DS vs. RNY

Hello all! I am currently seeing a surgeon and taking the steps to undergo WLS. When I first met my surgeon, we breifly discussed the DS but he advised me against it due to issues of maintaing pregnancies afterwards. We then agreed on the RNY. Since I have found the information about maintaing pregnancies not to be too accurate, I am considering the DS again.
I spoke with my insurance today and I am covered to have the RNY at no cost. However, my insurance has not heard of the DS but they advised me to speak with my surgeon about appealing the surgery to have it approved as a benefit exception.

My question to everyone is: Would you change the type of surgery you chose and why? What are the advantages and disadvantages (in your own opinion) of the surgery you chose?

Please and Thank you!  

I considered the DS because of my high staring BMI (57), but chose RNY.  IF I were going to do it over again, I would still not have the DS... I would have the sleeve instead so as not to have to worry about vitamin deficiencies even WITH taking handfuls of supplements with the RNY (and even MORE supplements with the DS).

Are you looking to still have the surgeon who gave you bogus info about pregnancy after WLS do your surgery...?

Lora

I am still going to the surgeon who gave me this info. He has been great otherwise and has had awesome reviews. I do feel comfortable with him but wonder where he has gotten his info on pregnancies. He explained that it is very easy to get pregnant but hard to maintain the pregnancy after the DS because of malabsorption. Everyone on here has said otherwise and I have not found sufficient info on the web. I plan to bring this up again at my next appointment (8/12/11).

I would change the type of surgery to VSG if I could.  I would not want the DS due to concerns about vitamin deficiencies.  And because I would not want to have to take even more vitamins than I take now.  I realize that may not be a big deal for some people, but if I am honest about myself, I know that it's hard for me to get all my vitamins in all the time now.  

I would change to VSG if I could for the  much lower risk of nutritional deficiencies and for the ability to take NSAIDS.

The advantages to my RNY are that I was able to lose all the weight I needed to lose in a little less than 18 months, I feel full on small amounts of food and because I dump on too much sugar, my surgery helps me avoid eating sugary treats.  I know dumping doesn't seem like a pro to some people and it's not that I enjoy dumping but I've done it a couple times and am very careful not to do it again.  It does help me make good food choices.  I realize not every dumps, though.

The disadvantages to my RNY are the vitamin deficiencies (nearly everyone seems to develop some deficiencies, no matter how good they are at taking their vitamins; so far since my surgery, I have dealt with B12, D, A and zinc deficiencies) and the fact that I cannot take NSAIDS.

If you want to get pregnant post-surgery, I would not suggest DS. Severe vitamin deficiencies are very common with DS and that's something you don't want when your body is already under stress from a pregnancy.

I considered DS, VSG, and RNY -- my insurance would have covered all 3. I felt I needed malabsorption to help me lose faster in the early days, so that eliminated VSG. My surgeon felt that I didn't have a high enough BMI to recommend DS for me, plus there was the issue of vitamin deficiencies. On top of that, my surgeon doesn't do many DS operations. (There is definitely a correlation between the number of procedures a surgeon performs and their rate of complications -- generally, the more procedures, the fewer complications. Practice makes perfect!) Those factors eliminated DS. So that left RNY, which is also what my surgeon recommended for me, due to the fact that I had severe reflux, which RNY usually eliminates. 

Another reason I chose RNY included the fact that the remnant stomach remains in the body. If something horrible happened to my digestive system post-RNY, my remnant stomach would still be there and could be hooked up again. With VSG and DS, the excess stomach is removed and the surgery can't be "undone."

Reasons to choose VSG or DS over RNY are that both of those operation preserve the pyloric valve. This tends to reduce the tendency to "dump", which is caused by high-sugar or high-fat food entering the intestines too quickly. VSG and DS patients also do not have to contend with the lifetime elimination of NSAIDs that RNY patients have.

I'm very happy with my RNY and wouldn't change it to another surgery if I could.

