lightweights with DS

To go from RnY to DS, you have to first "take down" the RnY. (i.e., you reverse it.) You can do it but it's a hairy operation and most surgeons won't do it unless you have serious problems going on. They certain won't do it just so you can lose another 20-30 pounds!

In fact, that's an issue with all revisions. If the WLS you pick isn't quite enough to get you to a normal BMI, do you really want to have another major surgery? At least with the VSG, it's only doing the second part of the DS, but with the RnY, you have to do the take-down first and there is lots of scar tissue to deal with. Same with a band. And based on the how the scar tissue is, it might limit what kind of revision can be performed.

You shouldn't pick your surgery type entirely by how much weight you want to lose. In fact, the only time that is a factor, IMO,  is if you have more than 150 pound to lose. THen you need one that is going to give you the oomph to get that off. But otherwise, it's about food issues and post-op lifestyle and co-morbidities.

It's not like lightweights with a DS automatically lose more than lightweights with a sleeve. WLS doesn't work like that.

I am curious about this. How would you recommend the choice to be made then? I am currently slotted for a VSG but originally thought the DS might be tge right option for me but my surgeon said it would make me too thin and restrict me in my professional activity too much. (i work in all kinds of far and strange corners of the world where there are often no medical facilities at all let alone a bariatric centre). I have diabetes and high blood pressure. Maybe sleep apnea although I haven't been tested yet. I think a VSG is a great tool but am wondering if I will have enough willpower to work that sleeve and keep the weight off. I am certainly unlikely to be as active as you are in sports. My surgery is in April, end of April, so time to decide there is. I have already been approved and my insurance doesn't care which sugery I get. And my surgeon does both the VSG and the DS as well as all revisions, even complex ones.
Would be grateful for your views and experience.

I think you may want to discuss some alterations to a basic DS with Dr G. If you can't be physically active and you have diabetes, what about asking to lengthen the standard common channel and perhaps give you sleeve measured with a 60f bougie. The switch part will most likely put your diabetes into remission permanently and help with long term weight maintenance. With the slightly larger sleeve you'll be able to eat normally faster and with the longer common channel you most likely won't have near the intestinal issues some DSrs have with short common channels if you have to eat something with surprise ingredients. Just some ideas to discuss with Dr G.

--gina

I touched on it with him but he thinks I will do well with just the sleeve... He also thinks the diabetes will be dealt with effectively by the sleeve. I was only diagnosed a couple of months ago so he thinks as it is fairly new the VSG will be enough. I can be active, the only impediment is me and my couch potato habits which need changing as much as my food intake. I am one of those that does not do fast food and I eat all great stuff, just way too much. I will discuss the DS with alterations with him again.

Well your starting weight IS a consideration. I just don't  think it's the ONLY consideration.

This is how I look at it:

The heavier you are, the more important it is to get a weight loss surgery with great stats. Average excess weight loss for the band is very low and, if you have 200+ pounds to lose, but you only lose 100, you will still be obese or even morbidly obese! For the SMO, I believe the DS is the way to go for most people. The other surgeries over the long haul will not cut it for most people with a BMI of 60 or more.

Another consideration is how well you lose weight when you restrict calories. If you lose weight just fine when you are on the diet, then you don't really need malabsorption. If you find you can't lose weight unless you restrict yourself to 800-1000 calories a day and even then it's pretty slow, then you do need it.

Co-morbidty resolution is an issue but the difference between VSG and DS in comorbidity resolution is about 10%. Is that enough to tip the scales for you? For someone who has just been diagnosed with diabetes, any WLS will give excellent diabetes resolution so that probably isn't a consideration for you.

Another  issue is supplementation. The more you malabsorb, the more this is an issue. DSers have to take a lot more vitamins and other supplements than VSGers and the risks of developing something because of a vitamin or mineral deficiency are higher. I was very afraid that having WLS would "medicalize" me. So this was a big consideration for me. For others, it's no big deal.

