Question:
I am trying to decide if the RNY or the Duo Switch is best for me. On the

Duo Switch, Is your eating pattern of small amounts and small bites the same as the RNY? Do Duo Switch patients tolerate sugars better? What is the difference between the diet lifestyle patterns of the Duo Switch vs. the RNY? Also, I went to a seminar last night for the Fobi pouch and the doctor said 30 to 40% of the RNY patients gain at least 50% of their weight back. That seemed like a high statistic. Any insight on that?    — Judy W. (posted on November 8, 2001)

November 8, 2001
I think there are + and - to both the Ds and The RNY. One plus to the Ds is you can eat more. Your stomach is larger. Right after surgery the Rny pouch is @ 1 to 2 oz and the Ds is 4 to 6 oz. I chose the Ds for a couple of reasions. I can eat more normally and with the DS you keep the pyloric valve. Some people say that you have more problems with malabsorbtion and direhha with the DS, but I found that a distal Rny has the same risks. Everyone is different and makes a choice to suit them. Good luck on your journey. When I was researching I found a couple of GREAT sites. www.mywls.com and www.duodenalswitch.com
   — [Anonymous]

November 8, 2001
I chose the DS for several reasons: I didn't want to lose my pyloric valve--I wanted a functional stomach after surgery which would prevent "dumping" from happening. I can tolerate sugar and fat and can eat more than the RNY patient and still lose weight because of the malabsorption of calories. I heard horror stories about the stoma growing closed and having to have sometimes several endoscopies to stretch it back open. Sometimes the stoma is stretched too far which results in the stomach contents emptying too quickly resulting in being hungry shortly after eating. The biggest reason I chose the DS is so that I would never have to be on another diet. I've dieted for 20 years and it only made me fat. I don't ever want to be obsessed with sugar grams and fat grams ever again. I'm almost 10 weeks post-op and I do not suffer from diarrhea or gas. I feel great and am losing weight. I'm so happy with my decision.
   — artistmama

November 8, 2001
I am pre-op and hoping to have the DS. I chose it because I also wanted to keep my pyloric valve intact, I didn't want to experience dumping syndrome, and I didn't want to look odd when I ate in public (as in only being able to eat tiny amounts). I also like the fact that you still have some of your duodenum intact so that you will have a better chance of absorbing calcium and iron. It's all about what you're willing to live with post-op. It's hard since there aren't many doctors who do the DS (it is a more complicated surgery than RNY), and I'm kinda picky when it comes to going under the knife... so I'm going to go from Florida to California for surgery (hopefully) with Dr. Rabkim. Good luck!
   — [Anonymous]

November 8, 2001
I choose the BD without te DS which is similar. The reason I did it is I'm in the super morbidly obese category, and it seemed to allow a bigger weight loss. Talk to your doctor about it ask what he/she would do in this situation.
   — sherri W.

November 8, 2001
I was scheduled for an RNY and then cancelled that date and switched surgeons to have the DS. I had to wait 4 months longer in the process but I am so glad I had the DS. I have lost 110 lbs since FeB 7. I started at 288 and am at 178 today. I can eat whatever I want and I do. It's like somehow they fixed my rotten metabolism and I am a normal person. Tonight my son and I went to a Mexican restaurant for Fajitas and then to Friendly's for an ice cream cone. Seriously, it is a wonderful surgery and I would recommend it to anyone because of the freedom it gives you. I have to take vitamins and I do make sure I get in my protein, but other than that I am as normal as possible. I am still losing weight, although it's about 8-10 lbs a month now. I am looking at a tummy tuck and butt lift that will take off another 15 lbs or so. I have gone from a size 28 that was tight to a 12-14, pants are a 16 until my apron is removed. Feel free to email me if you like, I really believe in the DS. It is so good never to have to diet again, I love Hershey's chocolate too much for that!
   — Jean S.

