Is VSG not enough?

on 3/29/11 4:21 am - Hammond, LA
Hello all!
I was wondering if there is anyone out there that decided on the DS due to in adequate weight loss after the vertical sleeve? I was told that the 1st part of the surgery was actually the sleeve gastrectomy and the DS was performed as a second surgery. I am scheduled to have the VSG done as a stand alone procedure and I'm wondering about needing future revision? Please share your experience thanks  
one hoop at a time     
(deactivated member)
on 3/29/11 4:43 am, edited 3/29/11 4:47 am - Lafayette, IN
 i started out with a ds but i can say that having the vsg and then later having the switch part done does not have the same effect of a 1 stage ds. although you would "probably" lose more weight with the second stage at later date, it may not be as much as you want. i see that your surgery is coming up soon. i would make damn sure that you can be happy with the long term results of the chosen surgery before going under the knife. a lot of insurance companies have gone to the "only 1 weight loss surgery per lifetime" clauses so you may not qualify for a revision down the road. also, revisions often have more problems after their second surgery. if your dr has told you that the ds HAS to be done in 2 seperate surgeries then he is likely a "bait and dont switch" dr. this means that he doesnt actually do the ds but wants to convince you to have one of the surgeries that he does do with the promise that some day, IF you NEED it , he can do the second part. then when it comes that time and you may get told " i am sorry but its just not necessary" or "i dont do the ds anymore". then you may be stuck with results that you are not happy with. i checked the surgeon list on and your surgeon is not on their list. this means either he isnt a ds surgeon or he isnt a very experienced one. having said that, the ds is a very complicated surgery that demands strict adherence to a supplement schedule and the ability to be a strong self-advocate so if you cant be compliant with the supplements or have a hard time standing up for yourself then maybe you should just have the vsg. i would definitely be doing some more research before you go into surgery. wishing you the best with which ever surgery you chose.

Edited to add: you may even want to postpone your scheduled surgery to do some more research.
(deactivated member)
on 3/29/11 4:48 am - Lancaster, OH
I had the full DS, but I can say with certainty that a VSG would not have been enough for me.  I very likely would have gotten to a normal BMI right after the surgery, but now that my stomach is "comfortable" again, my malabsorption is the only thing keeping me at the weight I want to be.  So, with just restriction, I'd be regaining.
I know you weren't exactly asking this "demographic", but, there you are anyway.
Wishing you the best in whatever decision you make.
Samaro ..
on 3/29/11 4:58 am, edited 3/29/11 5:00 am
There are two aspect of a Duodenal Switch.  One of them is that the stomach is made about 75-80% smaller by performing a vertical gastrectomy (VSG) and the second is rearranging the intestines to create malabsorption.

However, even though there are two aspects this doesn't mean there are two different surgeries performed at two different times.  Most of the time the total DS is performed as a single sugery.  Exceptions apply when the doctor is in the middle of the surgery and determines that it has taken too long to perform the sleeve gastrectomy and keeping the patient under anesthesia any longer will be harmful to the patient. Or, the doctor may decide well in advance of surgery that a particularly sick patient should only have the sleeve to lose some weight and then come back later for the rest. In these cases, the intestinal portion is done at a later date.

There are a few members here who thought the VSG as a stand alone procedure would be sufficient for them only to discover that it wasn't.  They have gone on to have the intestinal part done as a second surgery.

It concerns me that you are heading into surgery with a mind to revise later if needed.  I would encourage you to examine your needs before you go under the knife and figure out which surgery is going to be the best for you.

If you are obese solely because you are a volume eater then the VSG may be sufficient for you since you will not be able to eat very much as a result of the gastrectomy.

However, if your obesity is caused by metabolic issues then you really need to consider the metabolic effects of the DS and get just one surgery right off the bat.

on 3/29/11 5:17 am
The VSG alone would NOT have been 'enough' for me. Without malabsorption, I have no doubt that I would once again be just as fat as I was pre-op.

Some things to consider: A VSG is NOT the same as the stomach portion of the DS---in most cases, it's made significantly smaller than a DS stomach. Since we've been seeing these tiny stomachs, we've also been seeing a signficant number of cases of strictures---something that we rarely EVER saw back when I had my DS seven years ago. Strictures in a sleeve can be life-threatening.

'Adding' the Switch to a Sleeve is a REVISION surgery. This requires a second insurance approval, and many insurance companies are adding a 'once in a lifetime' clause to their coverage of WLS.

Two-stage DSes are NOT as effective as one-stage procedures, unless the second stage is done within 6-12 months. How many people who opt for the Sleeve are not still 'in love' with it at that point? Typically, it's 3 or more years later that regain becomes an issue.

Think twice, cut once.
Chad M.
on 3/29/11 5:29 am - Indianapolis, IN
No how, no way would I have ever settled for a 2-stage procedure unless I absolutely, positively had no other choice.

Now, I had had over 200 pounds to lose, so that may seem like a very different thing to you who has only 90 to lose. But 90 pounds is nothing to sneeze at, and restrictive-only procedures don't have a great track record.

