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Hi folks! Like many, I waited to have the DS. While waiting, I researched and gathered information. Please feel free to look through the information and websites I put together here. One more thing: The DS surgery is a more complex surgery for surgeons to perform. Therefore, there is a higher learning curve for the surgeon to master this procedure (if possible, try to find a surgeon who has done over 100 DS surgeries, if you intend to have the DS).
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A study published In the October 2006 issue of The Annals of Surgery pointed to biliopancreatic diversion with the duodenal switch (BPD/DS) as the most effective type of surgery for morbidly obese patients (with BMI over 50).
Dr. Hess' study of 120 patients who had the DS at least ten years earlier, shows 94% were in the satisfactory category, having lost 50% or more of their excess weight. The average excess weight loss at the ten year mark was 76%.
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The Duodenal Switch on November 10, 2006 1:43 am
Learning about the DS
Here are some websites that were helpful for me in my search for the DS. Some have animations, some do not. Some have pictures, and one even has a video of the actual surgery (Dr. Smith's).
If you're just learning about the DS, I'd like to suggest the Dr. Hess website first.
Dr. Hess (suggestion: select PowerPoint presentation)
http://www.dshess.com
Dr. Smith (streaming video image)
http://tinyurl.com/y6ey9y
Dr. John Rabkin (gives an educational talk combined with a PowerPoint presentation on his website, where he explains pros and cons of the Lap Band, RNY (gastric bypass), vertical sleeve gastrectomy, and the Duodenal Switch.)
http://www.paclap.com
Cornell University in NYC (text description)
http://tinyurl.com/2odovv
Dr. Keshishian
http://tinyurl.com/y7w3ab (picture)
http://www.weightlossinla.com/media_clips.php (animation)
Dr. Cirangle (description)
http://tinyurl.com/y27ejl
Dr. Baltasar
www.bodybybaltasar.com
Dr. Husted (animated DS)
(look for animation link - scroll down)
http://johnhustedmd.com/switch.htm
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Our DS postop Bev designed and built a GREAT DS site:
http://www.dsfacts.com/index.html
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Empirical Evidence: Medical Studies
There are published studies based on empirical evidence regarding the DS (these may be helpful to you if you are filing an appeal, or you'd like further information). Articles are published every month in the medical community, so I try to keep an eye out for those DS related.
The chart is a compilation effort by Oakland Bariatrics, which incorporates many of the medical studies listed below(http://www.oaklandbariatrics.com/compareProcnew.html)
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Duodenal Switch: Long-Term Results
http://tinyurl.com/5www38
Marceau P, Biron S, Hould FS, Lebel S, Marceau S, Lescelleur O, Biertho L, Simard S., Department of Surgery, Laval University, Laval Hospital, Québec, Canada, picard.marceau@chg.ulaval.ca
BACKGROUND: This report summarizes our 15-year experience with duodenal switch (DS) as a primary procedure on 1,423 patients from 1992 to 2005.
METHODS: Within the last 2 years, follow-up of these patients, including clinical biochemistry evaluation by us or by their local physician is 97%.
RESULTS: Survival rate was 92% after DS. The risk of death (Excess Hazard Ratio (EHR)) was 1.2, almost that of the general population. After a mean of 7.3 years (range 2-15), 92% of patients with an initial BMI 50 obtained a BMI ;< 40. Diabetes was cured (i.e. medication was discontinued) in 92% and medication decreased in the others. The use of the CPAP apparatus was discontinued in 90%, medication for asthma was decreased in 88%, and the prevalence of a cardiac risk index >5 was decreased by 86%. Patients' satisfaction in regard to weight loss was graded 3.6 on a basis of 5, and 95% of patients were satisfied with the overall results. Operative mortality was 1% which is comparable with gastric bypass surgery. The need for revision for malnutrition was rare (0.7%) and total reversal was exceptional (0.2%). Failure to lose >25% of initial excess weight was 1.3%. Revision for failure to lose sufficient weight was needed in only 1.5%. Severe anemia, deficiency in vitamins or bone damage were exceptional, easily treatable, preventable and no permanent damage was documented.
