Confused what I should do!? DS or Loop

[Gigindallas]

Ohh I have insurance, Medicare and Medicaid. Thanks though

 

[southernlady]

Ohh I have insurance, Medicare and Medicaid. Thanks though

Medicare/Medicaid....medicaid is the issue as not many surgeons will accept it. Fewer than even Medicare.

 

[DSRIGGS]

I had my virgin DS with a guy who is Director of Trauma for a Level 1 trauma center with 600 plus beds. He is an excellent cutter. That is not the issue of concern when choosing a DS surgeon. The fast majority of surgeons are very good cutters but they can give you an improper DS based on the type of DS they do. Dr Stephen Marshall did my virgin DS and because of the way he does his DS, the standard limb DS where the total small bowel length is not measured to determine optimal channel lengths as a HESS DS surgeon would do, I have struggled with poor health for most of the last 4.5 years. He gave me malnutrition because his standard limb DS resulted in too short of a total AL(the absorbing part of our newly revised anatomy)so I didn't absorb enough nutrients to be healthy. I found Dr Ara Keshishian in Glendale, CA (now Pasadena as office moved but is just 10 miles away from old office) and he revised my DS in 2015, 22 months post VIrgin DS. There isn't a day that goes by where I don't say to myself, ******* why didn't you find Ara before you original DS.

I strongly recommend that you find a HESS DS surgeon who will make you limb lengths in the proper proportion of your total small bowel length and not just have a guy who says, it is easier for me to not have to measure the TSBL so I just do these standard lengths that I know will leave some patients not losing enough, some losing too much and some doing well. The "cookie cutter" can work if you fail into that range where the surgeons standard limb by chance lines up well with the TSBL so you in effect get a HESS DS by accident. Frankly my life was ****** up royally because Marshall did that "let's hope it lines up well, standard limb length DS". That is why I am passionate about finding the best DS surgeon which will be one who measures the TSBL and then does a proportionate limb length DS.

Best of luck to you.

 

[Settledownnow]

I know you said the money was an issue. Have you also calculated the regular costs of supplements and protein? You will want to do that. Do your research carefully to understand what amount of supplements and protein are needed to maintain your health (see Vitalady DS list of supplements). Many can swing $60 per month by shopping sales but I find my costs average around $100 for supplements and additional protein (drinks, meats, etc.).

 

[Larra]

If you go with these surgeons, you will need to ask some very specific questions about how many DS they have done, complication/mortality rate, and especially whether it's the real, 2 anastomosis DS and not SIPS being called a DS. If you are comfortable with their answers, fine. It's you that needs to be comfortable because it's you that will live with the operation, no one else. If you are not comfortable, you really, really need to look elsewhere, even if it's less convenient, further from home, more expensive.

 

[Gigindallas]

Medicare/Medicaid....medicaid is the issue as not many surgeons will accept it. Fewer than even Medicare.

My current surgeon accepts both...yes very few surgeons accept Medicaid. I have found quite a few that take Medicare, luckily I was able to find a practice that takes both

 

[Gigindallas]

Soo... after new research just came out from Duke University, I am going with MDS (Modified DS). Surgery is this month.. I will keep y’all updated! My surgeon is Jay Roberts, he actually teaches other Surgeons how to do the traditional DS.

 

[DianaCox]

Can you please provide a link or other sourcing for this research from Duke? I can’t find it online.

 

[Gigindallas]

Can you please provide a link or other sourcing for this research from Duke? I can’t find it online.

http://web.duke.edu/surgery/2017BariatricMasters/yurcisin_current_status_of_the_sips.pdf

 

[DianaCox]

https://www.soard.org/article/S1550-7289(17)30428-8/pdf#/article/S1550-7289(17)30428-8/fulltext (pathological in this context means not normal - it is in fact the malabsorption that is the purpose of the DS):

"Breath test for fat malabsorption showed pathological results for 77.78% of patients of DS and 60% of SADI-S after three months. At 12 months, these pathological results were found in 85.7% of DS patients, but no SADI-S patients had fat malabsorption."​

Fat malabsorption is what makes the DS work long-term.

 

[DianaCox]

Since both publications are from 2017, I’m not sure whether the study I posted was available to the Duke author; he did brush aside dealing with some publications on one slide. And I don’t see any objective evidence of fat malabsorption, which apparently can be done by a breath test.

The name of the game is long-term maintenance of weight loss and remission of comorbidities. Without fat malabsorption, I don’t see how that is going to be possible without lifelong dieting. I don’t need studies to show that that is unlikely to be an effective strategy for the vast majority of S/MO people.

 

[DSRIGGS]

For the life of me I just can't decide why anyone would have any Bariatric procedure other than a Hess DS It works without having to be on a life long diet.

 

[Gigindallas]

For the life of me I just can't decide why anyone would have any Bariatric procedure other than a Hess DS It works without having to be on a life long diet.

