Question:
DS or RNY

I really need help, this is long but please bear with me!! I have been working on insurance approval for this surgery for almost a year and have finally made the decision to self pay. I live in southeast MO and through this sight and the help of a wonderful friend and nurse-practioner I have decided to go with Dr. Chris Eagon in St. Louis. I have really enjoyed this sight and read most of the daily questions. In doing this, I have began to wonder if I have chose the correct surgery for me. I have heard more and more that DS is more certain to keep weight off than RNY. My problem is this. I already have a pre-eval. appt. with Dr. Eagon (May 10 &11)and have already paid for all of my "pre-things" with him. I really feel comfortable with this doctor and have waited in a very long line to get where I am with him. Only he does not do DS. I have felt very confident with my decision to go with rny until now. I really need to know the difference between the two, pros and cons; and I have no idea where to look for a surgeon. The only thing is I have heard good things about a surgeon in Nashville but don't really know anything about him. I know deep in my heart that all of this stems from an insecurity that I will regain weight, that is my biggest fear! Please help me!!! — Faith B. (posted on April 19, 2004)

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April 19, 2004
Faith, what you are asking is for somebody to talk you into one or the other. That is not the best way to decide which surgery you will have. You really just need to do your research and decide for yourself. Each person on this site is usually very happy with the surgery they chose for themselves. You need to look at the pros and cons of each surgery and then make an educated decision on which surgery is best for you, your lifestyle, and what is important to you as a post-op. <p>Obesityhelp.com (this site) has a DS message board which is a great resource for researching the DS. Also, check out www.duodenalswitch.com for lots of valuable info., access to patient stories, links to other DS sites and statistical information. <p>I had the DS 2 and 1/2 years ago. If you would like more info. after reading my profile, please feel free to email me with any questions you might have. I would be happy to answer them.
— artistmama

April 19, 2004
The one that is best, is the one that is right for you and only you can decide that. You will get tons of opinions on both sides of this issue. Read up on the post-op life of both procedures and figure out which one you can live with. I truly believe that an RNY can be as successfull long term as a DS patient. The success comes from how we embrace the surgery we choose. I believe we can sabotage either one to varying degrees. I suspect much of your pre-op stuff could switch to a new doc if you decide the DS is right for you, but would probably have to redo some bloodwork. Just make sure that whoever you go with, for either surgery, has tons of experience with the chosen procedure. Follow-up and suuport are very important key pieces also. Just because a doc can do the surgery, if their follow-up sucks it will likely factor into your long term success. We had a woman who came to our support group that had her surgery in France. She went there because she was self-pay and it was cheap. They sent her home with 1 piece of paper - nothing else. No info on eating, follow-up tests etc. That's darn scary. Fortunately she was able to connect up with our program and get some support to help her out. Good Luck in your quest for information!
— zoedogcbr

April 19, 2004
I had my DS in Nashville a little over four months ago. If youo'd like to ask questions about the doctors there who do the DS, feel free to e-mail me. I am VERY happy with the quality of life I'm enjoying as a post-op DSer. I am eating better than I ever have, and enjoying my food more. I have never felt deprived in any way, and I can still drink with my meals and---a real biggie for me---take NSAIDs for my arthritis. I have more energy that I have EVER had, and it just gets better and better all the time!
— MsBatt

April 19, 2004
Well, here is my 2 cents worth: I wanted a DS but the doctor I saw only does Open proximal RNY. Now that I have had it done, I am very happy. Not everyone will have the same experience, but this is my perception based on my own experience and from reading profiles and message boards. I like the RNY better now because my pouch although being large for most RNY's (4 oz) is smaller than the typical 6 oz DS stomach. I physically stop eating sooner and feel satisfied. I like that I can't eat sugar and other such things. I think the dumping is a good deterrent. I have been watching boards, profiles and people at my local group who have had DS who are losing slower. Why? Well, it could be they haven't changed any of their eating habits. It could be that there is a psychological sabatoge they do with themselves where they reason since there is more malabsorption that they don't have to worry about it if they eat lots of ice cream or drink milkshakes. It could be that they feel it's more of a sure thing, so they forget that even the DS isn't a magical cure. For whatever reason, I think it's easier to lull yourself into a sense of complacency with a DS than an RNY. Certainly this does not apply to everyone, and it's not scientific at all. It's something that I'm getting a sense of only. So I'm very happy with my RNY now and am happier that I didn't get the DS that I originally wanted. And just as I am happy with my surgery, there are lots of people with DS who wouldn't have it any other way as well. Good luck in your journey and I hope you are very happy with whatever one you get!
— Dinka Doo

April 19, 2004
Yes, definitely research this for yourself. You are the one who has to live with it for the rest of your life. If you need more time you could always reschedule your consultation with Dr. Eagon. Good luck.
— Shelly S.

