Question:
Which way to go - Duodenal Switch or RNY and why?

Which WLS is better Duodenal Switch or RNY? My plans were to have lap RNY - that is what my surgeon performs, but I have heard and read of the DS that some say are better. Which is the best route to go? My biggest deciding factor would be not regaining weight after a few years. Is one better than the other for keeping weight off permanetly?    — Denise B. (posted on May 26, 2003)

May 26, 2003
I had a lap DS in Oct. 2001 and couldn't be happier! I've gone from 304 lbs on surgery day to 138 lbs currently--that's 7 lbs below my goal of 145 lbs. My BMI is normal. I eat virtually anything I want to, with one caveat--PROTEIN FIRST! It is physiologically impossible to dump with a DS as we still have a pyloric sphincter. I have to take vitamin and mineral supplements three times a day, but that's a small price to pay for permanent WT loss! According to my surgeon--Dr. Pomp at Mt. Sinai in NYC--it is impossible to out eat the DS. Good luck with which ever surgery you choose.
   — dantevolta

May 26, 2003
Hi! This question gets asked frequently and no one weightloss surgery is better than the other...It's a matter of which type of surgery is right for you personally.I am choosing the rny because I know that I need the behavior modification aspect of dumping.I would suggest researching the heck out of both surgeries and also consult with your surgeon to get his opinion on which surgery you would be most successful with. Here are some pros and cons of the DS........Duodenal Switch Advantages~ More "normal" absorption of many nutrients than with BPD, including calcium, iron and vitamin B12 Better eating quality when compared to other WLS procedures Eliminates or greatly minimizes most negative side effects of the original BPD Essentially eliminates stomal ulcer and dumping syndrome Duodenal Switch Disadvantages~ Greater chance of chronic diarrhea Significant malabsorptive component More foul smelling stools and gas
   — jennifer A.

May 26, 2003
Only YOU can decide. I have heard people praise one surgery or the other as the only one that will keep weight off long term, but from all the profiles and other info I have read that is hogwash. The procedure you chose will be as successful as you make it. Some find it easier to be able to eat a lot more food and can live with whatever bowel issues they get, if they do, and others need the modification of learning to eat less, more normal. I had the RNY and am fine with everything. I can literally eat anything I want as long as it doesn't make me sick but I chose to avoid the carbs and sweets as that's how I got to be 442 lbs. Right now all I want to do is maximize my weight loss in this early period. For me personally the high degree of malabsorption scares me me and also I already have a quite a few bowel issues and did not want to gamble how my bowel would deal with the DS. <p>One other thing should factor in here. If you plan on having insurance cover your surgery then please check out ahead of time if they will cover a DS. Very few insurance companies will cover a DS. I know BCBS for one, won't. If you decide to proceed with the DS please find an experienced DS surgeon as you want the best possible procedure. There are a whole lot less DS surgeons available so you may have to travel out of state. I have heard of surgeons saying they will do a DS when they typically have done RNY's and maybe none or only a few DS's. You want the best no matter which surgery you have but it is harder to find that top quality DS surgeon. Good luck in your investigation. It is critical that you figure out the surgery that is right for you as there is no going back. This is for the rest of your life!
   — zoedogcbr

January 27, 2004
I don't know who these first two are trying to kid(themselves or us) I have a friend who had the RNY he lost great but now is 5 yrs out and is putting back on weight, he had blockages and was told by his doc if he had waited two hours more before he was airlifted to the University of Washington he'd have died. I on the other hand have had the DS along with some of my other weightloss surgery friends and none of us have had anything like that happen. I don't have any trouble with diarrea although it does smell a little worse than before but not a lot. I do know we tend to lose a little slower but not by much. We lose more over the long run usually along the lines of 85-90% of excess weight and we keep all of it off. RNY patients lose all of there excess weight very quickly but after 5-7yrs regain 50-60%. I personally would rather lose a little slower and lose 85% and keep it all off. We don't have dumping problem, we don't have to worry about chewing our food to death, we can drink and eat together like normal, we don't have to worry about our pouches blocking or closing and bursting. Anybody who tries to say both surgeries are equal don't have a clue how easy life is when you have the DS. WE can eat ANYTHING and lose and we don't have a stupid pouch to serve as our master.We don't have to worry about our pouches leaking and regaining. Both surgeries require taking vitamins for life afterwards and that is the only way these surgeries are equal.
   — Mark L.

January 28, 2004
Hi Denise: With either surgery you'll lose weight. You can keep the weight off, but with the RNY it'll probably be much more of an effort. I already knew that you couldn't take non-steroid anti-inflammatory drugs (NSAID) prior to having my RNY. I didn't know that it'd cause so many problems if you ever need to be hospitalized. I told everyone I had gastric bypass, but if they are not familiar with it they just can't seem to understand. I was told by more than one nurse that if I didn't start drinking the sugared liquids I wouldn't be able to advance to food. So I made myself sick trying to get out of there as fast as possible. Then I was told that if I didn't eat 2500 calories a day I wouldn't be released. I had to talk to 3 different dietitians about my surgery before they finally understood I couldn't eat and drink at the same time and that all the fruit juices were bad for me and that was way too much food for me. The doctors believe I ended up having a minor stroke during or shortly after surgery. (Not because of RNY. I don't know if there will ever be an explanation.) I had already told them no NSAID, but they had no idea what the alternatives are, so they gave me a suppository aspirin. My point is: you really are a prisoner/victim in the hospital, and if your doctors don't understand your RNY surgery you'll have a lot of problems. The thing to remember about the dumping with the RNY is it doesn't happen for everyone. That was one of the main "advantages" of the RNY for someone like me who can't put sugar down, and I would have been devastated if I didn't dump. I easily gained 41 pounds from month 13 to my 2 year date, and just cutting out the "bad" stuff didn't help. I could eat too much, so apparently my stoma had stretched too much. All and all, I so wish I would have had the DS. But then that surgery always struck me as a better option to start with. Problem is, as already stated, it's not always covered by insurance, and finding a lap DS surgeon isn't easy yet. This is your choice that you'll have to live with the rest of your life. No substitute for mass researching. Best of luck with whatever you decide to do. S
   — sherry hedgecock

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