RNY VS DS

Now I am totally bumfuzzled. I was set on RNY till I was blitzed with DS info. It is better, no dumping and by far the longest lasting weight loss. Eat more normally. On and on. Why did I not hear a word about this surgery. I need to know which to choose. My insurance pays once. No do overs! What do you guys say.

Not all surgeons do the DS, you should discuss it with them. I know for me if I ate "more normally" the surgery wouldn't work for me. I like the RNY because it gives me restrictive benefits and malabsorptive benefits, pretty similar to the DS. My surgeon did not do the DS.
BTW - I am losing weight with the RNY, only 30 -40 pounds to go and I am not quite 4 months out.
Good luck with your decisions!

The DS is a great surgery but it does require effort to be successful,  as does any WLS.   If you do not follow the DS programme, it is entirely possible to regain - I know several DS'ers who have never got to goal and/or who have had regain after 5 years ...   It is not a free pass!

If I had had a higher BMI, I would have chosen the DS without a doubt - I do believe you have to be highly motivated to be successful long term, with any WLS.

Your choice of surgery really is up to you - DSFacts is the best source of information - be sure to get an experienced surgeon as it is a much more difficult surgery than RNY.

Most insurance companies will pay for the RNY or the sleeve.  These same insurance companies may not pay for the DS though.  Fewer surgeons do the DS.  Supplement requirements are higher, you need a strict regimine of lab work to check on vitamin levels, etc.  I suggest you check to see if your insurance company pays for this surgery. And if so, discuss it thoroughly with the surgeon.  The DS is typically done to high BMI people also, likely above 50.  If I had a choice, I'd stay with the RNY I had. My wife had a somewhat similar surgery in 1980.  She had constant diarrhea for most of the next 28 years, living on Flagyl to help deal with intestinal bacteria issues, and lomotil to help deal with the persistant diarrhea. Yes she could eat almost anything, but it came at a price. She was revised to a RNY in 2008. DAVE

I also considered DS and some insurance companies (mine included) do not cover the DS.  There are also fewer surgeons out there that perform the surgery.

I certainly can't and wouldn't tell you what to do.  I honestly had to read up on duodenal (sp?) switch surgery.  Frankly, I had never heard of it. 

From reading the info on OH, it does have a malabsorbtion component, so it isn't that different from RNY.  I would not have considered the intestinal part due to polyps that were diagnosed when I was 43.  I probably would not have been considered a candidate.

There are pluses and negatives to everything.  As someone who is about ten weeks out, I have not experienced dumping on any food I've eaten.  I've only gotten sick a few times from eating too fast.  And there are only a few foods that have made me feel uncomfortable.  (I call those my try again in a few weeks foods!)

Whatever you decide, good luck to you.  I had the same dillemma with band vs. bypass.  I'm sure you will make the decision that is best for you!

I had RNY Dec 5, 2012.  I am soo very happy with my RNY.  There are foods that I simply cannot tolerate, and I don't like the feeling that I get if I eat them.....9 times out of 10 these foods are things that I shouldn't eat anyways.  I have learned to avoid them altogether, and this makes it sooo much easier to just not want to eat them....It's kind of my own built in monitor.....If I could eat whatever I wanted with no consequences, I'm afraid that...in my case....I would gain the weight back......I Love my RNY....wouldn't trade it for anything.  I feel great, and I'm told that I look great too.  I do have a friend that had DS and she is doing very well also, she just takes a lot more vitamins than I do, and she can eat anything she wants....no dumping.  Once you get all the information on both surgeries, you will be able to pick the surgery that is best for you.  Everybody is different.  I'm sure you will enjoy whichever surgery you decide on.  Good luck to you in your weight loss adventure.
--Trish