People choose SADI or MDS (Modified DS) over Traditional DS because of the malabsorption issues DS patients have and the surgery itself is so complex. I have seen so many people that have had the DS and want to do a revision to the MDS. I am not willing to take the risk of wearing a backpack around for the rest of my life just to make sure I get the vitamins and nutrients I need to survive or die under the knife, yes any surgery you take that risk...just the more complex ones have a higher risk.

 

[DianaCox]

"I have seen so many people that have had the DS and want to do a revision to the MDS." I call BS. I have never heard of ANYONE wishing they had a "MDS" which is NOT the name that the procedure goes by - it is SIPS, SADI, or LoopDS. But there's always a surgeon who wants to name the procedure. They are all a single anastomosis duodenalileal bypass with sleeve gastrectomy.

You can choose relatively safe and the certainty of eventually having to live on a diet to maintain your weight loss, or a small risk and a relatively diet-free life. Do you understand the relative risks? How many people have you heard of who are "wearing a backpack around for the rest of my life just to make sure I get the vitamins and nutrients I need to survive" - after 15 years of advocacy for the DS and being an active member of several message boards and speaking with multiple DS surgeons, I know of exactly nobody. The risks of DS surgery vs. a matched patient having another surgery is essentially the same, in skilled hands. The bigger statistical risk of DS surgery overall (which is not much) is largely due to it being reserved by insurance companies (blatantly lying) to older, fatter, sicker patients, although it is perfectly good for people with lower BMIs as well. It is NOT significantly more risky in matched patients.

If you think you can't handle the vitamin regimen for the DS, I suggest you don't have ANY malabsorptive surgery, because although the amount of vitamins may be slightly less, over time, there will STILL be micronutrient malabsorption issues because of the absence of the lower duodenum and jejunum in the alimentary tract - but you will absorb more calories, without selective fat malabsoprtion because you will have a 300 cm common channel. So you'll eventually end up on a diet, struggling to maintain your initial weight loss, AND you can still die of micronutrient malnutrition - just more slowly.

Ask yourself first - where are the longterm results? 5 years? 7 years? 10 years? Are you willing to be a guinea pig?

I wouldn't - it doesn't make sense to me. The best I can say is, it's probably a better surgery than an RNY, and it can relatively easily be revised to a long alimentary tract version of a DS. But I see the DS to RNY as comparing steak to a **** sandwich, so that's faint praise.

 

[Gigindallas]

"I have seen so many people that have had the DS and want to do a revision to the MDS." I call BS. I have never heard of ANYONE wishing they had a "MDS" which is NOT the name that the procedure goes by - it is SIPS, SADI, or LoopDS. But there's always a surgeon who wants to name the procedure. They are all a single anastomosis duodenalileal bypass with sleeve gastrectomy.

You can choose relatively safe and the certainty of eventually having to live on a diet to maintain your weight loss, or a small risk and a relatively diet-free life. Do you understand the relative risks? How many people have you heard of who are "wearing a backpack around for the rest of my life just to make sure I get the vitamins and nutrients I need to survive" - after 15 years of advocacy for the DS and being an active member of several message boards and speaking with multiple DS surgeons, I know of exactly nobody. The risks of DS surgery vs. a matched patient having another surgery is essentially the same, in skilled hands. The bigger statistical risk of DS surgery overall (which is not much) is largely due to it being reserved by insurance companies (blatantly lying) to older, fatter, sicker patients, although it is perfectly good for people with lower BMIs as well. It is NOT significantly more risky in matched patients.

If you think you can't handle the vitamin regimen for the DS, I suggest you don't have ANY malabsorptive surgery, because although the amount of vitamins may be slightly less, over time, there will STILL be micronutrient malabsorption issues because of the absence of the lower duodenum and jejunum in the alimentary tract - but you will absorb more calories, without selective fat malabsoprtion because you will have a 300 cm common channel. So you'll eventually end up on a diet, struggling to maintain your initial weight loss, AND you can still die of micronutrient malnutrition - just more slowly.

Ask yourself first - where are the longterm results? 5 years? 7 years? 10 years? Are you willing to be a guinea pig?

I wouldn't - it doesn't make sense to me. The best I can say is, it's probably a better surgery than an RNY, and it can relatively easily be revised to a long alimentary tract version of a DS. But I see the DS to RNY as comparing steak to a **** sandwich, so that's faint praise.

Lol wow don’t blow a gasket! These people with the backpack are on fb in local DS groups, a lady actually just commented in my sips (now MDS) group that she wants the revision. If the “King of DS surgeries” here in Tx was wanting to do the Modified DS on me and he had faith that it would rid my diabetes and be closely in numbers to the traditional DS.. how bad could it be!? I have read about a lady here by me in my group that had a infection that spread after surgery and now can’t even talk, she’s paralyzed. Maybe you should of done your research more? That’s what it seems... I have friends that tell me they regret the DS and just to do the SIPS (MDS).