DS for lower BMI revision

[HP62442 11]

I'm currently scheduled for a MGB in February (from a GS). My surgeon and I only talked about the MGB, and not DS. My BMI is 36.6 (with two co-morb.), but I really want this to be my final surgery (no more revisions!). Should I talk to my doctor about the DS? Is recovery/life style really that different than a MGB/GB? I'm a self-pay, so insurance is not a concern.

I have to take Rexulti for depression (I've tried stopping and it went poorly) and it caused me to regain 30 pounds, so I'm particularly concerned about weight regain.

Thanks in advance!

[ColoradoCanuck 70]

I'm not going in for a revision but I am getting a DS in 8 days. I didn't want to be in a place where I'd need a revision later and went right to it.

Sent from my Pixel 3 using BariatricPal mobile app

[GreenTealael 24,871]

7 hours ago, HP62442 said:

I'm currently scheduled for a MGB in February (from a GS). My surgeon and I only talked about the MGB, and not DS. My BMI is 36.6 (with two co-morb.), but I really want this to be my final surgery (no more revisions!). Should I talk to my doctor about the DS? Is recovery/life style really that different than a MGB/GB? I'm a self-pay, so insurance is not a concern.

I have to take Rexulti for depression (I've tried stopping and it went poorly) and it caused me to regain 30 pounds, so I'm particularly concerned about weight regain.

Thanks in advance!

Since you are paying all by yourself definitely talk to your Surgeon about DS/SIPS. (Pros & Cons for your particular situation)

[Strivingforbetter 246]

@HP62442I can't speak of the differences between the recovery of the MGD and the DS because I've only had the DS after a revision from a band. However, recovery wasn't bad at all for me. My BMI was about 39 when I received my DS. You might not be heavy enough for the DS with a BMI of 36, but your surgeon would know. Not many surgeons have been trained to do the DS, so that might be a factor for your doctor too.

[Postop 405]

@HP62442Who is your doctor? Does he/she do the DS?

Yes, the recovery is somewhat different and yes, the lifestyle is very different.

[Losingit2018 1,170]

I am revising from sleeve to bypass on Friday. I really never researched the ds surgery until recently. The fact that people that have had it are still able to take nsaids would be a big plus in my case. I am riddled with arthritis.

However I have read that it is a much more complicated procedure. Bigger concern of vitamin/mineral deficiency as well.

But the chances of not only losing the weight but also maintaining are outstanding. I kind of wish that I had researched it before now.

good luck with whatever you decide!

[GenevieveR 0]

My BMI is 36.2, I had a Sleeve Nov 2013 and significant regain since. I am scheduled for a revision to DS in January. Like you, I also want this to be my last surgery. The way I see it was is I don't have reflux so all options are open. The bypass is the most restrictive surgery, the DS has the most malabsorption and an increased metabolic effect. I don't think adding more restriction will help me long term personally, I think increased malabsorption and metabolic surgery will be best for my lifestyle and eating habits so that is why I chose the DS. Either surgery a lifetime of supplements is required, there is no one way to go about this so just look into it for yourself. Here's a link to something I think summarised my thinking re revision. https://www.tugruldemirel.com/en/content.asp?d=sleeve-gastrectomy-revisions&id=6134

All the best.

[summerset 5,261]

On 11/10/2019 at 11:00 PM, ColoradoCanuck said:

I'm not going in for a revision but I am getting a DS in 8 days. I didn't want to be in a place where I'd need a revision later and went right to it.

Who wants to have one? Unfortunately there isn't a procedure that guarantees that there won't be no revisions. (That said, what about patients with a DS who develop serious acid reflux similar to the sleeve?)

There also isn't a procedure that guarantees reaching and maintaining a svelte physique of BMI 20 for life either.

I know BPD/DS often seems to be marketed as the procedure to go for permanent weight loss but the desired 100% EWL seems to be more or less of an exception as well, at least in prospective studies?

Quote

https://www.ncbi.nlm.nih.gov/pubmed/27425842

One hundred patients underwent BPD (34%) or BPD/DS (64%). Mean preoperative body mass index (BMI) was 50.2 kg/m². Mean follow up was 8.2 years (range: 1-15 yr) with 72% of eligible patients in active follow up at 10-15 years postoperatively. Excess weight loss (EWL) was 65.1% at 2 years, 63.8% at 5 years, and 67.9% at 10-15 years. Approximately 10% higher %EWL was achieved for those with preoperative BMI<50 kg/m² versus≥50 kg/m² and patients who underwent BPD/DS versus BPD. Although co-morbidities improved, 37% of patients developed long-term complications requiring surgery.

Quote

https://www.ncbi.nlm.nih.gov/pubmed/22030148

Excess weight decreased from 91% (134 kg, body mass index 48 kg/m(2)) to 75% (124 kg, body mass index 44 kg/m(2)) after LAGB failure and decreased further to 40% (100 kg, body mass index 35 kg/m(2)) after BPD/DS. The mean percentage of excess weight loss was 55% after LAGB and BPD/DS together and 48% after BPD/DS alone.

Yes, I know... it's statistics. However, I wonder if these study patients are that different from the general surgery population. I highly doubt it.