Question:
Can someone please explain what the difference is between

Roux and Y and Duodenal Switch? Which is better? From my research is seems Duo is better but now very common.    — marcia5000 (posted on January 28, 2009)

January 28, 2009
Most RNYers even years later and WITH some complications will tell you that they would not do it any other way...The same with the DS...although I have heard complaints from both...Each surgery has it's own risks and lifestyle changes. DSers need to eat plenty of fat and have a less restrictive diet...and take TONS of vitamins...I have to take a lot of vitamins myself with RNY because I have a lot of trouble keeping my vitamin levels normal for whatever reason. Most RNYers do not realise the importance of taking vitamins forever...It usually catches up to them! It did, me! I also have a restrictive diet of eating basically healthy food. (low sugar, high fiber and protein, restrictive calories based on my personal metabolism and plenty of exercise) Those are my basic long term rules. Eating healthy food in smaller portions is what I personally choose with RNY. I have strived my entire life to eat healthy and smaller and RNY helps me achieve this way of eating to maintain a small sized person. I could not do that before RNY for long term. I was not interested in eating a high fat, high calorie diet...It's just a personal preference. I am not saying that DSers don't eat healthy...Certainly they can eat healthy... Their diet is not how I want to eat or what I want to eat...I pop so many vitamins daily at 5 years RNY post op regardless of what surgery I had...But I eat small and health conscious. If I had had DS...I'd be in serious trouble, I think because I am closer to a vegetarian than anything...but I do eat meat...I must! I do admit though that I am a bit envious of some of the things DSers eat daily with no troubles! LOL Here is an animated video of all three main WLS and how they are done. This is from the very prestigous Mayo Clinic. http://www.mayoclinic.com/health/gastric-bypass/MM00703
   — .Anita R.

