Question:
Explain the pros and cons of DS vs. RNY

OK, I'm usually pretty good at research, but I cannot find a succinct explanation of the differences between DS and RNY, and why some surgeons (and patients) favor DS over RNY. I know RNY is the "gold standard" but why and under what circumstances is DS preferred? What are the benefits of DS compared to RNY? The drawbacks? Help! I'm starting to interview surgeons and I really need to be better prepared than this! Diana    — [Deactivated Member] (posted on January 23, 2003)

January 22, 2003
Diana, My surgeon offers both surgeries. His website is www.johnhustedmd.com and it explains both procedures. Basically, the RNY is more restrictive in the amounts you are able to eat and less malabsorptive. The DS is less restrictive in the amount you can eat because the stomach is left larger, but it is way more malabsorptive. Some surgeons recommend the DS on larger patients because they can lose more weight over a longer period. My surgeon gives his recommendations, but lets the patient decide which surgery they are more comfortable with. I am having the RNY on 3/4 because I do not like the idea of having several bm's a day as you likely will with the DS. Obviously, this does not cover all of the differences, but hope it helps. Good luck to you. Ginger
   — Ginger N.

January 22, 2003
The main difference between the two surgeries is that the DS procedure leaves you with a normally functioning stomach because the pyloric valve is retained. The stomach reduction comes from removing the outer curvature (vertically) instead of transecting the stomach horizontally and creating a "pouch" that relies on gravity and uncontrolled peristalsis (muscle contraction of the stomach and intestine) to move the contents along. This condition is what creates the "dumping" associated with the RNY procedure that the DS-er's never have to worry about. It is why we DS-er's can eat a piece of birthday cake or a bowl of ice cream. Additionally, the RNY has prescribed lengths of intestine that is by-passed, either distal or proximal. With the DS, the surgeon measures out your entire small intestine and then by-passes a percentage based on your age, starting weight, genetics, etc. To give you a good example on why this is done, in measuring out my intestine, the doc discovered that I had 7 feet more small bowel than the average person. Having distal or proximal wouldn't have made much of a difference for me. However, he gave me a much shorter "common channel" as a result of all my other factors. As for the several BM's per day, as any vegetarian will tell you, it is actually healthier to have a BM after each meal. Transit time of food is determined by the length of bowel, type of food, etc. It doesn't bother me...
   — merri B.

January 22, 2003
I had the RNY. One thing to consider is that if you have the RNY there is a 1% chance (something the Surgeons are NOT telling you) is pouch failure. The DS elimiates this problem. with the RNY they make a new opening for the food to drop from the pouch to the intestines, if this is to large, your food bypasses the pouch all together and you will NOT have the 'food' limitations you are seeking with the RNY. If this happens your surgeon (99.9% DO NOT) will NOT fix it and you will be left with the aftermath.... I knew nothing about this problem pre op; there is little to no information on in post. I finally got a little from the Bariatric Association, and they told me surgeons have know about this problem for years, but have been unsucessful in fixing it, and refert their patients to 'drugs and diet' and if this happens (which if YOUR like most... if drugs and diet worked in the first place) we wouldnt havent needed the surgeon .. duh... well, if I had know about this before I would have choosen the DS over the RNY just for this factor alone. Granted its a small percentage that get 'it'... BUT trust me if YOUR one of them (like I am it sucks big time)...
   — star .

January 23, 2003
Just to clarify: Dumping Syndrom is not caused by horizonal pouch, gravity or uncontroled parastalsis. It is a group of symptoms related to sugar and carb molecules entering the bloodstream in larger portions than the pancreas can handle. The pancreas produces normal levels of insulin in everyone who is not diabetic. It is this insulin that regulates the sugars entering the bloodstream - insulin allows the sugars to enter the blood at a slow steady pace. Dumping is in reality a dumping of sugar molecules into the bloodstream causing feelings of lightheaded, weakness, sweats, chills, diareah, vomiting, confusion - symptoms that would make a diabetic reach for a shot of insulin. With the RNY surgery, the dumping syndrome is a deterrant to eating sugar or simple carbs like cookies. Dumping is a GOOD THING if you are hooked on sweets, you will avoid them post op. You are not likely to dump on a food that has low or no sugar or any food that is complex carbs like carrots, an apple or a small bowl of bran cereal. I think it is very important to understand the digestive system very well preop. It starts at your mouth and ends at your rectum. You should know how and where food is broken down, how it enters the bloodstream, the function of the stomach, small intestine, large intestine, the pancreas, the liver, the gall bladder, digestive enzymes, what parastalsis is and the difference between proteins, carbs and fats. Every thing we eat and drink falls into one of these three categories. Get a good book on the human body, digestive system or search the internet(not for wls just in general) for these topics and learn all you can. Understanding how your digestive system works preop will help you a great deal to do things correctly when you're post op. That is the end of the biology lesson for today people :)
   — mary ann T.

