RNY is only choice for me

Georgepds

Well-Known Member
Re item 2 larger pouch ( less restriction) versus smaller CC (more mal-absorption)

I know in europe they do a mal-absorption only procedure to control T2 diabetes. I recall it does not result in the large weight loss seen when coupled with the restrictive vsg. I don't have any references here.. my info comes from old posts in diabetes forums.

Can you point me to any studies?
Found a ref in dsfacts site........ suggests the less the restriction the less the weight loss. I dont know any studies that try to compensate by shortening the cc.

I realize this was not your exact suggestion, I'm taking it to the limit to explore the implication

Duodenal switch without gastric resection: results and observations after 6 years.
Cossu et al. Nov-Dec 2004

PubMed Abstract
BACKGROUND: The results on metabolic effects of the classical biliopancreatic diversion (BPD) have led us to investigate the operation without gastric resection, thus preserving stomach and pylorus, in patients who are not seriously obese but suffer from hypercholesterolemia, often associated with type 2 diabetes and hypertriglyceridemia.

METHODS: Between 1996 and 1999, we performed the duodenal switch (DS) without gastric resection on 24 mildly obese patients. Mean preoperative BMI was 36.2 kg/m(2). 17 patients (70.8%) suffered from type 1 diabetes, 4 (16.6%) had impaired glucose tolerance, while the remainder had fasting hyperglycemia. In 20 patients (83.3%), hypercholesterolemia and alterations in lipid profile were present. Another 20 patients were taking drugs for arterial hypertension. The pluri-metabolic syndrome was present in 41.6% of patients.

RESULTS: Mean follow-up was 4 years. BMI reduction and weight loss were not large. 2 patients who had severe longstanding diabetes type 2 needed a second operation of the classical BPD because of failure in improving diabetes. Another 2 patients were changed to classical BPD because of a relapsing chronic duodeno-ileal ulcer. The incidence of ileal ulcer was 29.1%. Regarding hypercholesterolemia, hypertrigliceridemia, and type 2 diabetes when there is a good pancreatic "reservoir", the operation seems effective in the long-term. Protein absorption is better than that obtained with the classical BPD.

CONCLUSIONS: Our long-term results suggest that in carefully selected patients suffering from serious hypercholesterolemia or type 2 diabetes with insulin reserves still at an acceptable level, and with BMI 30-40, DS without gastric resection can be proposed as a surgical treatment for metabolic diseases but not for obesity.
 

DianaCox

Bad Cop
Of course they didn’t lose a lot of weight - they were only somewhat obese to start with. I recall reading somewhere that they lost about 25 lbs.

I had a 100 cc/3.5 oz sleeve, which was an intermediate size. I still have reasonable restriction almost 17 years later.
 

RainCity

Well-Known Member
OP: I had severe GERD for many years prior to gastric bypass, as well as a family history of esophageal cancer. After my MGB in 2017, acid reflux was resolved but then I developed bile reflux and Barrett’s Esophagus 10 months later. I consulted with Dr Keshishian in Pasadena and he did not convert me to RNY or DS; instead, in July 2018 he repaired a hernia, performed a Nissen Fundoplication, removed an FDA-recalled LINX reflux device (installed in 2015), and he may have done some other magic internally. Result - I feel great, no more Barrett’s, no more reflux (acid or bile), and my BMI (right before surgery with him) has gone from underweight to low normal. Dr K is an expert at DS surgeries, revisions, and complex abdominal issues. I trust and trusted him 1000%. He made the right diagnosis and surgical plan for ME based on my anatomy, medical history, and family history. I still contact him on occasion if I have any concerns and he always answers my questions right away. I highly recommend you consult with him (in-person or virtually) to see what he thinks would be the right bariatric surgery plan for you. Good luck.
 

Georgepds

Well-Known Member
Of course they didn’t lose a lot of weight - they were only somewhat obese to start with. I recall reading somewhere that they lost about 25 lbs.

I had a 100 cc/3.5 oz sleeve, which was an intermediate size. I still have reasonable restriction almost 17 years later.
FWIIW.. the patients in the quoted study had an average starting BMI of 36, technically grade 2 obesity.

The point is the restrictive procedure in DS plays an essential role in the weight loss, and the results of trading sleeve volume with cc length, while reasonable, are, to my knowledge, not confirmed in the literature.... That's why I asked for a reference
 

Georgepds

Well-Known Member
For those who are interested... surgeons recommend RNY for obesity if the candidate has Barretts esophagus.. in fact it appears to heal the candidate of BE


To my knowledge, there are no such observations for VSG or DS


That's not to say its the surgery of choice to cure BE, more like its the surgery of choice if you have BE and want bariatric surgery for obesity


Ref 1


"BARRETT’S ESOPHAGUS AFTER ROUX-EN- Y GASTRIC BYPASS: DOES REGRESSION OCCUR?


