There r more options than just gastric bypass (also known as RNY) and lapband...come check out the Duodenal Switch (DS) board.  Know all your options. http://www.obesityhelp.com/forums/DS/a,messageboard/board_id ,5357/ another great website is: www.duodenalswitch.com

RNY compared to the DS

RNY – expected weight loss

• 50-65% expected excess weight loss (percentage varies in opinion – this is the most commonly seen estimate)
  • Results may vary
• Regain
  • Possible regain: 50% of weight after 5 years
  • 100% regain of weight has been recorded
  • Must follow “pouch rules” in an attempt to not regain
  • RNY must exercise and diet to maintain weight loss after 5 years

 DS – expected weight loss

• 85% expected excess weight loss
  • Results may vary
• Regain
  • Studies show little to no regain
  • 20 lb gain from lowest weight has been recorded
  • Highest success rate over 10 year study (78% avg. Excess Weight Loss – EWL)

RNY – have a stoma (stomach made into a pouch – size of an egg)

• Size: 2 oz
  • Stretch to average size of 6 oz in 2 years  (possible to stretch up to 9-10 oz)
  • You can eat more as time goes by
  • Average after 1 year is 1-1.5 cups of food
• Stoma: blind pouch
  • Doctor evaluation: cannot use an endoscope (to find ulcers and tumors)
  • Cannot take Nonsteroidal Anti-Inflammatory drugs (NSAID).
• NSAIDs are: Advil, Alka Seltzer, Aleve, Anacin, Ascriptin, Aspirin, Bufferin, Coricidin, Cortisone, Dolobid, Empirin, Excedrin, Feldene, Fiorinol, Ibuprofen, Meclomen, Motrin, Nalfon, Naprosyn, Norgesic, Tolectin, Vanquish
  • NSAIDs are used for arthritis, bursitis, tendonitis, back pain, headaches, and general aches and pains. This could develop into a bleeding ulcer and interfere with kidney function.
• Possible Problems
  • Ulcers (Doctor’s recommend taking prilosec for 1-2 years in an attempt to prevent the ulcers)
  • Possibility of a staple line failure
  • Noncompliance: simply do not lose enough (even with following the rules)
  • Vitamin Deficiencies
  • Narrowing/blockage of the stoma
  • Vomiting if food is not properly chewed or if food is eaten to quickly
  • Dumping syndrome and NIPHS/Hypoglycemia
    • No Valves (pyloric valve that opens and closes to let food enter intestines is bypassed) which means food empties directly into the small intestines and causes dumping and NIPHS/Hypoglycemia
• Dumping: food (most commonly sugar but not necessarily “just” sugar) enters/dumps directly into small intestines and causes physical pain (some people believe this pain enforces good eating habits)
  • Dumping varies in degree of occurrence and discomfort
  • Dumping symptoms:
    • Nausea
    • Vomiting
    • Bloated stomach
    • Diarrhea
    • Excessive sweating
    • Increased bowel sounds
    • Dizziness
    • “Emotional” reactions
• NIPHS (insulin over production): “the body overproduces insulin in response to food entering the intestines at a point where food would normally be more digested already - this part of the intestine is not used to coping with metabolizing glucose in the condition it arrives after RNY, and it is suspected that the intestine signals the pancreas for more insulin to aid digestion, causing a MASSIVE overproduction.  The change occurs on a cellular level, hard to diagnose.  Treatment: Removal of half the pancreas.”
  • RNY stoma that is created allows food to go straight through the stomach into the small intestine unrestricted so it does not control the flow.  Because of that the body reads that it needs more insulin because the food is moving through so quickly and it thinks there's going to be a lot more food.  With the DS, the normal peristalsis works because the pyloric valve is in place and can control the movement of food into the small intestines.  
  • NIPHS/Hypoglycemia is deadly if not corrected

 DS – whole stomach (size of banana)

• “Whole working stomach” - meaning the stomach’s outer curvature is removed as opposed to making a pouch/stoma.
  • Part of the stomach removed is where most of the hormone called Grehlin is produced.
  • Grehlin gives the sensation of hunger so by removing most of that section of the stomach a DSer is not as hungry as before.
• Whole working stomach: no blind stomach.  Endoscope can be used.
• Can take NSAIDs
• Do not need to take Prilosec to prevent ulcers.
• Valves are in tack: no Dumping Syndrome or NIPHS

 RNY – Eating

• Recommended to chew food to liquid (most important early out)
  • Foods need to be thoroughly chewed to prevent blockage (the hole/path leaving the stomach and into the intestine is the size of an eraser).
  • To get food unstuck, patients drink meat tenderizer mixed with water.
• 64 oz of water
  • Stop drinking within 15-30 minutes of a meal
  • Do not begin drinking after a meal for 1-1.5 hours
  • Not encouraged to use a straw (pushes food too quickly through the stomach and can cause gas/discomfort)
• Low carbohydrates (carbohydrates can slow weight loss)
  • Avoid sugars (to prevent dumping syndrome and slowed weight loss and/or weight gain)
• Low fat
  • Foods high in fat can also cause Dumping Syndrome
• Eat protein first
  • 60g of protein a day
• Water Loading
  • 15 minutes before the next meal, drink as much as possible as fast as possible. 
  • Water loading will not work if you haven’t been drinking over the last few hours.
  • You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.

