DS Safer than RNY

[more2adore]

Hi everyone. I'm currently in the research phase of all this... convincing hubby, my GP, and soon (I hope) my potential surgeon that yes, I know that this is what I want... and here's why.

I've been on dsfacts.com multiple times now reading through the information there. I've seen studies that show the weight loss, *especially* weight loss over years, is substantially better with the DS, so that's easily proven. I can demonstrate that the band (gag) is awful, and the VSG is not going to result in enough weight loss for me by itself. But that leaves my argument against the RNY.

Now, the RNY scares the *bleep* out of me. I've had many friends die as a result of it, and i'm SURE I have -- somewhere in all this reading I've been doing -- seen statistics that show that the RNY is MORE dangerous than the DS. I know on the chart from Dr. K's website it shows that the RNY has a higher rate of needing to be revised to another type of surgery, but that says for reasons of failure, not due to complications. I've looked through all the pinned threads here on the DS forum, and done a search on the DS forum specifically, but "RNY" is too short a search term and "safer" returned no results for thread titles.

Can anyone help? I'm trying really hard to learn everything there is to know about this so I can advocate for myself well. Thank you in advance!

 

[more2adore]

(By the way, hubby doesn't need much convincing... he's fully supporting me no matter what I decide, but he does of course want to know we're picking the safest option among those that will actually be helpful for me.)

 

[Elizabeth N.]

Meh, the complication rates are very similar between the two procedures, assuming an experienced surgeon and care team.

 

[Spiky Bugger]

Here's the deal...looking at unexplained numbers, like mortality rates, may not get the desired results.

BECAUSE...the DS surgeons seem to take on the very seriously super morbidly obese at a rate that is higher than the RnY or band or sleeve only surgeons attempt. (There are some doctors who think the DS is ONLY for the very highest BMIs.)

So, if you compare complications/mortality/etc., without knowing the BMIs of the patients involved, you may be comparing the surgical outcomes of people with BMIs of 42 vs BMIs of 70...and the patients with higher BMIs, as a group, are just going to have more complications, regardless of the surgery selected.

 

[Spiky Bugger]

(By the way, hubby doesn't need much convincing... he's fully supporting me no matter what I decide, but he does of course want to know we're picking the safest option among those that will actually be helpful for me.)

Also...have you been to pubmed?

Again, make sure you are comparing apples to apples and not apples to luaus...but you can search the meta studies there.

You get stuff like this. Takes a bit of getting used to, but worth it if you are careful...
http://www.sciencedirect.com/science/article/pii/S0039606007004928

 

[brooklyngirl]

I don't think the RNY is any more or less "safe" (as long as you're taking into account the BMI of the study group) but it has statistically less success in resolution of things like diabetes, sleep apnea, high blood pressure, and in long term weight maintenance.

 

[Spiky Bugger]

Here's one:

http://onlinelibrary.wiley.com/doi/10.1002/bjs.6802/full

 

[more2adore]

Thank you guys SO much for your answers. I don't know where I got the idea that it was much safer. But if it's comparable and results in greater weight loss (and less chance of regain, especially in the superobese as in that link SpikyBugger just posted) it seems like a no-brainer. I'm putting together a pros and cons lists with both so I can sit down and decide which qualities are the biggest priority for me.

 

[more2adore]

Going to do some more reading on PubMed - thanks for that, SB!

 

[Spiky Bugger]

Going to do some more reading on PubMed - thanks for that, SB!

I didn't give you that link...just google something like "pubmed bariatric meta" or "pubmed duodenal switch."

 

[Munchkin]

Major surgery is major surgery. Complication rates for the 2 procedures are pretty much the same. Especially if you consider the DS people are more likely to be larger to begin with and have more co-morbidities.

The truth is that the DS is really your only chance to ever get even close to a normal BMI. The most drastic DS possible. The RNY won't do it for you. RNY folks start regaining usually in years 2 or 3. Why? Because their body adapts to the malabsorbtion. This same adaptation is part of the reason we stop losing. The difference is we have so much bypassed that the body can never completely adapt. The 'bounceback' you read about is what happens when DSers reach the point where their bodies have adapted as much as possible.

I was one of 10 who had WLS in my office when I lived in Minnesota. I was the only DSer. The rest were bands and RNY. Today I'm not HAPPY about my weight....but I'm the only one that doesn't weigh MORE than they did preop. I just look like an average woman my age. And my RNY co-workers still dump and puke. And they get to be SSMO too! The worst of both worlds! I feel like I dodged a bullet!

One of the most successful DSers I know started at over 600lbs. Today she hangs around 150 to 170. I can tell you how she did it. She worked her surgery like no one else I have ever seen. She ate very little during the window. Mostly low or no carb shakes. She would eat a bite or two now and then but almost all her nutrition was from shakes. You could see her brain working whenever she did eat food. She calculated every bite. She knew it would be very easy for her to run out of window before she ran out of fat! And to get to her weight today, she also had extensive plastics. She has ongoing problems with lymphedema but her issues are easier to deal with at her current size. Her CC is 50 and she went to Spain(Baltasar) to get the most drastic DS available. She had the band before her DS. She went to Sweden for that, she was in the study group before the band was released to the marketplace in the US.