You didn't give a lot of information such as your location or BMI, which might help in knowing you.  I can tell you that I had a DS in 2002.  Back then there wasn't as much known as there is now, at least by me.  My surgeon hadn't been doing them very long and wasn't very good at them, as it takes a very skilled and experienced surgeon to do a DS properly to ensure the best success.  Back in 2002 I never heard of a vetted DS surgeon.  I thought any surgeon with a scalpel could do it well.  I have learned since then that if it isn't done exactly right it could lead to inadequate weight loss or regain.  Also, the hospital I went to didn't do a great job of educating patients pre-op or following up post-op.  I was given pretty limited directions as far as supplements.  As a result of their poor preparation and follow up they no longer do the DS because they had a lot of poor outcomes with patients experiencing too much  malabsorption, diarrhea and other issues, as I did.  I was miserable after 8 years.  I had regained almost all the weight I lost because with any WLS if you continue to eat poorly you will not lose as much as you could and you can regain.  I didn't address my eating issues and continued to eat as I did before surgery.  I also didn't do enough supplementing as is needed with such a malabsorptive surgery and I was very sick.  I could barely function.  Getting dressed was an ordeal, much less showering, brushing my teeth and brushing my hair.  I was extremely depressed, which is a result of vitamin deficiencies, and very apathetic.  I regretted ever getting WLS.  I had all of the negatives and not one benefit from having WLS.  I went back to my surgeon and begged for a reversal.  I learned that the surgery couldn't be reversed, only revised so I wouldn't malabsorb as much. Two years ago I had a revision and began taking better care of myself.  My sleeve was revised into a RNY pouch and my common channel was lengthened from 100 cc to 200 cc so I would absorb more.  My surgeon warned me that I may not lose any weight.  I didn't care at that point.  I learned that there were worse things then being fat and being sick and unable to function was one of them.  I just wanted my life back, fat or not.  I don't know if he warned me that because I had failed so miserably with my first WLS or why but ironically I lost all my excess weight and then some.  In hindsight I realize that I would have done fine with more restriction and less malabsorption.  When I had my first surgery my surgeon make my sleeve too large and I never felt any restriction.  Once I got restriction I did fine. A lot of surgeons don't perform the DS.  Some people will tell you that it is because they don't make as much money as they do performing the RNY but I think a lot of the reason is because there is so much noncompliance in patients that they are afraid of litigation.  The RNY and other WLS also require supplements but the consequences aren't as severe or as immediate as they are if you aren't compliant with the DS.  Also, while it is true that you can eat whatever you want with the DS, many people who have the DS find that if they eat white carbs such as sugar and white flour they will suffer from very bad smelling gas and diarrhea.  I honestly didn't know this and I had terrible problems with gas and diarrhea.  I was often incontinent and had accidents, which was very embarrassing, not to mention the odor when I used a public restroom or a friend's bathroom.  They say it can be controlled with diet but I found that if I was able to have that much self control I wouldn't have needed WLS in the first place.  Really, with the RNY you can dump if you eat the wrong things and with the DS you can have other issues if you eat the wrong things.  You just have to pick your poison I guess.  For me, I do dump and dumping is a very unpleasant, very fast consequence and I haven't chosen to take that chance.  The times I have dumped have been when I have unknowingly eaten things with sugar.  Fortunately I haven't dumped in a long time, thankfully.  Some people have found it very difficult to stop eating those things in spite of the consequences whether it is dumping or gas and diarrhea.  No matter what the surgery there is no free ride. Make no mistake.  The reason I failed my DS is because I didn't deal with my eating issues and I continued to eat the way I did prior to WLS.  If I had done what I was supposed to do I wouldn't have had the problems I did.  The reason I have done as well as I have since my revision is because I have finally treated WLS as a tool and not a cure.  I do not eat anything with sugar or gluten, I watch my portions and don't graze.  I follow the rules of protein first and lots of fluids.  I didn't do that the first time and I failed so hopefully I learned something from my experience. If you do pursue a DS make sure you are thoroughly educated and completely honest with yourself as far as your ability to follow a strict supplement program.  In fact, if you decide to have any WLS make sure you know that you will be willing and able to afford and use the necessary vitamins and protein.  With the DS it can get very spendy, not just for the vitamins and protein but the lab work and follow up.  Vitalady has a list of recommended vitamins for a DS patient.  You can buy a 3 month supply already packaged and ready to go for about $300, so it comes to around $100 a month.  The vitamins for the RNY are a little less but still an expense you need to be able to budget for. I hope I have been able to answer some of your questions.  Most people who have the DS are extremely happy with their choice.  I probably would have been too if I had been able to follow the requirements.  Also, with the DS not only may you have to travel to have the surgery but it can be harder to get follow up care as most health care professionals know little if anything about the DS so it is of the utmost importance that you are able to thoroughly educate yourself and be prepared to educate whoever you choose to follow up your care.  You can't be shy when it comes to your healthcare.  You must be willing to be assertive when it comes to having your labs done and you can't just assume that your doctor knows best just because they have MD at the end of their name.  When it comes to nutrition very few WLS agree on what you need.  They may advise a totally inadequate vitamin routine, as mine did and if you don't educate yourself you may find yourself very sick. Good luck with what ever you choose.

As others have pointed out, many surgeons do not do the DS. It is a more complex surgery than the RNY. My surgeon used to do it, but stopped because too many of her patients were not being compliant with the extensive vitamin regimen and were developing medical problems due to nutritional deficiencies.

I seriously considered it because I started with a BMI of 57. I did not like the idea of even MORE vitamins than are already required for the RNY, having the remnant stomach removed, and the possibility of CONSIDERABLE issues with foul smelling gas and oily diarrhea (one of the first people I met who had the DS had a terrible time with both do those things, and even though other DSers say that is not typical, I know several DSers who do struggle with the diarrhea). In the end, I could live with any of the POSSIBLE side effects of the RNY, but was not willing to risk some of the POSSIBLE side effects of the DS.

Lora

 The DS is very risky and there is a high mortality rate both during and years out from surgery.  I was considering it because I'm diabetic and it is very effective for sugar control.  There are a few surgeons near me who do it and are associated with great hospitals but , for me, the risk is too great relative to other WLS.  The sleeve (VSG) came about as a standalone surgery after being done with the DS for years.  It is showing promise as comparable to RNY for health benefits although weight loss is slower and not as high in the long term.  But if dumping is a real concern for you it might be something to look into without being as risky.

Elisa