With 200 lbs to lose you should really really really consider the DS.
Please come over to the DS board and read about the positive experiences.  I also encourage you to read the RNY board and compare their experiences to DS and VSG ((shutters))  Find out why DS is recommended for those with a 50+ BMI (here's a hint, stats show even RNY is less effective for those over 50BMI)

for more info start here: www.DSfacts.com




And here's a bit from Wikipedia:

Duodenal switch

From Wikipedia, the free encyclopedia  

Intervention: Duodenal switch
ICD-10 code:
ICD-9 code:	43.89 45.51 45.91[1]
Other codes:

The Duodenal Switch (DS) procedure, also known as Biliopancreatic Diversion with Duodenal Switch (BPD-DS) or Gastric Reduction Duodenal Switch (GRDS), is aweight loss surgery procedure that is composed of a restrictive and a malabsorptive aspect.

The restrictive portion of the surgery involves removing approximately 70% of the stomach along the greater curvature.

The malabsorptive portion of the surgery reroutes a lengthy portion of the small intestine, creating two separate pathways and one common channel. The shorter of the two pathways, the digestive loop, takes food from the stomach to the common channel. The much longer pathway, the biliopancreatic loop, carries bile from the liver to the common channel. The common channel is the portion of small intestine, usually 75-150 centimeters long, in which the contents of the digestive path mix with thebile from the biliopancreatic loop before emptying into the large intestine. The objective of this arrangement is to reduce the amount of time the body has to capture calories from food in the small intestine and to selectively limit the absorption of fat. As a result, following surgery, these patients only absorb approximately 20% of the fat they intake.

Contents  [hide] 1 Comparison to other surgeries 1.1 Advantages 1.2 Disadvantages 2 Risks 3 Qualifications 4 References

[edit]Comparison to other surgeries

[edit]Advantages

The primary advantage of Duodenal Switch (DS) surgery is that its combination of moderate intake restriction with substantial calorie malabsorption results in a very high percentage of excess weight loss for obeseindividuals, with a very low risk of significant weight regain.^[2]

Type 2 diabetics have had a 98% "cure" ^[3] (i.e. became euglycemic) almost immediately following surgery which is due to the metabolic effect from the intestine switch. The results are so favorable that some surgeons in Europe are performing the "switch" or intestinal surgery on non-obese patients for the benefits of curing the diabetes.^{[citation needed]}

The following observations were reported on the resolution of obesity related comorbidities following the Duodenal Switch: type 2 diabetes 99%, hyperlipidemia 99%, sleep apnea 92%, and hypertension 83%.^[4]

Because the pyloric valve between the stomach and small intestine is preserved, people who have undergone the DS do not experience the dumping syndrome common with people who've undergone the Roux-en-Y gastric bypass surgery (RNY). Much of the production of the hunger hormone, ghrelin, is removed with the greater curvature of the stomach.

Diet following the DS is more normal and better tolerated than with other surgeries. ^[5]

The malabsorptive component of the DS is fully reversible as no small intestine is actually removed, only re-routed.

[edit]Disadvantages

The malabsorptive element of the DS requires that those who undergo the procedure take vitamin and mineral supplements above and beyond that of the normal population, as do patients having the RNY surgery. Commonly prescribed supplements include a daily multivitamin, calcium citrate, and the fat-soluble vitamins A, D, E and K.^[6]

Because gallstones are a common complication of rapid weight loss following any type of weight loss surgery, some surgeons may remove the gall bladder as a preventative measure during the DS or the RNY. Others prefer to prescribe medication to reduce the risk of post-operative gallstones.

Like RNY patients, DS patients require lifelong and extensive blood tests to check for deficiencies in life critical vitamins and minerals. Without proper follow up tests and lifetime supplementation RNY and DS patients can become ill. This follow-up care is non-optional and must continue for as long as the patient lives.

DS patients also have a higher occurrence of smelly flatus and diarrhea. Although both can usually be mitigated through diet; avoiding simple carbohydrates and fatty foods.

