More about the DS that you may not know
1) The DS is suitable and accepted by the ASMBS, AACE, Medicare, and an increasing number of insurance companies for all people who qualify for bariatric surgery, not just the people for whom it is the CLEARLY better surgery. In fact, the DS is very customizable – the vertical sleeve gastrectomy can be varied in size from 1 oz to 6 oz; the length of the alimentary limb (in which many nutrients are absorbed, even without bile and pancreatic enzymes) can be varied; and of course the length of the common channel can be varied – I’ve seen 65 cm to 250, depending on the patient’s particular needs.
2) The resolution – CURE! – rate for type 2 diabetes is superior with the DS: http://jama.ama-assn.org/cgi/content/full/292/14/1724
There was a difference in diabetes outcomes analyzed according to the 4 categories of operative procedures. With respect to diabetes resolution, there was a gradation of effect from 98.9% (95% CI, 96.8%-100%) for biliopancreatic diversion or duodenal switch to 83.7% (95% CI, 77.3%-90.1%) for gastric bypass to 71.6% (95% CI, 55.1%-88.2%) for gastroplasty, and to 47.9% (95% CI, 29.1%-66.7%) for gastric banding.
3) The DS is clearly better for people with a BMI > 50. Duodenal switch provides superior weight loss in the super-obese (BMI > or =50 kg/m2) compared with gastric bypass.
4) The DS is a better option for African-Americans, and probably other non-Caucasians who have metabolic issues in common, e.g., Hispanics and Native Americans:
1: Obes Surg. 2008 Jan;18(1):39-42. Epub 2007 Dec 15.
The impact of race on weight loss after Roux-en-Y gastric bypass surgery.
Harvin G, DeLegge M, Garrow DA.
Department of Medicine, Division of Gastroenterology and Hepatology, Digestive Disease Center, Medical University of South Carolina (MUSC), 96 Jonathon Lucas Street, CSB #210, P.O. Box 250 327, Charleston, SC, USA.
BACKGROUND: Gastric bypass surgery for morbid obesity has dramatically increased in volume over the past decade. Caucasian patients have been noted previously to lose more weight after bariatric surgery than African-Americans patients. Data regarding predictors of maintaining weight loss after surgery are minimal. We sought to determine predictors of long-term weight loss after bariatric surgery. METHODS: Retrospective analysis using a multivariate logistic regression model of all patients undergoing Roux-en-Y gastric bypass surgery at the Medical University of South Carolina from May 1993 to December 2004 for whom 2 years of follow-up data was available. Our dependent variable was the percentage of weight lost from baseline, dichotomized at +/-35%. Our primary independent variable was race, defined as Caucasian, African-American, or other. Relevant covariates were added to the model to control for their potential effects on outcome. RESULTS: One hundred eleven patients (17 male/94 female; 85% Caucasian, mean age 44 years (range 18-68 years). In our model, Caucasian subjects (adjusted odds ratio [OR] = 7.60, 95% confidence intervals [95%CI] = 1.83-31.5) and late post surgical complications (adjusted OR = 2.67, 95%CI = 1.05-6.80) significantly predicted weight loss at 2 years, after controlling for relevant confounders. Other covariates did not significantly impact the model. CONCLUSION: Race and late post surgical complications significantly impacted the percentage of weight loss at 2 years for patients undergoing Roux-en-Y gastric bypass surgery at our institution. Future research should be directed at determining potential genetic and/or social reasons for these differences.
1: Obes Surg. 2007 Apr;17(4):460-4.
Are African-Americans as successful as Caucasians after laparoscopic gastric bypass?
Madan AK, Whitfield JD, Fain JN, Beech BM, Ternovits CA, Menachery S, Tichansky DS.
Section of Minimally Invasive Surgery, Department of Surgery, University of Tennessee Health Science Center, 956 Court Ave., Room G210, Memphis, TN 38163, USA. amadan@...
BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been demonstrated to provide weight loss comparable to open gastric bypass. It has been suggested that African-Americans (AA) are not as successful as Caucasians (CA) after bariatric surgery. Our hypothesis was that AAs are just as successful as CA after LRYGBP in terms of weight loss and comorbidity improvement. METHODS: A retrospective chart review was performed on all AA and CA patients who underwent LRYGBP for a 6-month period. Success after LRYGBP [defined as (1) 25% loss of preoperative weight, (2) 50% excess weight loss (EWL), or (3) weight loss to within 50% ideal weight] was compared by ethnicity. RESULTS: 102 patients were included in this study. 97 patients (30 AA patients and 67 CA patients) had at least 1-year follow-up data available. Preoperative data did not differ between both groups. There was a statistically significant difference in %EWL between AA and CA (66% vs 74%; P<0.05). However, there was no ethnic difference in the percentage of patients with successful weight loss (as defined by any of the above 3 criteria). Furthermore, there was no statistical difference between the percentages of AA and CA patients who had improved or resolved diabetes and hypertension. CONCLUSIONS: LRYGBP offers good weight loss in all patients. While there may be greater %EWL in CA patients, no ethnic difference in successful weight loss exists. More importantly, co-morbidities improve or resolve equally between AA and CA patients. LRYGBP should be considered successful in AA patients.
1: Obesity (
Weight loss and health outcomes in African Americans and whites after gastric bypass surgery.
Anderson WA, Greene GW, Forse RA, Apovian CM, Istfan NW.
Section of Endocrinology, Diabetes and Nutrition,
OBJECTIVE: The objective was to describe differences in weight loss, dietary intake, and cardiovascular risk factors between white and African-American patients after gastric bypass (GBP). RESEARCH METHODS AND PROCEDURES: This was a retrospective database review of a sample of 84 adult patients (24 African-American and 60 white women and men) between the ages of 33 and 53 years. All subjects had GBP surgery in 2001 at the Bariatric Surgery Program at
1: Obes Surg. 2006 Feb;16(2):159-65.
Ethnic differences in obesity and surgical weight loss between African-American and Caucasian females.
BACKGROUND: In the general population, African-American females are more obese and resistant to weight loss than Caucasian women. In the present study, we examined the severity of obesity among morbidly obese African-American and Caucasian females, studied the effectiveness of Roux-en-Y gastric bypass (RYGBP), and sought to identify factors contributing to obesity and weight loss. METHODS: The study population included 153 morbidly obese females randomly selected from our general bariatric patient population. Anthropometric measurements consisted of body weight, body mass index (BMI), excess weight, and waist, hip, thigh, and neck circumferences. Factors that may contribute to obesity included age, age of obesity onset, number of childbirths, calorie intake, diet composition, and degree of psychological distress. The effects of RYBGP were studied in weight-matched groups of African-American and Caucasian females (n=37 per group) at weight loss nadir, i.e. 12 to 18 months after surgery. RESULTS: We found that morbid obesity is more severe among African-American than Caucasian females. The greater degree of obesity of African-American, as compared to Caucasian, females is not due to ethnic differences in calorie intake, diet composition, age or age of obesity onset, number of childbirths, and psychological distress. RYGBP is less effective in reducing body fat and, consequently, excess body weight of the African-American than the Caucasian females, suggesting possible ethnic differences in fat metabolism. CONCLUSION: African-American females with morbid obesity have greater adiposity than do Caucasian women and lose significantly less body fat after RYGBP.
1: J Assoc Acad Minor Phys. 2001 Jul;12(3):129-36.
Bariatric surgery for severe obesity.
Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia 23298-0519, USA. hsugerma@...