January 23, 2003
I choose the DS for 2 main reasons. 1)I wanted to be able to eat a normal meal. I didn't want anyone to be able to tell that I had surgery, just by sitting down and having a meal with me. I wanted to be able to drink with meals and I can. 2)I wanted to keep my pyloric valve in tact. dumping is caused by your body getting a large amount of suger at once. The pyloric valve prevents that from happening. Some people think dumping is a good thing, it up to them what they think. I can tell you that not all people dump. Dumping can also stop after 6 months. Countless people have said that they stopped dumping, then what? I feel the only way any surgery is going to work is to learn to eat diffrently. I can have candy, cake and Ice Cream and I love it. I just don't have a lot and I don't have it everyday. One of the down sides of the DS can be the BM's. I don't have that problem. I can tell you this though, I know plenty of people who have had the RNY that have far worse BM's than me!!!!!! Anyone who has their intestines rearranged runs the chance of having bathroom problems. I will give you my 2 favorite websites that helped me make my mind up. www.duodenalswitch.com and www.mywls.com look at the links at these sites, they give other websites that are really helpfull too. One other thing that went into my choice. I detest vomiting!!!!! With the RNY there is a lot of throwing up. I have never vomitted with the DS. I felt thet I would rather be in the bathroom sitting on the toilet rather than bending over it!!!!!!!! ;0) The best of luck in what ever choice you make.
   — Jody Diou

January 23, 2003
"With the RNY there is a lot of throwing up." - what an uniformed statement... I had my surgery 7 months ago and I have thrown up (such as it is - it's more of a spit up) exactly ONCE. It was entirely my fault, eating too much and too fast on a two-month-old pouch. <p> As far as "bathroom problems" from "having my intestines rearranged", none whatsoever...JR (open RNY 07/17 -142 pounds)
   — John Rushton

January 23, 2003
I was fortunate enough to have a surgeon who likes RNY and DS equally, and gives his patients the choice about what they want. He told me the following pros about DS: No Dumping, the ability to eat more right away, the ability to eat a wider variety of foods. No 'blind stomach' to worry about later. No anastamosis to get scarred up. The cons about DS: Because absorption is so limited, vitamin deficiency is often a problem. GAS and BM's can be very frequent, bothersome, and offensive. The pros he told me about RNY: Dumping. If sugar is a problem that you need help to overcome, then dumping can be your friend. Less mal-absorption means less problems with vitamin deficiency. Gas and BM's are more normal in RNY'ers. the cons of RNY: The anastamosis (connection to small intestine) can scar up and get smaller, needing treatment to fix. Tiny portions especially at the beginning can discourage folks. Dumping. Less variety of foods that you can eat. After thinking about my life, my habits and what I wanted, I chose to have the RNY. I know lots of happy DS'ers, and I have suprised them by telling them of the wide variety of foods that I enjoy. At 2 1/2 years postop I can eat about 12 oz of food if I am really hungry (just had fried rice for lunch), I still sometimes dump but can have the occasional treat. I have had difficulty with throwing up, but usually it is me being stupid. While I detest throwing up, I am grateful that I have a built-in mechanism to help me correct problem eating. A website you might visit is www.duodenalswitch.com. That and the mayo clinic website has diagrams and things to read. Good Luck to you!
   — Cara F.

