Trying to decide between gastric bypass and DS

 So I'm in...I'm ready to take the plunge and get going on this weight loss journey. My BMI is over 50 and I weigh between 425-440 depending on the day I get on the scale. I'm 6'4" and male if that makes any difference on deciding which surgery to consider.

My concern with the DS is that it seems like life after is extremely altered with all the vitamins and labs required. I thought though that was the surgery I would most likely be recommended for until I went to the Davis Clinic (Houston, TX) and heard more about the gastric bypass. Now I'm kind of torn as to which would be best for me. Any thoughts?

The RNY requires a high level of vitamins and just as many labs as the DS.

Greater malabsorption can mean that you can go downhill faster with a DS, but neglecting vitamins and labs will get you into serious trouble with either surgery.

Obviously, my BMI was over 50 and I chose the DS...It's pretty obvious which procedure I favor :)

With a BMI over 50, you should read this. With your BMI, you need the DS. You will take supplements and follow labs with either DS or RNY, but your odds of losing the weight, and keeping it off are better with the DS. I didn't like the chance of dumping, reactive hypoglycemia or marginal ulcers. I didn't want to be unable to ever take NSAIDs or drink with a meal. My metabolism was screwed, and I needed something to deal with it. At 400+lbs, you can bet yours is shot too.

If you want accurate information, you need to talk to a surgeon that actually does the surgery. If they sell RNY or band, that is what they will try to sell you. I wouldn't consider any surgery unless I was ready to follow up with the supplements though.

The DS, hands down.  I am very happy with my RNY but based on your cir****tances coupled with the fact that several of my friends who had high BMIs have had great success with the DS.......that may be a better surgery for you.

And yes, even with the RNY I take vitamins throughout the course of the day.

Hey,

My high weight was 441, and I'm in the 170's now (I'm 5'8.5"). I was revised from a variation of the RNY known as the fobi pouch to the DS. I can tell you that  the RNY is a completely inappropriate surgery for someone your size.

There are potential complications no matter which type of surgery you have.  I think, if I were to have the choice all over again, and knew then what I know now, I'd probably have chosen the DS.  I've got a bad case of hypoglycemia, hyperinsulinism (to the point that I may need to have part of my pancreas removed) and, if I had to do it all again, yes, I'd still have the surgery, but I probably should have chosen the DS.

Take a look at the revision rates. There are many people who have revised from the RNY to the DS, either because they didn't hit goal weight or because of the complications of their rny surgery (dumping, reactive hypoglycemia, and in my case, because of the prolene mesh band). I am glad I had the RNY when I did and lost the weight, but if I'd had the DS I could have avoided 6 years of problems.

As for vitamin issues, I became extremely anemic post-rny after the first few years.

If you think that post-op life with DS is much different than post-op life with RNY as far as vitamins and labs are concerned, then I fear you've either been fed a load of crappy info on the difficulties of the DS OR a load of crappy info on the simplicity of the RNY. Both procedures require vitamins AT LEAST 3 times a day, and both procedures require labs about every 3-6 months in the first two years and at least annually for the rest of your life (more frequently if problems happen to pop up that require closer monitoring).

If I were in your position I'd choose the DS hands down.  Like everyone else has said with either surgery you're going to be on vitamins the rest of your life and you'll have to have labs drawn.  The vitamins aren't as horrible as it sounds.  I set a timer on my phone and take them when it goes off.  It doesn't even phase me anymore. 

If my insurance would of covered the DS that is what I would of had.  I'm very happy with my RNY, but I truly think if I were you I'd choose the DS.  

I was originally on track to have RNY back in 2002, but got derailed after preop testing revealed that I had pulmonary hypertension. It's a long story, but it's on my profile if you'd like to read about it.

Even though I was off the track for RNY, I continued to attend the program my then-surgeon required of all his patients. I'd paid for it, so I figured I could benefit from it anyhow :-).

I saw some disturbing trends there. This was a big group, as several surgeons sent patients to it. There was, of course, a cadre of very successful patients (all RNY). They finished their year of program and went on with their lives, and as far as anyone knew/knows, all is well.

There were a surprising number of people, though, who fought and fought and fought to comply with what was expected of them, and the weight didn't come off well. At every meeting, there was word of someone else in the hospital with this or that problem--usually an ulcer or a stricture.

I listened to stories of dumping episodes, of getting food stuck episodes, of the mental/emotional challenges of having to live on highly restricted diets.....and I thought, "There's not a chance in hell I could live with this." (I should add that I have a major vomiting phobia. I'll do just about anything to not vomit. Not a good thing in some cases.)

Well, time passed, I got fatter and sicker, and eventually (again, story in my profile), it came out that the pulmonary hypertension was caused by the fat on my torso squashing my heart and lungs. It went from, "You cannot have any surgery at all," to, "You must have surgery or die."

I came back here to OH, feeling desperate because the lap band wouldn't give me enough weight loss to have any real hope of curing what was ailing me, and the RNY seemed to me like foolish butchery for not enough good results.

Someone told me then about the duodenal switch, invited me over to the DS board, which at the time was pretty much brand new, and the rest was history.

What I like about the DS:

1. 98% cure rate for type II diabetes. This was a major biggie because I had very bad diabetes.
2. Normal stomach anatomy and function is maintained. The stomach is reduced in size, but the normal stomach outlet, the pyloric valve, remains intact and functioning. There is no "stoma" with the DS or the vertical sleeve gastrectomy (VSG).
3. The intestinal changes that are done in the DS "jump start" the body's metabolism. Mine was shot to hell from a lifetime of PCOS, dieting and other factors.
4. I'd already done many years of low fat, low carb, highly restrictive dieting and I knew I sucked at it. The DS gives an eating quality of life that I find easy to live with: eat a primarily animal protein based diet. I'm a happy carnivore :-). I had to learn to restrict my carb intake, but it was a lot easier to do when I could eat meat, cheese, fish, eggs, etc. with abandon, with little regard for fat content. (DS'ers only absorb about 20% of the fat they eat, so for most of us, fat is almost a "free" food.)

I felt so strongly about the superiority of the DS to any other procedure that I traveled and paid out of pocket to have it done, rather than have the RNY done fifteen minutes from home and covered by insurance. It's been over four years, and so far, so good :-).

Please come over to the DS board and visit with us there. Lots of folks will be happy to tell you about their experiences.