DS vs Sleeve

[ikt0075 0]

I am debating between the DS and Sleeve. I am type 2 diabetic. Feedback?

[OutsideMatchInside 10,166]

I wouldn't get the DS unless I was so obese I could hardly move. Like 600lb life obese.

I was diabetic, I got the sleeve. I'm not diabetic anymore and haven't been since like the 3 or 4 month mark. My diabetes was controlled with pills prior to surgery.

[RickM 1,747]

From a strictly weight loss perspective, there is a lot of overlap between the two, with the DS being better for those starting in the higher BMI ranges. The sleeve works well in the moderate BMI ranges (35-50) and also works well above that with somewhat more intensive dieting and greater discipline needed in the long term. The DS is stronger in regain resistance than any of the other mainstream procedures, so is particularly good for those with long term yo yo dieting patterns.

From a diabetes perspective, the sleeve is similar to the bypass, with remission/resolution rates of around 85%, while the DS typically sees 98-99% rates. This should not be overly surprising as the DS started as a procedure specifically targeting diabetes, to which the VSG was added to make it a WLS procedure. Longer term, the sleeve is still relatively new with only some five year data available for any kind of significant patient populations. There are some indications of somewhat significant recurrance after five years, though it is not clear how well correlated that may be with whatever regain problems some may be having. The DS does seem to show more significant staying power in the face of regain, which in itself is less of a problem due to the long term malabsorption, compared to the VSG or RNY

Note that this only applies to the "classic" DS and not the newer SIPS/SADI/"loop DS" which is a different procedure for which there is little long term data.

There is a fair bit of experience that indicates that the longer one has been diabetic, the longer it takes to knock it out even with the DS. My wife had been under treatment for it for some twenty years when she had her DS and it took the better part of a year for her to be off of all meds for it. Others, even long termers, will walk out of the hospital free of meds with either the sleeve or the DS - YMMV. She is still off of all diabetes meds after twelve years.

My feeling is that for a younger patient, particularly one whose obesity problem is only "moderate" in WLS terms can do very well with just the sleeve, particularly if they concentrate on learning long term weight control. If necessary in the future, a move to completing the DS (which is based upon the VSG so one is half way there already,) if the diabetes comes back again can be done. Last year at one of our support group meetings i was chatting with a gal who was some 25 years out on a RNY and by all measures has been successful in her weight maintenance until some of life's stresses hit a few years ago and brought on some regain (not the total regain we sometimes read about,) - enough to bring her diabetes out of remission, so she was lining up to get that revised to a DS to knock it out again (she would have done the DS originally had it been available then.)

All of these procedures can give you something of a "do over" and let you start relatively fresh, but one has to take that opportunity to learn how to manage oneself in the long term and not go back to whatever got us here in the first place. Good luck on whatever path you choose.

[ikt0075 0]

Thank you. I'm 42 with a moderate BMI (43), type 2 diabetic with high blood pressure. I'm leaning towards the DS.

[RickM 1,747]

One can make a good argument in either direction. I went with the sleeve because I was at a similar low 40s BMI at surgery time but without the diabetes. Further, I had already lost about a third of what I needed to lose while my wife went through her DS and effectively worked myself into a WLS maintenance lifestyle, maintaining what I had lost for several years, so I didn't feel that I needed the extra kicker on regain resistance that the DS provides. So far, so good after six years.