Help I went in for my initial consultation and wanted the Gastric Sleeve the doctor suggested the Duodenal switch surgery

[PorkChopExpress 820]

I usually tend to go with the surgeon's advice. Your BMI puts you in the "superobese" category and at that weight, surgeons are all probably going to go with the one that will result in the most weight loss, most quickly. You are young, so you will probably recover well and it's a good time to hit the "reset" button - now that I've done it, at 45 years of age, I'm sure I'm going to wish I'd had surgery 15+ years ago.

Discuss the pros and cons with him, express your concerns and go forward with whatever you agree is the best option. The results are what you're after, and at this weight your health is of primary importance...so my feeling is, go with what will get you the best result, the fastest. I initially intended to do the gastric bypass, however they had to convert to sleeve due to scar tissue from a prior abdominal surgery. At this point though, I'm just happy to have had a correction made so that I can be successful now

[BigJohn58 135]

I usually tend to go with the surgeon's advice. Your BMI puts you in the "superobese" category and at that weight, surgeons are all probably going to go with the one that will result in the most weight loss, most quickly. You are young, so you will probably recover well and it's a good time to hit the "reset" button - now that I've done it, at 45 years of age, I'm sure I'm going to wish I'd had surgery 15+ years ago.

Discuss the pros and cons with him, express your concerns and go forward with whatever you agree is the best option. The results are what you're after, and at this weight your health is of primary importance...so my feeling is, go with what will get you the best result, the fastest. I initially intended to do the gastric bypass, however they had to convert to sleeve due to scar tissue from a prior abdominal surgery. At this point though, I'm just happy to have had a correction made so that I can be successful now

Pork chop thanks so much brother for the nice words and encouragement and I wish you all the best. This forum is like a big family I love it. What's blowing my mind now is all the preop testing geeze lol I'm determined this time. Best regards

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[BigViffer 3,544]

I think that your weight is not the issue, nor your age really. It's your activity level. The sleeve is an excellent tool for a person who can control their eating habits AND maintain an active lifestyle. Weight loss is wholly dependent upon diet, fitness comes from exercise.

The DS is a more forgiving surgery from what I have seen. My mother-in-law had that surgery several years ago and has maintained a respectable amount of weight off. I don't think she eats worth a crap though. Rice is a staple in her diet as are cakes, pies and Cookies. Fried foods and eating out often. Low Protein intake, high fats and carbs. But since she has mal-absorption and frequent trips to the bathroom and has kept the weigh fairly consistent.

Can you control your appetite and make a lifelong change of eating habits? Will you get up every day and make sure you are active than the week before? If you have that kind of dedication, go for the sleeve. If you doubt that you will be able to do that, I would opt for the DS.

I understand your reticence about rerouting the plumbing, but if you have confidence enough in your surgeon to cut you open and remove 80% of your stomach I don't see that much difference. Good luck with whatever you decide!

[BigJohn58 135]

I think that your weight is not the issue, nor your age really. It's your activity level. The sleeve is an excellent tool for a person who can control their eating habits AND maintain an active lifestyle. Weight loss is wholly dependent upon diet, fitness comes from exercise.

The DS is a more forgiving surgery from what I have seen. My mother-in-law had that surgery several years ago and has maintained a respectable amount of weight off. I don't think she eats worth a crap though. Rice is a staple in her diet as are cakes, pies and Cookies. Fried foods and eating out often. Low Protein intake, high fats and carbs. But since she has mal-absorption and frequent trips to the bathroom and has kept the weigh fairly consistent.

Can you control your appetite and make a lifelong change of eating habits? Will you get up every day and make sure you are active than the week before? If you have that kind of dedication, go for the sleeve. If you doubt that you will be able to do that, I would opt for the DS.

I understand your reticence about rerouting the plumbing, but if you have confidence enough in your surgeon to cut you open and remove 80% of your stomach I don't see that much difference. Good luck with whatever you decide!

Well said brother I understand fully.

I hope to be riding my full dress Harley again I'm hoping with the weight off my knees I can be active again. Thanks

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[sammy246 235]

I usually tend to go with the surgeon's advice. Your BMI puts you in the "superobese" category and at that weight, surgeons are all probably going to go with the one that will result in the most weight loss, most quickly. You are young, so you will probably recover well and it's a good time to hit the "reset" button - now that I've done it, at 45 years of age, I'm sure I'm going to wish I'd had surgery 15+ years ago.

