Question:
Can someone please explain what the difference is between
Roux and Y and Duodenal Switch? Which is better? From my research is seems Duo is better but now very common. — marcia5000 (posted on January 28, 2009)
January 28, 2009
Most RNYers even years later and WITH some complications will tell you that
they would not do it any other way...The same with the DS...although I have
heard complaints from both...Each surgery has it's own risks and lifestyle
changes. DSers need to eat plenty of fat and have a less restrictive
diet...and take TONS of vitamins...I have to take a lot of vitamins myself
with RNY because I have a lot of trouble keeping my vitamin levels normal
for whatever reason. Most RNYers do not realise the importance of taking
vitamins forever...It usually catches up to them! It did, me! I also have a
restrictive diet of eating basically healthy food. (low sugar, high fiber
and protein, restrictive calories based on my personal metabolism and
plenty of exercise) Those are my basic long term rules. Eating healthy
food in smaller portions is what I personally choose with RNY. I have
strived my entire life to eat healthy and smaller and RNY helps me achieve
this way of eating to maintain a small sized person. I could not do that
before RNY for long term. I was not interested in eating a high fat, high
calorie diet...It's just a personal preference. I am not saying that DSers
don't eat healthy...Certainly they can eat healthy... Their diet is not how
I want to eat or what I want to eat...I pop so many vitamins daily at 5
years RNY post op regardless of what surgery I had...But I eat small and
health conscious. If I had had DS...I'd be in serious trouble, I think
because I am closer to a vegetarian than anything...but I do eat meat...I
must! I do admit though that I am a bit envious of some of the things DSers
eat daily with no troubles! LOL Here is an animated video of all three main
WLS and how they are done. This is from the very prestigous Mayo Clinic.
http://www.mayoclinic.com/health/gastric-bypass/MM00703
— .Anita R.
January 28, 2009
If those were the only two choices that I had, I would choose the Duodenal
Switch. The RNY, or Gastric Bypass is known as the "Gold
Standard" in Weight loss surgery because it is the most commonly
performed surgery. I suspect that this is because it is the surgery that
most INSURANCE companies are willing to PAY for. They fear paying for an
"unproven" option, and thus, artificially inflate the RNY to the
status of the "Gold Standard" in MY admittedly unprofessional
opinion. I am NOT a medical professional, so take what I say with a grain
of salt, if not with the whole salt cellar. ;-) The Gastric Bypass
basically creates a "Pouch" from the top or side of the stomach.
There are several different versions of this surgery, but the most common
style is to have the top of the stomach cut from the rest of the stomach,
and have a pouch created from that segment. Then a section of intestine is
re-routed and attached to the side of the pouch that has been created from
the top of the stomach. The BOTTOM of the stomach is left in the abdominal
cavity, but is vestigial. It no longer provides a function for digestion.
It remains attached to the intestine, and the rest of the intestine remains
attached to the bile duct. That segment of intestine is sewn back on to
the segment of intestine that had been rerouted to the side of the newly
created stomach pouch and constitutes the "Y" part of the
"RNY" or Roux eN Y. The Duodenal Switch is similar in some ways
to the Roux eN Y, or Gstric Bypass, in that there is a bypass of the
intestinal tract that occurs. Just like the Roux eN Y, the intestinal
tract is cut, and a "Y" is formed, but UNLIKE the Roux eN Y, the
stomach is NOT divided into an upper and lower section, bu instead it is
created into a tube, or "SLEEVE." Where in the Roux eN Y, the
bypassed intestine would be attached to the SIDE of the newly created
pouch, the intestine instead is attached to the bottom of the newly created
SLEEVE. The stomach is separated from the bile duct by the removal of the
gall bladder. One end of the "Y" is attached to the bypassed
intestine at a point on the intestine that is a bit farther along than is
typical in the RNY, and the other leg of the "Y" is attached to
the bile duct. Both surgeries are quite effective in helping the people who
HAVE them achieve significant weight loss. There are both benefits and
SIDE EFFECTS to BOTH, however. The Duodenal Switch is the MOST EFFECTIVE
in helping patients achieve their wieght loss goals in the shortest
possible time. It has the HIGHEST rate of effectiveness. It also has some
of the severest compications. You will need to be on dietary suppliments
for the rest of your life. You will require blood work to ensure that you
are getting the proper nutrition for the rest of your life. There are
certain medications that you will NOT be able to take because your body
will NOT be able to metabolize them due to your shortened intestinal tract.