April 19, 2004
Talk to your surgeon about your concerns! DS vs RNY tends to be a hot topic here. I think aftercare is as or more important than than the initial surgery, since we live the rest of our lives changed forever. Honestly I love my RNY! Have you thought about getting a part time job say at home depot for insurance so you dont have to pay for the surgery?
— bob-haller

April 19, 2004
Here is my opinon and that is all this is. I know that you can go from RNY to DS, but you CAN'T go from DS to RNY. I had RNY I lost 170 in 18 months and am alsmot at goal( i want to lose 10 more) I am happy for my loss and I am happy with my surgery, than some people came into our support group who had the DS and I was so jealous of them, they went down to bone, they were so thin and they said they were happy with their choice and told us what a day was like in their life. I also understand that because they malasorb more they need MORE supplements, One girl described it like taking that medication XENICAL if she eats something fatty she ends up in the bathroom. I go back and forth. You really need to weigh out the pro's and con's ask every medical proffesional for their opinon than ask them to tell you why they feel that way. Good Luck
— nicole79

April 19, 2004
Faith, I had the DS three years ago. I got to within 30 pounds of goal, and have regained about 5 pounds and appear to be holding steady. I eat ANYTHING that I want to eat, though much less of it than before. That includes sweets and fibrous food, and I don't have to chew, chew, chew to avoid blocking up a pouch stoma, because with the DS my stomach is fully functional, though much smaller. But, that's just me; others have their own very valid preferences. My life has changed for the better. At age 64 I feel better than when I was 50. Yes, there are bathroom issues, but they are not substantially different from the bathroom issues with the DISTAL RNY. When you think of the RNY, you have to differentiate between PROXIMAL, MEDIAL, and DISTAL, depending on how much of the digestive path is bypassed (PROXIMAL = least; DISTAL = most). As for asking surgeons, my impression is that most bariatric surgeons do the RNY (or banding), and that they will advise you to get the procedure(s) that they do. They will disparage other procedures. So, if you talk to surgeons about your question, you should talk to those who do both the RNY and the DS. Drs. Terry Simpson in Arizona and Hazem Elariny are among the docs that do both. I am sure there are several, but NOT MANY, others. Just remember one thing: "My worst day thin is better than my best day fat." --Steve
— Steve G.

April 20, 2004
Hi Faith. I agree with some of the other responses in that research is the key here. Go to http://www.duodenalswitch.com for sure to get a lot of info about the DS. Okay, now for some info on my experience. I had the DS 2.5 years ago (and I just had a tummy tuck 3 weeks ago!). I went from a size 30 to a size 14 (and now getting into smaller sizes without the extra skin!). Yeah, the weight loss was great, but it's the "little things" that really matter. I can go to a restaurant and choose any item on the menu. There are no "rules" to live by. When people hear that they can "eat anything they want, when they want" they often assume DS patients are gluttons, and that's NOT the case. The average DS stomach begins between 3-5 oz (whoever said 6oz is wrong). It functions EXACTLY as a fullsize stomach. You retain your pyloric valve, which regulates the emptying of the stomach - whereas it is bypassed in the RNY, which is what causes the DUMPING syndrome you may have heard about. The DUMPING in an RNY will NOT stop you from eating sweets. If you want to eat it, you will. Then you may or may not dump. It's not a sure-fire solution to stop eating those things. Also, if you totally devoid yourself of certain foods, you will eventually binge. Not good. Having a small DS stomach is tough at first because you have to make choices. "Okay, I have this tiny space. Do I fill it with chicken, or chocolate?" You'll find yourself making better food choices with ease, AND you can treat yourself to a small dessert with no ill effects. You can also DRINK with your meals (which I hear is a major complaint with the RNY). Now, I do have 2 dear friends who've had the RNY because that's all their insurance would cover (they initially wanted the DS). One has done very well in the last year, but her daily "diet" is 5 protein shakes. Every so often she eats food, but not too much because she still gets sick. Personally, I wouldn't want to live like that. The other friend did amazingly well also and reached goal in a year. Now, a year later, he's regained 35 lbs and he's able to eat sweets without dumping, so he does. His pouch has stretched and he's eating more every day. He's petrified of total regain, and honestly, he's headed that way. With the DS, your stomach DOES stretch, but it will never be as much as it was preop. After about 2 years you level out, and your stomach is 'normal' sized. This, along with the malabsorption that remains forever, enables you to maintain your weightloss. The RNY does not have the degree of malabsorption to ensure maintenance - hence the regain if the pouch stretches. I could go on and on, and you can see I'm pro-DS. For the record, I do NOT have stinky bowel issues or all those 'horror stories' that RNY doctors try to use to scare you. Each person is different, so you never know where you'll fall on that spectrum. As for supplements, both options require lifetime supplementation. I take pills daily and things are fine. So don't let that be a deterent. GOOD LUCK! OH, you can visit my site at http://www.sassssy.com if you like, or my profile here. Please write if you have any questions!
— Amber S.

