continuing on to duodenal switch

[tntransplant06 20]

Anybody did this? And how long after your sleeve did you?

[RickM 1,753]

I have not, but it is something that I have in reserve if I need it. The word I get from my surgeon is that it is best to do the second part of the DS fairly soon after the VSG, before there is a chance for much weight regain. If you stall out and still have a high enough BMI for insurance coverage, that is ideal - it works better than if you have significant weight regain before doing the revision. The downside is that the second part is usually done open rather than lap.

[JimmyGotSLEEVED 270]

That's not the reason why you should get it sooner than after the VSG, it's because of the staples they use are the big ones (temporary) and not the smaller (permanent). The reason you go through VSG before the DS is because the doctor NEEDS you to lose a significant amount of weight before he/ she attempts the DS for safety reasons. He/she wants to lower te risks at all cost. Depending on how much weight u lose in the first month, the Dr will calculate when the best time is to complete the second part of the procedure.

Bigger staples are most likely to leak, but easier to remove if necessary

Smaller staples are less likely to leak, but harder to remove if necessary

[RickM 1,753]

That's not the reason why you should get it sooner than after the VSG, it's because of the staples they use are the big ones (temporary) and not the smaller (permanent). The reason you go through VSG before the DS is because the doctor NEEDS you to lose a significant amount of weight before he/ she attempts the DS for safety reasons. He/she wants to lower te risks at all cost. Depending on how much weight u lose in the first month, the Dr will calculate when the best time is to complete the second part of the procedure.

Bigger staples are most likely to leak, but easier to remove if necessary

Smaller staples are less likely to leak, but harder to remove if necessary

That is the classic reason for two staging the DS. However, if one is getting the VSG alone, with the idea that if it fails it can (relatively) easily be revised into a DS, then what I posted applies - do it before you suffer any significant weight regain. The best results, in my doc's experience, is to do the DS in one stage, or if necessary for surgical risk reasons, a planned 2 stage procedure. Doing a later revision from something else, including the VSG, doesn't usually yield as good of a result, though certainly better than whatever failed the first time.

[MeMeMEEE 206]

I just know one DS'er and she was the all at once one.

[RickM 1,753]

I just know one DS'er and she was the all at once one.

The vast majority are done single stage; they usually only do a two stage procedure if a patient has such extreme health problems that they can't tolerate being under anesthesia long enough to do it single stage - do a VSG, lose weight, improve health and strength, then go back in and complete the DS.

[Tiffykins 673]

I only know of one lady who pursued a full DS after VSG and she only gave it 6 weeks all while her nut was telling her to not count carbs or calories, she had metabolic issues, and that stuff was not being addressed so she found a surgeon that agreed to go ahead and perform DS even though she only had the sleeve 6 weeks and was not following a normal post-VSG diet, and she wanted to lose weight faster and didn't want to seek additional nutritional or metabolic assistance from her current surgeon and team.

I have now seen 3 DS'ers around 2-3 years out looking to revise (shorten their common channel) because they haven't got to goal, or have gained weight back.

[RickM 1,753]

I only know of one lady who pursued a full DS after VSG and she only gave it 6 weeks all while her nut was telling her to not count carbs or calories, she had metabolic issues, and that stuff was not being addressed so she found a surgeon that agreed to go ahead and perform DS even though she only had the sleeve 6 weeks and was not following a normal post-VSG diet, and she wanted to lose weight faster and didn't want to seek additional nutritional or metabolic assistance from her current surgeon and team.

I have now seen 3 DS'ers around 2-3 years out looking to revise (shorten their common channel) because they haven't got to goal, or have gained weight back.

My doc's revision rate for DS with inadequate weight loss or regain is in the 2-3% range, which is a bit more than their revision rate for excessive loss; these past few years they've been doing more tailoring of the common channel length based on their experience with different patient and body types. But some people's bodies are more aggressive in adapting to the changes made, experiencing substantial growth in their common channels - that seems to be a harder one to predict.

[KabinKitty 11]

I hope your surgery goes well and you have good results.

