Comparison
- Thread starter kevin86
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Clematis
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Try here: http://www.dssurgery.com then look at tab on left "surgical procedures."
duh_Mom
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Hi Kevin, good for you doing your research. i added a few links too that detail out the different surgeries so you can do your own comparison. As you likely know, but just incase - the Gastric sleeve is based on restriction only. The DS adds a malabsorption component to the mix - so that the food you eat is not all absorbed by your body. Generally determining if you need the malabsorption is based on what your starting BMI is. Happy Researching
http://www.wlsinfo.org.uk/patient-stories/surgery-from-a-patients-viewpoint/duodenal-switch/
http://www.dsfacts.com/index.php
http://www.bariatric-surgery-source.com/gastric-sleeve-surgery.html#The_Difference
http://www.wlsinfo.org.uk/patient-stories/surgery-from-a-patients-viewpoint/duodenal-switch/
http://www.dsfacts.com/index.php
http://www.bariatric-surgery-source.com/gastric-sleeve-surgery.html#The_Difference
Larra
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Welcome! Good for you for researching before surgery instead of having regrets after.
I will disagree somewhat with the advice above in that there is much more to consider than bmi. Your comorbidities, if any, are very important considerations, as the sleeve doesn't provide the metabolic changes of the DS that gives the DS the best rate of permanent resolution of type 2 diabetes of any bariatric surgery. The DS also does better for the other major comorbidities where improvement/resolution relies on amount of weight lost, as the average amount of weight loss with sleeve is less than with DS. Of course, that's averages - individual results differ, and there are some people who do very well with a sleeve.
The other very important consideration IMHO is lifestyle. For the sleeve to be successful requires more discipline in terms of dietary restriction - amount eaten and restricting both carbs and at. The DS is more forgiving in that we can eat lots of protein and whatever fat comes with the protein because we absorb on average about 20% of the fat we consume. That opens up a lot of protein choices and cooking methods. On the other hand, the DS requires more didscipline on vitamins, as we malabsorb certain ones and require daily supplementation for life. If you're not on board for that, don't have a DS.
I will disagree somewhat with the advice above in that there is much more to consider than bmi. Your comorbidities, if any, are very important considerations, as the sleeve doesn't provide the metabolic changes of the DS that gives the DS the best rate of permanent resolution of type 2 diabetes of any bariatric surgery. The DS also does better for the other major comorbidities where improvement/resolution relies on amount of weight lost, as the average amount of weight loss with sleeve is less than with DS. Of course, that's averages - individual results differ, and there are some people who do very well with a sleeve.
The other very important consideration IMHO is lifestyle. For the sleeve to be successful requires more discipline in terms of dietary restriction - amount eaten and restricting both carbs and at. The DS is more forgiving in that we can eat lots of protein and whatever fat comes with the protein because we absorb on average about 20% of the fat we consume. That opens up a lot of protein choices and cooking methods. On the other hand, the DS requires more didscipline on vitamins, as we malabsorb certain ones and require daily supplementation for life. If you're not on board for that, don't have a DS.
Thank you everyone. I'm leaning towards DS because I weigh 530lbs and have a bmi of 71 but I have some concerns. My biggest concerns are the risks. How much greater are the risks of DS vs Sleeve? Also the distance is concerning to me. The closest surgeon for DS is like 13 hours away. I'm concerned that if there was an issue what would I be able to do. So I guess my main issue is my own concern. @Larra @duh_Mom and anyone else that can give more info.
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duh_Mom
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@kevin86, I agree with @Larra completely. comorbidities must be taken into account. For me, it was based on BMI completely as I was lucky enough not to have anything but sleep apnea. That is a sign of how sick we are in that I say I 'only' had sleep apnea.
@Larra, thanks for the reminder, I want to grow up to help new folks and need to remember all the reasons, not just mine.
Choosing the type of surgery is a very personal choice and one only you can make. The risks of surgery are profound regardless of the type of surgery you choose and the surgeon you choose. This would be a conversation to have with your chosen surgeon. Have you seen anyone yet? the higher your weight, the more profound the risks. Your comorbidities will also contribute to the risk.
It is also possible to have the DS done in 2 stages - the VSG followed at a later date by the DS. Personally, I would not do it separately and with your weight and BMI I would only consider the DS, but again that is me.
Good Luck on your research
@Larra, thanks for the reminder, I want to grow up to help new folks and need to remember all the reasons, not just mine.
Choosing the type of surgery is a very personal choice and one only you can make. The risks of surgery are profound regardless of the type of surgery you choose and the surgeon you choose. This would be a conversation to have with your chosen surgeon. Have you seen anyone yet? the higher your weight, the more profound the risks. Your comorbidities will also contribute to the risk.
