2011 Article - Harms of Duodenal Switch Surgery May Outweigh Benefits

Hi All - Newbie to this site, considering DS, no prior surgeries. Came across this article. Probably old news but this is my Primary Care Physician's position on bariatric surgery. Has anyone come across new data? How did you handle "educating" your PCP? I respect him and would not want to have to find another PCP. Thanks in advance. 

2011 Article - Harms of Duodenal Switch Surgery May Outweigh Benefits

http://www.medscape.com/viewarticle/749385

Conclusion: Duodenal switch surgery was associated with greater weight loss, greater reductions of total and low-density lipoprotein cholesterol concentrations, and more adverse events. Improvements in other cardiovascular risk factors and quality of life were similar after both procedures.

http://annals.org/article.aspx?articleid=747095&resultClick=1

If you are ready for WLS, there's a good chance you will end up changing your PCP anyway to one who is more accepting and willing to be on your side.  There is one WLS that works long term and that's the DS.  And the operative risks are pretty much the same if you assume a skilled, experienced surgeon.  Maybe a couple percentage points difference that can easily be explained by the fact that the DS patients are usually heavier/more comorbs and more of a risk than most of the others.

I'm thinking you already know diet and exercise won't keep the weight off.  What does your PCP think you should do?

Pretty much every article you can find will say the DS has the best results.  Why not have the surgery that works the best?  Do you know which one has the most complications?  The Crap Band.  Constant fills/unfills and emergency removals after it eats through the stomach.  It can cause all sorts of problems.  And that's the one the docs tout as least invasive outpatient surgery.  Always follow the money and look at the folks who write the papers.  Do they have a motive to prefer one surgery over another?  Do they routinely perform ALL the surgeries they discuss?

I was at one time a research scientist.  I wrote papers for journals.  The right and proper way to do research is to pose a problem and devise a method to come to a logical conclusion.  Find a real answer to a real problem.  Today too much research starts with a conclusion...and then you figure out how to get there.  It's done backwards.

Question everything and everyone.  Just because it's published doesn't make it correct and valid.  If you are going to delve into scientific papers you need to develop the critical thinking skills necessary to look at things like sample size and the folks who wrote the paper.  And did they ask all the right questions?  I CAN come up with any results you want to see.  It's not right but I can do it.  And if I can do it, so can they.

Funny, I read that same article last week. It comes up near the top of google searches on the DS. Since I had a DS Sadi a little over 8 months ago, I can tell you much of the info in the article is correct but the conclusion is pure opinion of someone that probably doesn't know as much about the DS as anyone on this site.

Regarding doctors that do not perform WLS, I have not met one yet that understands what a DS procedure is. I always end up explaining it to them. My PCP is there for checkups, blood work etc, but would not have any input about the best WLS options. It's not their thing.

OH, the Swedish study. Yes, those of us who have been around for awhile are well familiar with it. The devil, as always, is in the details.

First, even the authors acknowledged that their sample size was tiny, like 20 some odd patients in each group. What they sort of glossed over was that they were well experienced in doing gastric bypass (the only other operation involved in the study) and NOT experienced with the DS. Well, duh, of course they had more complications doing an operation they weren't experienced with, compared to one that was old hat for them.

Next, you have to see their post-op nutritional recommendations to believe it. They were totally inadequate, a further indication of their ignorance about the DS. Anyone with the Ds would be doomed to problems with these recommendations.

I'm not saying they screwed up deliberately, I have no way of knowing this. but they did screw up. If you have a surgeon experienced with the DS and get good advice as to post-op protein, vitamin and mineral needs, chances are you will do just fine. In fact, there is an excellent trial by 2 DS surgeons in Chicago who operated on similar patients, during the same time period and by the same surgeons, with either DS or gastric bypass. These surgeons were experienced with both operations. Their patients had complication rates that were nearly identical, AND the DS patients lost more of their excess weight, AND the difference in weight loss between the two groups increased as time went on. The same authors later presented information at a conference that I believe was on the same patients (I'm not 100% sure and don't want to mislead anyone) that also showed that the DS patients did better on resolution of the major comorbidities - type 2 diabetes, sleep apnea, etc.

The medical literature is filled with crappy studies. You need to read critically, and look at the details and not just at the conclusions.

Larra

Thanks for the great responses. Fortunately, I have a supportive dietician - to whom my PCP referred me - who has me going through the National Library of Medicine and American College of Gastroenterology sites for additional papers on DS benefits. She's the one who suggested I research and consider DS in the first place because although her knowledge is limited, she understood that DS has good long term sustained weight loss. My next appt with my PCP is Tues. Wish me luck. I'm highly likely to go ahead with the DS with or without him. 

Thanks again. There's some great support on these boards :-)

Mary F