Researching standard DS vs Loop DS surgery.

Bob

New Member
Hi!

My name is Bob and I just became a member of this forum a couple of weeks ago (January 2019). I am looking forward to learning and gathering more knowledge so I can make the right decision as to which weight loss surgery would be best for me.

I am 60 years old. My current BMI is 42.8 and I have been diabetic for 21 years. At 39 yrs old I ended up in the hospital with pancreatitis...that is when I learned I was diabetic. I take oral meds and two types of insulin for my diabetes. Also, taking meds for high blood pressure, high cholesterol, water retention, slight incontinence, eye drops for slight high pressure in my eyes, low dose aspirin, naproxen (Alieve) for arthritis and finally I where a mask at night for sleep apnea. Since I have been a diabetic for so long I am not sure if even DS surgery would be able to help me resolve my diabetes...but thinking that surgery would give me the best shot. I have been viewing a lot of YouTube videos the last two months from both bariatric surgeons and patients journeys with different types of weight loss surgery. Would love to hear from others in this forum who have had traditional DS surgery and also Loop DS surgery and what has been their experiences. I would really appreciate it.

Thank you!
 

southernlady

Administrator
Staff member
Welcome Bob
I wouldn’t even consider a Loop with your list. Are you a type 1, LADA, or type 2. I am a type 2. I got a reprieve with mine for 6 years. Unfortunately, my diabetes didn’t stay resolved.
 

Larra

Well-Known Member
Hi and welcome, Bob! You've come to the right place - people here tend to be very well informed.

The standard of care DS with 2 anastomoses has the best statistics of any bariatric surgery not just for permanent resolution of type 2 diabetes (though no operation is 100%, of course), but also for highest percentage excess weight loss and best maintenance of that weight loss, which is so important. I can't tell you how many people we've seen, over the years, who did well initially with other operations but began to struggle a couple years out and ended up regaining most or all of the weight they had lost. The DS also has the highest rate for resolution of sleep apnea.
No one can guarantee you that these problems will resolve permanently, but at the very least you will get the maximum improvement with the DS, and the comorbidities will be easier to control and live with.
Loop DS, aka SADI aka SIPS is experimental and not considered standard of care by the AMSBS. Long term results are not well documented. We've seen some people do ok and others do very poorly with it. We've also seen some very unfortunate people think they were getting the read, standard of care DS who got a loop DS and didn't find out about this until, maybe a year later, they wondered why their results weren't what they had expected and got their operative reports. Thankfully you aren't in that position.
I hope you will continue to research and will be very honest about my own bias - unless and until the loop DS has proven, well documented long term results equivalent to those of the DS, I can't in good conscience recommend it for anyone.
 

Munchkin

Full of Fairy Dust
Hi Bob and welcome. With your list of comorbs the real DS is the only one I would consider. The loop won't do enough to fix your problems. And there is a very good chance your diabetes will resolve if you have a true DS. You will be amazed when you see how much better you will feel after you heal from surgery. And being male, you will drop the weight fast as well.

Surgeons will try to sell you on the loop or other look alike procedures. It's an easier surgery. And just like car salesmen, they will sell you what they can do. Be a critical thinker and always follow the money. And remember surgeons are cutters. They don't have to live with the surgery. You do!
 

DonRobbie

Well-Known Member
https://www.nice.org.uk/guidance/ipg569/documents/overview-2

This was helpful to me making my decision, it has summaries and charts for several of the SADI/SIPS/Loop studies. The thing that pushed me firmly into the the two anastomosis DS camp was looking at the 5 year results of the original SADI-S patients. The first patients had the most radical procedure (200 CM "common channel") and despite that the cure rate for diabetes falls off pretty dramatically in years 4 and 5 along with cholesterol control. I didn't necessarily doubt the typical SADI patient will lose weight (extrapolating from the long term results from Mini/Omega Loop Gastric Bypass) but the reason I had bariatric Surgery was because I was scared of diabetes as well as the other obesity comorbidities I was running into. The traditional DS has much better durability of diabetes control.
 

