Should I revise from VSG to RNY or DS?

[Heather Modispaw]

Please post your opinion and what you have had done! I currently have a VSG and have a consult with my surgeon to revise. At my VSG in 2009 he said we could always do the second half of the DS surgery, but now I hear he no longer does DS (Dr. Schweitzer). Despite that the NP (Pat Jordan) had said I might be a "candidate for the second stage in which a portion of small intestine is bypassed". I asked her if that was the second half of the DS surgery. She replied back, "second stage procedure where he would bypass a portion like gastric bypass." What is the difference between the two and what are the advantages to one over the other?

Heather
Baltimore, Maryland

 

[Charris]

ds its the natural progression from a VSG if you don't loose sufficiently.

 

[DianaCox]

I would NOT use Schweitzer! I would not even REMOTELY consider revising to RNY!

After all this time, you will probably need a sleeve revision too, which is makes the revision more prone to complications. But if your sleeve is too big, you are unlikely to lose sufficient weight by merely adding the switch.

 

[Munchkin]

As long as you are capable of doing the supplements, I would do the DS. It has the best results. I mean after all, why screw around with the RNY. There is no advantage, and many disadvantages to the pouch, and they don't bypass enough. Your body adapts to the bypass in a couple years and here comes the weight.

 

[Larra]

Hey, you found us!

RNY and DS are very different operations, and I bet ya anything once they get you through the door they are going to push...oh excuse me I meant recommend ... gastric bypass because he no longer does the DS.

Quick summary - gastric bypass, often called RNY, involves making a small pouch from the uppermost portion of your stomach and attaching that to the small intestine with usually just a very small portion of the small intestine bypassed. The rest of the stomach, or sleeve in your case, is left in place as a "blind stomach", meaning that it can't be seen with usual diagnostic procedures. You lose the function of your pyloric valve. You can never take NSAIDs again for life. You may or may not have problems with dumping, which is a very unpleasant potential side effect of gastric bypass that is NOT a weight loss mechanism.

With the DS you keep the sleeve you already have. the surgeon divides the duodenum (the part of the small bowel right after your stomach), divides the small intestine roughly half way along, and attaches the small intestine to the duodenum such that about half of your small intestine is bypassed. Your sleeve might or might not need to be re-done. You keep the function of your pyloric valve, you can take NSAIDs if you need them now or later in life (in proper doses only) and dumping is very, very rare.

The DS provides the highest percentage excess weight loss of any bariatric operation presently being done. It also has the best rates of resolution for almost all comorbidities. It allows for the most normal pattern of eating. It does require more vitamin supplementation than gastric bypass, but both operations require certain vitamins and minerals to avoid nutritional deficiencies.

I do not hold out much hope with Dr. S no matter what he said to you back when. I think you need to get yourself to someone who really does the DS and that your consult with him will be at best a waste of time, and at worst an attempt to talk you out of the operation most likely to get you to where you want to be.

 

[Heather Modispaw]

I have ChampVA insurance and don't think they cover DS.

 

[DuodenalSwitchaRoo]

I know a handful of people who revised from VSG to bypass. Only 1 continued to lose a substantial amount of weight. The others only lost another 20lbs or so, some even less.

I did consider revising to an RNY was I was convinced having a pouch (smaller stomach) would help since I don't have much restriction. However, my surgeon was blunt enough to tell me I wouldn't lose much. He does all the WLS here in the UK and is now Professor status (the highest you can get in the EU). He only does DSes on patients he thinks can handle post op life, and he would have still got paid had I gone for the RNY and spent less time operating on me, but he was honest with me and advised the DS.

It's your choice obviously, but think very carefully about this once in a lifetime opportunity.

 

[Heather Modispaw]

Given that after reading my health insurance policy that states DS is not covered, I'm going to at least go ahead and show up for my consult to hear Schweitzer out on what he can do. Doesn't mean I have to do it. Maybe he can do the second half of the DS incognito

 

[star0210]

How can an insurance policy exclude one type of WLS but cover others?

Mine covers NONE! I had to self pay both times.