CONCLUSION: In the long term, DS was very efficient in terms of cure rate for morbid obesity and its comorbidities. In terms of risk/benefit, DS was very sucessful with an appropriate system of follow-up.
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Comparison of Effects of Gastric Bypass (RNY) and Duodenal Switch (DS) on Weight Loss and Body Composition 1-2 Years After Surgery http://tinyurl.com/yoq46y
Strain, Gagner, Inabnet, Dakin, Pomp. Jan-Feb 2007Weill College of Medicine of Cornell University, New York, New York, USA.
BACKGROUND: Gastric bypass (GB) is the most common surgical procedure for weight loss in the United States. Biliopancreatic diversion with duodenal switch (BPD/DS) is less routinely performed, perhaps because of its technical difficulty and metabolic concerns. The objective of this study was to determine whether these procedures had differential effects on weight loss and body composition.
METHODS: Body composition was measured by bioimpedance (Tanita 310) at the initial consultation, and follow-up measurements were completed 1-2 years after surgery.
RESULTS: Of the 72 patients in the study, 50, aged 46.2 +/- 8.5 years, had undergone GB and were measured 15.5 +/- 5.2 months after surgery and 22, aged 40.6 +/- 7.9 years, had undergone BPD/DS and were measured 19.5 +/- 7.5 months after surgery. Patient age and time after surgery were significantly different between the 2 groups. The body mass index (BMI) for the BPD/DS group was 53.6 +/- 11.9 kg/m(2), significantly greater than the BMI of the GB group (48.0 +/- 6.3 kg/m(2); P = .009). However, the percentage of body fat did not differ between the 2 groups (P = .515). Postoperatively, the BMIs for the GB group (31.5 +/- 5.0 kg/m(2)) and BPD/DS group (30.3 +/- 6.1 kg/m(2)) were not significantly different (P = .384). The percentage of body fat for the GB and BPD/DS groups had changed from 49.2% +/- 8.3% to 32.1% +/- 10.6% and 47.9% +/- 5.9% to 23.8% +/- 10.4%, respectively (P = .002). The BMI had decreased by 16.5 +/- 4.8 kg/m(2)after GB and 23.3 +/- 6.8 kg/m(2) after BPD/DS (P <.001). The decrease in fat was 17.1% +/- 8.2% after GB and 24.2% +/- 7.2% after BPD/DS (P <.001).
CONCLUSION: The BPD/DS procedure is more effective in reducing the BMI and promoting fat loss than is GB. The assessment of the impact of these two operations on an individualized basis offers additional information to assist in the evaluation of these procedures.
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Duodenal Switch Provides Superior Weight Loss in the Super-Obese (BMI >=50 kg/m2) Compared with Gastric Bypass
http://tinyurl.com/y7y4ya
Prachand VN, Davee RT, Alverdy JC. 2006 Oct;244(4):611-9, Comment in:Nat Clin Pract Gastroenterol Hepatol. 2007 May;4(5):250-1.University of Chicago, Chicago, IL 60637, USA.
OBJECTIVES: Although weight loss following Roux-en-Y gastric bypass is acceptable in patients with preoperative body mass index (BMI) between 35 and 50 kg/m, results from several series demonstrate that failure rates approach 40% when BMI is > or =50 kg/m. Here we report the first large single institution series directly comparing weight-loss outcomes in super-obese patients following biliopancreatic diversion with duodenal switch (DS) and Roux-en-Y Gastric Bypass (RYGB).
METHODS: All super-obese patients (BMI > or =50 kg/m) undergoing standardized laparoscopic and open DS and RYGB between August 2002 and October 2005 were identified from a prospective database. Two-sample t tests were used to compare weight loss, decrease in BMI, and percentage of excess body weight loss (% EBWL) after surgery. chi analysis was used to determine the rate of successful weight loss, defined as achieving at least 50% loss of excess body weight.
