Question:
Gastric Bypass or Duodenal Switch

My insurance will cover the surgery. I researched and was certain about the laproscopic Duodenal Switch. Then I met with my surgeon (Dr. Schweitzer, Johns Hopkins, Baltimore) and he has given me 2nd thoughts and says the laproscopic Gastric Bypass is the "Gold Standard". HELP?    — Roberta J. (posted on March 4, 2009)

March 4, 2009
The gastric bypass is the most common surgery, followed by the lapband. They are the most used and understood. You want to use the one that your surgeon recommends for your situation.
   — trible

March 4, 2009
The "gold standard" is a term I hear often in my support groups. It basically refers to the fact that the RNY is approved by the gov't as a wt loss surgery, and is covered under most insurance plans. The term also means it's done far more in numbers than the DS, and has a better success rate the lapband. The RNY is also made for more wt loss at a more rapid rate than lapband. The DS has more malabsorptive issues and you may have eating or taking enough supplement challenges in the future, due to the nature of the surgery. Many insurance companies may consider the DS still experimantal, and not fully cover the surgery either. DAVE
   — Dave Chambers

March 4, 2009
Bobbi, Lap bastric bypass is the norm. In fact, on Feb 23rd, i had it. I was 373 with a bmi of over 50, and I feel great. other then a little tired, I feel im doing great. in less then 1 week time, Ive lost over 15 lbs. biggest issue I have is actually eating all the time. I know that sounds weird, but you will need to eat 1oz of food, every hr or so. Good luck in your decision !
   — jawman

March 4, 2009
It IS the gold standard, for a good reason. Its the most tried and true of all the types. My humble opinion, is always go for the gold. Good luck with your choice, and listen to your doctors advise, but go with what you feel is best for you, unless your surgeon has reasons he/she wants you to have a certain type. Cindi M.D. retired -230# 3.24.04 maintaining loss
   — DollyDoodles

March 4, 2009
The two surgeries are similar in many ways. Both have the same issues, but the issues with the DS are more pronounced due to the longer segment of intestine that is bypassed. This also makes it more EFFECTIVE at helping the patient lose WEIGHT. According to MOST of the research I have seen, the RNY is about 70 percent effective at helping the patients who have the procedure done get to goal, while the DS is about 90 percent effective! If you want to virtually ASSURE that you will reach your goal, get the DS. However, these are not your only options. There is another procedure that is SIMILAR to the DS that is a PARTIAL procedure known as the VSG, or the VERTICAL SLEEVE GASTRECTOMY, where they just remove most of your stomach. This is similar in PART to the DS, in that part of the DS does the same thing. The difference between the VSG, and the DS is that in the VSG, the surgeons to NOT bypass the intestines. The results for the VSG are COMPARABLE to those of the RNY. The important part to remember is that there are NONE of the same unpleasant side effects that are found with both the DS and the RNY. You do NOT need nutritional supplements. You do NOT need Blood Work to keep your health in check on a regular basis. You do not have to worry about unpleasant side effects from eating sugars, fats, or taking certain medications. You have a FULLY FUNCTIONAL intestinal tract and stomach. The stomach is just SMALLER. You eat less, and lose weight. If you want to find out more about the different options available, check out my profile page at: http://www.obesityhelp.com/member/hubarlow/ . Look for the post titled "Surgical Comparisons." If you don't see it on the main profile page, look for it in the March 2008 archives. If I had to choose between the RNY, and the DS, I would choose the DS. If I had a choice between the RNY, the DS, and the VSG, I would choose the VSG. I did. I have lost 116 pounds in a year with the VSG. I have had NO trouble with the surgery, and I HIGHLY recommend it! I hope this helps. Hugh
   — hubarlow

March 4, 2009
My experience has been that DS patients will tend to keep their weight off essentially permanently because the malabsorption is a constant (as opposed to RNY where the initial malabsorption is limited). There are a few more side-effects (really, things to keep in mind) for long-term DS patients-- these can be compared with the long-term issues for RNY patients so you can make the informed decision about what you can and can't live with. The reason why lap RNY is called the "gold standard" is a National Institutes of Health report that critiqued the statistics and methods of each of the major weight loss surgeries. The report explained that RNY includes disincentives to over-eating and poor food choices (like dumping) and permanent restriction with fewer side-effects than other methods. There are many times I think I should have had the DS-- although I still dump (which was critical for me in avoiding all the bad foods I gravitated toward when I was over 500 pounds), portions can increase over time. And, although I have maintained most of my weight loss, I don't like having weight that bounces a little every year.
   — SteveColarossi

March 5, 2009
The reseach that I have done and what I was informed by sugeons is that the Duodenal Switch sugery is for people extreamly overweight. I need to lose about 150 and they said I did not qualify. It is also very good for those with diabetes it really helps to eliminate it. But there are more side effects and dangers to this surgery. I have also heard that there is an extreame gas problem. People with this surgery have a tendancy to make very very bad smelling gas that can clear a very large room. I know of someone that had to be released as a volunteer from our local hospital because the gas was creating such a big problem. I would research some more extensively before chosing this surgery. The results are excellent but there are more risk.
   — Lisa von Wallmenich

March 5, 2009
RNY is the "Gold Standard" because it has been done so often. If you check out the Revisions board you will see RNY and Lapband are the surgeries that fail the most. I don't recall ever seeing anyone who had a DS need a revision. Please take the time and research, research, research. You don't want to pick the wrong surgery and end up gaining (like me). I wish you good luck.
   — Katrina B.

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