Where did you get the information that only 50 surgeons worldwide do the DS?!?  I know of three just in the state of Ohio, and there are surely more (it's not like I am familiar with all of the bariatric surgeons in the entire state, after all!)  Even if there was only one DS surgeon per state in the US, that would be 50 surgeons!  

Although I know some surgeons have decided to stop doing it (two surgeons in Dayton used to do it, but no longer do (and they are not i clouded in the 3 I cited), that number just cannot possibly be correct.

Lora

"It (the DS) is more controversial due to the significant component of malabsorption (bypass of the intestinal tract), which enhances and aids in maintaining long-term weight loss. This is the most powerful and effective of the four weight loss surgery procedures, but may be associated with more complications. Virtually all insurance companies will approve the DS. Only approximately 50 bariatric surgeons worldwide perform this procedure due to the technical complexity, concerns of malabsorptive long term effects, and the necessary extensive post-operative follow-up."  Laparoscopic Associates of San Francisco

"The Duodenal Switch procedure (also called Vertical Gastrectomy with Duodenal Switch, Biliopancreatic Diversion with Duodenal Switch, DS or BPD-DS) is performed by approximately 50 surgeons worldwide. It generates weight loss by restricting the amount of food that can be eaten (removal of stomach or vertical gastrectomy) and by limiting the amount of food (specifically fat) that is absorbed into the body (intestinal bypass or duodenal switch). It is more controversial because it has a significant component of malabsorption (bypass of the intestinal tract), which seems to augment and help maintain long-term weight loss. Of the procedures that are currently performed for the treatment of obesity, it seems to be the most powerful and effective, but may also be associated with more side effects."  California Pacific Medical Center

My Bariatric surgeon told me the same approximate figure.

Both of the quotes come from weight loss surgery centers who perform the DS.

I can only go by what I have researched as a non-professional. I am not an expert, and don't know if the figures I found are accurate.

All the more reason to consult a Bariatric surgeon, who has access to accurate professional medical and surgical information, research and training.

Those sources are laughable, and the info is horribly out of date.

If you insist on putting out so much information on a surgery you don't even have, and have done so little real research on, I wish you would just follow your own advice and get educated about it. Your main effort here just seems to be putting up straw men for the very few posters here that have actually read any of the studies on the different WLSs. 

Oh, I do believe my sources are current and up to date; I have read many articles and studies about all the weight loss surgeries, including professional ones on restricted websites, as well as consulted with several Bariatric surgeons.

Again, I am only interested in a full, balanced, factual presentation of all the weight loss surgeries, not an emotional one sided view or inappropriate nonprofessional recommendation of any type of surgery. The stakes are too high for the person at the receiving end.

I don't claim to be an expert at anything other than my own point of view, opinion, and experience.

But thank you for sharing your opinion of my opinion. I just don't happen to agree with you.

 

Anne, it may better serve you and what you quote or post as "fact" to read these studies.  Pulling information off a surgeon's website.....well we all know how that works.  The surgeon will post whatever they need to negativity or positively to sell their services.

http://www.ncbi.nlm.nih.gov/pubmed/24018763

Surg Endosc. 2014 Jan;28(1):91-9. doi: 10.1007/s00464-013-3176-0. Epub 2013 Sep 10.

Response to glucose tolerance testing and solid high carbohydrate challenge: comparison between Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and duodenal switch.

Roslin MS, Dudiy Y, Brownlee A, Weiskopf J, Shah P.

Author information

• Lenox Hill Hospital, 100 E 77th Street, New York, NY, 10075, USA, [email protected].

Abstract

BACKGROUND:

Hyperinsulinemic hypoglycemia is common after Roux-en-Y gastric bypass (RYGB) and may result in weight regain. The purpose of our investigation was to compare the effect of RYGB, vertical sleeve gastrectomy (VSG), and duodenal switch (DS) on insulin and glucose response to carbohydrate challenge.

METHODS:

Patients meeting National Institutes of Health criteria for bariatric surgery selected their bariatric procedure after evaluation and education in this prospective nonrandomized study. Preoperatively and at 6, 9, and 12 months' follow-up, patients underwent blood draw to determine levels of fasting glucose, fasting insulin, glycated hemoglobin (HbA1c), C-peptide, and 2-h oral glucose challenge test. Homoeostatic Model Assessment (HOMA)-IR, fasting to 1-h and 1- to 2-h ratios of glucose and insulin, were calculated. Statistical analysis was performed using ANOVA and Student's paired t test. All procedures were performed via a laparoscopic technique at a single institution.