January 28, 2009
If those were the only two choices that I had, I would choose the Duodenal Switch. The RNY, or Gastric Bypass is known as the "Gold Standard" in Weight loss surgery because it is the most commonly performed surgery. I suspect that this is because it is the surgery that most INSURANCE companies are willing to PAY for. They fear paying for an "unproven" option, and thus, artificially inflate the RNY to the status of the "Gold Standard" in MY admittedly unprofessional opinion. I am NOT a medical professional, so take what I say with a grain of salt, if not with the whole salt cellar. ;-) The Gastric Bypass basically creates a "Pouch" from the top or side of the stomach. There are several different versions of this surgery, but the most common style is to have the top of the stomach cut from the rest of the stomach, and have a pouch created from that segment. Then a section of intestine is re-routed and attached to the side of the pouch that has been created from the top of the stomach. The BOTTOM of the stomach is left in the abdominal cavity, but is vestigial. It no longer provides a function for digestion. It remains attached to the intestine, and the rest of the intestine remains attached to the bile duct. That segment of intestine is sewn back on to the segment of intestine that had been rerouted to the side of the newly created stomach pouch and constitutes the "Y" part of the "RNY" or Roux eN Y. The Duodenal Switch is similar in some ways to the Roux eN Y, or Gstric Bypass, in that there is a bypass of the intestinal tract that occurs. Just like the Roux eN Y, the intestinal tract is cut, and a "Y" is formed, but UNLIKE the Roux eN Y, the stomach is NOT divided into an upper and lower section, bu instead it is created into a tube, or "SLEEVE." Where in the Roux eN Y, the bypassed intestine would be attached to the SIDE of the newly created pouch, the intestine instead is attached to the bottom of the newly created SLEEVE. The stomach is separated from the bile duct by the removal of the gall bladder. One end of the "Y" is attached to the bypassed intestine at a point on the intestine that is a bit farther along than is typical in the RNY, and the other leg of the "Y" is attached to the bile duct. Both surgeries are quite effective in helping the people who HAVE them achieve significant weight loss. There are both benefits and SIDE EFFECTS to BOTH, however. The Duodenal Switch is the MOST EFFECTIVE in helping patients achieve their wieght loss goals in the shortest possible time. It has the HIGHEST rate of effectiveness. It also has some of the severest compications. You will need to be on dietary suppliments for the rest of your life. You will require blood work to ensure that you are getting the proper nutrition for the rest of your life. There are certain medications that you will NOT be able to take because your body will NOT be able to metabolize them due to your shortened intestinal tract. This is true with BOTH surgeries. The differnce is only one of SEVERITY with the Duodenal Switch. It is simply a matter of DEGREE of the side effects that you will suffer in comparison to the benefit that you will get from the weight loss. There is also the possibility of Dumping Syndrome. This is not a guarantee, You are likely to get this with EITHER operation. It is not a pleasant experience. Most people who get this, get it from consuming sugar or fats. Some get the syndrome from consuming BOTH. You never know if you are going to be the one to get it. Some people go into surgery HOPING to get the syndrome, and some hoping to avoid it. Those HOPING to get it, want to use it as a crutch to help them lose weight. They feel that if the pain of eating their favorite foods was severe enough, they could overcome thier weakness, and finally give it up. You cannot COUNT on the outcome, one way or another. There is no way to TELL who is going to get the synddrome before they go into surgery. The good news is that these two surgeries are NOT your only options. I had the Vertical Sleeve Gastrectomy, which was essentially a MODIFIED version of the Duodenal Switch. In MY case, what the surgeon did was simply remove 85 percent of my stomach, cutting it down into a "SLEEVE." That is ALL that was done. There was NO bypass. There was no Gall Bladder removal. The Vertical Sleeve Gastrectomy (VSG) is almost as effective as the Roux eN Y. Statistically, it is almost EXACTLY as effective being within 2 or 3 percent difference. The Vertical Sleeve Gastrectomy is something like 78 or 79 percent effective, while the Gastric Bypass is about 80 or 81 percent effective in helping the people who have it lose weight, if I remember correctly (not that I am saying that I do). It is close to that, I am sure. The BENEFIT of having the VSG is that it is EFFECTIVE, and there are FEW SIDE EFFECTS. Since there is no BYPASS, there is no malabsorption issues that come with that. It is quite RARE to find someone who is dealing with "Dumping Syndrome" who had had the VSG. I had it BEFORE I had the VSG. The surgery REVERSED the symptoms! I have lost 110 pounds since March 2, and have had NO problems. I am QUITE happy with my surgery, and would highly recommend it to anyone. The biggest problem with the VSG is that MANY insurance companies will not PAY for it because they consider it to be an "EXPERIMENTAL" procedure. It has been around for DECADES as a treatement for STOMACH ULCERS and STOMACH CANCER, but NOT as a treatment for WEIGHT LOSS! Since it had not been APPROVED as a treatment for WEIGHT LOSS by the government, many insurance companies are reluctant to pay for the treatment. Doctors had noticed that one of the SIDE EFFECTS of the treatment of patients for STOMACH PROBLEMS that got the VSG WAS weight loss, so they began to USE the treatment for weight loss as well. If you want to find out more about the various surgical weight loss options, check out my profile page at: http://www.obesityhelp.com/member/hubarlow/. Looke for the post titled "Surgical Comparisons." If you don't see it on the main profile page, look for it in the March 2008 archives. I hope this helps. Hugh
   — hubarlow

