Question:
i'm kinda confused .....

I keep hearing about this duodenal switch and now i'm thinking that might have been a better choice for me i had rny about a month and half ago and so far have lost over 55 ibs. ....so basically what i wanted to know is what is the difference between duodenal swith and rny becuase i also read somethere that the rny is a mixture of decreasing the stomach and duodenal ........can anyone help me understand this more ? please Thanks i appreciate the time u take to answer my question.    — sugadaddiewanted (posted on August 11, 2008)

August 11, 2008
I had the DS and have had great succcess and recommend it highly. However that is not to say that all RNY should be revised to DS. You just had your surgery and it sounds like its doing its thing...55 lbs in 1.5 months is astounding! THis is what happens in the DS- A The stomach is trimmed to a 3-4 ounce volume, preserving its natural inlet and outlet ( the pylorus). Trimming the stomach results in a temporary restrictive effect on eating for several months, which then reverts to normal, and decreases the incidence of ulcer formation as well. B The small intestine that the stomach normally empties into (the duodenum) is "switched" to the downstream portion of the small intestine (the digestive limb-D). The outflow from the duodenum, carrying the digestive juices and enzymes (but no food) becomes the bilio-pancreatic limb (C) utilizing approximately 60% of the small intestines length. D The digestive limb takes up approximately 40% of the small bowel length, and most of this length is upstream from where the biliopancreatic limb deposits its juices to allow for the absorption of fats, starches, and complex carbohydrates. E The common limb, being the portion of intestine where both food and biliopancreatic outflow meet, is made up of the most downstream 100 cm of small intestine and is the only portion where absorption of dietary starches, fats, and complex carbohydrates occurs. The capacity for absorption reaches a maximum within several months after surgery and cannot be over eaten, resulting in long term sustained weight loss.. F The gallbladder and appendix are removed.
   — SameButDifferent

August 11, 2008
First, you should not be second gueessing you sergeon 's guidence to you at this point. You loss great, and that is what is important right now, so stay focused on what you have and not what you think you want. I do know that far fewer sergeons offer the Duodenal Switch and fewer insurance companies are willing to pay for it. That does not make it better or worse, but the fact is that part of your stomach is removed and desposed of, which is not the case in RNY. Here are the details. The Duodenal Switch (also known as Bilio-Pancreatic Diversion with Duodenal Switch or the DS) procedure is a weight loss surgery that alters the gastrointestinal tract with two approaches: a restrictive aspect and a malabsorptive aspect. The restrictive portion of the surgery reduces the stomach along the greater curvature so that the volume is approximately one third to one fifth of the original capacity. The malabsorptive portion of the surgery reroutes a lengthy portion of the small intestine, creating two separate pathways and one common pathway. The shorter of the two pathways, the digestive loop, takes food from the stomach to the large intestine. The much longer pathway, the bilio-pancreatic loop, carries bile from the liver to the common path. The common path, or common channel, is a stretch of small intestine usually 75-150 centimeters long in which the contents of the digestive path mix with the bile from the bilio-pancreatic loop before emptying into the large intestine. The objective of this arrangement is to reduce the amount of time the body has to capture calories from food in the small intestine and to selectively limit the absorption of fat. Advantages The primary advantage of the Duodenal Switch (DS) surgery is that its combination of moderate intake restriction with substantial calorie malabsorption results in a very high percentage of excess weight loss for obese individuals, with a very low risk of significant weight regain. Because the pyloric valve between the stomach and small intestine is preserved, people who have undergone the DS do not experience the dumping syndrome common with people who've undergone the Roux-en-Y gastric bypass surgery (RNY). The malabsorptive component of the DS/BPD is fully reversible as no small instestine is actually removed, only re-routed. The chance of developing anastamotic stricture (common with the RNY) is extremely low. Much of the production of the hunger hormone, Ghrelin, is removed with the greater curvature of the stomach. Diet following the DS is more normal and better tolerated than with other surgeries. Those who undergo the DS often find that comorbidities such as high blood pressure, diabetes mellitus type 2, and arthritis are significantly relieved in a short time after the surgery. Type 2 Diabetes is "cured" - or put into remission - in the large majority of patients having the DS. These benefits occur long before great losses in weight are seen. Some surgeons do the "switch" or intestinal surgery on non-obese patients for the benefits of curing the diabetes. Some surgeons are so confident in the benefits of the DS that they will accept super-morbidly obese patients, who are often turned down for other weight loss surgeries; however, anyone who qualifies with a body mass index (BMI) of 40 or a BMI of 35 with comorbidities qualifies for the more successful DS surgery. Disadvantages The malabsorptive element of the DS requires that those who undergo the procedure take vitamin and mineral supplements above and beyond that of the normal population, as do patients having the RNY surgery. Commonly prescribed supplements include a daily prenatal vitamin and extra calcium citrate. Because gallstones are a common complication of rapid weight loss following any type of weight loss surgery, some surgeons may remove the gall bladder as a preventative measure during the DS or the RNY. Others prefer to prescribe medication to reduce the risk of post-operative gallstones. Far fewer surgeons perform the DS compared to other weight loss surgeries because it is a more difficult one to learn compared to RNY and Lap Band procedures. RNY and DS patients require lifelong and extensive blood tests to check for deficiencies in life critical vitamins and minerals. Without proper follow up tests and lifetime supplementation RNY and DS patients can quickly become ill and die. This follow-up care is non-optional and must continue for as long as the patient lives. The restrictive portion of the DS/BPS is not technically reversible, since part of the stomach is removed and discarded. However, the stomach in all DS patients does expand over time and while it will never reach the same size as the natural stomach, some reversal by stretching always occurs. Risks All surgical procedures involve a degree of risk however this must be balanced against the significant risks associated with severe obesity. Some of the risks or complications that can attach to a bypass are: Almost one-third of stomach bypass patients suffer from nutritional deficits due to non-observance of medical guidelines on the type and amount of food supplements to be taken after the operation. Soon after the bypass operation patients may suffer from the following: staple failure causing leaks, infection, deep thrombo-phlebitis, ulcers and stomal stenosis. Latterly other problems can arise that may necessitate corrective surgical procedures. The mortality and morbidity rates of these secondary operations are higher than those of the initial surgery. Qualifications The National Institutes of Health state that if you meet the following guidelines, weight loss surgery may be an appropriate measure for permanent weight loss: BMI of 40 or over BMI of 35 or over with obesity-related illnesses such as: Diabetes mellitus type 2 Coronary heart disease Sleep apnea Osteoarthritis An understanding of the operation and lifestyle changes necessary following the surgery.
   — William (Bill) wmil