Munchkin

Full of Fairy Dust
https://www.nice.org.uk/guidance/ipg569/documents/overview-2

This was helpful to me making my decision, it has summaries and charts for several of the SADI/SIPS/Loop studies. The thing that pushed me firmly into the the two anastomosis DS camp was looking at the 5 year results of the original SADI-S patients. The first patients had the most radical procedure (200 CM "common channel") and despite that the cure rate for diabetes falls off pretty dramatically in years 4 and 5 along with cholesterol control. I didn't necessarily doubt the typical SADI patient will lose weight (extrapolating from the long term results from Mini/Omega Loop Gastric Bypass) but the reason I had bariatric Surgery was because I was scared of diabetes as well as the other obesity comorbidities I was running into. The traditional DS has much better durability of diabetes control.
It wasn't all that long ago a paper came out showing that the variant procedures lost their malabsorbtion of fat really quickly! https://www.soard.org/article/S1550-7289(17)30428-8/pdf#/article/S1550-7289(17)30428-8/fulltext
 

Bob

New Member
Welcome Bob
I wouldn’t even consider a Loop with your list. Are you a type 1, LADA, or type 2. I am a type 2. I got a reprieve with mine for 6 years. Unfortunately, my diabetes didn’t stay resolved.
Type 2. Sorry to hear your diabetes did not stay resolved. Mine might not either but the two anastomosis DS procedure sounds like the way to go for me. However, I have been told that this surgery has the potential of more complications. Hernias, bowel obstructions etc. Still, I am more afraid of what diabetes complications might show up in my future if I do not go through with bariatric surgery. Even if I was able to lose most of my excess weight on my own through diet and exercise...would I have as good of a chance to resolve my diabetes without surgery? Would I be able to keep the weight off the rest of my life? These are a few of my concerns.
 

southernlady

Administrator
Staff member
Type 2. Sorry to hear your diabetes did not stay resolved. Mine might not either but the two anastomosis DS procedure sounds like the way to go for me. However, I have been told that this surgery has the potential of more complications. Hernias, bowel obstructions etc. Still, I am more afraid of what diabetes complications might show up in my future if I do not go through with bariatric surgery. Even if I was able to lose most of my excess weight on my own through diet and exercise...would I have as good of a chance to resolve my diabetes without surgery? Would I be able to keep the weight off the rest of my life? These are a few of my concerns.
Hernia’s and bowel obstructions can happen to those who never had any WLS. My oldest stepdaughter had a strangled bowel going necrotic and never has had any weight loss surgery.

One of the reasons for this surgery having “more” complications is two fold. One is inexperienced surgeons doing it. Two is that a good majority have major medical issues before surgery.
 

Munchkin

Full of Fairy Dust
Type 2. Sorry to hear your diabetes did not stay resolved. Mine might not either but the two anastomosis DS procedure sounds like the way to go for me. However, I have been told that this surgery has the potential of more complications. Hernias, bowel obstructions etc. Still, I am more afraid of what diabetes complications might show up in my future if I do not go through with bariatric surgery. Even if I was able to lose most of my excess weight on my own through diet and exercise...would I have as good of a chance to resolve my diabetes without surgery? Would I be able to keep the weight off the rest of my life? These are a few of my concerns.
You already know diets don't work long term. The chances of you dieting yourself down to a normal BMI and staying there are just about zero. And that normal BMI will not likely resolve your type 2 either. And that diet would leave you very food restricted for the rest of your life. BTW any abdominal surgery carries the exact same increased risk of hernias and obstructions. Doesn't matter, surgery is surgery. The DS is your best shot at having a normal rest of your life. And don't let anyone talk you into a long CC either. The first doc who ever wrote about the DS for diabetes was Noyes. You might be able to find his paper but it will take some looking. He advocated for a short CC of 50cm. Not likely you will be able to find anyone who will do one that short now. I believe the shorter CC is what gets rid of the diabetes.

You need to read about my H. He died of a massive heart attack at 61 but it had nothing to do with his DS, it was crappy genetics. His family history was abominable. Here is his story. https://bariatricfacts.org/threads/ds-for-diabetes-dans-story.355/

I honestly believe the DS should just be Standard of Care for Type 2. You get diagnosed and you are scheduled for surgery. A 95% chance of getting rid of it is good enough for me. People are going blind and losing limbs every day because of diabetes and almost all of it is preventable. Why doesn't this happen? Follow the money. Diabetes is a multibillion dollar industry. How much do you pay per year for meds and doctor stuff related to your diabetes? You will never spend even half of that after the DS.

