Read this question carefully

I would like to ask a question of the long-term post-ops/grads (3+ years out, please) *****ad here, but I would like you to read my question carefully and understand what and why I'm asking it and answer accordingly.  This is a sincere question, and I'm not trying to "start" anything other than an open and honest discussion.  I'd like to elicit thoughtful comments from those who have actual experience significantly past the "honeymoon" phase, and who are now doing the long-term maintenance phase.

The question I would like to ask is, knowing what you know now, if you got a do-over, and all things being equal (access to insurance, access to a nearby surgeon, etc.), which surgery would you chose (or would you chose any surgery at all)? The important thing I'd like you to consider in asking this question is that I'm not asking you to question your original choice -- I assume you made the best choice you could, at the time, with the information and other limitations (like insurance limitations, urgency of getting your weight under control because of illness so you couldn't affort to wait through appeals, etc.) you may have had.  I'm asking if you could chose to live long-term with a different surgery now, with 20:20 hindsight, would you do it? Yes, I'm looking to see if some of you would be more inclined to have the DS, and in particular if you would say so publicly for the benefit of the pre-ops *****ad here.  I don't know if that will be the result, but I'm curious. Although I am 4.5 years out from my DS, I don't post on this forum, but I have been reading here lately, and it seems so many people who do post here are struggling.  While you may not be posting for the benefit of the pre-ops who lurk to see how people are doing, but rather to share your experience with and get help from others in the same situation, it would be interesting to know how you feel on this topic.  I am in no way suggesting that those of you who are successfully working your tools should be getting revisions -- far from it!  But given the struggles you may be having living with your tool long-term, would you chose differently if you could start over right this minute, knowing what you know? Those of you who are succeeding with your surgery, no matter how much work it is -- I commend you.

I did not research many other options when I started this journey, so I really couldn't tell you if I would choose a different type of surgery...  I can tell you that if I had to make the decision today, I would again choose gastric bypass.  But it would have to be with the same surgeon.  I was blessed with having one of the best surgeons in the world perform my surgery, which I am sure is the reason why I have had (count them!) zero complications.   As for the struggles... I cannot speak for anyone else, but my struggles are my own doing.  Nothing to do with the type of surgery I chose.  I believe anyone can sabotage any type of surgery.   It's a very simple "mind over matter" issue for me.  Now that I've refocused, I'm working with my tool again, and I intend to keep it that way.  :-) Not sure if this is the type of answer you were looking for... but there you go ;-) Angie

Hi Diana, I'll try to answer......for me I would choose the RNY again because I wanted the limited intake and the chance of dumping it gave me.........so far though my struggles are minimal to what others have experienced at 3 years.  I've had no complications, I understand my limitations and I'm happy. Now on the other hand, if we could do it again for my husband I would strongly recommend the DS to him because of his eating habits......he has the lapband and although he's kept off over 100 lbs of his excess weight, he has regained 80 of what he had lost (total lost was 180 lbs), he's taken off 13 lbs of this regain in the past month.  He struggles everyday with his choices.....I don't believe he would chose a different surgery though because he thinks the DS and RNY are too invasive for him.   Oh BTW, we were both self-pay our insurance had an iron clad exclusion.

I did a lot of research before I chose my RNY. Now 6+ years out, if I were doing it again, knowing so much more about both procedures, I would choose RNY-- only I would be more confident about it.

Did my research and I chose RNY distal and have been very happy with my tool. 3 yrs post op and successful....but work at it everyday.

Hi Diana! I am 3+yrs post op and I had gastric bypass~I would stick with my original decision. For me, it was what would work for the long haul, even though I have to work at it. I consider myself a success in losing from 328lbs down to somewhere between 150-159lbs on any given day. I allow myself that room to bounce around, bu****ch the scale to be sure I do not move outside of my limits. I have been in "maintainance mode" for about 2yrs now and I feel good about my decision. Hope this helps!

My allergist is suggesting that, due to the surgery (specifically stress to the system that may or may not have caused Celiac Disease) I have the RNY reversed. If the stress to my system caused Celiac Disease, so be it. I LOVE my RNY and wouldn't do it any other way. Knowing what I know now about all the other choices available, still: NOPE. rny worked for me. 