IMHO, I  agree with John, but I wanted to add that with RNY there is longterm data to support the success of this operation - which is important to me.  The other surgeries are newer so therefore do not have this longterm data..  Also, I was very uncomfortable with getting rid of the stomach remnant.  My surgeon does not do the DS.   I am only a few weeks out but I feel very comfortable with my decision.  My friend's friend had the DS.  She is years out and I understand that she likes it b/c she can eat a "normal" amount of food and she looks amazing....SOOOOO, that is the extent of my knowledge.  Hope this helps.

I wrote this a while ago and I'm feeling lazy so I will just copy it.  

I did have a DS and I revised from it because I had bad side effects.  I won't go into detail because I have hashed it out many times and you could check my previous posts if you wish but lets just say me and malabsorption didn't get along.  I wasn't compliant and ate a lot of carbs and had a lot of diarrhea and gas.  I also didn't follow the vitamin regiment as I should have and had deficiencies as a result.
I will say this, at the risk of being flamed,  which I have been numerous times for stating my experiences, but there is a reason that not a lot of doctors do the DS and it isn't because they are lazy, money grubbing people who don't want to learn a surgery that won't make them a butt load of money.  I think it has more to do with not wanting to be liable for the dangerous results when a patient isn't compliant and sadly that stats show that is a lot of patients.  That is also why the insurance companies aren't covering it.  The savings just aren't there.  My surgeon and the hospital I had the surgery in won't do it any more because there have been a high percentage of complications.  The surgery has been performed for many years so it's not like it is experimental like I heard nearly 9 years ago when I had the surgery.  
It is a great surgery, especially for those who are SMO but it is also a dangerous surgery for those who can't be 100% compliant.  If you lose your insurance, which has happened to many, how are you going to pay for the expensive labs that need to be run?  If you lose your job how are you going to pay for the supplements you need, which can get very costly?  Unfortunately, most WLS patients aren't as diligent as some on OH and don't have the ability for whatever reason to be able to be as compliant as they need to be.  I was one of them.  I had the surgery and lost a lot of weight and then, because of my bad eating habits and maybe because the surgery wasn't done correctly, I don't know, but I regained most of the weight I lost and mistakenly thought that if I was gaining weight I must be absorbing vitamins.
By this time last year I was so sick I couldn't function.  I am still getting my health back slowly.  I regret that I didn't know more about what I was doing to myself.
In hindsight I realize I would have been better served with a longer common channel and a smaller stomach.  My surgeon left my stomach to big and I never felt restriction.  I was always hungry.  I also would have been better served with a lot more education and follow up.  The hospital I went to has a miserable bariatric program.  They don't mind doing the surgery but they do little, if anything to prepare you for post op life.
Since my revision, which reduced the amount of malabsorption I have and also gave me a RNY pouch, I have completely changed the way I eat.  I totally avoid all refined carbs.  My side effects are gone.  I still take a ton of vitamins because I don't trust malabsorption and I never want to go back to how sick I was.  I am careful with my labs to make sure my levels aren't declining and if they are I increase my supplements.
Not trying to talk anyone out of it.  Like I said, it is the best surgery there is for weight loss, maintenance and resolution of comorbidities, but it comes at a cost.  If you think you are up to the responsibilities and are informed about all the risks, and have an excellent surgeon with an excellent program, then you will be very happy like many DS post ops are.
Just to add, I really didn't want to get a pouch because of all the horror stories I had heard but I was scared to death that I was going to really regain out of control without help.  I figured I had gained 100lbs with malabsorption, what would happen without it.  It has not been nearly as bad as I expected or maybe I am just lucky.  No food intolerance's (except sugar, I dump so I stay away, which is good).  I eat whatever I want except refined carbs, which should probably be avoided after a DS, too, since simple carbs are always absorbed 100% and can cause miserable side effects.  I have lost all my excess weight and don't really feel that different.  Of course I worry about reactive hypoglycemia.  Given the choice I would rather have kept my pyloric valve but I found out after the fact that my surgeon removed my remnant stomach so there is nothing I can do about it except be glad that right now I don't have any bad effects because of it.

Thank you everyone for your replies! It has definitely helped me see more pros and cons to both procedures. I am definitely looking into both more carefully and will post when Ive made a decision!

Thank you all again!