November 8, 2001
As a nurse, I researched both surgeries extensively, but finally made my decision based on a critical examination of my own "psychology" and eating behavior patterns. The DS was extremely appealing because it would allow me to lose weight but essentially continue to eat as before. However, it is a surgery that relies on malabsorption as the mechanism for weight loss and requires even more supplementation and attention to lab values in most cases than the RNY does. In addition, many (but not all) DS patients report an increase in diarrhea and gas. After battling Irritable Bowel Syndrome for over 15 years, I just wasn't excited about a surgery which might make that situation even more difficult. Psychologically, I took a long, critical look at myself and easily identified my obsessive eating patterns, history of grazing and binging, love of very high-fat foods, etc... I was already at mid-life with dangerously high cholesterol and triglyceride levels, as well as Type II diabetes. I knew that the time had come for me to make a radical change in my eating lifestyle and patterns....not only to lose the weight, but to correct those metabolic problems which were also killing me. I needed a surgery which would "force" me to make those changes in my life and that is why I chose the RNY in the end. I feel certain that in my own case....and everyone is different...that if I had had the DS, I would have continued to graze through every AYCE restaurant available for the rest of my days, eating all the wrong things. Yes, I would have been thinner, but not necessarily healthier because I probably wouldn't have changed my food choices. The RNY has "miraculously" given me everything I had hoped for. Not only have I lost 145 lbs. and am only a few pounds from goal...I simply supplement with calcium and one multivitamin a day and my labs have remained perfect over the past 20 months...my Irritable Bowel Syndrome and all symptoms of my diabetes disappeared completely as of the day of surgery...and my desire/cravings for high-fat foods is non-existent. I now eat the way all my "skinny" friends have eaten over the years....smaller portions, healthier items, eating more slowly, chewing thoroughly instead of swallowing items nearly whole, and stopping as soon as I feel full instead of "cleaning my plate" each time. The RNY "forces" and teaches patients to do those things, but isn't that the way we have always known and been told that we should eat? I concentrate on getting my protein in each day, as every WLS patient must do irregardless of the procedure they have chosen. However, I have never given calories or fat grams a second thought and yes...sugar makes me experience "dumping syndrome" (thank God), an unpleasant but not life-threatening reminder that that is a food group that I, as a diabetic, can and should live without. I enjoy going out to eat with family and friends and I am usually able to eat approximately half of what is served and no one questions that I don't "clean my plate". I eat three meals a day and have to remind myself that it is time to do it, because I have not experienced "hunger" EVER since the day of surgery. The RNY "magically" changed my taste buds....a phenomenon which almost every RNY patient reports....and the foods which I craved in the past don't interest me at all, but I will run you down on a busy street for a salad or fresh fruit :-) The greatest blessing has been that food no longer has any power over me. I can take it or leave it...I truly eat to live now, instead of living to eat. I have several wonderful friends who are equally "in love with" their choice of DS surgery. For each of us, the decisions were deeply personal and based on what was "right" for us as individuals. The same should be true for you. Best wishes!
   — Diana T.

November 8, 2001
Judy, I forgot to address your question regarding long-term statistics for RNY patients. My surgeon is one of the pioneers in lap RNY, and when I questioned him about the long-term statistics, he replied: "Our patients are maintaining 78% of their weight loss, and the same is true for Wittgrove and Clark (other internationally renowned pioneers in the field) out to 7 years. Only about 10% (RNY patients) regain some weight after 2-5 years." This statistics are probably similar for DS, but certainly dramatically better than for VBG or banding over the long-term. It simply reinforced for me that no WLS is a "silver bullet" or "magic cure" all by itself. We each have a responsibility to continue to "follow the rules" for the remainder of our lives....stick to our surgeons' dietary guidelines, supplement as directed, maintain adequate water intake, and be faithful to an exercise regimen. When we are true to our own responsibilities, our surgeries will be true to us :-)
   — Diana T.

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