It's all about quality of life. You are already 60 so you will never have to worry about stuff like osteoporosis like the younger folks. You can spend the rest of your life on a diet and constantly taking meds/shots. You can watch your comorbidities like hyperlipidemia, diabetic retinopathy, and neuropathy get worse no matter how vigilant you are about keeping your BS under control. Or you can take a chance on getting rid of all this completely. Worst case scenario, you remain diabetic. But you will also lose weight and I have never yet seen any patient whose diabetes was not easier to manage post DS. So either way you are much better off. And I can say there is 98% chance you will lose your hyperlipidemia and none of your comorbididites will get worse!

Next, complications. If you go to a real DS surgeon, the increased risk of complications is insignificant. If you go to Dr. X who runs the local RNY mill and somehow talk him into doing a DS, your odds are not quite as good. Or Dr. X just might tell you he is doing a DS and only DO half the surgery or do the surgery he wanted to do in the first place. I am not making this up. It has happened. More than once or twice. If a doc tells you he does not do the DS, listen to him. He is telling you he doesn't have the skills. Go to a real DS surgeon! Yes, you might have to travel. Yes, it might be inconvenient. Don't settle. Get the expert.

The next line of baloney you might hear is a doc telling you to have the sleeve done and then in a year or so get the switch. Don't buy it. Remember what I told you, this doc is telling you he does not have the skills. Listen to him. The 2 part DS is necessary for some people in very bad shape but unless there is a lot you didn't tell us, that's not you. Real DS surgeons have done the whole OP in one shot on people who weigh 600 to 800 pounds. And BTW, the odds of your insurance paying for 2 OPs is also slim to none. You will be denied and end up with your type 2 still there and all you will have is a smaller stomach. Don't fall for this one!

You have to be smart and assertive to get through this. You have to be a critical thinker and advocate for yourself. You can't be a sheeple who will just trust Dr. X.
 
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Spiky Bugger

Well-Known Member
Munchkin Bob

Munchkin, I'm gonna challenge this claim...a little.

"You are already 60 so you will never have to worry about stuff like osteoporosis like the younger folks."

I believe--and my physicians concur--that the DS, which I had in November 2005 at the very young age of 58 years and 11 months is most likely a major contributor to my raging osteoporosis and my current three vertebral fractures and three broken ribs. A mother who had osteoporosis is also a major factor.

But:
•If you look at the COMB protocol for osteoporosis, one supplement needed is fish oil. We don't absorb oils very well. I can, and do, add calcium, strontium, Vitamin K and Dry Vitamin D...but that fish oil thing is a problem.
•Although the LapBand caused the original problem, GERD/reflux didn't stop when I had the DS. I took Proton Pump Inhibitors for YEARS. I have changed to Ranitidine, an H2 blocker. But PPIs are a contributing factor to osteoporosis and I see that many people post here about PPIs, so that may be considered a DS-related issue (and I want them to be aware.)
•"They say" that a diet high in animal protein may cause calcium loss and result in osteoporosis. My entire diet is animal protein. Given that we don't absorb it ALL, I don't even know how to calculate that.

~~~~~~


Oh, and not related to Munchkin's post but an interesting osteoporosis factoid that I encountered when speaking to TWO doctors at different times:

Me: Why is it that I have three lumbar compression fractures due to osteoporosis and my DexaScans say my lumbar spine has neither osteoporosis nor osteopenia...that I'm just fine there?

Them: Osteoporosis can mask the compromised bones.

Me, thinking but not saying: Then why TF do we bother?


~~~~~

Hi, Bob. Welcome.

Sue
 
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Munchkin

Full of Fairy Dust
Munchkin Bob

Munchkin, I'm gonna challenge this claim...a little.

"You are already 60 so you will never have to worry about stuff like osteoporosis like the younger folks."

I believe--and my physicians concur--that the DS, which I had in November 2005 at the very young age of 58 years and 11 months is most likely a major contributor to my raging osteoporosis and my current three vertebral fractures and three broken ribs. A mother who had osteoporosis is also a major factor.

But:
•If you look at the COMB protocol for osteoporosis, one supplement needed is fish oil. We don't absorb oils very well. I can, and do, add calcium, strontium, Vitamin K and Dry Vitamin D...but that fish oil thing is a problem.
•Although the LapBand caused the original problem, GERD/reflux didn't stop when I had the DS. I took Proton Pump Inhibitors for YEARS. I have changed to Ranitidine, an H2 blocker. But PPIs are a contributing factor to osteoporosis and I see that many people post here about PPIs, so that may be considered a DS-related issue (and I want them to be aware.)
•"They say" that a diet high in animal protein may cause calcium loss and result in osteoporosis. My entire diet is animal protein. Given that we don't absorb it ALL, I don't even know how to calculate that.

~~~~~~


Oh, and not related to Munchkin's post but an interesting osteoporosis factoid that I encountered when speaking to TWO doctors at different times:

Me: Why is it that I have three lumbar compression fractures due to osteoporosis and my DexaScans say my lumbar spine has neither osteoporosis nor osteopenia...that I'm just fine there?

Them: Osteoporosis can mask the compromised bones.

Me, thinking but not saying: Then why TF do we bother?


