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Duodenal Switch dumping
- Thread starter Cicca
- Start date
wannabeminime
New Member
Dont know Cicca, but i would like to know too!
Whilst looking around for the answer, i came across this; it makes very interesting reading! Its about the pyloric sphincter, and whether we need it or not;
New Data on Weight Gain Following Bariatric Surgery | Lenox Hill Hospital
Whilst looking around for the answer, i came across this; it makes very interesting reading! Its about the pyloric sphincter, and whether we need it or not;
New Data on Weight Gain Following Bariatric Surgery | Lenox Hill Hospital
wannabeminime
New Member
I've also just read that a 2 stage DS ie VSG first, then the malabsorption bit later on, isnt as effective as a DS from the beginning!
Its only anecdotal, but i'll copy it here anyway;
'Dr. Rabkin attended the SJ DS meeting last night. We had a great wide-ranging discussion, which at one point delved into the question of whether/why 2 part DSs are less effective. Rabkin acknowledged that, while there was NO study demonstrating this, and it is unlikely that there would be (I'm assuming because how do you match patients and assign them randomly into the two different groups?), it was his impression as a bariatric surgeon that this is true.
One possible explanation:
The sleeve gastrectomy part of the DS, which by restriction provides the primary weight loss benefit, of course and by design loses effectiveness over time. This weight loss, like all calorie restriction, causes the same undesirable metabolic changes as plain old fad diets - you dial down your metabolism. which thinks you are starving, and which remains at a lower pace (higher efficiency) thereafter - thus the "yo-yo dieted myself into morbid obesity" explanation for many of us ending up fat AND with slow and damaged metabolisms from years of dieting.
When you put the sleeve TOGETHER with the switch from the git-go, the metabolic changes (better insulin sensitivity being a big part) seems to ameliorate the slowed metabolism effect of the restriction - our metabolisms DON'T slow down in response to the calorie restriction. Thus, the synergism of doing the switch and sleeve together. As we lose the weight and our sleeves stretch out, the metabolism stays up and the malabsorption, especially of fat, helps maintain our weight loss despite eating satisfying calorie-dense food.
However, 2 part sleeves don't get this benefit. Their metabolisms adapt to the initial starvation diet and become slower and more efficient. By the time the switch is added, it cannot work as well in conjunction with the caloric restriction (which by this time is much less as well, due to sleeve stretching), and while it can help the patient maintain the prior weight loss, the patient is unlikely to lose much more, unless the sleeve is resleeved (a high risk procedure) and even then, the starting point is a further damaged metabolism.
Remember - non-MO people who get the switch as a stand-alone procedure for diabetes lose about 25 lbs at first, and then regain most of it.
THIS IS THEORY, AND HYPOTHETICAL. THERE IS NO DATA TO SUPPORT IT. However, Rabkin thinks this is not inconsistent with anecdotal reports.
But this makes me even more doubtful about the sleeve as a long-term weight loss solution for most MOs with underlying metabolic issues, especially diabetes.'
Its only anecdotal, but i'll copy it here anyway;'Dr. Rabkin attended the SJ DS meeting last night. We had a great wide-ranging discussion, which at one point delved into the question of whether/why 2 part DSs are less effective. Rabkin acknowledged that, while there was NO study demonstrating this, and it is unlikely that there would be (I'm assuming because how do you match patients and assign them randomly into the two different groups?), it was his impression as a bariatric surgeon that this is true.
One possible explanation:
The sleeve gastrectomy part of the DS, which by restriction provides the primary weight loss benefit, of course and by design loses effectiveness over time. This weight loss, like all calorie restriction, causes the same undesirable metabolic changes as plain old fad diets - you dial down your metabolism. which thinks you are starving, and which remains at a lower pace (higher efficiency) thereafter - thus the "yo-yo dieted myself into morbid obesity" explanation for many of us ending up fat AND with slow and damaged metabolisms from years of dieting.
When you put the sleeve TOGETHER with the switch from the git-go, the metabolic changes (better insulin sensitivity being a big part) seems to ameliorate the slowed metabolism effect of the restriction - our metabolisms DON'T slow down in response to the calorie restriction. Thus, the synergism of doing the switch and sleeve together. As we lose the weight and our sleeves stretch out, the metabolism stays up and the malabsorption, especially of fat, helps maintain our weight loss despite eating satisfying calorie-dense food.