RESULTS:

Data from a total of 38 patients (13 RYGB, 12 VSG, 13 DS) were available for analysis. At baseline, all groups were similar; the only statistically significant difference was that DS patients had a higher preoperative weight and body mass index (BMI). All operations caused weight loss (BMI 47.7 ± 10-30.7 ± 6.4 kg/m(2) in RYGB; 45.7 ± 8.5-31.1 ± 5.5 kg/m(2) in VSG; 55.9 ± 11.4-27.5 ± 5.6 kg/m(2) in DS), reduction of fasting glucose, and improved insulin sensitivity. RYGB patients had a rapid rise in glucose with an accompanying rise in 1-h insulin to a level that exceeded preoperative levels. This was followed by a rapid decrease in glucose level. In comparison, DS patients had a lower increase in glucose and 1-h insulin, and the lowest HbA1c. These differences were statistically significant at various data points. For VSG, the results were intermediary.

CONCLUSIONS:

Compared to gastric bypass, DS results in greater weight loss and improves insulin sensitivity and glucose homeostasis without causing a hyperinsulinemic response. Because the response to challenge after VSG is intermediary, pyloric preservation alone cannot account for this difference.


http://www.ncbi.nlm.nih.gov/pubmed/23803250

Duodenal switch for intractable reflux gastroesophagitis after proximal gastrectomy.

Someya S, Shibata C, Tanaka N, Kudoh K, Naitoh T, Miura K, Unno M.

Author information

• Department of Surgery, Tohoku University Graduate School of Medicine.

Abstract

Reflux gastroesophagitis is a common postgastrectomy complication after proximal gastrectomy, and conservative treatments including protease inhibitors and proton pump inhibitors are effective in most patients. Here we report a patient with severe reflux gastroesophagitis after proximal gastrectomy, in whom surgical treatment of duodenal switch was effective. An 80-year-old man complained of intractable heartburn, anorexia, and body weight loss after having undergone proximal gastrectomy, with reconstruction by esophagogastrostomy with valvuloplasty and pyloroplasty, for early gastric cancer 14 months before referral to our department. Oral administration of protease inhibitors and proton pump inhibitors was ineffective. Laboratory evaluation showed poor nutritional status. On endoscopic examination, we noted the redness, bleeding, and multiple erosions in the esophagus and the gastric remnant. He was diagnosed to have severe gastroesophagitis due to reflux of duodenal juice into the gastric remnant and esophagus. We performed duodenal switch to divert duodenal juice from the gastric remnant and esophagus; the duodenum was transected 2 cm distal to the pylorus, the duodenal distal end was closed, and a 50-cm Roux limb from the proximal jejunum was anastomosed to the proximal end of the duodenum. The heartburn disappeared postoperatively, and endoscopic examination revealed marked improvement of the reflux gastroesophagitis. One year postoperatively, the patient is free from symptoms including heartburn. His body weight increased, and laboratory data showed improvement in nutritional status. In conclusion, the duodenal switch may be surgical treatment of choice for intractable reflux gastroesophagitis after proximal gastrectomy.

 

http://www.ncbi.nlm.nih.gov/pubmed/22189411

Perioperative complications in a consecutive series of 1000 duodenal switches.

Biertho L, Lebel S, Marceau S, Hould FS, Lescelleur O, Moustarah F, Simard S, Biron S, Marceau P.

Author information

• Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada. [email protected]

Abstract

BACKGROUND:

In the past 10 years, most bariatric surgeries have seen an important reduction in the early complication rate, partly associated with the development of the laparoscopic approach. Our objective was to assess the current early complication rate associated with biliopancreatic diversion with duodenal switch (BPD-DS) since the introduction of a laparoscopic approach in our institution, a university-affiliated tertiary care center.

METHODS:

A consecutive series of 1000 patients who had undergone BPD-DS from November 2006 to January 2010 was surveyed. The primary endpoint was the mortality rate. The secondary endpoints were the major 30-day complication rate and hospital stay >10 days. The data are reported as a mean ± SD, comparing the laparoscopic (n = 228) and open (n = 772) groups.

