Which to pick Sleeve Gastrectomy vs Sleeve Gastrectomy with Single-Anastomosis Duodenal Switch

[Crystal Ann Keister 49]

I was just approved for surgery by my insurance, now I am waiting to schedule my Results Visit to pick my surgery and schedule. I have been approved for the Sleeve Gastrectomy with Single-Anastomosis Duodenal Switch by my insurance, but original was planning on the Sleeve Gastrectomy when I started this process 7 months ago.

What are your thoughts between the two?

My thinking is since this is a once in a lifetime chance for me, why not go for the Cadillac of WLS and get the most out of my surgery. I think the Sleeve would be perfectly efficient also, but don't want to leave anything to chance.

How did you choose which surgery to have?

[Christinamo7 4,042]

it's really going to boil down to any other issues you may have that would impact the choice, and personal preference regarding living with the surgery long term.

I went over my medical history and preference with my physician, and we both thought the same surgery would be the best for me, so going with the sleeve was a no brainer in my case.

I'd make a list of pro's and con's for each and then take time to evaluate - but hopefully a pretty clear winner would come from the list.

[smg 471]

I agree with @@Christinamo7 that you have to talk with your surgeon, family and team to see what's best for you, but I don't know that I would classify any surgery as the "cadillac of wls" because I think that differs for everyone. For instance, the sleeve was definitely the cadillac for me because it was less invasive than either a bypass or duodenal switch and none of the "plumbing" was changed. This was a big deal to me because even though Vitamins are an important part of life post-op with the sleeve, they are imperative with a bypass and they are the difference between life and death with the duodenal switch.

I have seen and heard from people that are both happy and unhappy with each procedure and it seems that those who are unhappy always fall into one of two categories. Either they were one of the small percentage with complications, in which case I can understand their feelings, or they either weren't informed of or didn't research entirely what was expected and required of them moving forward post-op.

As long as you fully understand what the requirements will be immediately following your surgery, and even 1-3-5-10+ years down the road, then you should make the decision that makes you most comfortable.

Best of luck to you!

[dtiller1147 137]

I went with VSG, I would be concerned with the malobsorption complications and the going to the bathroom 4-5 times a day. It seems like your BMI is not that high, most over 50 opt for single or double DS. I am sure you did your research and your team has come up with the best solution for you. That is what matters the most. Goos luck with what ever you decide.

[Djmohr 6,965]

I would definately steer toward your recommendation of your surgeon. I just wanted to reach out and say don't be afraid of the malabsorption factor. It is what almost scared me out of having RNY. Is designed to assist you in weight loss and it works.

The most important thing is to take your Vitamins as instructed and see your doctor for your annual blood work to ensure your nourishment is on point.

I cannot speak for the bathroom several times a day (I almost wish for that), with bypass I have struggled with Constipation which is normal. I now take Linzess daily and that has relieved that issue. I don't know enough about DS to know what bathroom issues you might have. Only a DS patient can help you better understand that.

I would not be afraid to go for the Cadillac myself. When I had RNY which is the gold standard, I was thrilled and not a day has gone by that I regretted it. Best thing ever for me personally.

Best of luck to you with either choice. I am certain you have done research and best understand your needs.

[Bufflehead 6,358]

I would have seriously considered DS if I could have -- but my insurance will only cover DS if your BMI is 60 or over, and mine was just under. I would say, talk it over with your surgeon and make your decision based on what is medically best for you, not emotional stuff like "I think rerouting your intestines is ooky." Not that it sounds like that is a factor for you, but just in case -- I have seen that referenced in other posts and to me that is just a strange basis to make a medical, scientific decision on.

[shelbys mom 70]

I was just approved for surgery by my insurance, now I am waiting to schedule my Results Visit to pick my surgery and schedule. I have been approved for the Sleeve Gastrectomy with Single-Anastomosis Duodenal Switch by my insurance, but original was planning on the Sleeve Gastrectomy when I started this process 7 months ago.

What are your thoughts between the two?

My thinking is since this is a once in a lifetime chance for me, why not go for the Cadillac of WLS and get the most out of my surgery. I think the Sleeve would be perfectly efficient also, but don't want to leave anything to chance.

How did you choose which surgery to have?

@@Kristal ann Kiester, what exactly is the DS?