DS – Eating

• 80-100g of protein
  • DS patients can on average eat more food than any other type of weight loss surgery.
• 64 oz of water
  • Can drink with meals
  • Can use a straw
• Low carbohydrates (carbohydrates can slow the weight loss)
  • No dumping syndrome from eating sugar
• Eat high in fat
  • DS only absorbs 20% of fat (do not need to eat low fat)
    • If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or RNY absorbs ALL 20g.
    • When experiencing a “stall” (slowed weight loss/plateau) a DS patient commonly increases fat consumption

 RNY – Possible Issues

• Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
  • Common vitamin deficiencies found in vitamins B12, iron, and zinc
  • Calcium must be supplemented for the rest of your life
• Bathroom issues
  • Gas
  • Constipation
• Reversible procedure (Reversals of any surgery is very complicated)
  • Revision often performed instead of reversal

 DS – Possible Issues

• Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
  • Common vitamin deficiencies found in vitamins A, D, and iron
  • “Water soluble”/ “water miscible” / “dry” vitamins absorb best (in other words get vitamins that are not fat/oil based)
  • Calcium must be supplemented for the rest of your life
• Bathroom issues
  • Gas
  • Loose stool (Most common in the first few weeks of surgery. Food related)
• Reversible procedure
  • The intestinal bypass is reversible for those having malabsorptive complications
    • revision: lengthening common channel
  • Stomach is obviously not reversible (part of stomach was removed)

 RNY - Diabetes

• 85% cure rate
  • RNY does not cure diabetes but puts it in remission.
  • Can come back in two or three years--even if the
    patient maintains most of their weight loss.
  • Even a small weight gain long-term can cause a diabetes
    relapse.

DS – Diabetes

• 98 % cure rate for type II diabetes.

  

DS – Myth or Fact

The DS is only recommended for the super morbid obese (BMI over 60) = Myth / Not True

• To be eligble for ANY type of weight loss surgery, a person has to be 100 lbs. over weight or have a body mass index (BMI) of 40 or more.
• BMI’s under 40 have also been approved (usually require a comorbidy/health problem - an example is sleep apnea).

The DS is “experimental and investigational” = Myth / Not True

• Medicare approves the DS
• Many insurance companies are starting to cover the DS.
• DS has been performed since the 1970s

DSer will have a problem when they become old = Not True

• We wont need to eat as much when we are older b/c our bodies will adapt
• The little hair-like villa located in the intestines grows longer to adjust to the new digestive system (grows longer to increase absorbtion).

DSer’s gas stink = true

• The gas does smell. (This is true for the DS and RNY)
• There are products called air fresheners that a person can use.

DSers may need to wear a diaper = Myth / Not True

• That is silly

Skin color turns yellow or pallor = Myth / Not True

• Patients who follow their regular vitamin regime (keep up with blood work) do not turn pallor
• If someone looks pallor, they could have a vitamin deficiency.  This applies to any type of weight loss surgery.
• Vitamins and blood work must be monitored for life. For both RNY and the DS.

DSers will have a heart attack from all the fatty food they eat = Myth / Not True

• Cholesterol levels lower after having the DS. 
• 80% of the fatty food is not absorbed – the fatty food is healthier to eat as a DSer than a person without surgery.
• If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or a person with the RNY will absorb ALL 20g.  Good meal for the DSer.

Dsers don’t need to exercise = Myth / Not true

• DSer’s are aware of the benefits of exercise (body and soul).
• Exercise helps in losing weight and maintaining goal weight 

 

Not every surgery will be right for everyone. Not every surgery will be covered by insurance. Good luck to everyone.  Hayley F.