RESULTS:

The mean age of the patients was 43 ± 10 years (40 ± 10 years in the laparoscopy group versus 44 ± 10 years in the open group, P < .01). The preoperative body mass index was 51 ± 8 kg/m(2) (47 ± 7 laparoscopy versus 52 ± 8 kg/m(2) open, P < .01). The conversion rate in the laparoscopy group was 2.6%. There was 1 postoperative death (.1%) from a pulmonary embolism in the laparoscopy group. The mean hospital stay was shorter after laparoscopic surgery (6 ± 6 d versus 7 ± 9 d, P = .01), and a hospital stay >10 days was more frequent in the open group (4.4% versus 7%, P = .04). Major complications occurred in 7% of the patients, with no significant differences between the 2 groups (7% versus 7.4%, P = .1). No differences were found in the overall leak or intra-abdominal abscess rate (3.5% versus 4%, P = .1); however, gastric leaks were more frequent after open surgery (0% versus 2%, P = .02). During a mean 2-year follow-up, 1 additional death occurred from myocardial infarction, 2 years after open BPD-DS.

CONCLUSION:

The early and late mortality rate of BPD-DS is low and comparable to that of other bariatric surgeries.

Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

 

 

Laparoscopic biliopancreatic diversion with duodenal switch (LBPD/DS) is a safe operation.Topart P, Becouarn G, Ritz P. Surg Obes Relat Dis. 2013 Jul-Aug; 9(4):588. Epub 2013 Feb 4.

Surgery for Obesity and Related Diseases
Volume 9, Issue 1 , Pages 63-68, January 2013
Perioperative complications in a consecutive series of 1000 duodenal switches
Presented to the 28th Meeting of the American Society of Metabolic and Bariatric Surgery, Orlando, June 2011.

Laurent Biertho, M.D.email address, Stéfane Lebel, M.D., Simon Marceau, M.D., Frédéric-Simon Hould, M.D., Odette Lescelleur, M.D., Fady Moustarah, M.D., M.Sc., Serge Simard, M.Sc., Simon Biron, M.D., M.Sc., Picard Marceau, M.D., Ph.D.

"Certain hypotheses, or rather speculations, can be drawn from the shifting percentages of the type of procedure being performed. Over time, a given operation’s weight-loss efficacy decreases and long-term complications increase. This predictable evolution could explain the drop in AGB in Europe, with the longest history of AGB in the world, and the decrease in RYGB in the USA/Canada grouping, with the longest history of RYGB in the world. With the overall number of operations essentially constant, a reduction in the number of a given operation must be balanced by an increase in the number of another. Worldwide, this increase has occurred in the number of SG performed, which rose from 0.0 % 8 years ago to over 25 % today. Another factor in the global popularity of SG may be faddism; surgeons and patients are not exempt from gravitating toward the latest innovation, even in their choice of a surgical operation.

A reason rarely discussed in the choice of operations is the skill of the surgeon. The numbers of BPD/DS remain extremely low (

Quote from AMSBS clinical guidelines, 2013 update: "Physicians should exercise caution when recommending BPD, BPD-DS, or related procedures because of the greater associated nutritional risks related to the increased length of bypassed small intestine."     *****  

JAMA Surgery Releases for September 17, 2012  Study Compares Duodenal Switch vs. Gastric Bypass for Morbid Obesity   "Although researchers note a relative increase in the use of the DS, this procedure is still used much less in the United States compared with gastric bypass. The researchers suggest that is likely due to several factors, including the technical difficulty of the procedure, the higher reported rates of short-term complications and concerns about the longer-term nutritional consequences of a primarily malabsorptive procedure (where absorption of calories and nutrients is reduced)."  *******

These are quotes that are from reputable professional sources.  

I am not interested in a debate about the DS as a choice of weight loss surgery, though I am concerned that only the benefits are presented here. The presentation is biased and one sided. There are substantial disadvantages and risks that are not presented, and a person needs to be able to take both aspects and full information into consideration of a weight loss surgery of any type.

Again, my primary concern is that we are everyone of us amateur strangers on the internet, and are not trained, licensed, expert professionals or Bariatric surgeons, or any kind of medical or surgical doctor, for that matter.  

We cannot know the person at the other end of the internet and their particular case and needs, nor are we experts no matter how much we think we know.  

It is neither ethical nor appropriate for us to be providing recommendations as to type of weight loss surgery a person should consider or obtain.

Did you actually read the studies?  I'm not for or against any WLS.  I do believe everyone needs to know the options available to them and the correct information based on studies and discussing the surgery options with more than one surgeon or at a minimum a surgeon that does ALL procedures.  A RNY surgeon will not tell "you" about the DS, if you ask then they'll talk it down as a horrible option. 

