Going from Sleeve to DS

Hello I am new to this board. I have a sleeve 3 1/2 years ago and am now considering the revision to a DS. Can you please tell me the pros and cons to this? I have heard that you have really bad gas and stool? I have also heard that long term it is not good for you. I am getting mixed feelings. I need more info from people who have had this done, thank you.

I will soon be eleven years post-DS. I was not a revision---I got the complete DS in one surgery. The only time I have bad gas or stools is when I eat very badly---waaaay too many carbs, or sugar alcohols. (Those things will hurt you!)

As for the DS not being good for you long-term---I'd be dead today had I not had it when I did. My health is better today than it was 25 years ago. I do take vitamins and minerals 3-4 times a day, every day. (Well, occasionally I miss a dose, but my goal is to take 'em all.) I get annual blood work to make sure I'm taking what and how much I need, and while I've had to tweak it a couple of times, my levels are better than they were pre-op. So's my cholesterol---way better!

The pros are that you'll lose weight while eating more food, and fat will pretty much be a 'free' food, because you'll only absorb about 20% of it. The cons are that since you do absorb so little fat, you'll have to take larger than normal doses of the fat-soluble vitamins A, D, E, and K. No big deal---mine are all tiny little capsules that I take once a day.

Gas and stool stinks are very controllable, once you learn your triggers (RNY suffers this too).

Long term health - I've never been this healthy before in my life.  I'm pushing 9 yrs post op DS.  You will quickly become a vitamin nerd.  If you're not willing to add supplements to your lifestyle forever, don't even go a step closer to DS or RNY.

Hi, I just had a sleeve to DS revision last week.  The surgery itself was fairly easy.  Here's the thing that I know for sure.  Obesity will kill me.  Without surgery, and IF I behave and eat well, I still would gain at least 25 pounds each year, easily.  That being the way my body is, I would be dead by age 50 or 60 (I'm 40 now) based on simple math and statistics.  I think I will take my chances with the DS and see what happens.  I too worry about the malabsorption, but we are fairly smart people, and really, if we put it into perspective, which is worse?  I want to live, so I will make darn sure I take my vitamins and eat what works for me and my new baby DS.  Good Luck!!!!

OH YEAH, about the gas and stool smells?  Well, that is what Febreeze is for LOL!

You need to follow your surgeon’s recommendations for appropriate supplementation.

I respectfully disagree. Most DSers who are a few years out and who tract their own lab results find their surgeon's recommendations woefully inadequate. Also, it's easier to maintain good levels than it is to raise low values.

I don't know what your supplementation recommendation is, so you may be the exception to the rule. Would you consider posting your recommendations here? Or link to where we can view them?

Dr Ungson........I recently had a RNY to RNY revision where my pouch was untouched! The only thing my surgeon changed was shorten? or lengthen? my common channel ( I get confused on this one).......anyway my intestines were rearranged! I am doing well and have loss 23lbs in 5 weeks. I started at 210 lbs and fortunately haven't stalled as of yet. As a result of the surgery.......I do experience gas and loose stools........which reminds me of the symptoms stated for a DS !!  Is this common for this type of revision? I'm definitely not complaining because it's doing what I want and I feel really good and energetic. I do follow my surgeons instructions regarding eating and walking etc.  I just keep seeing these post about the DS is the only way to go.....sounding like its a one size fit all.....which it isn't.  I had RNY (open) initially back in 1985 and maintained my weight until the last 9 years where I gradually put 50lbs of the 100lbs I initially lost. 

I'm so glad you're out here, Dr. Ungson.   I, too, would like to chime in on the inadequate nutritional counseling that surgeons and nutritionists are giving to patients.  We have rendered them relatively useless in this area.

• Many are given the same paperwork and instructions as RNY patients.  
• Flintstones and Tums should never be prescribed as an adequate regimen (yes, some still recommend this) even at the beginning
• Many docs and nuts have no idea what dry vitamins are and continue to prescribe D2 oil.  Mine didn't even go that far.  I was told to take an extra 400iu of D and together, we watched my levels tank to 12.  Her response - add another 400iu.  It took me 100,000 iu of dry D3 for 6 months (thanks to the suggestion of those who have suffered the same) to get my D levels to a normal level on my own s, and 50,000 iu to maintain good levels while the medical professionals continued to shrug their shoulders.  They had no clue what to do, and I'm not a unique case.
• Too much fat can cause very loose stools, but too little fat causes constipation - the key is not low fat, but balance.  I spend a week living on Milk of Magnesia after a few weeks of constipation before I figured this out.

Do you have any kind of outlet in which to spread knowledge to the DS surgeon community?  We've seen some ridiculous recommendations come out from the surgeon and nutritionists offices.  We seem to be light-years ahead of what they refuse to consider as true.