As someone who spent 5 years researching before I finally made the decision I went with RNY anyway. Primarily because I had food issues.  The DS - wouldn't help change my eating behavior.  What good is losing weight if you are just going to keep eating high sugar and high fat foods without the penalty? Of all the DSers I met - the succesful ones were people who didn't have food problems to begin with or had been successful at changing.  Some of us have been trying to change our behavior for years and it has been unsucessful which is why a detourant it sometimes needed - like Dumping. Lord knows I did it ones on a high fatty food and I haven't done it since!!!!! So keep in mind anyone researching - it's not just about the surgery - it's about your behavior.  The DS is great it has MANY Benefits. All the different types of surgeries each have their own benefit.  What becomes key are  1) the risks you are willing to take 2) the life style change you require and can handle 3) your eating behaviors. 

I think anyone who is Morbidly Obese has food problems.  I personally wanted to eat as close to a normal size portion (what a thin healthy person would eat) as possible while having weight loss surgery.  I can eat whatever i like but it doesnt mean i always do.  The DS has changed my eating habits.  While i still eat sugar and fatty foods...i am more carb conscious.  I dont feel the need to eat some things (i could but i choose not to).  For instance, I love Boston Market's Chicken Tortilla soup...it comes with a piece of cornbread. I give the cornbread away. It wont help me lose weight so i dont eat it.  I also dont include the tortillas in my soup.  Carbs will slow weight loss...that and I know i will make up for it with some candy (i love my sugar).  Sorry to hear about your dumping episode.  While i did not want to risk dumping, I understand why people may desire to experience the dumping syndrome.  *Whether you view dumping positively or negatively is a personal choice.  And new people should note that not all RNY people dump. This can be good or bad depending on how you look at it. 

Just curious but why the need to compare surgeries? It is great to get your info out about your surgery, but you will find just as many RNY'ers who are happy with thier surgery! Why not just accent the positives of YOUR surgery type rather than do a comparison. I have lost 136 lbs, feel better than I ever did! I eat enough and do no****er load before or after meals. I make healthy choices and I exercise. What works for one might not work for all. Again people must be encouraged to research for their surgery and what is best for them. There are positives and negatives in everything. Just my 2 cents. 

Because the few dsers want to be superior for some reason or feel they are,its sad.

Cmon -- she did it a little more objectively than Jade's attempt to bash the DS completely and she didn't tell any outright lies either (like Jade did) and can back up her statements with studies.   She's been away for a while, so I'll bet she hasn't happened upon that thread yet to contribute.

Val I have nothing against DS's....I am happy for whatever works for people. I did read Jades post and felt it was to entice an argument so I chose not to reply.....This one though makes me feel this original poster is knocking RNY. I do not throw up and occassionally I dump, but am very happy with my choice and would never knock someone elses surgery. There are ways to post positives about the Ds without bringing other surgery types into it! Congrats on your success....I am glad your surgery worked for you like mine is working for me! Hugs, Chris

I too know people who are happy with the RNY.  And yes i agree there are pros and cons to every surgery.  Not every surgery will be right for everyone.  Compared to show differences and to help in the researching process.  I encourage lurkers and new people to read from all the boards and profiles.   Again, Not every surgery will be right for everyone. Not every surgery will be covered by insurance. Good luck to everyone.

For those of you researching weight loss surgery, please do not believe anything you read from DS post-ops regarding RNY.  Do your OWN research. For those of you that truly have not researched enough on your own yet, let me clear up a few of the misconceptions being spread about RNY by the post above (which has been copied so many times by DSers that I don't even know who wrote it anymore).  I don't have the time, nor the inclination to correct all of them.  But I will correct a couple of the glaringly obvious ones.  1. RNYers do not chew food to liquid.  I ate roast beef from Arby's with my daughter yesterday.  Have you ever tried to chew roast beef to liquid?  RNYers are recommended to chew food 25 - 30 times.  This is a healthy "number of chews" that nutritionists/dieticians tell NORMAL NON-OPS to practice.  You have teeth for a reason.  Many obese people have gotten into the habit of eating so fast, that they barely chew their food anymore.  (My father is one of them.  He practically inhales his food.)  Do you have to chew your food well?  Yes, as any normal person should.  Do you have to chew it to liquid?  No. 2. The stoma (hole/path leaving the stomach) is NOT the size of an eraser.  It is the size of a dime.  Not only is this easily verified by various websites, but ObesityHelp's own lecture (one of several) on youtube even confirms it.   I won't go into the incorrect statements made regarding DS or the simply exagerated statements regarding RNY.  It would take all night.  Do your own research.  Read.  Read.  Read some more.  Go to a surgeon who will tell you ALL your options, not just some.  Talk to everyone on here, not just the surgery you THINK you want to have.  Go to ALL the forums to talk to ALL the post-ops.     Decide what is best for YOU as only YOU will have to live the post-op lifestyle you have chosen.   Good luck! 

I'm curious

you said "the incorrect statements made regarding DS "

can you please elaborate some???   Pick just one or two??