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[Dub 9,922]

I was just approved for surgery by my insurance, now I am waiting to schedule my Results Visit to pick my surgery and schedule. I have been approved for the Sleeve Gastrectomy with Single-Anastomosis Duodenal Switch by my insurance, but original was planning on the Sleeve Gastrectomy when I started this process 7 months ago.

What are your thoughts between the two?

My thinking is since this is a once in a lifetime chance for me, why not go for the Cadillac of WLS and get the most out of my surgery. I think the Sleeve would be perfectly efficient also, but don't want to leave anything to chance.

How did you choose which surgery to have?

So many considerations.

How has your weight loss been over that 7 months leading up to your surgery ?

Do you feel you need more help than the restriction and reduction / elimination of hunger that the VSG provides ?

What is your surgeon advising ?

[Crystal Ann Keister 49]

shelbys mom

Duodenal Switch

The duodenal switch is a weight loss operation that has been done for over 20 years but has increased in frequency significantly in the last several years. It has the greatest weight loss potential of all the operations available. It works by creating a sleeve gastrectomy for restriction and hunger control. Then after the sleeve the intestines are rerouted similar to a gastric bypass. The principle measured length with a duodenal switch is the common channel. This is the distance from where bile and food meet to the end of the intestines and determines the amount of malabsorption.

This common channel distance is an important number and has changed significantly over time. Originally this number was 50-100 cm and while it provided excellent weight loss, it left patients with nutritional deficiencies and diarrhea. We currently do a common channel length of 300 cm for most procedures. Deviations from this number are dependent on thepatient’s needs and this appears to be the sweet spot where weight loss is still excellent with fewer downsides. Vitamin supplementation is important and patients may have some increase in the number of bowel movements.

Surgery takes about an hour and a half and patients have a similar recovery to the other procedures. The dietary progression is the same. food enters the sleeve and is held there with the pylorus just like a sleeve. Because of this the dumping syndrome does not occur unlike the gastric bypass.

The ideal patient for a duodenal switch is a patient who has more weight to lose. We know that patients will lose more weight than the other surgical options. Particularly patients with a BMI over 50 will have better and more sustained weight loss than with other procedures. Additional benefits are a lower incidence of ulcers than a gastric bypass operation. This is particularly helpful for patients that need to take NSAIDs such as aspirin, ibuprofen etc.

Patients can expect to lose 80-90% of excess weight in the first year after a duodenal switch operation.

[Crystal Ann Keister 49]

Dub

My surgeon has suggested I am a good candidate for either The Sleeve or the Duodenal Switch. Because my BMI is a 43.4 he and my PCP suggested I not try to lose any weight on my own during the 6 months insurance weight management wait period because if I lost to much weight I would not longer be a candidate. So they had me stick to a management program rather then a weight loss.

[ginabee38 91]

I would definately steer toward your recommendation of your surgeon. I just wanted to reach out and say don't be afraid of the malabsorption factor. It is what almost scared me out of having RNY. Is designed to assist you in weight loss and it works.

The most important thing is to take your Vitamins as instructed and see your doctor for your annual blood work to ensure your nourishment is on point.

I cannot speak for the bathroom several times a day (I almost wish for that), with bypass I have struggled with Constipation which is normal. I now take Linzess daily and that has relieved that issue. I don't know enough about DS to know what bathroom issues you might have. Only a DS patient can help you better understand that.

I would not be afraid to go for the Cadillac myself. When I had RNY which is the gold standard, I was thrilled and not a day has gone by that I regretted it. Best thing ever for me personally.

Best of luck to you with either choice. I am certain you have done research and best understand your needs.

I don't necessarily agree with steering toward the recommendation of your surgeon, especially if you had a particular surgery in mind. I think it's very important to know the ins and outs of each surgery. I want to get a Vertical Sleeve, but my surgeon suggested RNY due to my diabetes (type 2, non-insulin, so far). He said the rate of improvement for VSG on diabetes is about 65-70%, but the RNY has a higher rate of improvement (80, 85%?) of A1C (a popular diabetes test). For me, I know I do not want to rearrange my internal organs. I know that by losing a significant amount of weight, that I will most likely improve my A1C. I know Vitamins will be extremely important, but I don't want to have to depend on them to the point that I will be extremely malnourished if I forget to take them. It's important to listen to your surgeon's suggestions and why he/she feels that you could benefit from one surgery over anothr. Read, research and make the best choice for you.

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