Denial: It ain't just a river in Egypt

Your posting is inaccurate, if not an intended falsehood.  The surgeon explains that, beginning, 3 years out, they changed the way that they did the surgery, going to a smaller bougie.  He attributes that with the year 4 data.

If you have an agenda, go peddle it on the other forum.

I find it odd that people keep posting studies such as the one above. These surgeries are just tools and what is not taken into account are peoples eating habits. All of these surgeries have the potential to fail if you don'****ch what you put in your mouth! You could have the smallest bougie or the most malabsorbtive procedure and if you spend all day sucking down crap you will fail. To me no research is valid if it fails to account for the human element.

The five year statistics on the DS show an average maintained EWL of about 80%. The five year stats on restriction-only procedures show an average maintained EWL of about 50%. The VSG stats are shaping up to be identical to those of other restriction-only procedures.

50% EWL would have left me weighing nearly 300 pounds. If that's acceptable to you, hey, have at it.

Taken from an on-line source for WLS info:


The DS and BPD have their own particular side effects. After a meal that is high in fat, people can experience foul smelling gas and diarrhea.

And, you can have that.  People weight the pros and cons and make their own choices. My Mom had the old intestinal bypass and was plagued with intestinal problems.  I choose to not have a procedure that touches my intestinal tract all.

Can you please state your SOURCE for the bold, italicized statement above? 

Seeing as it mentions the BPD, a surgery no longer performed, but often CONFUSED with the DS, even by medical professionals, I would take it with a grain of salt.   The word "DS" should be removed from the statement.

Posting LIES and MISINFORMATION such as this is EXACTLY what upsets the DSers. 

After YEARS of this ...some DSers have had enough!  They are not telling VSGers they will need a DS in the future to be mean or cruel; they are saying it because of their KNOWLEDGE of peer reviewed medical literature and trends shown in published studies. 

Since most of the VSGers here are relative newbies to the wls game, you may not realize just how many restriction only wls-ers are looking into revisions, most to the DS.   Check out the Regrets or the Revision boards and you might want to come over to the DS board and ask how many there are REVISIONS to DS ...  The DS board has many, many people who had a restrictive only procedure that did not give them the results they expected.

Think TWICE; Cut ONCE.    Don't say we didn't try to warn you ...

If we have already had a VSG and a large part of our stomach is now permanently removed - how is revising to a DS going to help us - because the little bits of food we can process will now not be absorbed at all???  Not sure that is a great result - but I guess if you were talking about a 600 pounder then it would be a different story. 

The sleeved stomach will stretch a bit over time. You won't always only be able to eat "little bits of food." Some who have had the VSG did not get the results they wanted, so they are seeking a revision to add the intestinal portion of the DS (at which time the surgeon will also likely tighten up the sleeve to provide the synergistic quality of the restriction and malabsorption working together).

"They are not telling VSGers they will need a DS in the future to be mean or cruel; they are saying it because of their KNOWLEDGE of peer reviewed medical literature and trends shown in published studies. "

Except the studies just aren't there. Just as the BPD with DS isn't the same as the VSG with DS, the VSG of today is not the VSG of yesterday.

The data isn't really there for the new version so it's not KNOWLEDGE but OPINION. My opinion happens to differ and after reading the same studies. I think regain won't be any more of an issue for the VSG than it is for the DS and for similar reasons -- the removal of ghrelin that you don't get with a lap-band or RnY.

Plus, even if you use the older data, it most certainly does not say that EVERYONE who gets a VSG will need a DS in their future. Yet that's pretty much what some of you guys are always running over here to tell us. And if we point out any inaccuracies in your message, we are "in denial" and you will just wait until we do regain so you can say "I told you so."

Which is a pretty crappy attitude to have, IMO. I think RnY is the worst of the four surgeries available but I don't tell RnYers "Just wait until your stoma stretches and you are hungry all the time and you regain all your weight." I hope that never happens to any of them, in fact, even if studies show it will happen to *some* of them.

I do think SOME people who get a VSG at a higher BMI will find they need to get switched after all to lose all the weight they want. I think that because all the surgeries don't work as well for the SMO as they do for the MO so the VSG won't be any different in that regard. The extra "oomph" of malabsorption can make a difference, in that case.

But it's clear that SOME will not.

So where does that leave them? Should all of those people have just jumped in and gotten a DS to start with? I'm sure you'll say yes, but I don't agree. I think it really depends.

I could certainly see someone who was SMO evaluating the risks of the DS and deciding it was worth it to them to at least *try* it without the switch even if they end up being one of the ones that needs a second surgery later. I wouldn't even consider it that the VSG failed them, if that happened. I would say that they made a gamble that made sense to them knowing full well that the consequences could be a second surgery.

OTOH if someone is saying "I only have to have one surgery" and is SMO, I would say they need to seriously consider the DS and not be afraid of it because it involves malabsorption. It's certain better designed (from an Engineering standpoint) than RnY, at least IMO, and, not only does it have better EWL stats, but it has better regain stats than RnY. But having a second surgery a few years later is not a horrible thing for some people. They would rather go with the least risky option first even if the change of success is lower.

And that's their right because it's their body and their value system being used to make the determination of what surgery to get and what is right for you, or me, or my next-door neighbor with his bypass, is not right for everyone.

On February 8, 2009 at 2:43 PM Pacific Time, MacMadame wrote:

I think regain won't be any more of an issue for the VSG than it is for the DS and for similar reasons -- the removal of ghrelin that you don't get with a lap-band or RnY.


I really don't think the long-term maintenance of weight loss with the DS has to do with grehlin removal, but rather malabsorption. I've read that grehlin will begin to be produced again further out from surgery--certainly not at the same quantities as prior to surgery, but some appetite will likely return.

But, this is only an opinion, just as you have yours.

Yeah, I think ghrelin is the key to everything including the mysteries of the universe. Oh wait, that's 42.

The thing is, the malabsorption lessens over time too. This is why when people say things like "the restriction causes you to lose the weight, but then the malabsorption *kicks in* and keeps it off" I shake my head.

The malabsorption doesn't sit dormant and then "kick in" later on. It's there doing it's thing from day one, but lessens over time.

Plus RnY has malabsorption, but regain is a big issue for that surgery. The reason IMO is that hunger control comes only from the pouch and stoma and that lessens over time. We (VSG and DS) get the benefit of both restriction and ghrelin reduction.

The way I look at it in general is:

VSG and DS are two parts of the same approach to WLS.

For some people, VSG is enough and for some people it isn't. I think it's great there is a less-risky option for people who don't need malabsorption and it's great that there is what one of my friends calls the "bazooka surgery" (the DS) for those that need a bazooka.

We need lots of choices because everyone is different. I'd love to see the day when all WLS had a sleeve stomach and all that varied was how the intestines were re-arranged... from not at all to different parts being done based on the person's health and weight history.