OK, as you know, back in 1993 when I was choosing, the choice offered to me was VBG or this radical distal RNY. No internet, just people in front of my face. But at least I'd been seeing them since 1976, a small few.

I often ask myself this question. I have maintained 100% wt loss EXCEPT for my brushes with sugar (sugar wins), and at least I CAN reverse those gains. I malabsorb fat at least as much, maybe more than DS. I dunno, all our lipids look good! LOL I prolly malabsorb protein more, but my husband is at the top end with RNY distal, 130cm. Both of us have the best albumin and pre-albumin on earth. The other nutritional stuff is fixed long ago, pretty much.

I appreciate my smaller pouch (not so small at 13 yrs). I needed to learn to eat spaced meals vs the one mega meal. I had some minor blood sugar issues pre-op. I would LOVE to be able to eat a ton of bread and potatoes with impunity. They have not made me fat in these 13 yrs (I can eat plenty), but they DO mess with my blood sugar.

The ONLY part I would swap would be the hypoglycemic episodes, which MAY have to do with the bypassing thing, more than the stoma thing. Pancreas gets confused.

If the avg wt maintenance for DS is say, 90% at 5 yrs, and I'm at 100%, based on THAT I would not swap.

That said, a distal RNY like this is simply not done any more. It's not like a person can ask for this one. I debated whether you wanted my answer, since I'm distal, but then I figured you might be asking more about living with the limitations of a pouch, since I got the good part of DS, major malabsorption.

I had ulcers early on, but then, I had them since I was 19. My stoma has always worked fine, and amazingly works enough to let me feel very satisfied on normal portions, allows me to get up and walk away from the food and do things before that full feeling gradually subsides. So, stoma is not too tight, has not loosened substantially.

You know, your darling Dr R saw my blood sugar crash at DS mtg and he offered to fix me! How sweet is that? But of course, with a life long history of ulcer, all my "fabric" went on the cutting room floor with revision in 2000. No fixing available.

The ONLY part I would want to go away would be the BS issues. And I mean, BLOOD SUGAR. But since I made it a point to drop my fudge pudge last year, I'm seeing a pattern about avoiding white carbs. I can still have some fruit. Protecting me from bread & potatoes doesn't seem to change my wt. And if you asked me pre-op to name my fave foods: bread, potatoes, pasta, rice....anything butter will melt on. And now, here they will not make me fat, but they will make me feel bad. That's just kinda sad, doncha think?

So, in the end, love my short common channel, and love everything about my pouch except the pesky BS issue.

With a do-over, I would still choose the RNY because ninety percent of my regain is from overeating chocolate.  As far as I know, none of the WLS types will deliver you from the effects of that. Even if one did, I'd seriously have to ask myself if medical science should bail me out (again?!) for my failure to knock off an obviously bad practice, for I fear I'd just replace it with something else.  You can outeat any WLS if you've a mind to. BTW, I knew about the DS before I had my RNY 5+ years ago.  I didn't want it then.  It's still not the right choice for me.   But I think it may be the right choice for some.  People with stubborn metabolisms, people who can't exercise, people who have high BMI's, people who just *know* that the RNY won't be enough for them (which is such a personal gut-level call).   Probably many others, I couldn't say.  But when I see people for whom the RNY failed, and there's no mechanical failure -- just a failure to use the "tool" and eat/exercise right -- I'm really not convinced that the DS (or any other WLS) will be *the* fix.  I'm sure healthful eating and exercise are integral parts of a successful DSer's long-term plan, too. Suzy C.

I have been accused of overthinking an issue. CAN YOU IMAGINE?

But since I've pondered this question for years and gave you such an involved answer, I thought I would cut to the chase this way.

In today's world, knowing what I know, assuming my options are PROXIMAL RNY or DS, I think my brain has finally come down on the DS side.

The thing my doc told me way back when: the small pouch gets it off, the malabsorption keeps it off, is still pretty much how I think.

And then, from all these many years of working with ppl, I would not want less than 100cm common channel (sometimes the very best supplements in the world cannot prevent or recover issues), nor would I want more.

I do suspect I'd weigh more if I could eat more and didn't have issues with sugar, but less than I would w/o the serious malabsorption. I can only ponder.

Which I do frequently. Ever notice?