However, 2 part sleeves don't get this benefit. Their metabolisms adapt to the initial starvation diet and become slower and more efficient. By the time the switch is added, it cannot work as well in conjunction with the caloric restriction (which by this time is much less as well, due to sleeve stretching), and while it can help the patient maintain the prior weight loss, the patient is unlikely to lose much more, unless the sleeve is resleeved (a high risk procedure) and even then, the starting point is a further damaged metabolism.
Remember - non-MO people who get the switch as a stand-alone procedure for diabetes lose about 25 lbs at first, and then regain most of it.
THIS IS THEORY, AND HYPOTHETICAL. THERE IS NO DATA TO SUPPORT IT. However, Rabkin thinks this is not inconsistent with anecdotal reports.
But this makes me even more doubtful about the sleeve as a long-term weight loss solution for most MOs with underlying metabolic issues, especially diabetes.'
wannabeminime
New Member
This makes me wonder about getting a VSG now, as, if it didnt keep the weight off long term, i thought i would have the option of the malabsorption operation later on! Oh well, i suppose it is only anecdotal.
wannabeminime
New Member
Here is the answer;
With the DS; About 70% of the outer curvature of the stomach is removed which reduces the amount of food you can eat. The stomach retains normal function, the pylorus continues to control food moving from the stomach into the intestine, and as a result DS patients do not experience "dumping".
With the RNY; A pouch is created at the top part of the stomach to restrict the amount of food you can eat. The bottom part of the stomach that is no longer used is called the "blind" stomach. Food passes through the anastamosis (connection), or stoma, created between the pouch and the small intestine, which is deliberately made quite narrow to keep food in the pouch longer, thus making you feel fuller longer. The pylorus is at the bottom of the "blind" stomach and is no longer used to control food moving into the intestine. For some patients, food with a high sugar or fat content hits the small intestine rapidly causing "dumping".
With the DS; About 70% of the outer curvature of the stomach is removed which reduces the amount of food you can eat. The stomach retains normal function, the pylorus continues to control food moving from the stomach into the intestine, and as a result DS patients do not experience "dumping".
With the RNY; A pouch is created at the top part of the stomach to restrict the amount of food you can eat. The bottom part of the stomach that is no longer used is called the "blind" stomach. Food passes through the anastamosis (connection), or stoma, created between the pouch and the small intestine, which is deliberately made quite narrow to keep food in the pouch longer, thus making you feel fuller longer. The pylorus is at the bottom of the "blind" stomach and is no longer used to control food moving into the intestine. For some patients, food with a high sugar or fat content hits the small intestine rapidly causing "dumping".
This is very interesting: having had the POSE procedure (which is endoscopic reduction of the stomach/fundus) I told my surgeon that I was still experiencing the same level of hunger as prior to surgery. He mentioned something about sugar/insulin production in connection with the fact that I'd been 'filling up' on fat free yogurts. This went over my head at the time but I'm now wondering if there's a relationship between this and the pyloric sphincter and insuling production etc.
This is stuff that I'd like to know - albeit at a very basic level but one which I can understand.
Thank you so much for that information.
x
This is stuff that I'd like to know - albeit at a very basic level but one which I can understand.
Thank you so much for that information.
x
wannabeminime
New Member
You're welcome Lynda, glad it was useful to someone! I've been following the POSE thread, as i was considering it, but i dont think it would work for me as my bmi is too high. You're doing well though!
Cicca
New Member
I haven't read all the responses well enough, however I think I disagree. I lost 10 stone with the sleeve alone and a further 8 stone with the procedure combined. I haven't put a single lb on in over a year, having maintained a stable weight. I don't diet at all, I make better choices but mostly forget I ever had a weight problem.
wannabeminime
New Member
Thats really good to hear Cicca! Whereabouts did you have your surgery?
wannabeminime
New Member
Thanks!
wannabeminime
New Member
Thanks Postop!! ) The lack of dumping sounds great!!
) The lack of dumping sounds great!!Similar threads