RESULTS: A total of 350 super-obese patients underwent DS (n = 198) or RYGB (n = 152) with equal 30-day mortality (DS,1 of 198; RYGB, 0 of 152; P = not significant). The % EBWL at follow-up was greater for DS than RY (12 months, 64.1% vs. 55.9%; 18 months, 71. 9% vs. 62.8%; 24 months, 71.6% vs. 60.1%; 36 months, 68.9% vs. 54.9%; P < 0.05). Total weight loss and decrease in BMI were also statistically greater for the DS (data not shown). Importantly, the likelihood of successful weight loss (EBWL >50%) was significantly greater in patients following DS (12 months, 83.9% vs. 70.4%; 18 months, 90.3% vs. 75.9%; 36 months, 84.2% vs. 59.3%; P < 0.05).
CONCLUSIONS: Direct comparison of DS to RYGB demonstrates superior weight loss outcomes for DS.
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Diana Cox has done an excellent job compiling several studies in one thread (different from those in this list) - please find here.
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Serum ghrelin, leptin and adiponectin levels before and after weight loss: comparison of three methods of treatment--a prospective study
http://tinyurl.com/suzsg
Kotidis EV, Koliakos GG, Baltzopoulos VG, Ioannidis KN, Yovos JG, Papavramidis ST. Aristotle University of Thessaloniki, AHEPA University Hospital-Third Department of Surgery, Thessaloniki, Greece.BACKGROUND: Ghrelin is a peptide hormone with orexigenic properties, primarily produced by the stomach. Leptin and adiponectin are the two adiposity products that participate in body weight control. Leptin always decreases and adiponectin increases after weight loss. Different changes in fasting ghrelin levels have been reported following bariatric surgery. In this study, we compare the changes in fasting ghrelin, leptin and adiponectin levels in 3 groups of patients who achieved weight loss by either diet, MacLean vertical banded gastroplasty (VBG) or biliopancreatic diversion with duodenal switch (BPD-DS).
METHODS: Serum fasting ghrelin, leptin and adiponectin concentration was measured in 40 obese patients who achieved weight loss by either diet (n=14), VBG (n=13) or BPD-DS (n=13), before and after weight loss. The follow-up period was 18 months for BPD-DS and VBG and 6 months for diet. Serum ghrelin level was measured by ELISA.
RESULTS: BMI was significantly decreased in all 3 groups: 9.2+/-2.4% (P<0.01) following diet, 38.47+/-7.26% (P<0.01) after VBG, and 42.88+/-9.09% after BPD-DS (P<0.01). Serum fasting ghrelin level increased after diet (110.45+/-117.84%, P=0.002) and VBG (65.48+/-92.93%, P=0.001),but decreased after BPD-DS (-21.63+/-28.63%, P=0.019). Leptin concentration decreased and adiponectin increased in all groups.
CONCLUSIONS: Unlike after diet or gastric restrictive surgery, BPD-DS is associated with markedly suppressed ghrelin levels, possibly contributing to the weight-reducing effect of this operation. Sleeve gastrectomy seems to be the main cause of this reduction.
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Bariatric Surgery: Getting Your Ticket Punched
http://tinyurl.com/2yybql
Schirmer BD, Schauer PR, Flum DR, Ellsmere J, Jones DB. J Gastrointest Surg. 2007 Jul;11(7):807-12. University of Virginia, Charlottesville, VA, USA.Laparoscopic bariatric surgery has gained popularity but has been proven to be a technically challenging set of operations that requires a long learning curve.
Trainees must acquire advanced laparoscopic skills and knowledge of the perioperative care of the bariatric patient.
The challenge is to ensure that those surgeons performing gastric bypass, gastric banding, and duodenal switch procedure are trained appropriately.
In the past, very different opportunities have been available for the general surgeon seeking to practice bariatric surgery.
Early on, many surgeons began performing bariatric surgery without any formal training.
Later, weekend courses, mini-fellowships, and formal minimally invasive surgery/bariatric fellowships were established.
Today, best practice requires an intensive training experience and ongoing commitment to the field.
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Long Term Mortality After Gastric Bypass Surgery
http://tinyurl.com/2swlrg
Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, Lamonte MJ, Stroup AM, Hunt SC.N Engl J Med. 2007 Aug 23;357(8):753-61. Comment in: N Engl J Med. 2007 Aug 23;357(8):818-20.