What scared me about virtually every procedure were the failure and regain rates. The DS stands apart in that area and that is what spurred me to look into it further.

Let me tell you this, even by VSG standards I had a small-ish sleeve, 80mL to be exact (less than 3 ounces). At not even 1.5 years out, I can eat plenty. Certainly not what I ate before, but as one surgeon put it to me pre-op, about 1/2 to 2/3 of what I ate pre-op. Last night, for example, I had a very large (for me) dinner of a 12 oz ribeye. Eaten slowly, and no side/salad/appetizer/dessert, but still a whole steak is a lot of food to eat at once if you don't have any malbsorption to back it up and your body likes to hold on to pounds.

I still think I could have lost the weight with the VSG. Heck, I think I *could* have lost the weight with no surgery at all. But I know I wouldn't have kept it off either way. Now, the idea of me regaining a bunch of weight isn't something I even think about. So, ask yourself this. What happens if you get the VSG and lose MOST of the weight, and have to fight like hell to keep it off? But you're still 20-30-40 pounds overweight, and you don't qualify for the revision anymore?
Emily F.
on 3/29/11 5:32 am
It wouldn't have been enough for me. Look at your eating habits, are you a volume eater or a sweet eater?

If you are sure you want a full ds, I would find a surgeon that would do it in 1 stage.
on 3/29/11 5:35 am, edited 3/29/11 5:40 am
I agree with what the others have said. Really think about your surgical choice and CUT ONCE.

You might also want to consider doing some research on the long term weight gain associated with the VSG. Although many people do lose much of their excess weight, there was recently a study that followed VSGers out over 6 years. The study found that after 6 years the average % of EWL dropped to something like 55 %. In your case, if you had the average 55% EWL at 6 years out you would weigh 175.5. (if I am reading your stats right and did the math correctly.)
The big problem with the VSG, in my opinion, is that it doesn't have the long term record for sustained weight loss. The DS does, and has the best overall long term EWL%.
There are several older posts around that cite to recent studies. If I were you I'd look them up before commiting to the VSG alone. You should also check out

Another thing to think about - even if you insurance company does not have a 1 bariatric surgery per lifetime exception, if you get the VSG it is possible that your BMI would be too low to qualify. (i.e. BMI of 40, or 35 with significant comorbidities.) You might still be considered obese but 'too thin' of a BMI for a revision.

Only you will know what will be the best surgery for your lifestyle. Do know that if you do persue the DS, you will have to faithfully take many supplements and lots of protein for life. This isn't negotiable nor is it cheap. I look at these mandatory supplement requirements as the exchange for the best long term success at weight loss. You might also have to postpone your surgery to find a qualified DS surgeon.

Good luck with whatever you decide.
                                      ~  Kim  ~

                             HW - 283        SW - 257.5     Goal - 156
Thanks to all the DS vets who have paid it forward - I <3 you guys!  
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on 3/29/11 5:48 am - South Central, PA
DS on 06/07/10 with
You say, "I am scheduled to have the VSG done as a stand alone procedure and I'm wondering about needing future revision?"

If you're already thinking that you may need a revision, you may have answered your own question!  I believe that we all have intuition about what's really best for us as individuals.

I was a lightweight (about 100 lbs to lose), and I was sure that any surgery could have helped me lose all of my excess weight.  What I wanted was a surgery that was going to help me KEEP it off long term.  I chose the DS because I didn't want to be looking at excessive regain down the road.  

As they say, think twice, cut once.  If you're concerned that the VSG alone won't do the job for you, please research the DS further.  There are some links in my siggy to help you get started.

Nicole  Lab rata data link- One-half of a DS couple!  - I'M BELOW GOAL!  After a very rough start it's official--I my DS!  Romans 8:28 
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on 3/29/11 5:48 am - AL
The DS is not a two part surgery.  It is one surgery with two components.  Some times people need to have these two components done in separate surgeries due to increased surgical risk for length of surgery.

The DS sleeve is different from the VSG sleeve.  That is one thing you should know.

There is some sort of mulitplier effect when you get the full DS done in one surgery and we know that these patients do MUCH better than patients who have to have  two surgeries.

The VSG data is coming in slowly, but what I've seen is not encouraging.  If you have ANY doubt that the VSG will be ENOUGH I highly encourage you to research the DS BEFORE you have your sleeve surgery.

For me, I knew that dieting was not going to work.  Restriction in the amount of food I ate NEVER worked before so why would I think it would work with a surgical restriction only procedure?  I was a light weight with less than 100 lbs to lose, but with plenty of years of failed dieting behind me.  I knew I needed the malabsorption to be successful.

I will be 18 months out tomorrow.  My initial goal weight was 175 (I am 5'8").  My surgeon's goal was 164.  I weigh 145 and am HEALTHIER than I've been in decades.

So whatever you do don't go into your sleeve surgery thinking that the rest of the DS is a fall back positon.  That is a terrible idea. has a ton of great info.


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