Expert: John Pilcher, MD - 4/21/2009

Question
I have been reading a lot about the different weight loss surgery options available and am wondering why more surgeons don't offer the duodonal switch.  I am probably going to have the RNY this summer, but keep reading about how great the DS is and several people who have had DS are suggesting I'm making an ill-informed decision in having the RNY.  Can you help me understand why the DS isn't more available and done by most bariatric surgeons?  There must be some good reasons and I'd love to know what they are.  Thank you.

Answer
Leanne,
My compliments on researching all of your options thoroughly.

Please allow me to disclose that I have never actually performed a DS, though I have assumed long term care for several DS patients and I am familiar with the unbiased experience of many others who participate in their care.

I think that everyone familiar with the surgical literature would agree on the following:
-On average, DS patients lose more weight than those who undergo any other commonly performed procedure.
-DS patients have a substantially higher rate of vitamin and protein deficiency than patients who undergo other procedures, both at the level of simple lab abnormality, and also at the more serious level of clinical illness.

My impression, which I think is shared by the other bariatric surgeons who don't perform DS, is that the extra weight loss does NOT on average correlate with better health and better function.

I believe it is also fair to say that, among the commonly performed weight loss operations, gastric bypass is the easiest to live with in the long run.  The DS is higher maintenance in terms of taking and monitoring supplement levels, as well as the common difficulty with foul bowel habits.  The Band tends to require fairly regular attention in terms of diet management and adjustment.

I hope this is helpful for you,
Dr JP