Sleeve to Bypass for Weight Loss

[jjwolfe 5]

Hi, looking for feedback on those who've done revision from sleeve to bypass. I do not have reflux/GERD issues so I'm only focused on additional weight loss. I did the sleeve 3 years ago. Was 429 lbs. Brought me to 320 lbs. My weight dictated a Bypass OR Duodenal Switch BUT I was doing it in Mexico and wanted to keep things simple. NOW my insurance covers and so I'm considered the jump from sleeve to bypass but ONLY if there's a chance for weight loss. For those who have done it... results from a weight loss perspective? Worth it?

[jjwolfe 5]

to answer any questions off of the bat... my sleeve was successful in terms of moving things forward. I lost the 100 or so lbs right away, haven't gained it back, solved a significant health problem, and can run! I can get down to 295 or so but I tend to bound to between 310-320 and stay there. Just looking to take the next step.

[jjwolfe 5]

Sorry... last reply to my own post. Anyone have a link to a revision study that covers the results from sleeve to bypass? Medical journal stuff?

[RickM 1,753]

I don't have any specific studies (though I'm sure there are some out there, FWIW) but from experience over the years on various forums, and looking at the basic results of the virgin bypass and sleeve procedures, I wouldn't look to such a revision as being a big help. The sleeve and bypass are quite close in overall results, that it doesn't seem to make much sense to switch from one to the other in order to get significant additional loss. You can expect some just from going through the whole pre-op/post-op diets and that initial restriction that you get, but longer term, the metabolic effect of the two are similar. The DS would make more sense as you are already half way there, and any competent DS surgeon can do a "completion" (and if it seems appropriate, do a re-sleeve as well.)

The other consideration is that the bypass is something of a dead end procedure, in that it is very difficult to revise it to something else (like the DS) if it doesn't work out - there are maybe half a dozen surgeons around who can revise it to a DS owing to the complexity of that revision. That said, I have seen a number of people go through that revision when their bypass didn't provide satisfactory results that did do well (including a couple double revisions who went from a band to a bypass and ultimately to the DS to get the desired result.) That would be my choice if I had no other conditions dictating a bypass.

[jjwolfe 5]

Thanks Rick! This is helpful. DS is my first choice but my closest bariatric surgeon doesn't do duodenal switch. Do you see a lot of risk with the DS or does it have a bad rep in your opinion?

[RickM 1,753]

You do have to look around more to find a doc who does the DS as it is something of a niche market.

https://www.dsfacts.com/duodenal-switch-surgeons.phphttps://www.dsfacts.com/duodenal-switch-surgeons.php

has a very incomplete listing, but is a start.

I don't see it as markedly more risky than the bypass; it is a more complex procedure and takes more resources for a surgeon to develop, and most particularly maintain, the necessary skills to perform it. This means that it tends to be the better surgeons who go into it, which tends to even out the risks, though that does mean that one needs to vet their prospective surgeon more carefully as there have been some over the years that got in over their heads. Thankfully, they tend to get weeded out, but it still helps to seek out a surgeon who has done several hundred of whatever procedure you are interested in.

It does get a bit of a bad rep in that there are some practices out there that advertise doing it (it is actually fairly common to see it listed on a surgeon's CV, or on a practice's list of offerings) but if one inquires about it, they sell you what they actually do perform, saying things like 'we used to do it but the patients had too many problems...' which by my experience means that either the guy in the practice who did do them left the practice, or they never got up the learning curve to do them correctly. It isn't something that a surgeon just "picks up" and starts doing, but is something that most go back to school to learn, usually doing a residency of a few months with an established practice to learn all the in's and out's of it. That's a lot of time off for a busy surgeon, so it often just means that it isn't worth it business-wise to go to the trouble to learn it. But many don't want to lose the business, so some will bad mouth it in the process of selling their own offerings. Oddly, when looking at practice's offerings, it is not unusual to see them list the Vertical Banded Gastroplasty (the old "stomach stapling") which has been obsolete for at least twenty years, but it seems that some will list anything they may have done once in the past as a current "offering".

My wife is about fourteen years out on her DS and is still doing well with it, and we still regularly attend a support group that is composed of mainly 10-20 year vets, and it is overall a healthy population. There are things that can crop up over time that is a result of the malabsorption, which is something that it has in common with the bypass. One may not recover from a blood loss event as readily as a normal person, or a VSG patient; Iron infusions may be needed to get things balanced out again rather than just upping oral iron. One will be more sensitive to nutrient deficiencies (with either) which means that it is much more important to stay current on labs; maintaining nutrient balance doesn't seem to be a big issue if one is aware of what one needs; skip the labs for a few years and odd things can happen as the potential deficiencies are different than with the normal population. But overall, with a fairly compliant population, it is hard to tell what issues people are having are related to their DS, and what is simple aging (one of the occasional topics of discussion when someone asks about a particular problem). Most of these people are in their 60's or early 70's now (a few later 50's too...) so things are naturally falling apart a bit - but not nearly to the degree that they would be if they were still 3-400+ lb!

[jjwolfe 5]

Thanks RickM. Your insight is invaluable.