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DS as an addend



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I recently had Gastric Sleeve surgery. It was only a week ago, so I am not trying to raise flags here or anything, but I am curious about something. I read that Gastric Sleeve was developed out of Duodenal Switch, when the surgery was done in two stages and it was found that the first stage (the Sleeve portion) provided adequate weight loss for most people.

That makes me wonder if it is possible for Gastric Sleeve patients, who did not do this as part of a Duodenal Switch, to later decide to have the mal-absorption portion of the DS done, in cases where there was difficulty in losing weight. Has anyone had that done? Is it even possible?

It would be nice to know what my future options are after having gone this far already.

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Yes you can always have the switch done later down the road if you feel you need the malabsorption

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Yes, you are correct. The sleeve is now done as a stand-alone for people who don't want or need the malabsorption of the switch part. Regain is a problem with the sleeve, however. Dieting will be necessary once the sleeve stretches out, which is inevitable. Re-sleeving is dangerous, because after the stomach is stretched, the resulting wall is thinner. A rupture after re-sleeving can happen, or a leak. Some surgeons actually started doing the sleeve and getting it paid for by insurance by getting the DS approved and then only doing the sleeve.

And while the second half of the DS can follow later, the weight loss results are vastly different from a virgin DS done all at once. The metabolic advantage of the complete surgery is far superior to a two-stage DS. There are many people who revise from all other weight loss surgeries to the DS because their WLS has failed them. I have heard of only 2 DS people who have revised to another WLS, in contrast. The DS is certainly the platinum of the WLS world.

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Yes, there have been people who've had the switch after the sleeve. Either for weight loss for not reaching goal OR to help with diabetes (DS has a 92-97% cure rate for diabetes I believe) OR they have it to prevent regain. I know a sleever who had the DS at goal because she was afraid to regain her weight because she was freaked out about suddenly being able to eat more and she wanted to be able to eat more calories without gaining weight. So basically she had the switch added so she could ensure that she could keep her weight off. You can eat a LOT more food with a DS than with a sleeve. I would seriously consider adding the switch if I have to if my diabetes starts coming back (it's in remission) or if I start gaining weight at a later point. I would have gotten the DS to start with but to be honest I was scared of the complications that could happen physically and financially. I was afraid to physically have complications and I was afraid to financially have to pay for the complications being I had no insurance for weight loss surgery. I chose to go with the "safer" surgery and I've done very well so far but I'm only 2 years out but I would not be afraid to have the switch added if my diabetes began to come back. I've realized I'm more afraid of the diabetes coming back than I am getting the switch added.

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Thanks for the info (and sorry for the late reply). I had looked into DS back when I was considering it. There were two things preventing me from going that route -- one is that I didn't think I was big enough to justify it and felt sleeve would be good enough for me (so far it is, we'll see as time goes on), and the other was that there doesn't seem to be a DS surgeon anywhere near me. I would have had to travel far out of State to get it.

It hadn't occured to me at the time that you could get the sleeve first and then the malaborptive part of DS later. I knew all the details about it, such as the fact that gastric sleeve came out of two-part DS surgeries, and that the malaborptive part can be fully reversed if this ever becomes necessary, but for some reason it hadn't occured to me that someone would be able to go to a DS after a sleeve until I read about some folks doing that.

I may consider it in the future if things don't go well with the sleeve. But right now the sleeve is doing its job for me, just not as fast as I was hoping it would :P

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