April 20, 2004
Faith, you sound very undecided. Stop now and think what you want to do. One answer to your question stated that you cannot go from a DS to an RNY, but can go from an RNY to a DS. This is not exactly right. With a DS you have your normal functioning stomach including your pyloric valve, which is a handy little thing to hang on to. With a RNY it is bypassed. Your stomach is smaller, but works the same with the DS. I know you have researched your surgeries and it sounds like you are really wanting the DS. If this is the case, you need to find a surgeon you are as comfortable with as the one you are seeing now. I had my DS 15 months ago and have lost 125 pounds with no regain yet, though I expect a few pounds to come back in the next few months. I do not deny myself any foods whatsoever and have not since my leak repair in December. This includes sugar which I know is not the best thing for a RNYer. Please do not misunderstand what I am saying here. I truly believe in choosing the surgery that you feel is best for you and YOU being happy with it. You don't have to justify anything to anybody. My honest opinion is that you will have less regain with a DS, and this seems to be your greatest fear. I wish you luck in your decision. Happy journey!
— Wenda C.

April 20, 2004
Faith, I'm postop DS, and I would like to correct 1 thing that was posted here. One poster states, "you can't go from DS to RNY but you can go from RNY to DS." Well.. not exactly. I COULD get the RnY configuration done and a pouch created.. but there's no need. The reason you never see a DS convert to RnY is because they don't need to. And yes, you can USUALLY convert from the RnY to a DS, but you also might not be able to fully convert- if your pouch was created by completely cutting the unused stomach free of the pouch, that's not reversible- the scar tissue would make the newly enlarged stomach pretty fragile, and no reputable surgeon is going to risk the chance that the scar tissue could break open. Also, depending on how long you've had an RnY, your stomach remnant may not be functional- the pylorus just might not work. But these are also not certainties, but possible problems. I looked at all the available surgeries out there before I chose the DS, and my final reason for choosing it was that research showed that I had a better chance of losing more of my excess weight and, allowing for a 10% "bounce back" that some (but not all DSers) experience, keeping the weight off permanently. One of my buds suggested that I "try the RnY first"- Umm.. I'm a pain wimp, this is a major surgery, and you want me to do something that I might need to go for a repeat? Not this girl. To be fair, I do need a revision.. but its not because my surgery failed, but because my surgeon failed me. I was only his 35th DS, and he was still learning, I guess. But (obviously) I'll do it again when things are right(with a different surgeon), and I'm still 100 lbs more comfy than I was, and I'm not regaining. I just need to lose another 100 lbs. Oh, and I feel the need to address the bowel issues, since folks act like its going to ruin your life if your Poop stinks. Yes, I had some issues. I was eventually diagnosed with diarrhea-prevalent IBS, which my gastro felt was caused more by the gallbladder removal than the DS. I had some seriously bad gas.. but my surgeon's partner put me on Flagyl 500 mg 2x/day for 14 days, and it went away. I take enteric coated acidophilus (so that the good criiters are dumped into my intestines) and unless I get lazy and stop taking it, my gas is no worse than it ever was preop.. in fact, its better. I was a very gassy girl! My BMs do not smell like roses, but they never did.. and they aren't deadly, so? Besides.. I have 2 coworkers who've had the RnY, and one of them has periodic gas & stinky BM issues, and the other one will candidly admit that there are days when she will walk to the far side of the building because she doesn't want to "gas out" her coworkers after she's had a BM (her choice of words, not mine). So don't think that DS= stinky gassy diarrhea, cuz it doesn't. I addressed it only because that's the first thing I hear. And for the record, both of my coworkers are fairly happy with their surgeries, as am I. When we talk about our surgeries, its not "My surgery's better than yours," its, "Isn't life easier?", or "Have you had to deal with...? What did you do?" At any rate, Learn everything you can, and if you have ANY doubts, you need to stop and learn whatever it takes to get rid of those doubts- this is YOUR body, YOUR life, and you deserve to be as happy and healthy as possible. And whatever surgery you choose, good luck on your journey!
— Liane F.