August 11, 2008
I didn't have either of the surgeries you are talking about, so I can't answer specifically to them. But... I don't think you need to be second guessing yourself at this point. I assume you did your research and made the best choice for you. You are doing great with your RNY, so why worry about what might have been? It's done, so start using the tool you have to begin your new life. Good luck!
   — corky1057

August 12, 2008
I'm also going to be so blunt to say, you need to not focus on what you coulda, shoulda, mighta done...You already did the RNY and you are doing FANTASTIC! The DSers, live in a a world of bliss eating their cookies and carbs...That's fine for them. I might have enjoyed that myself if I didn't have the surgery to eat healthy and be healthy...True DSers can choose to eat healthy...but their malabsorptionissues are FAR worse than RNY and so they HAVE to eat a tone of calories to make up for the the calories they will not absorb. They cannot miss meals or vitamins. PERIOD! You can't return your RNY ...you went thru it KNOWING you would have to eat healthy and that's what you must do now. There is no looking back right now. Focus on what you have. Don't let those DSers made you feel bad for what is already done. Stop talking to them and learning about their surgery and learn to live with the surgery you had. It's a GREAT surgery and it can be done...I eat cookies too...Just not everyday and only one or half...Or one and a half! So we give up old habits...Is it such a horrible idea to eat healthier leaner meals? Is it so bad to have restriction to ever eat like there is no food tomorrow? So you have to find healthy alternatives to simple carbs and sugars. So DSers can eat carbs and fats...Is that what you wanted? Really? So you have to work a little more at your diet...If you hadn't already had the RNY, I'd tell you to go learn all there is about DS and wish you much luck and health with it...But you have got to get it out of your head and focus on what a great job you are doing...Learn all there is to know about RNY and YOUR body. Ask anyone with RNY (over a few years) if they think they made a mistake. You'll find one or two out of 10's of thousands. And my last bit of advice is to just give yourself more time...You are only one month out and lost almost two pounds a day...In a year...you are going to be so much thinner....and soooo happy you had RNY. I know I am and I so much enjoy eating lean...I have malabsorption isssues with RNY...I would be soooooo sick if I had DS because my body has a hard time absorbing vits with RNY! Still I'd do RNY over and over again. Once in a while I'll walk passed the bakery and wish I had DS for about 3 seconds...Then I go get my fresh fruits and veggies and I'm happy...
   — .Anita R.