January 23, 2003
RNYer, I didnt get the DS because of the increased malabsorebtion risks AND concern that with the DS a large part of your stromach is removed and thrown out. The RNY leaves ALL the parts just in case there ever needed. I can eat ANYTHING. If it wasnt for the smaller amount of food I eat I would doubt I ever had surgery. I actually eat the amount that other thin folks do.
   — bob-haller

January 23, 2003
I'm not an expert and don't claim to be. It has been explained to me that there is more 'roto routering' with the DS, a longer hospital stay and a little longer recovery, larger stomach capacity, no dumping, less absorbtion, and a more 'normal' diet. Please don't quote me as I had the RNY and knew that I would not be able to handle having a larger stomach capacity and no dumping. I really wanted to get sick from bad foods--stupid, huh? A friend who had the BPD told me that she wanted the food freedom that should go along with BPD. It's a personal choice and no one surgery is better than the other!
   — jenn2002

January 23, 2003
I chose the DS. So take my comments with a grain of salt. Im a control freak and I researched everything to the point of exhaustion... I am proud of my choice and obviously I feel I made the right choice so obviously my comments aren't objective. You can read my profile for lots of specific reasons why I picked DS. In a nutshell, most DSers are pretty passionate about their pyloric valve. They have done lots of research and understand that not only does keeping this muscle intact prevent the dumping syndrome but it also is very important for the feeling of "satiety". Since I love to eat, feeling saitiated is VERY important to me -- thus my pyloric valve is important to me! Another thing about the vertically cut stomach that you might not hear about is that I know that my doctor talked a lot about that B vitamins are actually absorbed mostly in the bottom half of the stomach. So yes...there is lots of talk about DSers having more absorbtion problems, but we also gain some things that the RNyers have to deal with... like we dont have to take sublingual B vitamins because our bodies absorb these normally. Also, since Lactose is also broken down in the bottom half of the stomach, there are not as many Lacto intolerant DSers as RNYers. For me... I couldn't pick a surgery that I had to use as a "tool". I needed something that was stronger then my will power. My will power had already proven itself ineffective -- dieting was a complete failure. I considered the Distal RNY... but felt that the risks for Malnutrition were even higher with only a 2 oz stomach. Since I am a volume eater, starting out with a 8 to 10oz tummy appealed to me. I also wanted to point out that there is no scientific study to back up that dumping helps people to lose more weight. Im not saying it doesn't... I just want you to know that there have never been any conculsions about what dumping DOES do... other then make people feel sick. Most weight loss with gastric bi-pass surgeries is attributed to one or both factors of: restriction and or malabsorption. So why pick a procedure that makes you feel sick? And who the hell wants to go through their life never getting to eat another Krispy Kreme? LOL My doctor (who is only a DS doctor so take the info at it's source) has an interesting comparison chart on the procedures backed up with journal articles & proof on statistics. http://www.gr-ds.com/Comparison_Table.htm I wish you much luck on your journey and your decision. I recommend checking out www.duodenalswitch.com for more information on the DS, the surgeons who perform it, and reading profiles of the patients who have had it.
   — Kym L.

January 24, 2003
I got the RNY because my surgeon wouldn't do a DS on someone with a BMI of "only" 40. He stated that it is more for the "super" obese patient. The downfalls of DS are frequent, rancid-smelling loose stools and flatulus (usually with higher-fat foods), and deficiencies due to the degree of malabsorption. However, it's 70-85% excess weight loss with DS compared to 60-75% with the RNY. The good things about DS are that you can eat more normal-sized meals, and your anatomy is still in tact in case a scope, etc.., needs to be done in the future. But some insurance companies won't even pay for a DS because they (BC/BS Fed.) consider it "experimental". Hope this information helps!
   — jengrz

January 29, 2003
Check out my surgeon's website. He does both the DS & RNY and has a breakdown of the two under The Procedures. It's a matter of personal choice and I'm very happy with my DS. www.arizonabariatriccenter.com. Best wishes on your decision!
   — Melanie N.

January 29, 2003
Check out my surgeon's website. He does both the DS & RNY and has a breakdown of the two under The Procedures. It's a matter of personal choice and I'm very happy with my DS. www.arizonabariatriccenter.com. Best wishes on your decision!
   — Melanie N.

January 29, 2003
I'm back. Regarding going to the bathroom all day with DS - not true. On an average day I go twice - that's not excessive. Now if I eat "bad" I will go more, so it all depends on you.
   — Melanie N.

Click Here to Return