April 20, 2004
I also love my RNY. As Bob said, aftercare is the most important aspect of the surgery. Also, we can't forget that we need to be committed and follow the rules. This surgery needs to be taken seriously.
— Sara H.

April 20, 2004
My only comment to all the pro DS posts, which I carefully did not push the RNY in my earlier post, is that I will put my 250 lb loss in 14 months up against a DS any day of the week. I also will put my long term ability to keep my weight at a reasonable level into the picture. I know of quite a few long term RNY's that have had no more than the 10% regain. I eat whatever I want but because I have chosen a healthier life I don't gorge on total crap food, but I do eat some of it. I do eat sugar, in smaller quantities and have no problem with that. I have found some no sugar added ice cream type treats that are great. If I want a little cake or pie, I have it, but I am satisfied to have just a few bites. I do not deprive myself as that just sets a person up for failure in my opinion. I do not live on a diet or eat diet food, unless it's something I liked before surgery anyway. I eat a good sized portion of food and am shocked how much sometimes. My pouch does let me know when I've exceeded it's limit, but that's good. I have never touched a protein drink in my life. I do eat protein bars once in a while as a convenience food or snack. Most RNY's that are 150 cm's or less bypassed do not need to live on protein drinks. It's the RNY's that get revised to a DS that end up that way because their pouch is too small to get in enough nutrition to support the super long bypass/short common channel. I would never go into having an RNY thinking it can be revised to a DS. The DS is designed to have that long bypass by having the larger normal functioning stomach. The RNY is not designed to have a long bypass without serious malnutrition problems. So it is important to pick the surgery that will work for you the first time. I know that some DS people have little to no bathroom issues, but the potential is there for more problems than an RNY. When I researched it, it just reminded me of the two months from hell I spent on Xenical. I have other bowel issues etc. and did not want to gamble the DS in my particular situation. <p>All I can say is that my eating is very normal just somewhat smaller portions. It's a persons attitude about the surgery they have and the post-op life, that is the most important. Too many RNY's go into it thinking they can never have X again, which just isn't the case. You may choose not to have it, but the bottom line is you can if you can tolerate it. There are less than a handful of things I do not tolerate, so it's not like I had to give up everything I liked. <p>The bottom line is everyone's journey is different and what they are able to eat and how their body deals with the surgery there is no way to predict. If the DS is right for you, then go for it, but just don't assume that the life of an RNY is a problem or undesirable life. For me the only difference is that now my pouch talks to me and lets me know when it's full. I only had that feeling before surgery after I had way overeaten. I go out to eat often but just end up with multiple meals for the price of 1. I eat the bread and potatoes etc., but usually don't end up eating all of it by the time the protein is gone. I get plenty of the carbs etc. and am satisfied. Mental attitutde is the key to any of these surgeries!
— zoedogcbr

April 23, 2004
I would like to thank all of you for your opinions. I will definitely do my own research on DS and I appreciate the sites that were given. Another thing, I am definitely looking for the best surgery for me without any revisions ( unless absolutely medically necessary) since I am self pay. Once again thank you all for being so helpful
— Faith B.

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