Severe obesity is associated with multiple comorbidities and is refractory to dietary management with or without behavioral or drug therapies. There are a number of surgical procedures for the treatment of morbid obesity, including purely gastric restrictive, a combination of malabsorption and gastric restriction or primary malabsorption. The purely gastric restrictive procedures, including vertical banded gastroplasty and laparoscopic adjustable silicone gastric banding, do not provide adequate weight loss. African-American patients do especially poorly after the banding procedure with the loss of only 11% of excess weight in one study. Gastric bypass (GBP) is associated with the loss of 66% of excess weight at 1 to 2 years after surgery, 60% at 5 years and 50% at 10 years. For unknown reasons, African-American patients lose significantly less weight than Caucasians after GBP. There is a risk of micronutrient deficiencies after GBP, including iron deficiency anemia in menstruating women, vitamin B12, and calcium deficiencies. Prophylactic supplementation of these nutrients is necessary. Recurrent vomiting after bariatric surgery may be associated with a severe polyneuropathy and must be aggressively treated with endoscopic dilatation before this complication is allowed to develop. The malabsorptive procedures include the partial biliopancreatic bypass (BPD) and BPD with duodenal switch (BPD/DS). The BPD appears to cause severe protein-calorie malnutrition in American patients; the BPD/DS may be associated with less malnutrition. Weight loss failure after GBP does not respond to tightening a dilated gastrojejunal stoma or reducing the size of the gastric pouch. These patients may require conversion to a malabsorptive distal GBP, similar to the BPD. However, because of the risk of severe protein-calorie malnutrition and calcium deficiency BPD should be reserved for patients with severe obesity comorbidity. The risk of death following bariatric surgery is between 1% and 2% in most series but is significantly higher in patients with respiratory insufficiency of obesity. In most patients, surgically induced weight loss will correct hypertension, type II diabetes mellitus, sleep apnea, obesity hypoventilation syndrome, gastroesophageal reflux, venous stasis disease, urinary incontinence, female sexual hormone dysfunction, pseudotumor cerebri, degenerative joint disease pains, as well as improved self-image and employability.
What is the recovery time with the DS? I had RNY myself. But DH needs to get his weight under control. And he IS NOT willing to commit to the restrictions that I have committed to. As he said "I'm not ready to give up my food". But as his wife, sole mate, and mother of his child, I can NOT sit back and watch him slowly kill himself.
I have noticed in your previous post that you eat 3000 calories a day. Does that mean that you can eat what you want with no restrictions? And is weight loss slower for DS patients vs RNY patients? I am thinking this would be the surgery for DH.
We just switched to Kaiser, so I am a little nervous about the "fight" that will have to take place.
~Nicole
I love my RNY! Find me on myspace myspace.com/bebe_girl209 but be sure to tell me your from OH!
I had my lap DS 12 days before I turned 50, and my BMI was nearly 50. I was back to work (at a desk job) 20 days later. 5 weeks later I went on a cross-country business trip to DC and NYC, lugging my suitcase and computer stuff, and gave an hour long presentation to a group of lawyers for CLE credits. I was exhausted, but I didn't hurt myself. 2 months out, I traveled to Paris for a week on business/pleasure, and three weeks later, flew to Paris and then the UK for a 2.5 week vacation plus another legal presentation thrown in. Both trips, I lugged my own suitcase, and walked all over the place.
2) Yes I eat around 3000 cal/day, but no, not whatever I want without restrictions. Just mostly, and without guilt or concern about my fat intake.
a) I don't eat white flour products for breakfast or lunch on workdays, because they make me fart. I eat them at night and on weekends -- I call that TiVo'ing my white flour carbs, because it isn't that I CAN'T eat them, I just have to watch WHEN I eat them (I get gas 4-6 hours after eating them). It is MUCH easier to defer eating something until later in the day than to say I can't have it -- no deprivation involved.
b****ep my consumption of simple sugars to a minimum, sorta -- frankly, sweets have lost their appeal for me to some extent since my DS, because the surgery changed my insulin metabolism -- the first bite of something sweet is fabulously delicious (and guilt-free!), the second is yummy, the third tastes good, and often by the fourth bite, it is starting to taste cloyingly overly sweet. I share most desserts with my husband.
c) Related to b), I try to consume sugars as fluids as little as possible. I have grapefruit juice every day with my breakfast and taking my calcium, and of course I occasionally drink alcohol, but rarely a full sugar soda or lemonade with a meal or just to drink. I'd rather take my sugar in ice cream and cheesecake.
d) I eat a lot of protein -- without regard to fat or cholesterol. Crab drenched in butter; marbled meat; chicken or tuna salad with full fat mayo; roasted chicken WITH the crispy delicious skin.
3) I don't think the weight loss is, on average, slower with the DS than the RNY. It is, however, higher in %EWL, and in %EWL maintained long term. I personally did not limit my carbs in my first year (I was so thrilled to be released from the guilt I refused to diet at all) and didn't get below 200 at first -- but then 2 years ago, I started losing again, and I'm down nearl 35 lbs since then and ready for reconstructive surgery. No dieting, really. I don't do diets anymore, and haven't since 1992. Only instead of gaining, not dieting now doesn't matter.
