Expert: John Pilcher, MD - 4/11/2008

Question
Hi Dr. JP,

I am planning to have weight loss surgery, that is not in question--I have fought my waistline for my entire life, and despite being a fairly active person and maintaining healthy eating habits, I have dieted my way up to a BMI of 44.  I want my life back!

Which WLS do you recommend for a not quite middle aged, active person?  I am leaning toward the Roux en Y as it offeres both restriction and malabsorbtion, but still allows for a fairly normal lifestyle after healing is complete, with the addition of daily supplementation.

As much as I like the higher numbers of maintained weight loss, I have to wonder if the duodenal swtich is worth the much higher rate of malabsorbtion?  

Thanks for any thoughts and advice you might have.

Therese Kilpatrick

Answer
Ms. Kilpatrick,
I think it's great that you are researching this thoroughly before jumping in.

I can't speak directly about the duodenal switch - my partners and I have chosen to not take on this operation because of the fairly high long term nutritional complication rate that is reported in the literature.  This notion from the literature is supported by recurring reports from folks I work with in the bariatric community who encounter really severe nutritional problems following the switch.

It sounds as if you have dismissed the Band and the Gastric Sleeve.  I have experience with those operations in addition to the Gastric bypass, and I think that all three have a role.  I mention them only for completeness, and I would think I would be very comfortable with performance of a gastric bypass for you, given the limited information you have provided.

Best of luck!!
Dr JP