I'm 100% happy and successful with RNY....it's not for everyone.  Neither is the sleeve or the DS....YMMV for everyone.

You are adamant though that the DS has way more complications than other surgeries that is just not true.  All surgeries can have complications true....malnutrition can happen to anyone that has some of their intestines bypassed.  Everyone going into a malabsorptive surgery needs to know the results of not eating correctly, not supplementing correctly and listening to the "your labs for fine" that MANY hear without actually looking at the lab results and tracking them.  Vitamin Deficiencies can usually be prevented if the patient is proactive in supplementing.  Anyone thinking long-term they don't need vitamins should not even consider having the RNY or the DS.

Why are you so against the DS?  Do you wonder if you made the wrong choice with RNY?  I'm puzzled why you continue to dis the DS not only on OH but Facebook also.  Ever think about supporting someone considering having a different surgery than you......you should try it sometime.

And I'm done with you today.  Arguing with you is like beating my head against a brick wall.  This isn't the first time you've basically told someone you wouldn't consider the DS (and hope they don't alter their body like that) to someone.

 

I am concerned about the appropriateness of recommending any type of weight loss surgery as nonprofessionals to someone who is a stranger to us who we can't know what their needs or unique cir****tances are, and that we are not trained for or expert with.

I think people aren't reading what I am repeatedly saying. The specific issue I am raising is not being addressed.

I am speaking about ethics and the need for professional consultation regarding any type of weight loss surgery.

Personally I am grateful for my RNY, am grateful I have not had any complications so far, am grateful that I have done a good job managing myself so far and intend to continue doing so into whatever future I have, am grateful that my health is much improved, and am grateful to be a small size. 

I am not an advocate or a naysayer for any of the weight loss surgeries. My personal choice of surgery is irrelevant.

I think people need to know the advantages and disadvantages and risk factors of all the weight loss surgeries in order to make an informed choice as to type of surgery to obtain.

However, I am not an expert, and do not and will not recommend any particular type of weight loss surgery to anyone. That is not my call. 

"I am not an advocate or a naysayer for any of the weight loss surgeries."

Really?? Sorry, can't let that lie go by unchallenged. You are the definition of a naysayer when it comes to the DS.

Don't get me wrong. It's your right to be a naysayer; just don't deny it.

I guess people will believe what they want to believe and hear what they want to hear, in spite of repeated clarifications I have offered.

Yet again, I want both sides, or as many sides as there are, of ALL the weight loss surgeries presented so people can make a fully informed choice as to which surgery they wish to consult WITH THEIR BARIATRIC SURGEON about obtaining.

My objection to the way the DS is presented here to new people coming to OH is that the DS is wonderful and miraculous and will save the day and their lives, as well as make the weight loss relatively effortless and it will last forever without any effort, as well as a person will be able to eat lots and lots, particularly bacon, unlike the other weight loss surgeries that just make things too darned hard, a person shouldn't have to suffer that way. Never mind a person may not have been responsible for managing themselves, the inadequate surgeries fail them and they just need a "stronger tool." The DS will do it for them, and everything will be all better.

While the DS does offer benefits, there are also major disadvantages and risks that are never presented or discussed.

It is never pointed out that the DS involves by far the highest risk as well as by far the highest level of permanent rearranging of the digestive system of all the weight loss surgeries.

It is never acknowledged that few Bariatric surgeons are willing to perform it because of its risks, which has little or nothing to do with a surgeons skill level as is claimed. No one ever points out that both the AMSBS and JAMA caution Bariatric surgeons with regard to performing the DS.

I object strongly to the one sided presentation of the DS here, which is biased and insufficient, and not supportive of full informed awareness on the part of the person seeking weight loss surgery.

It seems to me that several people here are too pro DS to the exclusion of the other weight loss surgeries, and are unwilling to support any alternate choice of surgery that may in fact be more appropriate for that particular person considering WLS.

The DS is presented to everyone no matter the question a person asks as to type of surgery they are considering; I find that intrusive and disrespectful to the poster.

It seems to me that some people here who speak of the DS are proselytizing and attempting to convert people to the DS in an inappropriate fashion. I find myself wondering why people feel the need to do this- is it because the DS is little known or performed or not recommended by most Bariatric surgeons? Therefore people need to spread the word?

I object even more strongly to nonprofessional strangers recommending to other strangers over the internet a major elective permanent surgery that they themselves are not licensed or trained to perform.

I am not anti DS, I am anti the style of presentation of the DS here on OH.