Sleeve or Duodenal Switch?

Debating whether to have the sleeve or duodenal switch. I have to lose150lbs and am unsure as to whether I should have the sleeve or DS. Have any of you had difficulty with either of the procedures or had a revision because the procedure was not for you or had weight regain. Would love to hear your thoughts on both procedures. I am particularly interested in hearing from sleevers that revised to a Duodenal switch and why.

I've never heard of anyone on this board talking about revising to a DS.  It may have happened, but I haven't heard it here and I've pretty much read every post for the past 8 months.

Jane

a few people have switched but it is rare

I would not get a ds if you only need to loose 150 lb unless you have other very bad health problems

If you stay on a good plan you should be able to loose 150 lb with the sleeve

with the ds you will need to take handfuls of expensive vitamins and minerals

 people with the ds tend to have a lot of gas and diarrhea

if you need to have some malabsorption you would be better off with the rny

my surgeon had 1 patient that was 900 lb and lost most of his extra weight with the vsg 

you can regain with any wls if you get off your plan

 if you get the sleeve and need more help it can be revised  to the ds 

but it is much harder to undo the ds if you get sick or loose to much

There ARE people who have switched from the VSG to a DS and have done well. It is better, however, to make that decision up front if you can for a variety of reasons (weight loss is better with a virgin DS rather than doing it later when your stomach is matured). Anyway, only you can make that decision. I had about 100-110 pounds to lose and also debated between the two. The DS is certainly more forgiving in terms of quantity of food you can eat because of the malabsorption of protein and especially fat. However, you absorb all carbs with the DS, so sugar, bread, pasta, rice, etc. will be fully absorbed AND may cause the intestinal difficulties, like gas, that some DSers have. Plus you MUST supplement with vitamins. A LOT. Without fail. We need to supplement, too, but it isn't as critical because we absorb all that we eat and as our stomachs mature, we can get all or the majority of our vitamins from our food. I still take a multivitamin daily, plus a B1 (which I tend to run low in) and calcium for my bones.

My doctor, who does all the surgeries, told me that he feels the VSG is sufficient for someone with a BMI up to 45. From 45-50, he feels one can go either way, and he tends to recommend the DS for patients with a BMI over 50. But it is TOTALLY up to you. We have many people on the boards who have lost way over 150 lbs and are maintaining successfully.

At the end of the day, I chose the VSG because my BMI was relatively low, I didn't want to worry about gas from certain foods, I HATE taking supplements and knew that was non-negotiable for the rest of my life with the DS. Plus, I feel like I can eat as much protein and fat and veggies as I want with the VSG, so the malabsorption of those nutrients was not as appealing.

I am 6 years out from the VSG and successfully maintaining. I don't track calories but it's probably around 1800/day or so. There is nothing I don't eat sometimes, including carbs, desserts, etc., but most of the time I DO still eat protein first, followed by non-starchy veggies. I don't worry about fat. This is actually the type of food that DSers eat as well, only they can eat more of it. I don't feel like I'm deprived of quantity at all.

I do exercise, though I didn't during the weight loss phase. I do it now for health and to help maintain my weight, but I'm not hard core by any means. I do an hour of flow yoga 2 or 3 times a week, step aerobics another 2 days and meet with a personal trainer for strength training once every two weeks. I'm 59 and have osteoporosis, so it's particularly important for me to build bone!

Yes, I have made a decision to lead a healthier life, and you will need to do the same with either surgery. Both require dedication and determination.

The DS is a wonderful surgery too and the people I know who had it initially or who switched from the VSG are happy with it. You just need to consider all the pros and cons for YOU!

Best of luck in your decision.

Lizanne

Brilliant and truthful.  I just wish we had a "like" button. 

Thank you for your thoughtful response. My BMI is 52-5'2.5 and 300 lbs.  Just trying to figure this all out. I want the sleeve to work for me because I like the idea of not malabsorbing; however, I have about 150 lbs to lose and I tend to struggle with keeping the weight off. I also struggle with carbs-which are absorbed by either surgery; however, they could give me bloating and diarrhea with the DS. Everyone keeps saying you have to lead a healthier life. I'm all for that; however, if you couldn't lead a healthier life prior to surgery then what enables you to do so now. What is it that changes?  It's hard to grasp this since I'm not on the other side of the surgery.

That is such a hard question to answer, and I think it varies from person to person. For either surgery, part of it is making sure that you are emotionally ready for the change, that you're in the right place to commit to keeping your head in the game and doing the work that is required. None of us is perfect and probably ALL of us have gained and lost significant amounts of weight before. You will make mistakes but you have to make sure you're in a strong enough place to not get derailed when you do. You do have to believe in yourself and your ability to do this. Many people see counselors about food issues before WLS. I would also caution you, if you do go with the VSG, not to think about the DS as a safety net that you can revise to down the line if the VSG doesn't work. That's true, of course, but I think you could undermine your success that way. So that's some of the psychological stuff...

On the physical side, many things change. Hunger goes away or is greatly diminished. If you go low carb, as most of us do, your cravings for the carbs go away, and you use those first 6 months to a year, when weight loss is fastest, to create new habits and new relationships with food. You eat only a tiny amount of food and you feel very full. You lose a lot of weight, so you feel and look so much better. Moving becomes a joy instead of a pain. The list goes on and on...

Why do you think you cannot lead a healthier life now? Maybe take a good hard look at what stops you--perhaps some of the reasons would be addressed by the weight loss itself. I know that by the time I had WLS, I was really unable to lose weight on my own as I had become pre-diabetic and insulin resistant. And I had yo-yo'd many times so I was very discouraged. AND I was post menopausal.  I wasn't sure it would work either, but I made the commitment to do all that I could to succeed, to follow my program (LapSF)'s  strict eating plan and to be completely vigilant during the weight loss phase. As the weight came off, it became easier to see success and realize that the changes I was making weren't that hard and were SO worth it. I am not perfect and I still have food issues and make mistakes, but I NEVER want to go back to the way I was.

I think you are very wise to really take the time to ask these questions and to make sure you are ready. I know that I had to think about it for quite a long while--it is a big change. But a great one! Hope that helps,

Lizanne

Really hard to pin point. I am just over a year out and I still have no idea what is making it work for me now and why it didn't work before. I am just really glad it is working!!  I think before surgery I ate and overate because I love food and I could eat whatever quantity I felt like...now not so much. The restriction is a great help. It triggers my thought process which helps me stop. Also I am still really impressed by the fact that I actually went through with a surgical procedure to cut out a perfectly healthy organ. My first surgery. My first night in a hospital (apart from giving birth). I would really have to be super daft to f that up...so I am sticking to my plan. Maybe that's it? Simply taking this drastic step does flip a switch in your head.

If you want to hear from sleeve to DS revisions, post on the DS board, 'cause that's where they're probably hanging out!

The decision is totally personal choice.  Do you believe you need the malabsorptive part of the DS or not?  There is no question that the DS is the biggest gun of WLS, but it comes at a cost.  Can you keep up with the required supplementation for the rest of your life?

I was 52 when I had the sleeve, post menopausal.  I lost 160 pounds.  Parts of it have been very hard - that whole change of lifestyle thing.  But you have that with ANY of the surgeries.  Unless you have metabolic reasons that prevent you from losing weight, there's no reason why the sleeve won't get you where you want to go.