RNY VS DS and VSG Q&A
Thanks for the well wishes I got for my upcoming revision. Two preopers sent me pm's asking to explain the difference between the RNY and DS. I figured I would post it here for preopers that are still unsure of which procedure to have.Keep in mind that I chose to major in statistics to avoid having to write papers. I suck at writing, but I will do my best to explain the different procedures. Keep in mind that I am writing this for preopers. If you are post op, please do not read this and claim that I offended you or am trying to start a surgery war. This is for the preopers who have asked me to explain the difference between RNY and DS.
Note: 18 months ago I had a variation of the RNY known as the fobi pouch. It is a gastric bypass with a silastic ring placed around the stoma. It acts as a choke chain to prevent surgical failure. I am being revised to the DS on the 11th to correct reactive hypoglycemia, dumping syndrome and other dietery complications
The duodenal switch is a two stage procedure. The first stage is the restrictive component known as the vertical sleeve gastrectomy (VSG). This is similar to a gastric reduction and has the advantage of keeping a normal functioning stomach (unlike with RNY, which I will explain later). Also, having most of the stomach removed eliminates most of the hunger hormone ghrelin.
The second stage is the malabstorbtion component, which is an intestinal bypass to a much greater degree than with RNY. The malabsorbtion with the DS is permanent and has a metabolic affect such that you take on the metbolism of a lean individual. The metabolic aspect of the DS is why it is the most effective surgery for weight loss, long term maintanance and curing diabetes.
After the DS your diet is normal. You do not require calorie counting, atkins or any other extreme dieting. With the DS you malabsorb 80% of fat calories, as well as 40% protein and complex carbs. You absorb all simple carbs. Because of this it is important to eat a higher fat/protein diet and being mindful with carb intake.
Overall with the DS you have less restriction but more malabsorbtion than RNY. This allows for larger portions and a greater variety of foods in your diet. With the DS are free to eat and drink at the same time. You can also drink carbonated beverages. These are " no no's"with the RNY.
RNY: A RNY is performed by bypassing the stomach. This entails cutting a portion of your stomach along the lesser curvature of the stomach and creating a man made pouch. You will no longer have a normal functioning stomach. A hole is made at the bottom of the pouch called the stoma. The rest of your stomach is sewn closed and is called the blind stomach. The upper portion of your small bowel is then severed to form the roux limb. The rest of your small bowel is connected to your pouch.
It is important to note that in contrast to the DS, the primary component of the RNY is restriction. The roux limb is a very mild forof malabsorbtion (in comparison to the DS) and only malabsorbs calories during the first 12-24 months.
The problems that can come from bypassing the stoma*****ludes: dumping syndrome, marginal ulcers and solid intolerance. If these complications are severr, revision to the DS is generally done. This is why i'm having revision.
Also, the stoma tends to stretch which often leads to regain. A primarily restictive surgery that is not permanently restrictive is a bad combo IMHO. This is one of the many reasons why 20% of RNY patients undergo revision within the first 5 years post op (this statistic can be found anywhere on the web. google it). Less than 5% 0f DSers require reoperation. This is why you will hear many DS patients say, "think twice, cut once." Or you can be like me and think 3 times and cut twice. LOL
The dumping syndrome myth: I have seen people post many tims that they are having RNY for dumping syndrome hoping that it will act as behavioral modification. The fact is that dumping syndrome has absolutely no benefit to the individual. Dumping is a complication. If it is severe, it can only be corrected with reoperation.
In contrast to benefiting your waistline, dumping syndrome can actually lead to regain due to the hypoglycemic episode that generally follows dumping syndrome. Imagine this
eat --> dump --> hypoglycemia --> binge (to stabalize blood sugar) --> redump -- > hypoglycemia --> binge --> gain weight --> needs revision
Gold Standard Vs Platinum Standard: The RNY is considered the gold standard because it is the standard procedure for weight loss surgery. It is standard because it has acceptable weight loss results and is much easier to perfom than the DS. The DS is considered the platinum standard because it is the most effective.
Note: The DS is primarily a malabsorbtion surgery. This is why it is definitely not for everyone. Those who are non compliant with supplements would have life threatening complications. For this reason many surgeons are now considering the VSG, which is the first stage of the DS, to be the gold standard. It has shown to have just as much success as RNY, yet it is much safer and doesn't have the complications of dumping, ulcers, and solid intolerance. Also the sleeve has the great benefit of removing most of the hunger hormone ghrelin.Many gastric bypass patients, mself included, never feel satisfied after eating. This is because our blind stomach still produces ghrelin. It seems that higher bmi patients are the ones that have this problem the most (my bmi was 66, just fyi).
I hope his helps. If you have more questions, please ask.
Here is a link to a very important research paper. It is titled,"The billiopancreatic diversion with duodenal switch: results beyond 10 years. You can get free access to the full text if you have access to a university library. If you give me your email, I would gladly email the full text in pdf format.