This is true with BOTH surgeries. The differnce is only one of SEVERITY
with the Duodenal Switch. It is simply a matter of DEGREE of the side
effects that you will suffer in comparison to the benefit that you will get
from the weight loss. There is also the possibility of Dumping Syndrome.
This is not a guarantee, You are likely to get this with EITHER operation.
It is not a pleasant experience. Most people who get this, get it from
consuming sugar or fats. Some get the syndrome from consuming BOTH. You
never know if you are going to be the one to get it. Some people go into
surgery HOPING to get the syndrome, and some hoping to avoid it. Those
HOPING to get it, want to use it as a crutch to help them lose weight.
They feel that if the pain of eating their favorite foods was severe
enough, they could overcome thier weakness, and finally give it up. You
cannot COUNT on the outcome, one way or another. There is no way to TELL
who is going to get the synddrome before they go into surgery. The good
news is that these two surgeries are NOT your only options. I had the
Vertical Sleeve Gastrectomy, which was essentially a MODIFIED version of
the Duodenal Switch. In MY case, what the surgeon did was simply remove 85
percent of my stomach, cutting it down into a "SLEEVE." That is
ALL that was done. There was NO bypass. There was no Gall Bladder
removal. The Vertical Sleeve Gastrectomy (VSG) is almost as effective as
the Roux eN Y. Statistically, it is almost EXACTLY as effective being
within 2 or 3 percent difference. The Vertical Sleeve Gastrectomy is
something like 78 or 79 percent effective, while the Gastric Bypass is
about 80 or 81 percent effective in helping the people who have it lose
weight, if I remember correctly (not that I am saying that I do). It is
close to that, I am sure. The BENEFIT of having the VSG is that it is
EFFECTIVE, and there are FEW SIDE EFFECTS. Since there is no BYPASS, there
is no malabsorption issues that come with that. It is quite RARE to find
someone who is dealing with "Dumping Syndrome" who had had the
VSG. I had it BEFORE I had the VSG. The surgery REVERSED the symptoms! I
have lost 110 pounds since March 2, and have had NO problems. I am QUITE
happy with my surgery, and would highly recommend it to anyone. The
biggest problem with the VSG is that MANY insurance companies will not PAY
for it because they consider it to be an "EXPERIMENTAL"
procedure. It has been around for DECADES as a treatement for STOMACH
ULCERS and STOMACH CANCER, but NOT as a treatment for WEIGHT LOSS! Since
it had not been APPROVED as a treatment for WEIGHT LOSS by the government,
many insurance companies are reluctant to pay for the treatment. Doctors
had noticed that one of the SIDE EFFECTS of the treatment of patients for
STOMACH PROBLEMS that got the VSG WAS weight loss, so they began to USE the
treatment for weight loss as well. If you want to find out more about the
various surgical weight loss options, check out my profile page at:
http://www.obesityhelp.com/member/hubarlow/. Looke 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. I hope this helps. Hugh
— hubarlow
January 28, 2009
If those were the only two choices that I had, I would choose the Duodenal
Switch. The RNY, or Gastric Bypass is known as the "Gold
Standard" in Weight loss surgery because it is the most commonly
performed surgery. I suspect that this is because it is the surgery that
most INSURANCE companies are willing to PAY for. They fear paying for an
"unproven" option, and thus, artificially inflate the RNY to the
status of the "Gold Standard" in MY admittedly unprofessional
opinion. I am NOT a medical professional, so take what I say with a grain
of salt, if not with the whole salt cellar. ;-) The Gastric Bypass
basically creates a "Pouch" from the top or side of the stomach.
There are several different versions of this surgery, but the most common
style is to have the top of the stomach cut from the rest of the stomach,
and have a pouch created from that segment. Then a section of intestine is
re-routed and attached to the side of the pouch that has been created from
the top of the stomach. The BOTTOM of the stomach is left in the abdominal
cavity, but is vestigial. It no longer provides a function for digestion.
