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Choosing between SIPS and traditional DS



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I’m researching SIPS vs DS and I’m so confused on the correct choice! SIPS seems easier to live with less side effects possibly and an up and coming surgery while DS has been around longer and has more follow up data. My surgeons office only does SIPS and truly has not done that many of them so I’ll probably switch surgeons as well.

My story is that I had a nightmare band experience in 2011, didn’t lose much at all and regained all as well as port discomfort etc until being revised in 2017 to sleeve. I did amazing on sleeve for 2 years lost almost all my weight (112lbs) but regained about half. I’m desperate to find the right surgery and so afraid I will make another mistake!

I know I need a more powerful surgery than the sleeve and yes I’m doing the “head work” in therapy. Any advise on which I should choose or how I should make the decision?

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It is difficult to compare the two directly as few surgeons do both, (Mitchell Roslin in NYC is the main one I can think of that actively performs both) so there a lot of variables that get in the way. The DS is indeed the most powerful procedure commonly available, but it is also the most complicated to do, which is why few surgeons offer it. It has been around since the late '80's, it is one of the procedures endorsed by the ASMBS (along with the VSG, RNY and bands) and accepted by US insurance as a mainstream WLS procedure (they can't call it "investigational" any more since Medicare started paying for it.,) The SIPS (SADI, Loop DS, and other names that it goes by,) is newer and not as well established, nor quite as standardized, as everyone is still figuring out the optimum configuration. It is being promoted as being "almost as good as" the traditional DS, but "more accessible" - simpler so more surgeons can offer it. The hope is that it will fall somewhere between the RNY and DS in performance, with fewer side effects and limitations than either. If that holds true, then it will earn a spot in the WLS world, and if not, it will be another procedure that doesn't quite make it, like the "mini" bypass.

Most of the BPD/DS surgeons don't offer the SIPS as they don't need a simpler procedure, and already have the VSG for the less challenging patients. Here is one very biased opinion on it from one of those surgeons:

https://www.dssurgery.com/weight-loss-surgery/sadi-sips/

The position of the ASMBS on the matter:

https://asmbs.org/resources/position-statement-single-anastomosis-duodenal-switch

and, here is Dr. Roslin's take on it:

https://www.nycbariatrics.com/weight-loss-surgery-options/sips-procedure

Dr. Roslin is well quaiified on the BPD/DS (and is one of the few with the skills to do the very complex RNY/DS revision) but it seems that he is actively working on the SIPS for the greater good of the WLS community as a whole - that "almost as good as, but more accessible" concept that can hopefully benefit more patients over the long run.

At this point, only time will tell.

As an individual decision for right now, that's a tough one. With your regain history, I would be inclined to go the the well established BPD?DS, as that has proven to have the best regain resistance, but that would likely involve travelling for you (I don't know of any DS docs in MA, but there are several in the NY/NJ/PA area.)

It is good to see that you are doing the "head work" as that is an essential part of any of these procedures - one can "eat around" any of them, though it is harder to do with the DS. One of the things that I have found to be helpful is what this doc covered here -

One of the things that doesn't get covered much by other surgeons is that our eating capacity does increase slowly over time, and this is something we have to compensate for. One may or may not get along with this doc's prescription for a veg first diet, but it does make sense from the perspective of filling in that added capacity with bulky, low calorie veg. Think about it, discuss it with your therapist, and maybe you find a different approach to handling this problem.

Good luck!

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Dr. K is definitely a proponent of the traditional DS.

I’ve only met Sips patients at Lenox Hill (Dr. Roslin’s Practice) I don’t even know if he’d do the full DS anymore

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