So what's a DS? - ThinnerTimes

MsBatt · 04-11-2005, 09:51 PM

Since Christina suggested I do so, I'm starting a thread about the DS. I realize that nearly everyone on this board has had or is pursuing the RNY, and that's fine with me---I was pursuing the RNY myself when I learned about the DS. (*grin*)

The DS (Duodenal Switch) has been around since 1988, when Dr. Hess developed it to correct some problems with an older procedure called the Bilio-Pancreatic Diversion. (Which was basically a large-pouch, extremely-distal RNY.) This led the DS to being called the BPD/DS, which has, in turn, led to a LOT of confusion. More and more it's being referred to as the GR/DS (Gastric Reduction/Duodenal Switch).

The DS differs from the RNY (AND the BPD) in both the stomach portion and in the intestinal portion. In the RNY, a small "new pouch" is formed, with most of the stomach becoming a large "blind pouch", still connected to the bilio-pancreatic duct. A section of the upper portion of the small intestine remains attached to this blind pouch---just how much depends on whether the RNY is proximal or distal, but it's usually all of the duodenum, sometimes more. Then the new pouch is connected to the lower portion of the small intestine via a stoma, and this is what causes 'dumping syndrome'.

In the DS, there is no pouch. The stomach is made smaller (Gastric Reduction), but the pyloric sphincter is retained, so all normal stomach functions are preserved. (Including the ability to process B-12 and iron normally.) This eliminates the need for a stoma, so---no dumping, and no reason not to drink with meals.

The excess stomach is completely removed from the body, so---no 'blind pouch', and for most people, no need to avoid NSAIDs. (One serious danger of NSAIDs for RNYers is the possibility of developing ulcers in the blind pouch.) This was a biggie for me, since I've suffered from severe arthritis since my early 20s. NSAIDs will always be an important part of my daily life.

The intestinal portion is also different from the RNY. Oh, the same configuration is used---technically, all DSers do have a 'Rouex-en-Y' procedure, but instead of connecting the lower portion of the small intestine to a pouch via a stoma, the 'switch' is done in the upper portion of the duodenum, just above the common bile duct.

And the amount bypassed is greater---MUCH greater. It's a little difficult to compare, since RNYers talk about 'amount bypassed' whereas DSers talk about the 'length of the common channel', but it all boils down to the same question---just how much of the small intestine remains fully functional? For comparison's sake, one night I and a friend of mine who had the RNY compared surgical notes. Her RNY is distal, and she's bypassed 200 cm. I have a common channel of 90 cm---which, according to my surgical notes, means I'm bypassed a whopping 535 cm.

The current theory is that it's the gastric reduction that causes the initial weight loss, and the high degree of malabsorption in the DS that makes it so effective at maintaining that weight loss. (I sure hope they're right!)

With the DS, only about 20% of dietary fat is absorbed, about 40-50% of protein and complex carbs, and about 90-95% of simple carbs (like refined sugar). This means that not only does the DS offer a more liberal post-op diet, it actually DEMANDS that DSers take in quite a few more calories than RNYers. (I can live with that, LOL!)

With malabsorption, comes the need to be diligent about daily vitamins and supplements, whether your malabsorption comes from the DS or from the RNY---but exactly what supplements you need varies. As a DSer, I don't need B-12 supplements---my food is still coming in contact with the lower portion of my stomach, where 'intrinsic factor' is produced. (Intrinsic factor is needed to absorb B-12 from food. Many of you probably take Trinsicon, which I believe is a B-12/intrinsic factor/iron compound.) But most DSers DO need ADEKs, a specially-formulated version of the fat-soluble vitamins A, D, E, and K. Other than one ADEK a day, I also take one multi-vitamin and 1500mg of calcium citrate. (That's all!)

I eat about 100-110 grams of protein a day---no protein shakes or bars, just meat, eggs, cheese, nuts, fish, etc. I do my best to get the rest of my 2000 calories a day from fat and complex carbs, but I confess---I do usually eat anywhere from 25-75 grams of simple carbs most days. (If I eat more than a 100 grams of simple carbs, things get unpleasantly gassy.) Some DSers have to watch their fat intake more closely than I do, because a lot of un-absorbed fat can cause frequent trips to the bathroom, but it's largely an individual thing that everyone has to learn for himself. I'm lucky---I can eat pretty much anything I want, and in amounts that completely satisfy my new small stomach, without causing myself distress and weight gain.

The DS isn't for everyone---but I firmly believe that there are a lot of people out there for whom it is/would have been the best choice, and that's why I'm very vocal about it. I'm so VERY thankful that someone told *me* about the DS and allowed me the opportunity to make that choice that I feel an obligation to put the info out there for others who are considering WLS. I don't really care what form of WLS anyone chooses---what I care about is everyone having access to enough accurate information about ALL procedures to make a truly 'informed choice' possible.

I'm certain I've probably left out things someone will be curious about---so feel free to ask. (*grin*)

Blueyz · 04-11-2005, 10:07 PM

MsBatt~

Thank you for posting this. It is very informative and I believe that it will help many who browse this forum. I have learned a lot in these past few days. I have always known that "I do learn something new every day".

watergirl · 04-12-2005, 06:55 AM

Wow! Thanks so much for allowing others researching WLS to hear about this procedure.

JJ Girl · 04-12-2005, 07:18 AM

Veeerrrrry interesting - now if they could just combine the positives of each!

lealphachienne · 04-12-2005, 07:50 AM

So, basiclly DS is an intestinal bypass while RNY is a gastric bypass?

Christina · 04-12-2005, 08:48 AM

Thanks for that post. It was very informative. I learned a lot from it. I hope others will learn a lot as well. You're right, there does seem to be a lot of misinformation out there.. even on obesityhelp. Well at least when I was looking into the proceedure anyway. To be honest with you I bet that Dr. Callery doesn't do the DS for the specific reason that they remove the old stomach. You see Dr. Callery used to be a cancer surgeon for stomach cancers and whatnot so he even told us that in the event that we get cancer in our new pouch that he could somehow reverse the proceedure (albeit a difficult proceedure) but he could do it if he had to. That is probably why he is biased to this specific proceedure. I guess in that way it makes sense for him to want to do the RNY exclusively.. (his old training and all)

No matter how we get to our goals.. as long as we get there and get there together.. we've all accomplished what we set out to do.

Thanks again for posting that.. I am sure a lot of people can benefit from it.

bridgetgirl · 04-12-2005, 09:46 AM

Now this is more like it.......

Dara · 04-12-2005, 09:54 AM

Ms. Batt:

Wow...what a hugely informative post. I appreciate you taking the time to write it for us. I learned a ton of new information. Thanks so much for helping us learn.