Maria Veronica Gorodner, MD, Gaston Clemente, MD, Alejandro Grigaites, MD. Programa Unidades Bariatricas, Argentina


Introduction: Barrett’s esophagus (BE) is recognized as a premalignant lesion for esophageal adenocarcinoma. BE appears as a consequence of gastroesophageal reflux disease (GERD), which is clearly increased among obese population. There is no question that laparoscopic Roux -en- Y gastric bypass (LRYGB) is the best treatment option for obesity combined with GERD. ...."


Ref 2


"Barrett’s esophagus before and after Roux-en-Y gastric bypass for severe obesity
Brandon Andrew, Joshua B. Alley, Cristina E. Aguilar & Robert D. Fanelli


Surgical Endoscopy volume 32, pages930–936(2018)Cite this article


Barrett’s esophagus (BE) has been associated with obesity and metabolic syndrome. Laparoscopic Roux-en-Y gastric bypass (LRYGB) may represent a surgical approach which addresses both severe obesity and BE. "



Ref 3

"Effect of Gastric Bypass on Barrett's Esophagus and Intestinal Metaplasia of the Cardia in Patients With Morbid Obesity

Author links open overlay panelAttilaCsendesM.D., F.A.C.S. (Hon)Ana MariaBurgosM.D.GladysSmokM.D.PatricioBurdilesM.D., F.A.C.S.AnaHenriquezM.T.



Gastric bypass in patients with morbid obesity should be an excellent antireflux procedure, because no acid is produced at the small gastric pouch and no duodenal reflux is present, due to the long Roux-en-Y limb. .....,.There was no progression to low- or high-grade dysplasia. Gastric bypass in patients with Barrett's esophagus and morbid obesity is an excellent antireflux operation, proved by the disappearance of symptoms and the healing of endoscopic esophagitis ...

<note.... looks like there is no acid produced in the pouch.. mea culpa,mea culpa, mea maxima culpa>
 
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Jerry

Member
Does your doctor even perform DS?

Trust, but verify.

And fight for the correct surgery.
Yes,that is why
Does your doctor even perform DS?

Trust, but verify.

And fight for the correct surgery.
Hi and welcome Jerry ! It probably would be best to get a consultation with one of the true DS experts who are both very experienced with the DS and with patients who have other conditions. Specifically, it would be worth a visit to like Dr. Keshishian in California.
I chose this doctor because I knew she is a ds dr.
 

Jerry

Member
Not bad advice...Don't let enthusiasm for DS, and I'm an enthusiast, ignore the inceased risk of esophageal cancer for someone with Barrett's esophagus. The VSG part of DS increases the risk of GERD which exacerbates Barrett's esophagus

What it is

"Barrett's esophagus, tissue in the tube connecting your mouth and stomach (esophagus) is replaced by tissue similar to the intestinal lining.

Barrett's esophagus is often diagnosed in people who have long-term gastroesophageal reflux disease (GERD) — a chronic regurgitation of acid from the stomach into the lower esophagus. Only a small percentage of people with GERD will develop Barrett's esophagus.

Barrett's esophagus is associated with an increased risk of developing esophageal cancer. Although the risk is small, it's important to have regular checkups for precancerous cells (dysplasia). If precancerous cells are discovered, they can be treated to prevent esophageal cancer."

Risk factor

."Having GERD that doesn't get better when taking medications known as proton pump inhibitors or having GERD that requires regular medication can increase the risk of Barrett's esophagus."

Vsg/DS RISK

"Longer term risks .... Gastroesophageal reflux" (GERD)

Ref
[URL="http://www.mayoclinic.org/diseases-conditions/barretts-esophagus/symptoms-causes/syc-20352841[/URL]"]www.mayoclinic.org/diseases-conditions/barretts-esophagus/symptoms-causes/syc-20352841[/URL]

thanks for the info.
 

Jerry

Member
I want to thank everyone for their information,I appreciate all of it.
Dr Inman is my dr,I fully trust her.She is at St Vincents in Carmel IN.
The reason I'm going through with the rny.My reasoning is because I trust her,and Im 65 and out of the 6 people in my imediate family,Im the only one that hasn't had cancer.I dont want to take any chances.Thanks again for all of your concerns and info
 
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