 

[more2adore]

Wow, okay - that's great info, Munchkin. I would actually be perfectly happy landing between 175-225. I've been over 325 pounds since I was 16 - I have no memory of how old I was when I was ~200 pounds (between 12 & 16 is when I gained from 120 to 325), and my quality of life would be so much better at that weight I can't even imagine it at this point. But I imagine with the RNY there's no way I would get even that far (and stay at that weight). I was a little concerned I might lose TOO much weight (I like being at least a little plus sized) with the DS, but from what you've said it sounds like that is likely to not be a concern.

 

[Spiky Bugger]

Wow, okay - that's great info, Munchkin. I would actually be perfectly happy landing between 175-225. I've been over 325 pounds since I was 16 - I have no memory of how old I was when I was ~200 pounds (between 12 & 16 is when I gained from 120 to 325), and my quality of life would be so much better at that weight I can't even imagine it at this point. But I imagine with the RNY there's no way I would get even that far (and stay at that weight). I was a little concerned I might lose TOO much weight (I like being at least a little plus sized) with the DS, but from what you've said it sounds like that is likely to not be a concern.

There are enzymes you can take if you need to increase absorption, but generally, finding whatever worthless carbs your body can process without making you miserable (bloating, gas, etc) will get you as fat as you want. Or fatter. (In my case, cookies are dangerous, but candy is not. i'm fatter than I need to be.)

 

[hilary1617]

I think it is very important to view surgery and surgeon choices holistically as risk/reward decisions. To me, a critical part of the risk equation is the possibility that a patient undertakes a non-successful surgery (risking complications therein and limiting future surgical options) and doesn't lose sufficient weight to significantly improve their health and probably longevity (or regains). There is also lifestyle risk - considerations such as exposure to "dumping syndrome" with the RNY, while this is avoided in DS which preserves the pylorus, risks posed by the "blind stomach" in RNY; plus the different limitations in diet posed by both operations (meal size restriction of a pouch in RNY vs. increased vitamin supplementation requirements with DS).

I'd agree with those that have expressed that*generally* DS and RNY would be expected to pose similar risks, but that available data on complications and mortality is likely skewed by 1.) small sample size for DS; 2.) selection bias, where insurance and surgeons sometimes limit access to DS to higher BMI's and where DS is the selection of choice for the highest BMIs ; 3.) potentially different levels of skill and experience between normal RNY surgeons and vetted DS surgeons.

Ultimately, though, what matters most in terms of complication potential for a given patient is his/her current physical condition at time of surgery and the specific experience and skill of the very surgeon that is yielding the scalpel. In my view, the most important decision is the surgeon.

At the end of the day, from what I've seen, DS has better long term results; provides a preferable stomach anatomy (pylorus remains intact and in use, no pouch, no blind stomach); and is more likely to be more fully effective for high BMI patients while posing similar risks to RNY. Thus, in my opinion DS has a significantly more favorable risk/reward profile.

 

[Munchkin]

Wow, okay - that's great info, Munchkin. I would actually be perfectly happy landing between 175-225. I've been over 325 pounds since I was 16 - I have no memory of how old I was when I was ~200 pounds (between 12 & 16 is when I gained from 120 to 325), and my quality of life would be so much better at that weight I can't even imagine it at this point. But I imagine with the RNY there's no way I would get even that far (and stay at that weight). I was a little concerned I might lose TOO much weight (I like being at least a little plus sized) with the DS, but from what you've said it sounds like that is likely to not be a concern.

This is going to be one heck of a ride for you. We are probably both superabsorbers and even with the DS it won't be easy. Take as much weight loss as you can get and don't be concerned at all unless you actually see an underweight BMI. You will stop losing and you will have regain. I will be surprised if you see a normal BMI. My guess is you will settle somewhere in overweight just like me. I think your expectations are quite reasonable. Much more reasonable than mine were. I wanted to be one of those people who lost too much. I guess I wanted to see what the other side was like.

I got my first diet when I was six weeks old and I was fat before I was old enough to make a single food choice. Knew the meaning of the word obese when I was two. Being fat was part of my identity. I had no idea how much difference it would make in my life to be seen as a 'normal' person. It's hard to explain decades of being on the outside looking in. Never quite 'fitting' anywhere.

After I had surgery, I rode a horse across Mexico, kayaked the Amazon, rode zip lines, and rappelled down cliffs. Did a lot of scuba too. Mostly in Tahiti, not all that far from where you live. If you can embrace the changes it will be a whole new life for you too! My 2 regrets are 1) not having this done when I was 10. 2) Not losing as much as I wanted to.