Confussed about RNY vs. DS

Amy,
It is a huge decision and you should be proud that you are researching before you decide. When I first learned about the DS I thought what I was hearing was "too good to be true," and I was always taught to be skeptical and that when something sounded too good to be true that it probably was.

But in the case of the DS the information was actually TRUE!!

Then my next hurdle was not understanding why I couldn't get this surgery at the big hospital bariatric program in the city nearest where I live. Nope, I had to TRAVEL. Who ever heard of traveling for surgery? LOL.

I'm coming up on my year anniversary of my surgery and it has been a WILD ride, let me tell you. I have lost about 120 lbs so easily. Entirely too easily. All I have to do is EAT (I never go hungry), drink my protein drinks (yum, I love them), take my vites, drink my fluids and stay away from the carbs.

Has anyone directed you to www.DSFacts.com? There you can find links to the scientific studies that back up all you hear from those of us who post about our success with the DS here on OH.

 Wow I am new here, but glad I found this. I have been told over and over again that Gastric Bypass is the "gold standard" of bariatric surgery. I have done a lot of research on Gastric Bypass and Lapband. For many different reasons I decided against the lap band and that I needed to have Gastric Bypass. 

The few seminars that I have been to have causally mentioned all the different types of WLS saying that DS was no longer done much at all. And now its pretty much just the lapband and gastric bypass. Honestly I must have not done all my homework and believed that. From reading this I did a quick search and see a lot of people are getting revisions after Gastric Bypass and switching to DS. 

However it looks like the DS is done with the sleeve and sometimes something else or is this all one operation? I am confused. What are the main differences and I am self pay so does anyone know if DS is a lot more then gastric bypass.

To the original poster and the posts that I have read, I agree its better to find out pre surgery so you have a chance to research more and find out what is best for you. I thought I had done all my research and that gastric bypass was the best option for me. I now know there are more options that are not what I believed them to be which is outdated and not done anymore. I personally am thrilled I have read this and now have a chance to make a more informed choice about what is right for me. So thank you to the previous poster for raising this topic. 

Both Ds and rny are restrictive and malabsorption.

DS keeps the stomach intact and functioning and the valve that keeps the food from dumping into the intestines, so no dumping syndrome. No blind stomach that can have ulcers and can't be scoped. DS you can take nsaids, rny not.

I was self pay in Mexico for about 13,000 plus airfare, I believe there is a Texas doc doing self pay ds for around 20,000. Research Research Research docs. Visit the ds board for more specific info.

KImberly, I would start by reading www.dsfacts.com . This website should answer a bunch of your questions. I would also ask you to read thought the last 10 pages or so of the DS forum. Usually, that main questions are covered in there. At that point, feel free to ask any questions that you may have. We love to educate people about our wonderful surgery. Good luck and come on over :)

I'm going to Dr. Bonnani for my DS in November!

Ok, so although I haven't had the surgery, the research and personal stories I've heard from both sides of the surgical fence lead me to fall right over to the DS side. It just seemed like the logical choice (to me). I agree with what others are saying, research is EVERYTHING when it comes to a life-altering decision.  I read as much as I can, talk to as many people as I can - and ask as many questions. I'd rather get the facts (statistics) and hear it from someone who's experienced it than to just accept what's readily available (unfortunately, I know someone who's choosing that route - she's going for RNY because his office is close and it's the more "common" surgery). However, all the medical problems she has as well as her eating habits and behaviors make me think she'd do better with DS and probably won't make it or end up needing a revision.

Whatever you decide, good luck.

Hi Kimberely Heidi!    Check www.dsfacts.com it may help answer alot of your questions! Good Luck! Feel free to stop by thd DS board and ask questions!!

Part of the duodenal switch procedure IS the sleeve.  It is a vertical sleeve gastrectomy with duodenal switch.  Some surgeons prefer to do the surgeries in 2 steps (step 1: sleeve, step 2: intestinal rerouting), depending on their protocol, patients preoperative BMI, etc.  If you can get it done in one fell swoop, a one step operation, then definitely go that route.

My surgeon, a bariatric leader in the field who conducts many studies and even holds his own patents, rarely performs the gastric bypass and lap band anymore, unless a patient is hell bent on one of the two procedures.  He strongly leans toward the VSG and a DS that is made slightly less malabsorptive than the DS from 10 years ago.  I am 18 months post DS and don't have any vitamin deficiencies and never lost any hair, etc. 