Cardiovascular Genetics Division, University of Utah School of Medicine, Salt Lake City, UT 84108, USA.
BACKGROUND: Although gastric bypass surgery accounts for 80% of bariatric surgery in the United States, only limited long-term data are available on mortality among patients who have undergone this procedure as compared with severely obese persons from a general population.
METHODS: In this retrospective cohort study, we determined the long-term mortality (from 1984 to 2002) among 9949 patients who had undergone gastric bypass surgery and 9628 severely obese persons who applied for driver's licenses. From these subjects, 7925 surgical patients and 7925 severely obese control subjects were matched for age, sex, and body-mass index. We determined the rates of death from any cause and from specific causes with the use of the National Death Index.
RESULTS: During a mean follow-up of 7.1 years, adjusted long-term mortality from any cause in the surgery group decreased by 40%, as compared with that in the control group (37.6 vs. 57.1 deaths per 10,000 person-years, P<0.001); cause-specific mortality in the surgery group decreased by 56% for coronary artery disease (2.6 vs. 5.9 per 10,000 person-years, P=0.006), by 92% for diabetes (0.4 vs. 3.4 per 10,000 person-years, P=0.005), and by 60% for cancer (5.5 vs. 13.3 per 10,000 person-years, P<0.001). However, rates of death not caused by disease, such as accidents and suicide, were 58% higher in the surgery group than in the control group (11.1 vs. 6.4 per 10,000 person-years, P=0.04).
CONCLUSIONS: Long-term total mortality after gastric bypass surgery was significantly reduced, particularly deaths from diabetes, heart disease, and cancer. However, the rate of death from causes other than disease was higher in the surgery group than in the control group.
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Day-to-day eating after DS
Pretty Dove asked this and many other very good questions and we answered her. This is an excellent resource, and a straight-from-the-source dialogue. http://tinyurl.com/2v7yyn
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Financing Your Surgery
Some people have insurance companies that will cover the DS. Some insurance companies exclude any weight loss surgery for any reason. It's a waiting game, a legal fight, a tormenting journey for some to get their DS covered by insurance.
However, some have fought the good fight. Some are denied time and again, and they continue to appeal, AND WIN!!! Some are tenacious, strong, courageous, and able to wait it out as the big insurance companies play the waiting game. People have pushed for their DS procedure that extends/saves their lives.
These people are real, they have posted on this sight and others. They generously share their profiles for those of you fighting the good fight will have hope, resources, and support . AGAIN...SEVERAL HAVE WON THEIR FIGHTS with their insurance companies.
Some have not won, and/or have comorbidities that they want/need addressed before the insurance companies can help them. So...MANY of these FOLKS go OUT OF COUNTRY for the DS procedure due to insurance problems, or the self-pay COST of the DS within the U.S.
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DS Surgery Out of Country
SO MANY FOLKS go OUT OF COUNTRY for the DS procedure due to insurance policy limitations, appeal denials, or the simple fact that to self-pay the entire COST of the DS within the U.S. is prohibitive when compared to out of country costs.
Most out of country surgeries cost much less than in the United States (Approximately $34k in U.S. vs. $11k in Mexico for example.)
There are several DS postops on our message board that are very helpful for those wanting more information about going out of country. Just post that you're interested, and you'll receive several responses, I promise.
DS Surgeons Out of Country
(not an all-inclusive list)
Dr. Baltasar in Spain, www.bodybybaltasar.com (Patient Created)
http://www.drbaltasar.com/ (Official Surgeon Site)
Dr. Ungson in Mexico
Dr. Marchesini in Brazil: He doesn't have a web sight anymore due to some Brazilian laws that considered it advertising. Here is a link to his Yahoo group to get all the info you need.
http://health.groups.yahoo.com/group/DrMarchesini-DS/
He does have an e-mail address that is jbmarchesini@hotmail.com
He can answer all you questions and can send you a fact sheet that has all the info you want on it.
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Financing the DS in the U.S.