It remains attached to the intestine, and the rest of the intestine remains
attached to the bile duct. That segment of intestine is sewn back on to
the segment of intestine that had been rerouted to the side of the newly
created stomach pouch and constitutes the "Y" part of the
"RNY" or Roux eN Y. The Duodenal Switch is similar in some ways
to the Roux eN Y, or Gstric Bypass, in that there is a bypass of the
intestinal tract that occurs. Just like the Roux eN Y, the intestinal
tract is cut, and a "Y" is formed, but UNLIKE the Roux eN Y, the
stomach is NOT divided into an upper and lower section, bu instead it is
created into a tube, or "SLEEVE." Where in the Roux eN Y, the
bypassed intestine would be attached to the SIDE of the newly created
pouch, the intestine instead is attached to the bottom of the newly created
SLEEVE. The stomach is separated from the bile duct by the removal of the
gall bladder. One end of the "Y" is attached to the bypassed
intestine at a point on the intestine that is a bit farther along than is
typical in the RNY, and the other leg of the "Y" is attached to
the bile duct. Both surgeries are quite effective in helping the people who
HAVE them achieve significant weight loss. There are both benefits and
SIDE EFFECTS to BOTH, however. The Duodenal Switch is the MOST EFFECTIVE
in helping patients achieve their wieght loss goals in the shortest
possible time. It has the HIGHEST rate of effectiveness. It also has some
of the severest compications. You will need to be on dietary suppliments
for the rest of your life. You will require blood work to ensure that you
are getting the proper nutrition for the rest of your life. There are
certain medications that you will NOT be able to take because your body
will NOT be able to metabolize them due to your shortened intestinal tract.
This is true with BOTH surgeries. The differnce is only one of SEVERITY
with the Duodenal Switch. It is simply a matter of DEGREE of the side
effects that you will suffer in comparison to the benefit that you will get
from the weight loss. There is also the possibility of Dumping Syndrome.
This is not a guarantee, You are likely to get this with EITHER operation.
It is not a pleasant experience. Most people who get this, get it from
consuming sugar or fats. Some get the syndrome from consuming BOTH. You
never know if you are going to be the one to get it. Some people go into
surgery HOPING to get the syndrome, and some hoping to avoid it. Those
HOPING to get it, want to use it as a crutch to help them lose weight.
They feel that if the pain of eating their favorite foods was severe
enough, they could overcome thier weakness, and finally give it up. You
cannot COUNT on the outcome, one way or another. There is no way to TELL
who is going to get the synddrome before they go into surgery. The good
news is that these two surgeries are NOT your only options. I had the
Vertical Sleeve Gastrectomy, which was essentially a MODIFIED version of
the Duodenal Switch. In MY case, what the surgeon did was simply remove 85
percent of my stomach, cutting it down into a "SLEEVE." That is
ALL that was done. There was NO bypass. There was no Gall Bladder
removal. The Vertical Sleeve Gastrectomy (VSG) is almost as effective as
the Roux eN Y. Statistically, it is almost EXACTLY as effective being
within 2 or 3 percent difference. The Vertical Sleeve Gastrectomy is
something like 78 or 79 percent effective, while the Gastric Bypass is
about 80 or 81 percent effective in helping the people who have it lose
weight, if I remember correctly (not that I am saying that I do). It is
close to that, I am sure. The BENEFIT of having the VSG is that it is
EFFECTIVE, and there are FEW SIDE EFFECTS. Since there is no BYPASS, there
is no malabsorption issues that come with that. It is quite RARE to find
someone who is dealing with "Dumping Syndrome" who had had the
VSG. I had it BEFORE I had the VSG. The surgery REVERSED the symptoms! I
have lost 110 pounds since March 2, and have had NO problems. I am QUITE
happy with my surgery, and would highly recommend it to anyone. The
biggest problem with the VSG is that MANY insurance companies will not PAY
for it because they consider it to be an "EXPERIMENTAL"
procedure. It has been around for DECADES as a treatement for STOMACH
ULCERS and STOMACH CANCER, but NOT as a treatment for WEIGHT LOSS! Since
it had not been APPROVED as a treatment for WEIGHT LOSS by the government,
many insurance companies are reluctant to pay for the treatment. Doctors
had noticed that one of the SIDE EFFECTS of the treatment of patients for
STOMACH PROBLEMS that got the VSG WAS weight loss, so they began to USE the
treatment for weight loss as well. If you want to find out more about the
various surgical weight loss options, check out my profile page at:
http://www.obesityhelp.com/member/hubarlow/. Looke 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. I hope this helps. Hugh
— hubarlow
January 29, 2009
I'm still pre-op, but I decided on the DS rather than the RNY because the
DS has the highest success rate of all the WLS options, and also because
the "cure" rate for diabetes, high blood pressure, etc. is almost
immediate (at least from what I've read - the RNY may have the same cure
rate, not sure). I don't want to have to deal with dumping. And I believe
I will have less of a problem getting in all of my protein with the DS than
I would have limiting my intake of various foods with the RNY. Keep
educating yourself on both the DS & the RNY and make the choice that is
best for you. Also you might want to check out duodenalswitch.com. Best
of luck to you:-)
— sem51
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