The DS will probably cost you more out of pocket as it is a more complex procedure.  It requires much more time and skill than any of the other WLS procedures. 

I believe Dr. Peters in PA charges between 15-20k for self pay.

Unfortunately its tragic and in my opinion criminal what some bariatric surgeons will say in order to keep patients. There are so many untruths and horrible exaggerations that happen with the DS and often by surgeons who never performed the DS and know very little about it. We are constantly correcting the misinformed about our surgery.

As far as lapband and rny being the only 2 that are being performed, I have heard several surgeons say, including my own, that he believes that the dynamic is shifting rapidly and soon it will be the VSG and the DS since the results are so much better.

The DS is ideally done in one step but consists of 2 essential components; the restrictive component which is the sleeve and the malabsorptive component which is the intestinal configuration (rny has 2 components as well, the pouch and the intestinal configuration).

Both parts of the DS can be done as stand alone surgeries. The sleeve as a standalone procedure is rapidly gaining popularity, especially amongst lightweights who don't want to deal with the band. The VSG sleeve is usually a bit smaller than the DS sleeve but some DS surgeons also favor tiny sleeves so there is a lot of variability there. The intestinal configuration as a standalone is not done in the US as far as I know but it is done in Europe as a cure for diabetes (other wls help counter diabetes due to weight loss but with the DS the configuration of our limbs generally cures it immediately.)

There are cases where the DS is done in 2 parts but barring an extremely high BMI or a complex revision where the added risks due to anesthesia etc. are involved, the complete DS is usually done all at once and seems to be most successful that way as well.
 
I urge you to spend some time on the DS forum with us and learn more about the DS before making up your mind as to what surgery you want. It is unfortunate how many people we get on the DS forum who are revisions and they are so upset that they didn't know about the DS when they first got their surgery and have come to regret it and now need a very risky and complex revision to correct things. The DS motto is think twice, cut once :-)

I hope to see you around on the DS board and I wish you the best of luck with whatever surgery you decide is best for you.

" The few seminars that I have been to have causally mentioned all the different types of WLS saying that DS was no longer done much at all."

Hi Kimberly,  I believe that the DS procedure is actually becoming a more popular surgery choice than ever before.  The BPD is an older surgery but the BPD/DS is actually newer and superior.  More and more insurance companies are adding the DS choice their policies.  My insurance changed their policy to include DS in Sept 09 - just in time for me!  They, and many other carriers, no longer view the DS as 'experimental'.  I feel so blessed to have had this surgery!  

The info you got from your seminar is very typical, especially if that Dr doesn't have the skill perform the DS.  There was a resident at the hospital where I was recovering after surgery who told me that my surgery was older and had fallen out of favor to the now popular RNY.  What an idiot!  He had no clue and if I hadn't been so drugged and tired I would have kicked his boney little med school ass.

I remember during a seminar a nurse stating that the DS would give me 6-8 bowel movements a day LOLOL  I almost bought into that crap too.  

Surgeons will only promotes the surgeries they have the ability to perform.  RNY's and lap bands can be performed quickly and many can be done in a day.  That's big money for surgeons.  I didn't want to have a procedure that only took 45 minutes to convenience my Dr.  I wanted the surgery that would serve my needs best for years and years to come. 

Kimberly, a lot of surgeons who don't DO the DS confuse it with the old BPD (Bilio-Pancreatic Diversion), which is rarely done any more. It's essentially a large-pouch, very distal RNY, and combines some of the worst parts of both.

The DS was originally called the Bilio-Pancreatic Diversion with Duodenal Swtich (BPD/DS), in part to pay hommage to Dr. Scopinero, a pioneer in bariatrics. Today, it's commonly referred to as either the Duodenal Switch, or the Vertical Sleeve Gastrectomy with Duodenal Switch. The latter is more acurate, as VSG refers to the stomach part and DS refers to the intestinal part. When done as a stand-alone WLS the VSG is called the Sleeve, and when the intestinal part is done as a stand-alone surgery for the treatment of Type II diabetes it's called simply the Switch. When you see people on here referring to the DS, they mean a single operation in which both parts are done. The DS has been shown to give the very BEST long-term, maintained weight loss AND the very best long-term resolution or prevention of co-morbs like Type II diabetes and high cholesterol.

I believe you can get the DS done in Mexico for around 15K, but I'd also check with Dr. Peters in PA---his self-pay price isn't much more than that, and you don't need a passport. (*grin*)