Also go to www.dsfacts.com to read more about this surgery.
Here is a link from my surgeons site showing the differences between a distal bypass and DS. This is for anyone needing revision.
http://www.dssurgery.com/newsletters/duodenal-switch-and-distal-gastric-bypass.php
Note: 18 months ago I had a variation of the RNY known as the fobi pouch. It is a gastric bypass with a silastic ring placed around the stoma. It acts as a choke chain to prevent surgical failure. I am being revised to the DS on the 11th to correct reactive hypoglycemia, dumping syndrome and other dietery complications
The duodenal switch is a two stage procedure. The first stage is the restrictive component known as the vertical sleeve gastrectomy (VSG). This is similar to a gastric reduction and has the advantage of keeping a normal functioning stomach (unlike with RNY, which I will explain later). Also, having most of the stomach removed eliminates most of the hunger hormone ghrelin.
The second stage is the malabstorbtion component, which is an intestinal bypass to a much greater degree than with RNY. The malabsorbtion with the DS is permanent and has a metabolic affect such that you take on the metbolism of a lean individual. The metabolic aspect of the DS is why it is the most effective surgery for weight loss, long term maintanance and curing diabetes.
After the DS your diet is normal. You do not require calorie counting, atkins or any other extreme dieting. With the DS you malabsorb 80% of fat calories, as well as 40% protein and complex carbs. You absorb all simple carbs. Because of this it is important to eat a higher fat/protein diet and being mindful with carb intake.
Overall with the DS you have less restriction but more malabsorbtion than RNY. This allows for larger portions and a greater variety of foods in your diet. With the DS are free to eat and drink at the same time. You can also drink carbonated beverages. These are " no no's"with the RNY.
RNY: A RNY is performed by bypassing the stomach. This entails cutting a portion of your stomach along the lesser curvature of the stomach and creating a man made pouch. You will no longer have a normal functioning stomach. A hole is made at the bottom of the pouch called the stoma. The rest of your stomach is sewn closed and is called the blind stomach. The upper portion of your small bowel is then severed to form the roux limb. The rest of your small bowel is connected to your pouch.
It is important to note that in contrast to the DS, the primary component of the RNY is restriction. The roux limb is a very mild forof malabsorbtion (in comparison to the DS) and only malabsorbs calories during the first 12-24 months.
The problems that can come from bypassing the stoma*****ludes: dumping syndrome, marginal ulcers and solid intolerance. If these complications are severr, revision to the DS is generally done. This is why i'm having revision.
Also, the stoma tends to stretch which often leads to regain. A primarily restictive surgery that is not permanently restrictive is a bad combo IMHO. This is one of the many reasons why 20% of RNY patients undergo revision within the first 5 years post op (this statistic can be found anywhere on the web. google it). Less than 5% 0f DSers require reoperation. This is why you will hear many DS patients say, "think twice, cut once." Or you can be like me and think 3 times and cut twice. LOL
The dumping syndrome myth: I have seen people post many tims that they are having RNY for dumping syndrome hoping that it will act as behavioral modification. The fact is that dumping syndrome has absolutely no benefit to the individual. Dumping is a complication. If it is severe, it can only be corrected with reoperation.
In contrast to benefiting your waistline, dumping syndrome can actually lead to regain due to the hypoglycemic episode that generally follows dumping syndrome. Imagine this
eat --> dump --> hypoglycemia --> binge (to stabalize blood sugar) --> redump -- > hypoglycemia --> binge --> gain weight --> needs revision
Gold Standard Vs Platinum Standard: The RNY is considered the gold standard because it is the standard procedure for weight loss surgery. It is standard because it has acceptable weight loss results and is much easier to perfom than the DS. The DS is considered the platinum standard because it is the most effective.
Note: The DS is primarily a malabsorbtion surgery. This is why it is definitely not for everyone. Those who are non compliant with supplements would have life threatening complications. For this reason many surgeons are now considering the VSG, which is the first stage of the DS, to be the gold standard. It has shown to have just as much success as RNY, yet it is much safer and doesn't have the complications of dumping, ulcers, and solid intolerance. Also the sleeve has the great benefit of removing most of the hunger hormone ghrelin.Many gastric bypass patients, mself included, never feel satisfied after eating. This is because our blind stomach still produces ghrelin. It seems that higher bmi patients are the ones that have this problem the most (my bmi was 66, just fyi).
I hope his helps. If you have more questions, please ask.
Here is a link to a very important research paper. It is titled,"The billiopancreatic diversion with duodenal switch: results beyond 10 years. You can get free access to the full text if you have access to a university library. If you give me your email, I would gladly email the full text in pdf format.
Also go to www.dsfacts.com to read more about this surgery.
Here is a link from my surgeons site showing the differences between a distal bypass and DS. This is for anyone needing revision.
http://www.dssurgery.com/newsletters/duodenal-switch-and-distal-gastric-bypass.php
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