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Explain why DS would be done instead of bypass



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So I am scheduled for bypass in December. Recently I’ve read several things about the switch. Wondering why one opts for that or what makes you more suited for that vs the bypass. It comes down to the end of the line before final decision from my surgeon and I, but looks like my office isn’t a big pusher of the switch due to more risks and complications. Would just like to hear from real people here who have had it.

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My surgeon pushes more for the DS or SADI-S/Loop DS if the patient has a BMI of 50+. I was originally wanting the Gastric Bypass but my surgeon told me that statically I wouldn't get under 200 pounds if I chose the Gastric Bypass as I'm disabled and can't exercise much at all so I was really having to rely upon statistics. According to my surgeons statistics the lowest weight I would have gotten to with the statistical average of Gastric Bypass was 206 pounds, while the DS was 184 pounds (which I've surpassed that statistic by 8 pounds).

In the end, the decision on what surgery you decide is YOURS. Not your surgeons. YOURS. I chose the SADI-S/Loop DS because my insurance doesn't cover revisions and my ultimate goal was 180 pounds (which I've surpassed by 4 pounds) and I didn't think I'd be able to get there with the Gastric Bypass. The downside to the surgery I chose is more Vitamins and more Protein, but you get used it. I haven't really had any issues other than that I developed a wheat allergy, but you can develop that with any of the surgeries with malabsorption which INCLUDES the Gastric Bypass (it's only a 3% chance, but my luck is crap). So really, just weigh the pro's and con's and choose whichever surgery that you are most comfortable with.

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The most compelling reason for the DS, particularly the "classic" or "traditional" BPD/DS (as distinct from the SIPS/SADI/Loop DS, which is a different procedure with its own, albeit similar tradeoffs,) is much better regain resistance than the other mainstream procedures like the RNY or VSG. It's hard to say where the SIPS fits into that spectrum as it is still a relatively new procedure, but I would expect it to be somewhere between the RNY and BPD/DS.

The RNY is a mildly or minimally malabsorptive procedure; the caloric malabsorption dissipates after a year or two as the body adjusts to it so metabolically it winds up being similar to the VSG long term, This is why some doctors will classify the RNY as essentially only a restrictive procedure. However, the nutritional malabsorption is a long term thing that you need to accommodate. The DS malabsorption is a long term feature, so it continues working to help you maintain your weight over the long haul. With the RNY, as with the VSG, that is much more up to you. It is much more common for people with the RNY or VSG to have substantial regain problems than it is with the BPD/DS.

I went with the basic VSG as I had lost around a third of my excess weight with diet and lifestyle changes (that we should all do anyway....) I went through when my wife had her BPD/DS and kept that off for several years before deciding to go with the VSG (which wasn't commonly done before) to complete the job - I didn't feel that I needed the extra power of the DS to maintain the loss longer term, and wasn't comfortable going the the RNY as it really doesn't do markedly more than the VSG, but "costs" about as much as the DS when it comes to long term compromises - the extra fussiness over supplements, etc. Further, it has additional long term potential problems with medication and medical treatment limitations that the DS and VSG don't have.. The simpler was the better option for my needs. If one has substantial metabolic problems (including diabetes) or a history of yoyo dieting, the DS is a better choice.

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it's a more powerful surgery than the VSG or RNY. You're likely to take more weight off, and it's likely going to be easier to maintain your loss long term (although you'll certainly find people who've had VSG or RNY who've taken off all their excess weight and managed to maintain it). But your odds are better with the DS.

My insurance doesn't cover DS, just RNY and VSG, otherwise I would have considered it given my starting weight. Although I ended up losing all my weight with my RNY anyway, so I'm good.

DS does come with more potential complications than either the VSG or the RNY, so there's a trade off. But as with the other two, you'll find a lot of people who've never had complications at all with it.

If you have a history of GERD, I'd still go with the RNY, since DS has a sleeved stomach (in fact, the VSG used to be phase 1 of the traditional DS surgery, back when it was often done in two phases. A lot of people ended up losing a substantial part of weight with just the sleeved stomach and really didn't need phase 2 - the intestinal part. So eventually VSG ended up being offered as a standalone surgery). So you still have the potential of worsened GERD (or new-to-you GERD) if you go with a DS, but then 70% of VSG/DS people don't develop GERD issues at all, so there's that...

tough decisions. I'm still very happy with my RNY - but I would have at least considered DS if my insurance covered it.

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I wanted the TDS bc I felt it gave me the best chance to lose the most & to keep it off.

I eat often. I just ensure it's mostly Protein.

TDS 2005

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Thank you for your responses! My doctors info says it is reserved for patients with BMI 50 or greater, I’m in the low 40s. I also have reflux so I guess that part would make me not so suited for the switch??? I am interested though because just like you all have said, it gives you better weight gain resistance for the long haul. It also, I’m sure, does come with more risk/complications maybe.

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17 hours ago, RickM said:

The RNY is a mildly or minimally malabsorptive procedure; the caloric malabsorption dissipates after a year or two as the body adjusts to it so metabolically it winds up being similar to the VSG long term, This is why some doctors will classify the RNY as essentially only a restrictive procedure.

RNY does usually result in greater weight loss than VGS, and it usually resolves GERD and Type II Diabetes. These benefits should not be overlooked.

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2 hours ago, mrsjo said:

I’m in the low 40s. I also have reflux so I guess that part would make me not so suited for the switch???

The RNY Gastric Bypass would be more suitable for you. It usually resolves GERD, whereas the Sleeve does not. Sleeves are sometimes revised to RNY because of GERD after the original WLS.

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