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Have you looked into getting the 2nd stage of the DS as you have the 1st stage, vsg.  Why lose your pyloric valve and end up with with the less desirable of the two surgeries.

I agree a DS would go with a DS since you already have the first stage. You do need an experienced DS surgeon tho as it is a more difficult surgery but the best from what I've read.

The others are right. The DS is the most effective surgery for weight loss, weight maintenance, and resolution of co-morbidities, and you have the first half of it. It would be criminal to ruin you sleeve for an inferior pouch and cut your pyloric valve. 

Not every surgeon can do the DS, but you shouldn't settle.

I have talked to my doctor extensively about RNY vs DS.  When we first decided to have surgery again we were set for the DS.  After talking to Dr. Joya he explained the complications of the DS vs RNY and th bile backup alone was enough to change my mind.  He always suggest RNY after sleeve for a greater wight loss. 

Bile back up??? Is he suggesting that will be an issue, or do you have that issue now? I can't see if it was in the initial question or title as you have erased those. 

Bile backup is NOT normal for sleeve or DS (well, it shouldn't be with any surgery), and would suggest the sleeve was done incorrectly if that has been an issue. There are a few surgeons that made problematic sleeves that were more hourglass shaped, than bananna shaped, and caused issues. Some will fixed with surgery, and one that I know of without.

You wouldn't have bile back up with the VSG/DS as you have your pyloric is left intake.  Now if you are talking acid reflux, the RNY is recommended.  There are those that have reported acid reflux with the RNY not, the norm though.