VSG to Duodenal Switch needed?

 New to this board.....I had VSG exactly one year ago and have lost 125 lbs.  I think I still need to lose 75 to 100 lbs. since I began at 444.  Anyway, I am going for my one year check up and was wondering if I should be prepared for "step 2".  Originally, my surgeon told me that this would be the course of action for me--but also said I could expect to lost about 80 lbs in a year--and i have lost much more than that.  My weight lose has slowed to about 1-1 1/2 lbs. a week.

My question is, should I continue with what I am doing or procedure towards the switch?  The one thing I like about the sleeve is not having to worry about malabsorbtion too much.  I am a high risk patient because of I have a blood clotting disorder and am on coumadin for life.

Any converters here?

Marian

Not a revision here---I started out with a full DS. (Althought my surgeon scared the crap outta me just before they wheeled me into the OR by telling me he *might* have to do a 2-stage DS on me. That was the very first time I'd ever heard of such a thing!)

In your situation, I would most definitely get the second half of the DS done, ASAP. There's some evidence that the two parts don't work together nearly as well if they're done more than 12 months apart. And it seems the malabsorption of the switch isn't nearly as important in LOSING weight as it is in MAINTAINING that loss long-term. In other words, you quite likely CAN finish losing your weight with what you've got now---but will you be able to KEEP it off, given that most people who become 150 to 200 or more pounds overweight DO have metabolic problems.

 I have never heard of a "time limit" issue with getting the second stage done.  I find it hard to believe that it would be true--my surgeon at Cornell is one of the top surgeons in the country doing the VSG and they pride themselves on all the latest procedures, etc.

I guess I will find out on Monday.....

Your surgeon has a history of only giving people half the DS, even though he's told them he'll be doing the whole thing. Then they wake up with just a Sleeve, and a 'promise' to do the second stage later.

I'm an RNY to DS revision person, and everyone's mileage will vary, but there's no malabsorption with the VSG. Statistically speaking, there's a good chance you won't reach goal with the VSG, and you will have partial regain. You've done remarkably well with the VSG, and should be extremely proud. However, you might consider the DS because it will help you get much closer to goal and will help keep the weight off long-term.

It's not for everyone, but do your research and see what you think. Your doctor is a good guy, from what I've heard he's very caring and he is conservative in his approach. Those are good thing, and makes considering whatever advice he gives a good thing.

Anyway, no matter what you decide, I wish you continued success.

congrats on your excellent weight loss.  if you are losing 1-1.5 lbs a week i think that is excellent, fantastic actually 50-75 lbs in a year, you could almost be at your goal if you have to lose 75 lbs.  you have a few questions to think about......

-how long am i going to continue to lose?  if it stays at 1-1.5, no need to get intestinal bypass and you would not have to worry about the malabsorption issues.
-if you can no longer lose anymore and still have 50-100 to lose, think about intestinal bypass
-how can i handle the keeping the weight off if i do lose the last 100 lbs with vsg?  can i maintain it with that or would i need the intestinal bypass portion added?
-insurance co. are strange when it comes to the DS in 2 parts, most will not cover the 2nd half after a certain time limit, but you would have to get your specifics

a lot of these questions are really specific to you, what you want and what you are willing to do and what you are comforta ble with, good luck to you and your travels

 Thank you.  Those are very good questions to mull over.  One of the problems is that I just don't know how much longer I WILL continue to lose.  I didn't know anything about the insurance companies and DS limitations.....

Is the weight regain less after a DS?  If so, why?  Is it different than the RNY regain rate?

The DS has the very BEST long-term, maintained weight loss stats. The VSG and the RNY appear to have similar long-term stats, but the VSG hasn't really been around long enough to have a good, long-term study available.

The reason the DS has the best long-term stats is because of the PERMANENT malabsorption of CALORIES. Most bariatricians agree that the malabsorption of calories with the RNY pretty much disappears after 18-24 months---there's so very little bypassed to begin with, and the body's really good at 'fixing' itself.

 Thanks, that explains it.