Question:
Can someone honestly give the CONS of the DS??

I have only seen the PROS. Some say it is more malabsorptive than the RNY, but this doesn't seem to be true. Less is bypassed and you keep most of your stomach. So- since it's been around since 1997, why aren't more surgeons doing this procedure? What's wrong with it? There are over 15 bariatric surgeons in my state and 2 of them teach different bariatric procedures around the world, but only one of them, not one of the teachers,(and he is the middle of nowhere) does this procedure. Any input??    — toolio (posted on February 7, 2003)

February 7, 2003
Do a search for Barbara Henson in "find peers". Her profile outlines some of the problems. She ended up having her DS reversed.
   — mom2jtx3

February 7, 2003
I am getting the DS in 1 week. Wouln't have any other wls. For an accurate portrayal of the DS, go to website: duodenal switch.com. It is a site full of information. Besides the infor is an area of patient stories. Close to 100 of them.I have read everyone, and these folks tell it like it is. The good with the bad. You'll learn alot.
   — Leslie E.

February 7, 2003
Because the DS creates the most malabsorption of the WLS options, it requires a lifetime of vitamin supplements and lab tests to ensure that the patient doesn't develop serious nutritional deficiencies down the road. My guess is that insurance companies fear that some people *won't* be vigilant in the long run, which could create more health problems, so they tend to not want to pay for DS as readily as they will for the RNY (or to a lesser extent, the band). Even with the RNY, some of us are told to use vitamin supplements, but our docs don't even agree on what to use (which is really frustrating). Since the RNY doesn't create as much malabsorption as the DS, insurance companies may be less concerned about the issue of what vitamins to use, or whether there will be patient compliance, where the RNY is concerned. I'm not saying I agree with that attitude (I don't), but I'd guess they're just more comfortable with the more conservative procedure (the RNY) because of those issues. Bottom line: Whatever the reason, if insurance companies are refusing to pay for the DS in many cases, while at the same time they're approving the RNY more frequently, the docs are gonna follow the money and become proficient and experienced with the procedure they're getting paid for. You really can't blame them there. :(
   — Suzy C.

February 7, 2003
Hi Juliet, I have to disagree with some of what Suzy said. My DS was 13.5 months ago. We absorb MORE of our nutrients, not less. Because we still have a stomach and our pyloric valve, more of our nutrients are absorbed. The pyloric valve regulates food and liquid leaving our stomach. This gives more time to break down. We take two multivitamins and two calcium w/ D per day. RNY patients are required to take the vitamins and calcium plus vitamin ADEK, iron and B12. We also have our bloodwork done every three months to catch any problems that may occur while they are still minor. Our local Medical Center does NO follow up bloodwork on it's RNY patients. Also, with the DS you are bypassed for fat absorption. Unless you have a distal RNY, you are not. This is what people do not understand. They hear bypass and assume both surgeries bypass the same, they do not. This is only my opinion on why more doctors aren't doing it. Why learn a new procedure when you can do another surgery faster and cheaper and you know the insurance will pay for it without question. Why aren't the insurance companies paying for it more? They are slowly coming around but nothing moves quickly. Look how long it takes new proven life saving drugs to be approved and on the market. I'm sure you have a fair share of the surgeons fighting the change too - back to the surgeon part of my answer. We have two surgeons, statewide, doing the DS but more and more are changing their ideas as they see the differences in the quality of life and long term statistics of the two surgeries. Actually, the DS has been around much, much longer than 1997. Like most surgeries, it was done overseas for years before the Americans decided to try it. Both surgeries are good. It is the patient who makes a surgery a success. Good luck! Carol
   — grammie5

February 9, 2003
Actually, the Duodenal Switch originated in the United States, not abroad. Dr. Hess in Ohio performed the first DS in 1988, so it has a wonderful 15-year track record at this point. I researched both the DS and the RNY pretty exhaustively before I made my WLS choice, and I had a long spreadsheet going with the pros and cons of each, including all of the "hard numbers" I could find from reading dozens and dozens of published medical studies. Here was the bottom line for me: With the Dudoenal Switch, patients tend to lose more of their excess weight and keep it off much better. There is very little risk of late regain, which is a significant problem with the RNY. DS patients also enjoy a more "normal" quality of eating after surgery. We don't have to worry about dumping syndrome, or avoiding fibrous foods, or chewing everything very carefully and thouroughly, or not drinking with meals. We generally eat very freely -- just a little less than we did before. So, these are great benefits, but is there a downside? Yes, of course. Every surgery has pros and cons. For the DS, the major drawbacks are: 1) It's a longer, more complex surgery. In an experienced surgeons hands, it can be as safe as an RNY, but you have to research carefully to find the right surgeon. 2) Because of the greater malabsorption, the risks of nutritional deficiencies are higher. Even with proper follow-up and supplementation, about 5% of DS patients will develop some nutritional deficiency that will have to be addressed medically (vs. 1-2% of proximal RNY patients). DS patients have to be VERY diligent about taking their vitamin/mineral supplements (sometimes up to 12 pills a day) and they have to watch their protein intake as well (consistenly getting 70-100 grams a day). If they aren't compliant with the post-op routine, they WILL develop serious problems... it's only a matter of time. This scares many doctors, who don't want to be responsible for non-compliant patients or for extensive, life-long follow-up programs. 3) As with any malabsorptive procedure (such as the distal RNY), DS patients face a higher incidence of "bathroom" side effects, especially in the first few months after surgery. This can mean (for some) frequent BMs, excessive gas, and even diarrhea. In my experience, the pre-op worries about these side effects turn out to be much worse than the actual side effects themselves. For most people, it's simply not a big deal. In my case, I am 8 months out from the DS, and I usually have about one bowel movement a day. It's a little larger and softer than it was pre-op, but certainly not a problem. I never had diarrhea. I do sometimes have a little more gas than I did pre-op. Not every day, or even every other day... but every now and then. It's not uncontrollable or anything more than slightly inconvenient. And it's getting better over time, as my body adjusts to this new arrangement. For me, the DS has been everything I hoped and more. I love it, I feel terrific, and am SO glad I cancelled my RNY surgery date and held out for the procedure I really wanted. But everyone has to make their own decision and assign their own weights to the risks and benefits of each surgery. YMMV. Best of luck to you.
   — Tally