Lifestyle is also a big consideration. With the DS, you will malabsorb 80% of the fat you eat. If you don't like greasy foods, that can be an issue. Plus, malabsorbed food has to go somewhere.  I already have issues with clogging up toilets and other stuff I won't get into (TMI) because of not having a gallbladder (which also causes a small amount of fat malabsorption). I didn't want to increase those issues enless I really needed to. But, for other people, that's not a big deal.

Another issue is that eating simple carbs gives most DSers noxious gas. I didn't want to have any limitations on what I could eat and when. I didn't want the dumping of RnY for that reason. The simple carb issue of the DS wasn't a completely deal-breaker for me like dumping was, but it was a consideration. If I could avoid it, I wanted to.

What about losing too much?

There are always people who think they will lose too much weight with any surgery. But the thing is, you can always eat more. Trust me on this... it's easy to outeat these surgeries.  Most people struggle with not getting to goal. Most people experience bounceback and many have regain issues. The people who can't eat enough and have problems with losing too much are very rare. They exist (ask LadyTazz) but they are a tiny, tiny minority.

However, if you have a DS and are very active, like I am, and very short, like I am, you may have to eat so much that it's a burden. There are people with RnY who eat 3000-5000 calories a day while training for really long distance events (yes, they are guys). They are far enough out that they aren't malabsorbing. If they had a DS, they'd have to eat even more! OTOH, there are plenty of people with a DS who run marathons and such. So obviously they aren't having issues with not being able to eat enough. 

If you aren't very active though and you couldn't be active if you wanted to (say you have exercise restrictions not limited to weight), then that's a consideration for a stronger surgery. Now a lot of us become more active when we lose the weight even if we didn't think we would pre-op. But the people who can't get active, even if they want to, do have only calorie restriction on their side in the battle. So a little malabsorption can be their ace in the hole, so to speak.

Finally, there a number of DSers on here who paint a picture of the DS as very rosy and act like, for example, like regain is impossible. Regain is possible with ALL the surgeries and there are definitely DSers who haven't gotten to goal or who struggle with regain. These same people paint a picture of the VSG (and other surgeries) as a constant struggle and being on a diet for the rest of your life. But, as I point out when I see them do this: THEY DON'T HAVE A VSG. So how the hell do they know what life is like with one post-op?

There are plenty of VSGers who lost all their excess weight (or at least 80% which is better than average stats) and don't live their life like they are on a diet every day and they don't all do Ironmans. Some hardly exercise at all. It really comes down to appetite. Both VSG and DS have excellent appetite control and so it becomes easy to eat whatever maintenance calories you need and you don't feel like you are on a diet at all with both surgeries for most people.

The bottom line is: there is no such thing as a free lunch. DS gives you more on average -- higher rates of EW loss, higher average co-morbidity resolution. But you don't just get that stuff by magic. You get it because of malabsorption and malabsorption increases the risks of complications and complicates the post-op lifestyle.

I think you have to decide (a) if you need more than a VSG and (b) if the tradeoffs are worth it. You also are lucky in that your surgeon is excellent and he's not one who does the DS but only if you beg. So you can trust his judgement when he tells you his own take on it. However, it's ultimately up to you as it's your body and your life. 

My suggestion is to lurk on both the VSG and DS boards and see what life is like for both groups. See what issues come up again and again. Don't listen to what people say when you ask them if they are happy with their surgeries. We all will tell you we love our surgeries! But, as you easedrop on our daily lives, a picture will emerge. And you will have a viceral reaction to it. This reaction will tell you what is the right WLS for you.

Wow... Thanks so much for taking the time to reply in such detail. I am going to read very carefully!!! Thank you again and Merry Christmas!!!!!

Can't quote apparently...

It sounds like a philosophy rather than a medical strategy. Can you see another surgeon in your Provence?

I am not in Canada. Its a long story.. But I would be getting surgery in Europe. As Dr G is in Europe a lot he agreed to do it on one of his trips. I am approved and my insurance doesn't care at all where I get the surgery nor with which surgeon. I could go anywhere, pre pay and get it all reimbursed or the insurance would pay directly or any number of arrangements are possible. I am kind of destabilized by this as I thought him to be one of the best, medically rather than philosophically! I can do the philosophising myself, but need a good surgeon. One who will do what is right for me.