January 28, 2009
If those were the only two choices that I had, I would choose the Duodenal Switch. The RNY, or Gastric Bypass is known as the "Gold Standard" in Weight loss surgery because it is the most commonly performed surgery. I suspect that this is because it is the surgery that most INSURANCE companies are willing to PAY for. They fear paying for an "unproven" option, and thus, artificially inflate the RNY to the status of the "Gold Standard" in MY admittedly unprofessional opinion. I am NOT a medical professional, so take what I say with a grain of salt, if not with the whole salt cellar. ;-) The Gastric Bypass basically creates a "Pouch" from the top or side of the stomach. There are several different versions of this surgery, but the most common style is to have the top of the stomach cut from the rest of the stomach, and have a pouch created from that segment. Then a section of intestine is re-routed and attached to the side of the pouch that has been created from the top of the stomach. The BOTTOM of the stomach is left in the abdominal cavity, but is vestigial. It no longer provides a function for digestion. It remains attached to the intestine, and the rest of the intestine remains attached to the bile duct. That segment of intestine is sewn back on to the segment of intestine that had been rerouted to the side of the newly created stomach pouch and constitutes the "Y" part of the "RNY" or Roux eN Y. The Duodenal Switch is similar in some ways to the Roux eN Y, or Gstric Bypass, in that there is a bypass of the intestinal tract that occurs. Just like the Roux eN Y, the intestinal tract is cut, and a "Y" is formed, but UNLIKE the Roux eN Y, the stomach is NOT divided into an upper and lower section, bu instead it is created into a tube, or "SLEEVE." Where in the Roux eN Y, the bypassed intestine would be attached to the SIDE of the newly created pouch, the intestine instead is attached to the bottom of the newly created SLEEVE. The stomach is separated from the bile duct by the removal of the gall bladder. One end of the "Y" is attached to the bypassed intestine at a point on the intestine that is a bit farther along than is typical in the RNY, and the other leg of the "Y" is attached to the bile duct. Both surgeries are quite effective in helping the people who HAVE them achieve significant weight loss. There are both benefits and SIDE EFFECTS to BOTH, however. The Duodenal Switch is the MOST EFFECTIVE in helping patients achieve their wieght loss goals in the shortest possible time. It has the HIGHEST rate of effectiveness. It also has some of the severest compications. You will need to be on dietary suppliments for the rest of your life. You will require blood work to ensure that you are getting the proper nutrition for the rest of your life. There are certain medications that you will NOT be able to take because your body will NOT be able to metabolize them due to your shortened intestinal tract. This is true with BOTH surgeries. The differnce is only one of SEVERITY with the Duodenal Switch. It is simply a matter of DEGREE of the side effects that you will suffer in comparison to the benefit that you will get from the weight loss. There is also the possibility of Dumping Syndrome. This is not a guarantee, You are likely to get this with EITHER operation. It is not a pleasant experience. Most people who get this, get it from consuming sugar or fats. Some get the syndrome from consuming BOTH. You never know if you are going to be the one to get it. Some people go into surgery HOPING to get the syndrome, and some hoping to avoid it. Those HOPING to get it, want to use it as a crutch to help them lose weight. They feel that if the pain of eating their favorite foods was severe enough, they could overcome thier weakness, and finally give it up. You cannot COUNT on the outcome, one way or another. There is no way to TELL who is going to get the synddrome before they go into surgery. The good news is that these two surgeries are NOT your only options. I had the Vertical Sleeve Gastrectomy, which was essentially a MODIFIED version of the Duodenal Switch. In MY case, what the surgeon did was simply remove 85 percent of my stomach, cutting it down into a "SLEEVE." That is ALL that was done. There was NO bypass. There was no Gall Bladder removal. The Vertical Sleeve Gastrectomy (VSG) is almost as effective as the Roux eN Y. Statistically, it is almost EXACTLY as effective being within 2 or 3 percent difference. The Vertical Sleeve Gastrectomy is something like 78 or 79 percent effective, while the Gastric Bypass is about 80 or 81 percent effective in helping the people who have it lose weight, if I remember correctly (not that I am saying that I do). It is close to that, I am sure. The BENEFIT of having the VSG is that it is EFFECTIVE, and there are FEW SIDE EFFECTS. Since there is no BYPASS, there is no malabsorption issues that come with that. It is quite RARE to find someone who is dealing with "Dumping Syndrome" who had had the VSG. I had it BEFORE I had the VSG. The surgery REVERSED the symptoms! I have lost 110 pounds since March 2, and have had NO problems. I am QUITE happy with my surgery, and would highly recommend it to anyone. The biggest problem with the VSG is that MANY insurance companies will not PAY for it because they consider it to be an "EXPERIMENTAL" procedure. It has been around for DECADES as a treatement for STOMACH ULCERS and STOMACH CANCER, but NOT as a treatment for WEIGHT LOSS! Since it had not been APPROVED as a treatment for WEIGHT LOSS by the government, many insurance companies are reluctant to pay for the treatment. Doctors had noticed that one of the SIDE EFFECTS of the treatment of patients for STOMACH PROBLEMS that got the VSG WAS weight loss, so they began to USE the treatment for weight loss as well. If you want to find out more about the various surgical weight loss options, check out my profile page at: http://www.obesityhelp.com/member/hubarlow/. Looke for the post titled "Surgical Comparisons." If you don't see it on the main profile page, look for it in the March 2008 archives. I hope this helps. Hugh
   — hubarlow

January 29, 2009
I'm still pre-op, but I decided on the DS rather than the RNY because the DS has the highest success rate of all the WLS options, and also because the "cure" rate for diabetes, high blood pressure, etc. is almost immediate (at least from what I've read - the RNY may have the same cure rate, not sure). I don't want to have to deal with dumping. And I believe I will have less of a problem getting in all of my protein with the DS than I would have limiting my intake of various foods with the RNY. Keep educating yourself on both the DS & the RNY and make the choice that is best for you. Also you might want to check out duodenalswitch.com. Best of luck to you:-)
   — sem51