4) Yes, he will have to fight to get the DS with Kaiser. But he will almost certainly win. AND, if you are in NorCal, he will get Rabkin as his surgeon -- paid 100%. Come on over to the DS forum, where there are a number of Kaiser patients -- and a Kaiser surgeon who got a DS for herself! -- who will help with the process.
I am really thinking that DH wouldn't fight with me on him having this surgery. He is Mexican, so he cant give up his tortilla's and yummy goodness of his Mexican food, lol.
One more quick question. Is beer an option after having DS? Because us RNYers aren't supposed to have carbonation (well at least that's my dr's recommendation).
I will definitely check out the DS board.
Thanks for your help.
~NicoleI love my RNY! Find me on myspace myspace.com/bebe_girl209 but be sure to tell me your from OH!
2) I was back to my carbonated sodas within a month or so after my DS. The whole "no carbonation" thing is a BIG FAT LIE, by the way -- if it doesn't bother you, there's no reason not to have carbonatiion with any surgery. Your stomach WON'T STRETCH -- that's ludicrous. There are two outlets to the stomach, and even the pouch -- up or down -- that the gas will escape through LONG before the muscle of the stomach wall could possibly "stretch." Not drinking carbonated beverages if they trigger the urge for more sugar in some people might be a good idea, or if you are drinking full sugar beverages or alcohol when you shouldn't, but the carbonation is NOT the reason.
Having said that, nobody who has had WLS should be drinking alcohol in the first year post-op -- rapid weight loss puts a strain on the liver.
I was craving Mexican almost all day yesterday! I had a steak and egg burrito from Carls for breakfast (extra cheese). I ate about 1/2 of the tortilla, and for dinner I had nachos with carne asada and extra cheese. I ate about half the chips, and a small bean and cheese burrito. I was full and happy. I'm almost 2 years out, so it will be a while before he can eat like I do. Your husband will do great with the DS and good for you for looking into this for him. You guys will make a great team!
4 Years Post Op: At Goal And STILL Loving My DS!
340/180/180 ~ 5'11" ~ I lost 160 lbs!! 
LBL & Hernia Repair: Done! Arm Lift: Done! Next Up: Thighs & Boobs!
Get the facts about Duodenal Switch at DSFacts.com
I think as long as he can be satisfied with the foods he wants to eat then he will do wonderful. He's not a bad eater (meaning prefers fast food and deserts over healthy food and veggies), it just takes a lot for him to feel satisfied.
Thanks again for responding!
~NicoleI love my RNY! Find me on myspace myspace.com/bebe_girl209 but be sure to tell me your from OH!
My husband is hispanic and we live in So Cal, so tend tow eat lots of Mexican/Central American food. In fact last night, we went out to our fav old fashioned mexican sit down restaurant and I consumed an obscene amount of freshly fried chips w/ fresh made salsa.
Flour tortillas seem to gum up in my DS stomach, so I try to make quesadillas/tflour tortilla tacos fried in some oil (remember DSers malabsorb 80% of fats, so it's as if we never ate it) and that crisps up the flour tortillas a bit so they are easier on my tummy. Corn tortillas are never a problem. However, when making enchiladas, I usually make a lasagna-type layered casserole and cut back on the tortillas to cut back on carbs/increase the meat to increase protein and my family really doesn't notice.
Carbonation is not a problem because DSers have the normal inlet and outlet (pyloric valve); he just won't be able to cosume massive quantities. DSers can also drink WITH their meals - due to having the pyloric valve - there is no stoma for food to wash through.
But be warned that these beer and tortillas have carbs and if he is willing to give up other carbs in order to keep his comfort foods, he will do just fine with the DS.
I also did not tell my hispanic inlaws and having the DS has allowed me to eat normal meals in their presence without giving away the fact I've had wls. They think I've gone low carb, elimating sugary sodas and massive amounts of rice. Best of luck!
Laurie
PRE OPS ... Want a surgery that has the least chance of long-term re-gain, is BEST at curing your Diabetes (98%+), removes much of the hunger hormone Ghrelin, NO DUMPING, NO MARGINAL ULCERS and NO STOMA / STRICTURES? CURIOUS WHY I CHOSE THE DS? VISIT MY PROFILE.
It will be very useful when talking to DH about WLS.
~NicoleI love my RNY! Find me on myspace myspace.com/bebe_girl209 but be sure to tell me your from OH!
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