Hello all! I am new to this community! I had my first appointment with my surgeon today, and I love him, he's really great. We talked a lot about different surgeries but I'm still really undecided and I'm finding myself obsessing about it even though I have several months to decide. So if anyone wants to weigh in (haha, no pun untended) please do.

I'm in my early 30's, female, BMI of 44. SW is 255, GW is 125-135. I'm 5'4. I think that's all the applicable information. Anyways, I have a good friend who has similar stats but is slightly older then me. She had the sleeve and stalled out at 6 months after only a 30lb loss and started regaining. She ended up getting the Duodenal switch which has since worked fabulously for her. She has met her goal and is maintaining. My surgeon has never performed a DS but is not against it. I do not mind being a pioneer patient and I definitely trust his experience. He is not really swaying me in either direction because he wants me to make my own decision. He says the majority of his patients get the sleeve and tend to do really well with it, and the weight loss center has a really nice aftercare program.

It is pretty important to me to hit my goal. I have another friend who counted calories to lose about 100lbs and has now regained it all plus some. Over being skinny, I want to be healthy, but I also want to feel comfortable in my own body, have the self-confidence to be seen in public again, etc. I'm sure a lot of you know where I'm coming from here. I also really don't want to have to come back and pay for a revision. I have kids and I have a lot of things I could be spending those thousands on instead of a second surgery.

So I'm sitting here bouncing back and forth between not losing all the weight I need to with the sleeve and being worried about the harsh side effects of the switch as well as having concern for the severe malabsorption as I age into my twilight years. But then again I won't live to see old age if I don't get a minimum of 100lbs off. Help. Please.

And yes I Know the surgery is a tool and should work if I use it well, and I plan to, but..I don't know. Just help please.

15 hours ago, Jessa4140 said:

No worries, I know she's not uber compliant. She still eats almost nothing but fried, processed food.

I am a grazer and I eat a lot of carbs and large portions.

I guess I just want to make sure the sleeve will get me where I need and want to be? I want to lose around 125 lbs, is it possible with a sleeve, or is the sleeve more for 50 lbs weight loss? I won't want to go too aggressive with the switch if I don't need to, but I don't want to regret not going aggressive enough and not losing it.

I can answer for me...I am 4 days away from being 6 months post op, and I am down 96 pounds. I had the sleeve. I think if you dont have issues with reflux, sleeve is a wonderful option. My restriction is great and I dont feel the need to snack.

I'll speak for myself I started at 322 and I'm now 165lbs and I had RNY gastric bypass and had no issues at all.. lost all my excess weight and only took 8 months

I had a lot of restriction for months and lived off shakes. Didn't even feel like eating had no urge at all for months..

You have difficult decisions to make and it’s completely understandable that you’re obsessing about all of it – how could you not? I, too, am a strong advocate of the “think a million times, cut once” philosophy.

With regard to being a pioneer patient, from extensive research conducted prior to my own bariatric surgery, and as a medical scientist, please allow me to offer an assessment: no surgeon would select a ultra-low or even low-volume surgeon for him-/herself or his/her relatives for any surgery.

The correlation between high volume and quality of surgical outcomes is empirically well documented, meaning that the outcome of every surgical procedure is directly dependent on the number of operations performed at a given hospital as well as by the designated surgeon. In other words, the higher the number of operations of a specific type a surgeon performs, the more likely optimum treatment results and low complication rates are achieved. This fact is supported by a large volume* of studies and meta-analyses that have been conducted, peer-reviewed, and published between 1979 and 2019.

Because of comorbidities and lower cardiopulmonary reserve thresholds, bariatric patients are often high risk patients. In complex procedures like bariatric surgery – and particularly with riskier procedures such as RYGB, BPD/DS, and SIPS – it is worth paying extra attention to the correlation of procedure-specific skills of the surgeon and the complication rate.

Since you’re several months away from surgery, I’d encourage you to keep researching extensively, and talk with as many people as possible who have recently had DS and VSG, and particularly those who are at least 5 years out from both surgeries. I hope that by the time you reach a final decision, you’re able to do so with clarity and a sense of ease. Wishing you all the very best!

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*A small sampling of available data includes:

1. Zevin B, Aggarwal R, Grantcharov TP: Volume-outcome association in bariatric surgery: a systematic review. Ann Surg 2012;256:60-67.

2. Nguyen NT, Paya M, Stevens CM, Mavandadi S, Zainabadi K, Wilson SE: The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg 2004;240:586-593; discussion 593-594.

3. Birkmeyer NJ, Dimick JB, Share D, Hawasli A, English WJ, Genaw J, Finks JF, Carlin AM, Birkmeyer JD; Michigan Bariatric Surgery Collaborative: Hospital complication rates with bariatric surgery in Michigan. JAMA 2010;304:435-442.

4. Birkmeyer JD, Finks JF, O'Reilly A, Oerline M, Carlin AM, Nunn AR, Dimick J, Banerjee M, Birkmeyer NJ; Michigan Bariatric Surgery Collaborative: Surgical skill and complication rates after bariatric surgery. N Engl J Med 2013;369:1434-1442.

5. Chowdhury MM, Dagash H, Pierro A: A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg 2007;94:145-161.

6. Luft HS, Bunker JP, Enthoven AC: Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 1979;301:1364-1369.

7. Birkmeyer JD, Siewers AE, Finlayson EVA, Stukel TA, Lucas FE, Batista I, Welch HG, Wennberg DE: Hospital volume and sugical mortality in the United States. N Engl J 2002;346:1128-1137.

8. Amato L, Colais P, Davoli M, Ferroni E, Fusco D, Minocci S, Moirano F, Sciatella P, Vecchi S, Ventura M, Perucci CA: Volume and health outcomes: evidence from systematic reviews and from evaluation of Italian hospital data (Article in Italian). Epidemiol Prev 2013;37(suppl 2):1-100.

9. Pieper D, Mathes T, Neugebauer EAM, Eikermann M: State of evidence on the relationship between high-volume hospitals and outcomes in surgery: a systematic review of systematic reviews. J Am Coll Surg 2013;216:1015-1025.

10. Al-Sahaf M, Lim E: The association between surgical volume, survival and quality of care. J Thorac Dis 2015;7(suppl 2):152-155.

11. Maruthappu M, Duclos A, Lipsitz RS, Orgill D, Carty MJ: Surgical learning curves and operative efficiency: a cross-specialty observational study. BMJ Open 2015;5:e006679.

12. Schrag D, Panageas KS, Riedel E, Cramer LD, Guillem JG, Bach PB, Begg CB: Hospital and surgeon procedure volume as predictors of outcome following GI resection. Ann Surg 2002;236:583-592.

18 hours ago, rjan said:

Google found this surgeon who offers a version of DS that preserves the pyloric sphincter.

Stomach Intestinal Pylorus-Sparing (SIPS) surgery has been around for about 8 years. It's a simplified DS procedure, and lots of bariatric surgeons perform it. Long term SIPS outcomes are similar to any other bariatric surgery.

Edited July 4, 20206 yr by PollyEster