The Pacific Laparoscopy office (Rabkin in San Francisco, CA) provided me with these websites to research for myself, so I thought I'd pass them on to you, in case they'd be of help. I'm not endorsing them, nor have I used them. Just fyi:
www.carecredit.com
www.cosmeticfeeplan.com
www.abfcredit.com
The Duodenal Switch Continued on October 31, 2006 10:27 pm
PostOp Eating Guidelines
These guidelines are an excellent resource, especially if your surgeon's nutritionist is not DS specific.
DS-specific eating guide from day of surgery on
http://www.cornellweightlosssurgery.org/wei_los_faq/
(In list on the right side of webpage.)
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My Story Like many on these boards, I've been overweight all of my conscious life (since 5 years old).
Like many on these boards, I've lost weight, and gained all my weight back and then some. Even when my diet and exercise attempts were safe, effective, and medically supervised.
Like many on these boards, that have been fat since very early on, I've been teased, skipped over for promotions, looked at as less-than, and dismissed as invisible when clearly, I'm the largest human being in the room.
Though at 40 years old, I hadn't given up the fight, yet...not until January 2005.
In January 2005 I was working on contract as a content coordinator for a website. Unfortunately, on that day, I was given my pink slip, being told my health wasn't allowing me to perform up to par, and it was something they were "concerned about" and that I should look into it right away. Hm. In hindsight, they were right. Quite honestly, I thought I'd had a stroke or a brain tumor.
What was it, you ask? It was oxygen deprivation. The pulmonologist, the sleep lab technicians, and the sleep doctor/specialist all concurred - I had been suffering from oxygen deprivation for several months, and it had finally caught up to me. I had severe sleep apnea.
My physician asked if I'd ever considered weight loss surgery. From that day on, I was researching weight loss surgeries, going to Informational-Orientation type groups - of local weight loss surgery surgeons, and promptly decided the RNY was for me.
HOWEVER, while in the OH Main Chatroom, a thoughtful man told me about his experience with the Duodenal Switch.
After researching the DS, in February 2005, I knew it was for me. I waited, for about 3 years for my DS surgery...because my roadblock to getting it was financial. I had my DS on July 31, 2007.
My preop wish list:
To be able to drive my car without my gut sticking out so much I can feel every corner and turn I make cuz of the wheel of my car. :(
To be able to take the stairs without my bones hurting with each and every step.
To be able to get out of bed in the morning without pain in my body - all of my joints.
To be able to stand and walk more than 5-10 minutes without sweating, or having my back seize up.
To be able to take my aqua aerobics classes without inhibition.
To be able to walk in public, to the point where the smiles I give generously and often are returned in kind.
To receive eye contact. (The "invisible" fat person syndrome.)
To be acknowledged monetarily at work for my abilities and effectiveness. (Of course once my sleep apnea and comorbidities are gone.)
To lose my meds for high blood pressure, osteoarthritis, and depression.
To fit into booths and chairs.
To look forward to meeting new people.
To go on dates.
To participate more fully in my family - parties, traditions, birthdays - lots of things I'm missing. To have a family of my own.
To buy clothes "off the rack" in my size.
To wear vibrant colors.
Be comfortable in my own body.
Ride a motorcycle (perhaps own one).
Learn to fly.
Visit Universal Orlando, Disneyland, Disneyworld, SeaWorld. Ride the rides I want to - and do them again and again.
Swim with dolphins, learn to scuba-dive, snorkel in tropical waters.
Write a book or screenplay (already wrote one screenplay - Bewitched meets The Little Mermaid/Splash).
Generate enough income to live comfortably.
Enjoy my career choice.
Excel in my career track.
Record a CD.
Put a jazz combo together, and create arrangements to fit my style and highlight the combo's talents.
Volunteer to perform at local nursing homes.
Perform at restaurants/bars occasionally.
I'll think of more, I'm sure, but that's a start.
If you've read this far, thanks!
UPDATES AS A POSTOP (written January 8, 2008):
"Ch-ch-ch-ch-changes." - David Bowie
I can drive my car without my gut getting in the way of the steering wheel.