February 9, 2003
As for referring to Barbara Henson's profile, please know that she had expected to have the DS, but her surgeon did not do the typical DS. As a result, she had his inadequate surgery revised. Barbara has been very vocal contributing her difficulties to the DS, when in fact, her difficulties came from an attempt to do a DS procedure. We know nothing of the skill or credentials or malpractice history of her surgeon. Additionally, there is question as to whether Barbara was compliant with the vitamin regime, although given her intestinal condition of "blind loop syndrome" determined during the revision, it is questionable whether any extra vitamins would have helped her. Please consider that when reading of her troubles.
   — merri B.

February 9, 2003
Thanks, all, for the great information. It has definitely helped.- Juliet (original poster)
   — toolio

February 9, 2003
Barbara Henson had terrible problems with her DS, and she was fortunately able to get it reversed. I hate that her name gets dragged through the mud everytime there is a discussion of the pros and cons of the DS surgery. She had a bad result from her surgery. She went into it with the same hopes and dreams as any one of us, and she had some rotten luck. It could have happened to anyone, and it has happened to others... DSers, RNYers, VBGers, even AGBers. Weight loss surgery is risky business, and it's always a leap of faith. Faith in the research we've done, faith in our surgeons, faith that we'll be part of the lucky majority who wake up to a happier and healthier life. It doesn't always happen that way, though, and the people who have poor results need our support the MOST. It makes me incredibly sad when I see Barbara getting no support, no benefit of the doubt, especially from many of her fellow DS patients. I talked to Barbara before I made my decision to have the DS. I heard her story, and I believed that while she may not have been *perfect* in her post-op compliance (and who the heck is??), she did her best and that should have been plenty good enough. She just had some bad luck. It doesn't mean the DS is a bad procedure... it doesn't even necessarily mean that her surgeon is a bad doctor (though it does sound as if he's made some significant errors) -- it just means that she was unlucky. I took her story as one example out of hundreds of personal accounts I heard. I weighed it and decided that it was an awful thing that happened to her (several years of chronic diarrhea, malnutrition, and overall illness), but that it was definitely NOT the norm for the DS. However, I was very grateful to Barbara for sharing her story. I needed to hear the "worst cases" and to factor those kinds of risks into my decision-making. I felt awful for her, and I was so glad to learn later that she'd been able to have a reversal and that she was doing so much better. What a nightmare she'd been through, and I understood very well that it could just as easily have been me in her shoes. I wish her the very best, always.
   — Tally

January 28, 2004
The only draw back I see with the DS is we don't lose quite as fast as RNY patients. I know some DSers will say I'm wrong there but I have friends who've had both surgeries and the ones who had the RNY have lost quicker. Now if you have 100lbs to lose you'll probably lose at about the same rate but if ya have 200lbs to lose you'll lose the last 100lbs a little slower but we DSers keep our weight off. I have a friend who weighed 585lbs and lost down to 178lbs and he is now starting to regain after his 5th year and he had the RNY. He had a lot of trouble with his pouch closing off too and almost died. Both surgeries have a few bad stories but for the most part they're pretty safe. Now some here have said that the RNY is less malabsobtive but I have to say that depends on how distal the RNY is done. If you have a distal RNY you could have more problems with malabsobtion than a DSer. Smelly gas and freqeunt bowel movements are a draw back for the first year but after that we don't really have a problem. As far as having to take a large amount of vitamins a day I only have to take 2 multi vitamins and calcium citrate pills everyday. My blood work has been perfect. DSers don't have the worry of our pouches getting blocked or closing(which can kill ya). So you make up you're own mind but the friends I have that have had the RNY most of them say they wish after seeing how I'm able to live after my surgery wish they'd have had the DS.
   — Mark L.

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