything less than 200, I wouldn't go near him.  

Roux-en-Y gastric bypass versus a variant of biliopancreatic diversion in a non-superobese population: prospective comparison of the efficacy and the incidence of metabolic deficiencies.
Skroubis et al. April 2006
http://www.ncbi.nlm.nih.gov/pubmed/16608616

BACKGROUND: In the non-superobese population, an agreement has not been made as to the optimal bariatric operation. The present study reports the results of a prospective comparison of Roux-en-Y gastric bypass (RYGBP) and a variant of biliopancreatic diversion (BPD) in a non-superobese population.

METHODS: From a cohort of 130 patients with BMI 35 to 50 kg/m(2), 65 patients were randomly selected to undergo RYGBP and 65 to undergo BPD. All patients underwent complete follow-up evaluation at 1, 3, 6, and 12 months postoperatively and every year thereafter.

RESULTS: Patients in both groups have completed their second postoperative year. Mean % excess weight loss (%EWL) was significantly better after BPD at all time periods (12 months, P=0.0001 and 24 months, P=0.0003), and the %EWL was >50% in all BPD patients compared to 88.7% in the RYGBP patients at 2-year follow-up. No statistically significant differences were observed between the 2 groups in early and late non-metabolic complications. Hypoalbuminemia occurred in only 1 patient (1.5%) after RYGBP and in 6 patients after BPD (9.2%). Only 1 patient from each group was hospitalized and received total parenteral nutrition. Glucose intolerance, hypercholesterolemia, hypertriglyceridemia and sleep apnea completely resolved in all patients in both groups, although mean total cholesterol level was significantly lower in BPD patients at the second year follow-up (t-test, P<0.0001). Diabetes completely resolved in all BPD patients and in 7 of the 10 diabetic RYGBP patients.

CONCLUSION: Both RYGBP and BPD were safe and effective procedures when offered to non-superobese patients. Weight loss after BPD was consistently better than that after RYGBP, as was the resolution of diabetes and hypercholesterolemia. Because the nutritional deficiencies that occurred following this type of BPD were not severe and were not significantly different between the 2 operations, both may be offered to non-superobese patients, keeping in mind the severity and type of preoperative co-morbidities as well as the desired weight loss.
 

Urol. 2009 Apr 15. [Epub ahead of print] Links

Effect of Gastric Bypass Surgery on Kidney Stone Disease.

Matlaga BR, Shore AD, Magnuson T, Clark JM, Johns R, Makary MA.

Departments of Urology, Surgery, Anesthesiology and Medicine, the Johns Hopkins University School of Medicine, and the Departments of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland.

PURPOSE: Recent studies have demonstrated that mineral and electrolyte abnormalities develop in patients who undergo bariatric surgery. While it is known that these abnormalities are a risk factor for urolithiasis, the prevalence of stone disease after bariatric surgery is unknown. We evaluated the likelihood of being diagnosed with or treated for an upper urinary tract calculus following Roux-en-Y gastric bypass surgery. MATERIALS AND METHODS: We identified 4,639 patients who underwent Roux-en-Y gastric bypass surgery and a control group of 4,639 obese patients who did not have surgery in a national private insurance claims database in a 5-year period (2002 to 2006). All patients had at least 3 years of continuous claims data. Our 2 primary outcomes were the diagnosis and the surgical treatment of a urinary calculus. RESULTS: After Roux-en-Y gastric bypass surgery 7.65% (355 of 4,639) of patients were diagnosed with urolithiasis compared to 4.63% (215 of 4,639) of obese patients in the control group (p <0.0001). Subjects in the treatment cohort more commonly underwent shock wave lithotripsy (81 [1.75%] vs 19 [0.41%], p <0.0001) and ureteroscopy (98 [2.11%] vs 27 [0.58%], p <0.0001). Logistic regression demonstrated that Roux-en-Y gastric bypass surgery was a significant predictor of being diagnosed with a urinary calculus (OR 1.71, CI 1.44-2.04) as well as undergoing a surgical procedure (OR 3.65, CI 2.60-5.14). CONCLUSIONS: Roux-en-Y gastric bypass surgery is associated with an increased risk of kidney stone disease and kidney stone surgery in the postoperative period. Clinicians should be aware of this hazard and inform patients of this potential complication. Future studies are needed to evaluate preventive measures in the high risk population.