The restrictive portion of the DS is not reversible, since part of the stomach is removed. However, the stomach in all DS patients does expand over time and while it will never reach the same size as the natural stomach, some reversal by stretching always occurs.

[edit]Risks

All surgical procedures involve a degree of risk however this must be balanced against the significant risks associated with severe obesity.

Some of the surgical risks or complications for this procedure are: perforation involving small bowel, duodenum, or stomach causing a leak, infection, abscess, deep vein thrombosis (blood clot), and pulmonary emboli (blood clot traveling to the lungs).

Longer term risks include hernia and bowel obstruction.

Malnutrition is an uncommon and preventable risk after Duodenal Switch. ^[7]

[edit]Qualifications

The National Institutes of Health state that if you meet the following guidelines^[8], weight loss surgery may be an appropriate measure for permanent weight loss:

• BMI of 40 or over
• BMI of 35 or over with obesity-related illnesses such as:
  • Diabetes mellitus type 2
  • Coronary heart disease
  • Sleep apnea
  • Osteoarthritis
• An understanding of the operation and lifestyle changes necessary following the surgery.

[edit]References

1. ^ "Coding for Obesity". Retrieved 2007-10-14.
2. ^ Prachand VN, Davee RT, Alverdy JC (2006). "Duodenal switch provides superior weight loss in the super-obese (BMI > or =50 kg/m2) compared with gastric bypass". Ann. Surg. 244 (4): 611–9.doi:10.1097/01.sla.0000239086.30518.2a. PMID 16998370.
3. ^ Hess DS, Hess DW, Oakley RS (2005). "The Biliopancreatic Diversion with the Duodenal Switch: Results Beyond 10 Years". Obesity Surgery 15 (3): 408–16. doi:10.1381/0960892053576695. PMID 15826478.
4. ^ Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004). "Bariatric surgery: a systematic review and meta-analysis". JAMA. 292 (14): 1724–37. doi:10.1001/jama.292.14.1724.PMID 15479938.
5. ^ Baltasar A, Bou R, Bengochea M, Arlandis F, Escriva C, Mir J, Martinez R, Perez N (2001). "Duodenal switch: an effective therapy for morbid obesity--intermediate results". Obesity Surgery 11 (1): 54–8.doi:10.1381/096089201321454114. PMID 11361169.
6. ^ Aasheim ET, Björkman S, Søvik TT, Engström M, Hanvold SE, Mala T, Olbers T, Bøhmer T. (2009). "Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch.". American Journal of Clinical Nutrition. 90 (1): 15–22. doi:10.3945/ajcn.2009.27583. PMID 1943456.
7. ^ Marceau P, Biron S, Hould FS, Lebel S, Marceau S, Lescelleur O, Biertho L, Simard S (2007). "Duodenal Switch: Long-Term Results". Obesity Surgery 17 (11): 1421–30. doi:10.1007/s11695-008-9435-9.PMID 18219767.
8. ^ Weight-control Information Network, National Institutes of Health. 

Hi Mary,

 Most of my life I was around 350 lbs.  I managed to lose some weight on my own, but I regained most of it back.  I got my lapband 3 years ago, and I now weigh 40 lbs MORE than when I started. The only thing the band has given me is physical pain and emotional shame and dissapointment.

I have NEVER in person met anyone who did not have issues with their band.  There are people online who claim to not have issues, but I personally do not know any of those people in "real life".   There are posts here from folks with the band and say "work your tool" and "follow the rules" which translates to "be on the band diet and use your willpower". Let me tell you, the band is no different than any other diet you have tried.  It is a self inflicted eating disorder .

I am now geting a revision to the DS.

The lap band has been one of the worst decisions I have made.  I am a totally normal person otherwise.  I work at Microsoft, I own a home, I have children, a college degree, etc - I didn't go into this uneducated or without resources for support.  I see a therapist regularly and attend support groups. I have had to come to terms with not labeling myself a failure yet again.