I personally know 6 people who had this surgery done in BG Ohio and all have issues. I work with them. They all have had lot of problems with malabsorbtion and really nasty smelling loose bowels and gas. My surgeon (Dr. Lalor) told me about one woman who asked him to reverse her sugery when she could not leave the house due to her constant foul smelling gas.

I don't know if these symptons were due the surgeon (Dr. Hess) or why these people had such bad results. I hope your experience is MUCH better!

[RickM 1,753]

I hope your surgery goes well and you have good results.

I personally know 6 people who had this surgery done in BG Ohio and all have issues. I work with them. They all have had lot of problems with malabsorbtion and really nasty smelling loose bowels and gas. My surgeon (Dr. Lalor) told me about one woman who asked him to reverse her sugery when she could not leave the house due to her constant foul smelling gas.

I don't know if these symptons were due the surgeon (Dr. Hess) or why these people had such bad results. I hope your experience is MUCH better!

I think that you can say that there are issues with any of these procedures that we may choose, but overall it is the price we pay for the tool that helps us live a better life. Much of it is dietary - you learn what foods cause problems and avoid them, or plan for the result if it's something you really value - some of it is just individual metabolism. Stool is going to tend to be looser since there is the unabsorbed fat going through there too (which goes back to learning what causes what problems - you may not absorb all the calories from the fat with a DS, but it's still going through you. A permanent Xenical, if you will. Probiotics (and the right Probiotics - different ones work for different people) seems to help many people with those issues as well. I would be surprised if Dr. Hess were doing anything extraordinary to be creating the problem, as he has been doing them about as long as anyone. There are always going to be variations in the results that people get, and perhaps part of the problem is compliance and willingness to learn how to use their tool - people can get poor results with any of these procedures if they don't want to work with the tool they have been given (or bought.) You can similarly get poor results from the VSG or RNY from not learning how to use them correctly. Eating poorly with a VSG may not slap us with foul gas or dumping, but the scale will tell the tale.

I've been living with a DS postop for the past 6 years, and sometimes it is a problem, but rarely since she has been able to learn what causes it and can generally avoid it. When we went back up to San Francisco for her one year follow up we had a get together with around a dozen other DS post ops in the back room of a small Italian restaurant (danger, danger!) but the place did not get fumigated by them, and I can't recall it being an issue at any of the support group meetings (that are DS intensive) that I've attended with her the past eight years or so, though it is certainly a frequent topic of discussion.

[Tamz 8]

My dr never mentioned this DS thing to me......... is this something that most ppl have to do after the sleeve? I dont want to have to do something again... I guess I never was told that the sleeve could only be part 1 of 2... can someone explain? Thanks

[RickM 1,753]

My dr never mentioned this DS thing to me......... is this something that most ppl have to do after the sleeve? I dont want to have to do something again... I guess I never was told that the sleeve could only be part 1 of 2... can someone explain? Thanks

Most docs don't mention it because they don't do it - it is a longer and more technically challenging procedure than most of the other WLS procedures. The DS uses a VSG, usually leaving a somewhat larger stomach than our standalone VSG, and then it does some intestinal rerouting that results in malabsorption of the fats you eat - you just don't absorb them very well post op. It has a long term record of very good weight loss along with good durability of the loss, generally the best of the mainstream WLS procedures that are widely accepted by Medicare and the insurance industry. Interest in the VSG as a routine weight loss procedure came from DS experience, where some of the heaviest patients who had severe health problems such that the DS surgery was too risky for them were instead given a staged DS where they first got a VSG and then after they lost some weight and their health improved some were given the intestinal rerouting as a second stage procedure. It was found that a fair number of such patients lost enough weight and maintained it that the second stage wasn't necessary for them. The vast majority of DS procedures are done single stage. The other case where you might go through this again is if you need a revision - if the original procedure wasn't successful in reaching and maintaining your weight loss goals or if other complications exist. Many people having VSGs are being revised from failed lapbands. Likewise, if the VSG doesn't work for you, it can be revised into an RNY or a DS. The VSG, since it is already a part of the DS structure, is much easier to revise into a DS than a failed RNY.

All of these procedures have ups and downs to them. One needs to do their research and get comfortable with the tradeoffs involved in whichever one they choose.