Question:
What Is DS, and The sleeve

I have never heard of these, Well my doc has not told me about them. Does Ins pay for them? Are they easier than gastric bypass? And has anyone in the Colorado Springs are have Dr fedorack? If so is he good and what kind of problems if any did you have. Thanks to every one who is answering my questions, you are all angels. Heidi    — hlt1960 (posted on August 21, 2008)

August 21, 2008
OK! MY kind of QUESTION! Let me FIRST state that I am NOT an "EXPERT," I am merely a PATIENT that has done some RESEARCH. There are MANY people on the boards that CLAIM to be "EXPERTS" that are NO SUCH THING. They are simply EXACTLY what I am, PATIENTS that have done some RESEARCH! The DUODENAL SWITCH is probably the most EFFECTIVE weight loss surgery AVAILABLE today! It is also one of the most controversial because it has one of the harshest effects on the body when it comes to issues of malabsorption, intestinal gas, and "Stinky Poo." Many of the people who HAVE this surgery do not have these issues, but many of the people who DO have this surgery DO have these issues. SOME of the most VOCAL proponents FOR this procedure are MILITANT in their support of it and can be quite unpleasant and confrontational on the boards. Let me WARN YOU IN ADVANCE about asking about this procedure on the boards at OH, that once you step into that world, it will be like you stepped into Alice in Wonderland. Things get strange beyond the Looking Glass! THIS SURGERY is BEST USED on a patient that is SEVERELY MORBIDLY OBESE. SOMEONE whose BMI is GREATER than 50 or MORE is a GOOD CANDIDATE for the DUODENAL SWITCH if they have severe co morbidities that require FAST weight loss. A person who is at risk of a heart attack NOW, for example, due to his or her OBESITY is a GOOD CANDIDATE for the DUODENAL SWITCH. It is the MOST EFFECTIVE weight loss procedure currently available, but there are severe side effects, and it is a bit COMPLICATED, so there is a GREATER RISK of complications with this procedure. In this procedure, the surgeons remove about 80 - 85 percent of the stomach, and then they reroute the intestine so that part of it is BYPASSED like the Gastric Bypass. Instead of being attached to the SIDE of a POUCH, like the Gastric Bypass, the SWITCHED part of the intestine is RE-ATTACHED to the bottom of the reduced stomach and the Y part of the intestine is put FARTHER down the intestine than it would OTHERWISE be on the Gastric Bypass. The Malabsorption in the Duodenal Switch is MORE SEVERE than it is usually in the Gastric Bypass, from what I have seen in my research. This is PART of what makes it MORE EFFECTIVE than the Gastric Bypass in helping people lose weight faster. It is also what contributes to the greater problems with the more severe side effects. One of which is the RELIANCE on DIETARY SUPPLEMENTS for the rest of your LIFE. You will also need BLOOD WORK regularly to MONITOR your nutritional needs and to ensure that the supplements are WORKING. If you ever MOVE or CHANGE INSURANCE, you MAY have to PAY THESE EXPENSES OUT OF POCKET! These are things you have to WORRY about with the DUODENAL SWITCH. The VERTICAL SLEEVE GASTRECTOMY was CREATED in an attempt to make a SAFER version of the DUODENAL SWITCH! Essentially what the surgeons DO in the Vertical Sleeve Gastrectomy is remove about 85 Percent of the stomach. THAT IS IT! The doctors leave the patient with a TUBE in place of a stomach that holds anywhere from 2 to 6 ounces of food initially. It can and often does stretch a BIT from THERE, but hardly EVER back to it's ORIGINAL size. While the Duodenal Switch is about 95 percent effective in helping the patients lose weight, and the Gastric Bypass is about 80 percent effective at doing so, the Vertical Sleeve Gastrectomy is about 78 percent effective in helping patients lose weight, if I recall my research correctly. It is CLOSE to those numbers, I am sure. The DIFFERENCE between the Gastric Bypass and the Vertical Sleeve Gastrectomy is STATISTICALLY insignificant. They are VIRTUALLY the same in effect concerning weight loss, but the Vertical Sleeve Gastrectomy has been PROVEN to be MUCH SAFER than both the GASTRIC BYPASS and the DUODENAL SWITCH when it comes to COMPLICATIONS and SURVIVAL RATES. While there is no long term data for the Vertical Sleeve Gastrectomy for WEIGHT LOSS SURGERY, there is DECADES of data on the procedure for OTHER surgical reasons. This procedure has been used for the removal of STOMACH ULCERS and STOMACH CANCER for DECADES and the data from THOSE procedures shows it to be QUITE SAFE. One of the reasons that BOTH the Duodenal Switch AND the Vertical Sleeve Gastrectomy are NOT more popular than they CURRENTLY are, is that there is DIFFICULTY in getting SOME insurance companies to PAY for these procedures. One of the REASONS for this is that the AGENCIES that ACCREDIT these procedures will NOT accept data that comes from OUTSIDE of the US as CREDIBLE. Both procedures are fairly NEW to the US, although they have been performed OUTSIDE the US for YEARS. There are DECADES of data to be had on these procedures, but not HERE, in the US. The US AGENCIES require TEN YEARS of data on these procedures before they will CONSIDER them for safety and effectiveness. Both procedures have about 7 years in the US now, I believe. Since these procedures are considered "EXPERIMENTAL" in the US, the Insurance Companies will not COVER them. The WORST part is, the VERTICAL SLEEVE GASTRECTOMY is NOT an "EXPERIMENTAL" surgery and has been PROVEN to be SAFE and EFFECTIVE ELSEWHERE. This would SAVE the INSURANCE COMPANIES MONEY if they were to ADOPT this procedure as their "Standard" instead of the Gastric Bypass! There would no longer BE the ongoing expense of the supplements and constant doctor's visits and blood work! SOME Insurance Companies have already figured this out. I APPLAUD them! Let's hope that there are more SURGEONS that follow SUIT! The GOOD thing about the Vertical Sleeve Gastrectomy is, that if you NEED to have a conversion to the Duodenal Switch at a later date because you find that the Sleeve just isn't QUITE doing the job (it DOES happen). It can EASILY be converted to the Duodenal Switch! The Gastric Bypass is NOT easily converted! Having said all of THIS, I have HAD the vertical Sleeve DONE about 5 and a half MONTHS ago. I have lost 100 POUNDS in 5 and a half MONTHS with the Vertical Sleeve! I am PROOF that the SLEEVE WORKS! If you want to learn MORE about the most COMMON types of weight loss surgery, check out my profile page at: http://www.obesityhelp.com/member/hubarlow/ . Look for my post titled "Surgical Comparisons." If you do not see it on the main page, look for it in the March 2008 Archives. I have information about all of the most common Types of Weight Loss Surgery. Use these as a FOUNDATION for your own RESEARCH. DO your own research. DON'T rely on the folks on the BOARDS to answer your questions because you may get some MISLEADING answers. There are SOME folks who consider themselves to be "EXPERTS" who are giving some VERY BAD advice on the boards. Remember, YOU are ultimately the FINAL person who is responsible for your health care. DO your research and then CONSULT with a COMPETENT DOCTOR. If you do not TRUST what the doctor told you, GET A SECOND OPINION! If you feel that the INSURANCE COMPANY is messing you around, FIGHT THEM! Often, you can get the procedure you want if you can get the SURGEON to say that it is MEDICALLY NECESSARY. Sometimes the fight is worth it. I hope that this answers your questions and that this helps. Hugh
   — hubarlow