I hope you read all the success rate data and research results on line. There is no garantee the band won't work for you, but the the data shows the odds are against you.

Good luck to you with whatever you choose. 

 

Hi Mary,

Everyone has given you plenty of info. But let me give you my take...

I was 22.5 yo when I had the DS. I seen the scale hit 402 at the age of 21. Today 5.5 years after my DS and staring my 28th b-day in the face im 219lbs. I've steadily been here, size 10 jeans with a L/XL top depending on style(I've still got plenty in the sweater puppy department). I really am broad shouldered, big boned, and high bone density, with more muscle than I think should be normal, lol.

If just restricting your food intake was enough to lose weight and keep it off, you wouldn't have 200lbs to lose. I ate less in one day than either of my skinny ass sisters, so my intake was not the problem. So thus a purely resistrictive procedure (Lapband or VSG) would be worthless. So that left the gastric bypass or DS. Well I killed the bypass ages ago because I disliked it anatomically and function wise. I'm on the go to much to have the crazy ass restrictions or the dumping to put up with it, just to lose the calorie malabsorption a few years down the line and basically have nothing but a restrictive procedure. Not including I can not have any sort of artificial sweetener, flat out allergic. I also have a bad knee and tylenol does NOTHING for me, I NEED NSAIDs. The DS was the only choice of smarts to me. Anatomcally it makes sense (your body basically functions normally) and I don't have crazy restrictions. I eat normally! Nothing is off limits really as long as its protein first. I can have my NSAIDs without worry. The DS was a no brainer, a fist full of vites is better than a fist full of meds.

I have no regrets with my DS. I live life, people that met me post DS have no clue I had surgery. I eat nomal amounts. Buy normal clothes etc etc etc.

Do your research....make sure YOU CHOOSE what surgery YOU WANT. THEN find a surgeon.

Hi Mary, I'm a pre op DS'er scheduled for surgery 3/8/11.  I did tons of research on all of the surgeries.  And I found the the DS is the better option due to it's overall weight loss, and long term ability to KEEP the weight off.  The Band has the lowest statistics as you've read from the others, of helping people KEEP the weight off.  If you go to DSfacts.com there is more info there also, and experiences from women who've had successful pregnancies after DS surgery. 

So do your homework, as they say Think twice, cut once! Come to the DS boards and read. 

Good luck!

 it depends on how fast you want too loss the weight and if you want part of your intestines and stomach removed. Do you want to take loads of vitamins the rest of your life. what happens on the future and you have trouble with your intestines and they need to remove a portion and there's not enough to work with

Okay, let's play fair.  It's not cool to comment on things you appear to know nothing about.  There are NO surgeries that involve removing your intestines and only two where a portion of your stomach is removed (VSG and DS).  Even if a person has the full on DS treatment, the intestinal portion of the DS is fully reversible.  The sleeve portion is not because there is no 'blind stomach'.  The portion of the stomach that is sectioned from the sleeve is removed and thus, not reversible.  So, any surgery where you would need a portion of your intestines removed would still be possible.

Most Americans NEED to take vitamins daily.  Our food doesn't provide us with nearly enough bio-available vitamins and minerals (enrichment usually provides the cheapest form of vitamins and minerals, regardless of bio-availability) and so most of us are deficient in something or another.  May I ask you some questions?  What are the side effects of taking vitamins daily as opposed to most prescription medications to treat our various comorbidities from being MO or SMO?  How much more expensive is it to suppliment with vitamins and minerals than it is to pay for prescription drugs?

I'm not going to sway anyone who has already decided their path with WLS.  However, at the very least, understand, FULLY, all of your options and make an informed and wise choice.  It's your life.

Nicely done, AGAIN, Mark.

Nicolle

   Mark...you rock.   

sorry to say that what i posted is true i know 4 people that had there intestines partly removed and part of the stomach with everything rerouted and they are on 1o different vitamin's a day and I'm not trying to sway anyone everyone needs to choice what is best for them self