Too low of a BMI to have DS?

Hello,

I am wanting to have a revision from the LB to a DS or RNY.

When I had the surgery 10 years ago my BMI was 40, and now it is about 38.

Is it dangerous to have the malabsorption procedures with a low BMI? I

Thanks for your help.

Kim

I'm not sure how the revisions work, if you don't have any co-morbidities, you may not qualify for any surgery. With a BMI of 35, and co-morbidities or 40 and no co-morbidities my surgeon would counsel the patient and they could pick any surgery they wanted.

I have HBP and cholesterol. I take medication for both of these conditions, as well as horrendous reflux compliments of the lap-band.

I keep hearing glowing things about the Ds and I'm a bit skeptical.

 I don't believe so .... then again i had an RNY at 35 BMI .   This was my reasoning - DS is malabsorptive of FAT - I hardly eat any fat - I might get too skinny - or too unhealthy .... or STINK ....

in retrospect i wish very much i had insisted on the sleeve or even better a DS with a longer common channel . 

I have very little restriction now ( 11 months post op ) , find it impossible to get to my goal weight ..... and have to contort myslef every single day to MAINTAIN  15 - 20 lbs ABOVE goal .    

If I was doing a revision it would certainly be to a DS .

Frankly , if extensive plastic surgery with liposuction doesnt solve this problem ( and keep it solved ) i intend to have a DS done in Mexico - for an extra thirty lbs lol !!  

Knowing what i know now .... as opposed to what I THOUGHT ( was told )  pre wls ... the surgeries are designed to take only 65 % of Ur excess weight off - never mind KEEP it off .

So if my goal was to be SLIM ( which it was and IS ) as well as HEALTHY - I should not have been afraid of choosing a more extreme version of the WLS surgeries  offered me .

 At the very least I should have insisted on a tiny pouch and a longer bypass , knowing full well that i love to eat food , that I love to graze ...etc.

Its all a matter of understanding Ur eating habits / dieting willingness too and working with that .   I believe the modified dS ora distal RNY would have been a better choice for me and still safe because i love to EAT  LOL.   

It is no more dangerous to have a DS than to have a RNY for a LW. In both you restrict the size of the stomach, just in different ways. And in both, you reroute the intestines, just in slightly different ways. A GOOD DS doc will give a LW a slightly longer common channel to avoid the possibility of you loosing too much but you CAN loose too much with a RNY!

Now, the similarities:
You have to have lab work religiously.
You have to take vitamins every day.
You have to eat healthy to avoid issues with your system, avoiding white carbs/too much refined sugars.
You must get in your protein/water/and exercise.
You can loose too much weight on both

The differences:
You can't take an NSAID with a RNY, you can with a DS
You might dump with a RNY, but you might have terrible gas/odor with a DS (Gas-X helps)
You will typically lose (and this varies person to person) about 77% in the first year but in the 10-15 year it goes to 50-60% EWL (Est Weight Loss) for the RNY and for the DS it's 74% at one year, 78% at two years, 81% at three years, 84% at four years, and 91% at five years was achieved. Now, remember those are averages.

You will notice there was a passing in the DS family this morning. It happens but good surgeons do all they can to avoid them. That is one reason to go to a good surgeon, esp if you are a revision.

You need to look at your co-morbiditors and your habits and decide which is for you. I chose a DS because I wanted to resolve my diabetes, my PCOS, and I didn't want the reactive hypoglycemia that seems to be a result of RYN. I already have reactive hypoglycemia. To see more about that, read my blog.

Whatever you decide, check out your surgeon here on the boards, ask questions.

Liz

Hi Kim,
I responded to you on the DS board but it might help someone who might be lurking here to read also:

I think you're probably a fine candidate for a DS. I think I'd want to know a lot more about your surgeon though. How many DSs has he successfully done? How many band to DS revisions has he successfully done? Those kinds of things. Otherwise, you might want to talk to Dr Sudan at Duke, Dr Smith in Atlanta, or Dr Elariny here in northern VA.

I wouldn't go for a longer common channel as a revision patient though. Seems revision patients have a little bit harder time losing and maintaining (just personal observation). If you are still comfortable after you speak with your surgeon, do ask about the size sleeve he usually gives patients. 3-5oz is pretty normal. Or, he may speak in terms of French bougie size. All I can tell you about that is from what my surgeon does. 3-5oz stomach is a 60f bougie. The way I understand it, that's a pretty decent sized sleeve. Smaller than that might not be so good. I have a feeling once you're rid of the band, issues with GERD may be much easier to handle. 

--gina

Hi Kim!  I initially had the same worries--and my BMI is 42 (up from a 39 from before I had my baby 2 months ago.) I wavered between if a VSG would be enough for me or if I needed the full DS since I can actually lose weight very well by restriction--I just can't keep it off to save my life.   I talked to my surgeon and he is giving me a "conservative" version of the DS.  By this I mean a 6 to 8 ounce sleeve and a 125 cm Common Channel.  I used to be very active and loved to exercise and I really want to get back to that so I think this will work out really well for me and he thought it would work well too.  I do worry from time to time though if it will be enough of a surgery in the event I cannot be as active as I want to like if I were to get an injury or something like that.  I guess only time will tell.  

I do have moments where I worry that by getting a conservative DS I could battle some regain in the future regardless but that is a risk I am willing to take because, like you, I worry that my surgeon's traditional DS (about a 3-4 ounce sleeve and 100 common channel) would be too much of a surgery FOR ME.   That being said I see lots of of lightweight DS'rs who seem to do just fine with the exact same surgery measurements as someone who has more to lose. 

And as Gina mentioned I think since you are a revision that could play a part as well.  Sorry this is not a definitive answer but good luck with whatever you decide! 

Shannon

Wow! Thanks for all the awesome information.

I am waiting for a consult with Dr. Voellinger in Charlotte right now. He has about 60 revsions under his belt, but he's a pretty young doctor and this does concern me.

I have been hearing a lot of good things about Dr. Sudan in Durham. I am going to contact his office today when they open up.

My gut keeps leaning towards the DS for some reason.

Kim

Good luck with your consult and finding a surgeon. Gina's surgeon is just a wee bit further up the road in VA.

And even further up in NY is mine. :)

I suspect your heart knows what is best for you. :)

Liz

I don't know of any research that shows a danger of having either the RnY or the DS at a lower BMI.

Through most insurances, all surgeries have the same qualifications for the initial WLS:  a BMI of 40, or a BMI of 35 with co-morbidities.  (I'm not sure what the requirements of a revision are, except to prove that the original WLS had some type of malfunction.)  If you're paying out of pocket, reputable surgeons will stick within the basically-accepted guidelines for qualification for a revision:  you just get to avoid insurance hoops, like maybe another 6 month diet.

I had the DS when my BMI was 38ish.  I did have higher blood pressure and acid reflux; those were my co-morbids.  Since I qualified for surgery and wanted it, my surgeon let me pick my surgery.  I'm still alive and typing! 

Check out www.dsfacts.com for more information.  Good luck!