~~~~~

Hi, Bob. Welcome.

Sue
Curious if you were tested before you had the DS? No one can be 100% sure but the fact that he is male plus had the DS late in life makes big issues unlikely. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380170/ But women are also tested more than men are for osteo type problems.
 

Spiky Bugger

Well-Known Member
Yes. But since, apparently, osteoporosis can hide osteoporosis (?), I had MILD osteopenia (hips) way back when.


(And it could be that NONE of this is DS-related, because...Mom.)
 

Bob

New Member
You already know diets don't work long term. The chances of you dieting yourself down to a normal BMI and staying there are just about zero. And that normal BMI will not likely resolve your type 2 either. And that diet would leave you very food restricted for the rest of your life. BTW any abdominal surgery carries the exact same increased risk of hernias and obstructions. Doesn't matter, surgery is surgery. The DS is your best shot at having a normal rest of your life. And don't let anyone talk you into a long CC either. The first doc who ever wrote about the DS for diabetes was Noyes. You might be able to find his paper but it will take some looking. He advocated for a short CC of 50cm. Not likely you will be able to find anyone who will do one that short now. I believe the shorter CC is what gets rid of the diabetes.

You need to read about my H. He died of a massive heart attack at 61 but it had nothing to do with his DS, it was crappy genetics. His family history was abominable. Here is his story. https://bariatricfacts.org/threads/ds-for-diabetes-dans-story.355/

I honestly believe the DS should just be Standard of Care for Type 2. You get diagnosed and you are scheduled for surgery. A 95% chance of getting rid of it is good enough for me. People are going blind and losing limbs every day because of diabetes and almost all of it is preventable. Why doesn't this happen? Follow the money. Diabetes is a multibillion dollar industry. How much do you pay per year for meds and doctor stuff related to your diabetes? You will never spend even half of that after the DS.

It's all about quality of life. You are already 60 so you will never have to worry about stuff like osteoporosis like the younger folks. You can spend the rest of your life on a diet and constantly taking meds/shots. You can watch your comorbidities like hyperlipidemia, diabetic retinopathy, and neuropathy get worse no matter how vigilant you are about keeping your BS under control. Or you can take a chance on getting rid of all this completely. Worst case scenario, you remain diabetic. But you will also lose weight and I have never yet seen any patient whose diabetes was not easier to manage post DS. So either way you are much better off. And I can say there is 98% chance you will lose your hyperlipidemia and none of your comorbididites will get worse!

Next, complications. If you go to a real DS surgeon, the increased risk of complications is insignificant. If you go to Dr. X who runs the local RNY mill and somehow talk him into doing a DS, your odds are not quite as good. Or Dr. X just might tell you he is doing a DS and only DO half the surgery or do the surgery he wanted to do in the first place. I am not making this up. It has happened. More than once or twice. If a doc tells you he does not do the DS, listen to him. He is telling you he doesn't have the skills. Go to a real DS surgeon! Yes, you might have to travel. Yes, it might be inconvenient. Don't settle. Get the expert.

The next line of baloney you might hear is a doc telling you to have the sleeve done and then in a year or so get the switch. Don't buy it. Remember what I told you, this doc is telling you he does not have the skills. Listen to him. The 2 part DS is necessary for some people in very bad shape but unless there is a lot you didn't tell us, that's not you. Real DS surgeons have done the whole OP in one shot on people who weigh 600 to 800 pounds. And BTW, the odds of your insurance paying for 2 OPs is also slim to none. You will be denied and end up with your type 2 still there and all you will have is a smaller stomach. Don't fall for this one!

You have to be smart and assertive to get through this. You have to be a critical thinker and advocate for yourself. You can't be a sheeple who will just trust Dr. X.
Thank you so much for the link to Dan’s story...it definitely left an impression on me. Should be required reading for Type 2 diabetics. I noticed you shared “Dan's CC was 50cm.” Is this still common practice for DS surgery in Europe?
 
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