Discuss the pros and cons with him, express your concerns and go forward with whatever you agree is the best option. The results are what you're after, and at this weight your health is of primary importance...so my feeling is, go with what will get you the best result, the fastest. I initially intended to do the gastric bypass, however they had to convert to sleeve due to scar tissue from a prior abdominal surgery. At this point though, I'm just happy to have had a correction made so that I can be successful now

Pork chop thanks so much brother for the nice words and encouragement and I wish you all the best. This forum is like a big family I love it. What's blowing my mind now is all the preop testing geeze lol I'm determined this time. Best regards

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Oh man... After 6 months of appointments and a bunch of other tasks, they just told me I needed 4 individual psych appointments. I feel your pain right now!! They really do fly by but I had a bit of sticker shock after everything else I had already done.

I'm confident you will find the best surgery. Just keep an open mind (this does not mean a closed mouth- express your desire for the sleeve and why) and then really take the time to weigh the options out. You've got this!!!!

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[FunkyMunkyBrat 205]

Initially I went in wanting the RNY.. I figured at my age and health issues that would be best for me but at the first appt with the surgeon we talked and he felt like th band would be a better option for me.. I wasn't entirely convinced, but told him if he felt that was the best way for me I trusted him to make that decision.. Fast forward to after I've had an GI & EGD.. Found out I had Barrett Esophagus Syndrome and H. Pylori infection.. He wasn't sure we could do the surgery till he did some asking around.. And now the RNY is the only choice because of the Gerd ..

Definitely get a 2nd opinion.. Any doctor should be explaining WHY they feel 1 particular way is better than the other..

Munky

[BigJohn58 135]

I usually tend to go with the surgeon's advice. Your BMI puts you in the "superobese" category and at that weight, surgeons are all probably going to go with the one that will result in the most weight loss, most quickly. You are young, so you will probably recover well and it's a good time to hit the "reset" button - now that I've done it, at 45 years of age, I'm sure I'm going to wish I'd had surgery 15+ years ago.

Discuss the pros and cons with him, express your concerns and go forward with whatever you agree is the best option. The results are what you're after, and at this weight your health is of primary importance...so my feeling is, go with what will get you the best result, the fastest. I initially intended to do the gastric bypass, however they had to convert to sleeve due to scar tissue from a prior abdominal surgery. At this point though, I'm just happy to have had a correction made so that I can be successful now

Pork chop thanks so much brother for the nice words and encouragement and I wish you all the best. This forum is like a big family I love it. What's blowing my mind now is all the preop testing geeze lol I'm determined this time. Best regards

Sent from my iPhone using the BariatricPal App

Oh man... After 6 months of appointments and a bunch of other tasks, they just told me I needed 4 individual psych appointments. I feel your pain right now!! They really do fly by but I had a bit of sticker shock after everything else I had already done.

I'm confident you will find the best surgery. Just keep an open mind (this does not mean a closed mouth- express your desire for the sleeve and why) and then really take the time to weigh the options out. You've got this!!!!

Sent from my iPhone using the BariatricPal App

Sammy thanks for the nice words and man alive brother 4 psych appointments that's crazy. I'm hoping I say the right thing my Psych app is next week I better not tell her the meatballs in my refrigerator call me at night and they know my name

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[BigJohn58 135]

Initially I went in wanting the RNY.. I figured at my age and health issues that would be best for me but at the first appt with the surgeon we talked and he felt like th band would be a better option for me.. I wasn't entirely convinced, but told him if he felt that was the best way for me I trusted him to make that decision.. Fast forward to after I've had an GI & EGD.. Found out I had Barrett Esophagus Syndrome and H. Pylori infection.. He wasn't sure we could do the surgery till he did some asking around.. And now the RNY is the only choice because of the Gerd ..

Definitely get a 2nd opinion.. Any doctor should be explaining WHY they feel 1 particular way is better than the other..

Munky

Ok Munky I hear that thanks and I hope things work out for you I been hearing that word Gerd a lot hanging out on the forum for only 2 days lol

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[BayougirlMrsS 3,933]

@BigJohn58. John. I told u @@BigViffer was a great person to take advice from

[BigJohn58 135]

@BigJohn58. John. I told u @@BigViffer was a great person to take advice from

I'm glad you chimed in so I can thank you I sent a message to all you recommended to contact. Thanks again

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[Alex Brecher 10,484]

@@BigJohn58,

I agree – a second (and possibly third and fourth and fifth) opinion is a good idea. Even if you agreed with the first surgeon, more opinions are always good.

I would also agree that you should ask the surgeon why he suggested the DS. Then go over each of his points and decide if you agree or disagree. He should be willing to discuss each one with you. Then, go over each of your reasons for wanting the sleeve and get his opinion on each.

At the end of the day, there probably is no “right” answer. Just like every other WLS patient, you will need to make the final call based on the benefits and risks of each choice, and on your gut feelings. Good luck!