I am no longer on prescription medications to manage my arthritis pain. I take Advil or Tylenol when I get a flare-up (which seems to be weather-related, or exercise-related).
I am no longer on prescription meds for my high blood pressure. Blood pressure is now NORMAL.
I am no longer using a CANE to walk.
I am no longer using a scooter in stores.
My back no longer seizes up within 3 minutes of standing (though now the issue is my upper back - don't know what that's about, but will see).
Had anemia issues, but am no longer anemic after ONE MONTH on PROFERRIN ES www.coloradobiolabs.com/ProferrinES/default.aspx. (Recommended by Dina McBride(sp?), long-time Dr. Baltasar U.S. patient advocate, who told me this is the ONLY OTC Oral Iron Supplement that WORKS for postop DSers, and it WORKED for ME!)
I purchased three pieces of clothing "off the rack" from Marshall's and Ross, never quite believing I would be able to fit into any of them.
I fit in *some* restaurant booths now!
I am feeling much more comfortable in my own body, even though it's still a very obese body, I'm feeling better by being 87 POUNDS LIGHTER than I was just 5 short months ago.
DEVROM www.Devrom.com got rid of my stinky postop BM's and flatulence. Now my BM's and gas are less stinky than they were as a preop! Wow! What a difference!
***UPDATE***
I'm experimenting with different ways to get rid of the "peel the paint off the walls" stinky gas/bm's that the DS causes me. I had thought Devrom was my answer, but after about a week on it, I've decided to try flagyl (metronidazole).
---UPDATE---May 13, 2008---
My iron deficiency and anemia showed up in November/December 2007. I had had large-volume menstrual cycles just after surgery (August 2007), and also throughout September 2007. The cycles became a little less in volume, but by then the anemia was showing up in my blood lab work. That's when I tried Proferrin.
I took one Proferrin a day for a week. It stopped my weight loss dead, because sometimes iron supplementation can do that to folks. I didn't like that one bit, so I started to take the Proferrin once every other day, and I upped my fiber intake (more green salads, to keep things moving through, and upped my my hydration levels. That worked! My next blood work that came back in December showed I had begun to trend back UP in the iron department.
I kept using Proferrin until it ran out (I only needed to use one bottle of 30 tablets), one every other day, or one every two-three days. Since my anemia was retested in January, and my anemia indicators showed I was still low in iron - but NOT OUT OF RANGE anymore (though very low in the normal range), I stopped supplementing with Proferrin. I relied on my multivitamins with iron, cuz I figured that my weight loss had all but stopped for the time I was on Proferrin, and I still had(have) a LONNNGGG way to go in the weight loss department, and that was unacceptable to me. ALSO, my menstrual cycles flow was under control via the ob/gyn intervention, so I was not losing much (if any) blood every month anymore.
THIS IS IMPORTANT:
My 6-months blood work was done at the end of January. All was good. (Iron levels still low-end, but in normal range.)
THREE MONTHS LATER (close to now) a friend of mine asked if I'd had my Ferritin level drawn at the same time as my other usual labs. Nope, I hadn't.
Had my Ferritin test, and it came back WELL BELOW NORMAL. That means I'm IRON DEFICIENT, though not necessarily showing up as ANEMIC.
I'm tired much of the time. (Classic symptom of anemia, though iron deficiency doesn't have strong symptomology - until it's too late.)
The information I'd like for you to take away from all of this information is this - get BOTH your CBC and Ferritin levels checked. ONE can be within normal range (blood flow CBC), and the other can be tanking (iron stores in organs Ferritin). Neither in abnormal ranges are desired, however, the Ferritin levels are SO IMPORTANT, and they are quite difficult to replace (get back into normal range) once they sink.
ORAL supplementation of IRON for DSers is moot. Iron is NOT ABSORBED in the ileum (the small intestine that we have left for digestion). Iron transfusions are recommended for those of us who are unable to absorb iron. Some DSers CAN absorb iron, however, it's ALWAYS GOOD to get your blood levels (CBC) of iron drawn to check for anemia AND your iron storage levels drawn (Ferritin) to check for iron deficiency.
Let me know if this was useful to you.
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