It is also possible to have the DS done in 2 stages - the VSG followed at a later date by the DS. Personally, I would not do it separately and with your weight and BMI I would only consider the DS, but again that is me.
Good Luck on your research
DSRIGGS
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Kevin any surgery has risk because going under anesthesia is dangerous. The DS is a longer procedure than the VSG, but I viewed it as really no more risky for me than a RnY (never considered having that procedure) or VSG e as I would already be under anesthesia for both and just have to be under another 1-1.5 hours for the switch. Studies have shown (others can find as I am not finding anything right now) the DS to be on par with the other Bariatric surgeries for mortality rate.
The bottom line is you have to weigh the pros and the cons of each procedure. If you have a Sleeve gastrectomy and it doesn't do the trick (at your weight I just don't know that you will be happy with the weight loss from a sleeve alone) and you have to have a revision to a DS that is another surgery you would have to undergo. Then you would be under the same risk you were under for the Sleeve procedure when you had the second procedure.
The DS has the best comorbidity resolution and longer term average weight loss of any bariatric procedure. The bottom line is you have to decided for yourself if a VSG will give you what you are looking for in a WLS and if the risk of not losing enough weight is enough to sway you to have the most effective procedure for weight loss, the DS. In the end only you can make that decision.
DSRIGGS
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You are welcome and keep researching and keep asking questions.
Dr Rabkin and Keshishian both discuss it on their sites, you just have to dig around a little to find it. I was looking for a neat comparison chart that I had seen before but I can't find it. The bottom line is that surgery carries risk but the RnY, VSG and DS are all roughly equivalent in terms of mortality. The DS is a tiny bit higher in studies I have seen but something like 1.35 vs 1.28 in terms of death per 1,000 patients. Remember that our demographic going into surgery are not the safest candidates in the world, but a good surgeon will do a thorough exam and make sure a patient is fit for surgery.
BTW, these two are the best of the best in the Bariatric world.
Haha funny you should mention a nice little chart. I remember seeing one also but can't find it for the life of me again.
DSRIGGS
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Found one on Dr K's site (I love this man so I am a little biased...he is incredible).
http://www.dssurgery.com/blog/?p=1057
Larra
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@kevin, did you mean your bmi was 71, not your BUN? BUN stands for blood urea nitrogen, which is a measure of kidney function, so they are both medical abbreviations, but for very different things.
Given your bmi, it MIGHT be necessary for your to have the DS done in 2 stages, depending on your overall health and on the comfort level of your surgeon. If you are at all interested in going the DS route - and in my opinion you should be, with as much as you need to lose in addition to any comorbidities that you haven't mentioned - it would be best to get insurance authorization for a full DS, get just the sleeve if necessary, and you could always decide later to stick with your sleeve if you get really good results. After all, no one is going to force you to have a second operation against your will. On the other hand, if you get just a sleeve authorized and then decide you need the DS after all, that would require a second authorization, and it is much, much harder to get authorization for a second bariatric operation regardless of your circumstances. Some policies even have a "one bariatric operation per lifetime" provision, and won't pay for a revision even if the patient self-paid for the first operation. Totally unfair, but apparently legal.
Given your bmi, it MIGHT be necessary for your to have the DS done in 2 stages, depending on your overall health and on the comfort level of your surgeon. If you are at all interested in going the DS route - and in my opinion you should be, with as much as you need to lose in addition to any comorbidities that you haven't mentioned - it would be best to get insurance authorization for a full DS, get just the sleeve if necessary, and you could always decide later to stick with your sleeve if you get really good results. After all, no one is going to force you to have a second operation against your will. On the other hand, if you get just a sleeve authorized and then decide you need the DS after all, that would require a second authorization, and it is much, much harder to get authorization for a second bariatric operation regardless of your circumstances. Some policies even have a "one bariatric operation per lifetime" provision, and won't pay for a revision even if the patient self-paid for the first operation. Totally unfair, but apparently legal.
bearmom
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I don't consider distance to surgeon very relevant, and went outside the US for my surgeon. My follow up is mainly getting blood drawn for labs, and I wouldn't have my surgeons office doing that any way. My local PCP does that. I'll forward the results to my surgeon if I feel like it, especially if there is anything that I might like his input on, but my pcp does great at following my labs with me, and when there is anything that she thinks needs to be addressed more closely, she has no issue referring me to an endocrinologist or whatever specialist would best address it. That is how I want it.
The main drawback to the DS over the sleeve for me is that I have to not only commit to taking a variety of supplements, but paying attention to the lab work and reading it myself to try to ensure nothing is overlooked. I also know that the vitamins I take are totally non-negotiable, and it can be fatal if I'm negligent about taking them.