[BigJohn58 135]

@@BigJohn58,

I agree – a second (and possibly third and fourth and fifth) opinion is a good idea. Even if you agreed with the first surgeon, more opinions are always good.

I would also agree that you should ask the surgeon why he suggested the DS. Then go over each of his points and decide if you agree or disagree. He should be willing to discuss each one with you. Then, go over each of your reasons for wanting the sleeve and get his opinion on each.

At the end of the day, there probably is no “right” answer. Just like every other WLS patient, you will need to make the final call based on the benefits and risks of each choice, and on your gut feelings. Good luck!

Alex I can't thank you enough for the great comments and the great people on the forum that are so willing to help.

Thanks for all you do to make this website possible. I read today on one of the forums that I think it was a Dr Nausbaum I believe in NJ has a App that you can send him messages along the way during your journey to WLS..

if you have questions or concerns to stay in touch with your surgeon I thought that was a great idea. I don't take surgery lightly call me a chicken but I do have questions that I think of I would like to ask and I will next week. I'm in Central Jersey and had many choices either NYC Philadelphia or NJ.. I not only wanted the experience of a great doc but the Hospital that can accommodate a 6ft2 450 man in every way including radiology and big beds things like that. Alex its a real honor that you took the time out of your busy day to comment on my weight loss journey.

Best regards

John

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Edited October 22, 2016 by BigJohn58

[catwoman7 10,864]

statistically the DS results in the best weight loss and it's supposedly easier to maintain that loss. I know it's sometimes recommended for people with really high BMI's (which was me pre-surgery). If it was available to me, I would have gone that route as I had over 200 lbs to lose. But my insurance didn't cover it, and my surgeon doesn't do it. So I went with the second most effective - the RNY - and through a lot of hard work I was able to lose all my excess weight. There are sleevers who have done it too, though - it's just going to take a lot of hard work and dedication.

[RickM 1,747]

Trying to keep this as short as I can, here is my perspective on this problem. After researching alternatives, my wife and I went to our first WLS seminar in mid 2003, targeting the DS as the most likely procedure - she was short woman w a 64 BMI and I was an average height guy w a 48BMI. The sleeve wasn't a routine alternative then, as even the DS was still considered investigational by many insurance comanies, including our. We went thru the usual insurance mandated 6 month diet/exercise roadblock to approval before the ultimate denials for her - she was no. 1 on the runway with her size and diabetes, and it took us a couple years to get her on the table on a self pay basis.

The philosophy we took with our PCP for that med supervised diet was primarily sustainability - what do we want our diet to be long term that will promote weight control and general good health, not a quickie short term weight loss diet which typically leads to regain. I wound up losing 50lb. about 1/3 of my excess weight, over the six months or so which was great - can I actually be one of those 5% who can lose it all and keep it off? No, but despite making tweaks here and there and working to improve things, I maintained that loss over the years and effectively worked into a WLS maintenance lifestyle with my post op wife. Once the sleeve was being approved by our insurance and it was apparent that I wasn't going to get to normal on my own, I went with the sleeve. Had I regained what I had lost, I would have been inclined to go for the DS as that regain, had it happened, would have shown me that I needed the extra power of the DS to maintain the loss; since I was maintaining what I had lost, I felt that the sleeve would be adequate for the job. Five plus years later; it still is for me, and the DS is working well for my wife after 11+ years.

With the DS, it's the regain resistance that is its' greatest asset - I have seen many lose 2-300 lb or more with the sleeve or the bypass, but it is keeping the regain at bay that is the challenge with them. My wife needs the extra help that the DS provides while I am getting along fine without it. There are some metabolic issues at play here too, that are usually more critical at the higher BMI levels.

My general observation over the years (and there are always exceptions....) is that if one is still gaining weight going into a WLS program (the start of it, including whatever dieting, etc is part of the program, not the surgery itself) or continuing a yo-yo dieting pattern and expecting the WLS to break that pattern long term, go with the DS as you will probably need that extra power and regain resistance.

Look at WLS as a do-over. You can likely attain a normalish weight with any of the mainstream procedures, but then you have to keep it off. Can you learn the healthy eating habits during your weight loss period - many go on various popular weight loss diets during that time which puts off learning the long term skills until maintenance, and that is where many falter.

I agree with Alex and others about second opinions, and learning as much as you can from the surgeons as to what they see as their critical success criteria, and why they recommend what they do. You have a number of good DS/sleeve surgeons in your area (BTW, which one have you been talking to so far - the DS community is fairly small so we all tend to know who most of the players are?) but they often have somewhat different perspectives.

[BayougirlMrsS 3,933]

@@BigViffer @@BigJohn58

Viffer... and Dub are two that will deff. give you great advice and inspiration.... I mean go look at how well they both have done....

I can't say much as i had the band done.