Do i do the duodenal switch after getting sleeved?

I went to my doctor today for my 4 week post-op appointment after having gastric sleeve surgery on 4/4/16.  My doctor recommends that i get the duodenal switch surgery.  He feels that it will benefit me the most with losing weight for the long term and keeping the weight off.  Before surgery my bmi was 54.  Since two weeks before surgery until now i have lost 44 pounds.  The doctor and i discussed the DS surgery in great length when i first met with him but at that point i only wanted the gastric sleeve.  He brought it up again today for me to consider.  It's totally up to me but he thinks i would still benefit the most from DS.   I have to think about what's going to be better for me years from now.  

My BMI was over 70 at my highest weight.  I had the sleeve, and have absolutely no plans to get a DS.

Why don't you try working your sleeve before you make any decisions?   Sounds like your doctor is 

You don't have 2 months to decide...

take all the time you need...

he wants you to schedule in 2 months...

I'd say youre rocking it, so see how far you can take it...

many, many people here have lost well over 150-200lbs

with just the VSG..it all depends on you...

I'm happy with my sleeve & have lost a good deal of weight with it, so have others. Whether you stay with the sleeve or you get the DS you'll still have to work to keep it off long term. It's ultimately up to how you feel, not how he feels. If you're doing well with the sleeve then stay with that. You can get the DS at any time, he just wants to schedule you in 2 months.

Do what you want to do, not what he feels like doing.

The consensus that I have seen from the docs is that the DS works best as a virgin, or standalone, all at once procedure, or when staged fairly closely to the sleeve - certainly before any significant regain occurs. That takes a bit of crystal ball work to decide if it is needed.

At your BMI, as you can see from others, the weight loss is certainly possible with the sleeve alone. However, it's the regain issue that's tricky. How prone to yo-yo dieting are you? How damaged is your metabolism from your past history with obesity - are you naturally a "slow loser" or know that you maintain (such as it may have been,) at a fairly low caloric level? Your first month looks great, and doesn't look like a "slow loser." However, many here, particularly many of the ladies, wind up maintaining in the 1000-1200 calorie range (a few lower, and some run higher); some have adapted and learned how to live at that level while others find that like being on a permanent "diet" and can't stick with it - for them the DS would be a good choice for the long term.

In my case, I had lost about a third of my excess weight in the years pre-op (while my wife was going through her DS adventure,) and while not losing to a "normal" weight, I did maintain that loss for several years. That gave me the confidence to go through with the sleeve alone and keep the prospect of the DS as a long term "plan B" if I needed it, with the understanding that it may not be as effective as if I had done it all at once - it was worth the risk for me, and five years on I'm still within a couple pounds of my goal weight with minimal deviations. There are quite a few of us who have learned how to maintain with the sleeve, at least for several years, while there are others who have found it difficult to lose enough with it, or have had significant regain problems and quite a few of them have made the move to the DS over time.

Unfortunately, there is no simple or one-size-fits-all answer for this question. You have to look at your own history and your own crystal ball and make the best decision for you. Good luck,

Thank you so much califsleevin.  You gave me some great advice and insight.  I have had problems before surgery with losing weight and regaining it back plus more.  And my biggest fear is regaining weight later on down the road after the sleeve surgery.  I have a lot of thinking to do about what's best for me now and the years down the road.  

Just keep in mind why you gained the weight back, was it due to not being able to stay at a low calorie amount, in which your wls tool can help you, or did you "eat back your feelings?", in which no tool can help you, but therapy/support groups can.

Congratulations on dong so well!  

I have to be honest, I am absolutely flabbergasted that a surgeon would recommend you convert to a DS at your 4 weeks postop appointment.  You are doing incredibly well and haven't even healed fully from your first surgery.  There is no reason to consider another surgery right now, and maybe never.  If he was so certain you should have a DS why didn't he suggest that before you had your sleeve?  (EDIT: I reread your message and saw that you did discuss the DS before surgery.  Stick to your guns and keep up the good work!)

I see dollar signs. Lots and lots of dollar signs.

Keep rocking that sleeve!!

I was approved for the DS, but a scope broke during my surgery and I was under anesthesia a long time, so long they ran out of time to do the DS. I ended up only with a sleeve. I think it was a blessing, I've lost 260 pounds with my sleeve and have ZERO plans or needs to getting the DS.