Why don't more surgeons perform the DS?

I'm curious why more surgeons don't perform the DS. I'm scheduled for RNY in May, but I've read a lot about the DS being a better option for long-term weight loss and diabetes resolution. Why, then, with those statistics, are there so few surgeons who perform it? I'm just curious. The members who post on the DS board are VERY big fans of their procedure, but they talk about being able to eat larger meals and fatty foods as a bonus, while to be honest, I would kind of see that as a way to maintain the same disordered eating habits that caused me to become obese in the first place. It still sounds appealing on a primal level though! So what are the hidden downsides that prevent so many surgeons from performing it?

The DS is a more complicated surgical procedure, which is probably why there are fewer surgeons who do them regularly.

As Julie said, it's a more complicated procedure.  It may have something to do with insurance companies being willing to pay a certain amount for the surgery, and the time involved to perform a DS isn't financially appealing to them.  Surgeons can knock out a VSG in an hour whereas the DS takes several hours.

Some of the side effects of the DS were disconcerting so I didn't think it was an option for me.  Those that have it seem to love it.

Yep- more complicated, longer to learn and longer to perform, but the insurance company pays the same as they do any procedure.   My DS surgeon's bill was $12000 just for her, and if I recall correctly, the insurance company paid all of $2600 (I didn't have to make up the difference - its the contractual pay)

The previous replies addressed he main reasons, but there can be some other issues. Like the RNY, the DS is a malabsorbtive surgery, so you have to take supplements for life. Not negotiable. There are people that lose the weight, start feeling "normal" and just sort of fall off the wagon with taking supplements, and that is life threatening with the DS (or RNY). There have been some surgeons that aren't willing to deal with non-compliant patients. 

That said, I see the eating I did before my DS far more disordered than how I eat now.

I was not fat from disordered eating, but being fat made my eating disordered.

You have a skewed idea of a few things. The sleeved stomach is only capable of holding a few ounces, so you can never eat a huge amount post op. I could eat no more than 2-3 ounces newly post op, and now that I'm 7+ years post - DS and my stomach is about as stretched as it's going to get, I can at most eat a smallish sized meal. Not obvious to those that don't know that I have had surgery, but no one would say I eat a lot. 

The other thing is fats. I learned how to remove just about all fats from my diet for decades in a effort to reduce calories. That also means things like avocado, coconut oil, olive oil, nuts and peanut butter. Those are all really good for you, and some body functions need fats. In fact they are learning that fats can help with maintaining weight, not be the fat causing culprit it's been labeled as. The low fats diets I was on for years did far more harm than good. 

So I'm eating as close to "normal" as I ever have in my entire life, and that's not a bad or unhealthy thing. I've had to unlearn the unhealthy things like using substitutes for fats and sugar, and that it's unhealthy to try to live on 800 calories a day.

I guess my shrimp and asparagus with hollandaise dinner may sound primal to you, but it sounds better than the carrots and rice cake crap that I used to live on.

As a happy VSGer, who eats fairly high-fat, I don't see the DS as any sort of disordered eating free-for-all. For the vast majority of us, it's a combination of a uber-efficient metabolism, and over-eating carbohydrates in excess, along with calorically dense fats that got us here.

The DS gives a wonderful benefit of life-long decent fat malabsorption, along with a smaller protein and carbohydrate malabsorption side.. so, while a DSer may be able to eat a significant (and actually NEED) to eat a significantly higher amount of fats, they still need to limit (like all normies, previously obese or not) their carb intake to maintain and not regain slowly over time.

The biggest reason I have seen for the lack of widespread use of the surgery is just a couple.. 1. cost vs. gain for the surgeon and facility, it takes longer to perform, and more skill to perform, it's not as simple and fast as the VSG or RNY, and especially, b. patient compliance and liability.. many, many people just aren't as invested in really putting the time into learning about post-op needs and nutrition, labs and lifestyle as would be needed to maintain health.. hell, I see a lot of RNYers not doing the barest minimum and suffering 5 years out from deficiencies, and not understanding why, and that is a hugely forgiving surgery! The DS requires much more of the patient than the AVERAGE patient is willing to commit to, for life.. that is likely the biggest non-starter... the fact that the average person is not willing or able to learn, understand, and apply the knowledge to maintain their health after recieving a much more malabsorptive procedure, and not many doctors are willing to go through the trouble to vet their patients, knowing human nature..

So, IMO, the downsides- financial upfront for surgeons, skill set, requiring more time learning and cutting skill, along with overall liability long term when dealing with the average patient.

It's sad though, as eating higher fat, and lower carb (regardless of surgery type or even non-altered persons) would likely lead to a better level of health and health maintenance long term. I know from personal exp. just by having a restrictive only surgery, I only gain when I eat an over-abundance of carbohydrates in combination with fats (comes down to hormones, carbs=insulin rise=fat storage).. keep my carbs under 100g or a bit less a day, and eat about 40-55% of my cals *when I tracked* in fats- equilibrium.. cut those carbs to 60g or under a day= lose.. 

You got great answers above. Because of those reasons, many surgeons never start doing the DS. There are also a fair number of surgeons that stop doing the DS because of all those issues.

My own surgeon told me that his biggest reason was patient noncompliance and resulting complications further down the road.

Thank you everyone! That makes sense. I do like the idea of giving myself the best option for long-term success though, but it doesn't look like I'd even have that option as the DS isn't performed by any surgeons that are in network with my insurance. I'm still trying to get used to the idea of RNY after being told I couldn't do VSG because of my GERD, but things like a stretched stoma and ulcer risk scare me.

I'm not totally sold on the sleeve causing gerd either. If a sleeve is super small as most used to be, then I think it's more likely.

That said, I have the DS, with of course is also a sleeve stomach. My surgeon makes his DS sleeves the same size as his stand alone sleeves, so IIRC I think I had a 28 bouie, with is fairly small.

I also had terrible gerd before surgery, and have none now. I think it depends on why you are having issues, and many of us have hernias we may even be unaware of prior to surgery, but they get fixed when they do the sleeve, and POOF - no more gerd. My gerd resolved immediately post op, but I'm sure mine was due to my excess weight, and once that started falling off, no more gerd, not even once in over 7 years now.

Of course I know sleeve and DS folks that also lost the gerd, and some who now have it worse, so it may be worth discussing with your surgeon what your actual cause for your gerd may be.