RNY or DS - How did you decide?

Humor me for a moment if you will, please.

Let's say your BMI is 54, and you are in a situation where your insurance will pay for either the RNY or the DS.  Let's also say that you have a very well vetted surgeon who can do either. 

How would you choose - or how did you choose which surgery to have? 

Thank You!!

I chose rny as it seems that some people end up going back after bands, etc. and getting revised.  I didn't want to deal with the possibility of that, so I went "all in" so to speak...lol.

Actually, since the DS bypasses more of the intestine, and is the most "drastic" of the weight loss surgeries, truly going "all in" would have been the DS.

Lora

I know we see people with the band getting revised all the time.  But how often do you see people with the DS getting revised?  It happens.  But sure not a lot.

My bad.  I was thinking band, not Duodenal Switch.

If my BMI were 54, I would want to choose the surgery that provided the absulte best possible outcome while also provided great long term success stats.  From what I understand, that is the DS.  I know there are many successful patients with RNY who started with BMIs in the range you cited.  I would have preferred the DS, but my surgeon reserves that for higher BMIs.  I think more and more are performing DS on those whose BMIs are lower. 

I would assume the worst possible outcome for each and ask myself if I could live with the results (okay, the second worst possible outcome since the first would be death).

Then I would do some deep introspection to decide which I would be the most compliant with.

I speak with a bit of experience here since 54 was my starting BMI. I just felt, bone deep, that DS was not the choice for me, although it is an excellent choice.

 I would do my research on both, the DS is a much more intensive surgery however the long term effects of a DS are better than an RNY, however and RNY although difficult can be reversed if medically needed, a DS is not reversible. It is a tough choice I had to make as well, and I decided on the RNY because that is what worked for me. But please do a lot of research and choose which ever is best for you. Good luck, and in the end you will make the right choice for yourself.

I had a starting BMI of at least 57 (based on highest recorded weight), and both surgeons that I considered using in my area did both at he time.  My insurance did not cover DS, but I had heard of others who had very high BMIs who successfully petitioned for approval, so I think that I could have convinced them to cover a DS.

I chose RNY for a couple of reasons.
1) I was not excited about having ANY intestinal rearranging (but had already been told by both surgeons that I would not lose all the weight I wanted/needed to  with the band) or the vitamin malabsorption (I have serious questions even with the RNY about what will happen as I age and my body naturally is less efficient at absorbing nutrients), and the RNY had less bypassed and therefore fewer supplements required and a smaller chance of nutritional deficiencies.
2) the only person I knew IRL who had the DS had terrible problems with somewhat uncontrollable oily, smelly diarrhea (so much so that she always carried a change of clothes in her car), and while I was willing to accept all of the potential side effects of RNY, I was not willing to take the chance of having to deal with THAT potential side effect of the DS.  (NOT all DSers have this, but the woman I knew had a terrible time with it.)
3) I did not like the idea of the surgeon removing the rest of my stomach
4) I liked the potential of dumping with RNY since I do like sweets (turns out that I only dump if I have a large amount of sugar (more than I should have in terms of calories anyway)

I believe that both aregood surgeries.  The surgeon I chose stopped doing the DS a few years ago because too many people were not being compliant with their vitamins and were having nutritional issues.  Good luck with your decision.

Lora

In the situation you describe, I may well have chosen the DS.

One reason I did not chose the DS in my case is that there were no surgeons near me that did that surgery.  I had to travel 180 miles from home to get RNY, but I didn't want to have to go out of state or fly somewhere for the DS.  Not only because of the expense involved in traveling a long way for surgery, but also the difficulty in accessing my surgeon for follow up, especially if I had problems.

Also, most doctors around me probably don't know anything about the DS.  I have enough trouble educating them about RNY.  I wanted to know I could go to my local ER if I had a problem and there would be a doc there that would know how to treat it.

Finally, the risk of nutritional deficiencies with RNY scares me, but the risk with DS is even scarier.

But again, if I had had a surgeon that could do the DS nearby, I might have gone with that.