 

[Heather Modispaw]

From ChampVA:
Since these surgical procedures do not require authorization, it is important to understand what may be covered and what is not covered. If the VA denies coverage, then you may be responsible for the cost. Not all bariatric surgical interventions are covered. The following list of bariatric surgical procedures may be covered when medically appropriate and the criteria have been met:
1. Roux-en-Y gastric bypass – This surgery achieves weight loss by gastric restriction and malabsorption. The stomach size is reduced allowing it to hold only about an ounce
Additionally, the first portion of the small intestine, the duodenum, and part of the next portion (jejunum) is bypassed. This bypass reduces the amount of food that can be absorbed.
2. Vertical banded gastroplasty – This surgery achieves weight loss by gastric restriction only. The upper part of the stomach is stapled, creating a narrow pouch that remains connected with the remainder of the stomach. In addition, a non-adjustable band is placed around this new inlet in an attempt to prevent future enlargement of the stoma (opening).
3. Gastroplasty (stomach stapling) – This procedure achieves weight loss by gastric restriction.
4. Adjustable gastric banding using an FDA approved device, frequently referred to as a LAP-BAND. – This laparoscopic procedure achieves weight loss by restricting the size of the stomach.
The surgical interventions that are not covered for morbid obesity include the following:
1. Liposuction as a substitute for surgery for morbid obesity.
2. Sleeve gastrectomy – This is a restrictive procedure that removes 80% of the stomach.
3. Gastric bubble or balloon – This is a restrictive procedure and is considered unproven.
4. Biliopancreatic bypass (also known as a jejunoileal bypass, Scopinaro procedure) – This procedure relies mainly on malabsorption because so much of the small intestine is bypassed.
5. Gastric wrapping/open gastric banding.

 

[southernlady]

@Heather Modispaw sounds like Champ VA is similar to Tricare. And I KNOW that Tricare covers the DS...

 

[Heather Modispaw]

@southernlady ChampVA is similar to Tricare in that it is for military dependents, but it is for military dependents of a 100% disabled veteran. I think I just need to call for complete clarification. But isn't BPD another name for the DS???

 

[more2adore]

@southernlady ChampVA is similar to Tricare in that it is for military dependents, but it is for military dependents of a 100% disabled veteran. I think I just need to call for complete clarification. But isn't BPD another name for the DS???

It's confusing because people use the wrong name for it all the time, but the Scopinaro procedure is definitely NOT the same thing as the modern-day DS. Search this forum for "Scopinaro" and read.

 

[southernlady]

But isn't BPD another name for the DS???

I got all twisted around early in my research as well...took a verbal 2 x 4 to the head and two VERY patient members during my research to get it straight.

The problem STARTS with surgeons and staff of the various bariatric offices who refer to the DS AS the BPD/DS. And some of the staff use BPD as their "shortcut" not the DS. Surgeons use the entire thing typically, BPD/DS.

The original BPD is a very large POUCH (minus the pyloric valve) added to a very short common channel. Also known as the Scopinaro procedure. Dr. Nicola Scopinaro introduced the Biliopancreatic Diversion in Italy during 1979.The procedure combines malabsorption with some gastric restriction. A large pouch between 250 and 400 ccs is created with the upper portion and the lower stomach is surgically removed (distal gastrectomy). The pyloric valve is circumvented so "dumping" often occurs. The duodenum (top part of the small intestine) is bypassed and the stomach pouch is connected to the lower 2-3 meters of the small intestine. Then, 4-metres of the small bowel (60%) is bypassed making the channel approximately 50 cm.

They no longer DO the BPD and that one is not approved by (as far as I know) by ANY insurance company.

The Stand-Alone Duodenal Switch procedure (without the accompanying gastric bypass as used in weight-loss surgery) was developed by Dr. Tom R. DeMeester in the 1980's to treat bile-reflux gastritis, a condition in which the stomach and esophagus are irritated by bile that goes back through the pylorus to the stomach. This is JUST the bottom half and is also fairly common in Europe to resolve diabetes regardless of BMI. See Dan's Story

The DS as WE know it was a reformatted version developed by Dr. Hess. In 1986, Dr. Douglas Hess modified BPD and combined it with Duodenal Switch. This hybrid procedure is often referred to as the Biliopancreatic Diversion with Duodenal Switch, or GR-DS (Gastric Reduction- Duodenal Switch). Keep in mind; the BPD portion has been modified from the original procedure so the name can be misleading. HOW he modified it was to preserve the pyloric valve and make the sleeve MUCH smaller.

But NO insurance company pays for the BPD BUT listing it as the BPD-DS or BPD/DS or BPD/GR is allowed by insurance companies.

I know that Medicare covers the DS (known AS the BPD/DS) and that is similar to TriCare in what they allow.

 

[Heather Modispaw]

@southernlady that gives me some hope as I understand that typically ChampVA is much like Medicare in what they allow. I'm on hold with ChampVA right now waiting to speak to someone for clarification. They don't spell out that they do or don't allow DS.