Report on Obesity Surgery By Jim Avila NBC NEWS July 23

[Guest guest]

Dear Mr. Avila,

While it often feels supportive for those of us who have undergone

weight loss surgery

(WLS) to see reports on the topic in the popular media, it is also

distressing to the minority

of WLS post-ops who have had an alternate procedure called the Bilio-Pancreatic

Diversion with Duodenal Switch, or " DS " for short (see

www.duodenalswitch.com) that

all the publicity is afforded to the much more prevalent Roux en Y

(RnY) procedure.

Whereas the RnY has been dubbed the " Gold Standard " of WLS, we feel that, by

comparison, the DS qualifies as the " Platinum Standard. " The DS is a

more difficult

surgical procedure to perform, and therefore somewhat more expensive (which may

tend to bias health insurance companies in favor of the RnY), but

we DS-ers believe

that the DS leaves us with a much more comfortable quality of life

than the RnY-ers.

While both the RnY and the DS make use of restriction in intake (by

making the stomach

smaller) and malabsorption (by shortening the intestinal path for the

food that exits from

the smaller stomach), the DS differs primarily in that the major portion of the

sleeve-shaped stomach is removed after stapling, but the essential

features of gastric

physiology are retained (stomach acid production, a functional

pyloric valve at the base of

the sleeve-like stomach, cells near the pylorus that produce

" intrinsic factor " needed to

absorb vitamin B-12, and a greater amount of pre-digestion of food

before it is metered by

the pylorus into the small intestine). Also, a small section of

duodenum is preserved distal

to the pyloric valve, thus permitting a good deal of absorption of

iron and other minerals.

The rearrangement of the small bowel is similar in the two

procedures, and the " distal "

choice of the RnY is almost identical to the intestinal rearrangement

in the DS. The

malabsorptive possibilities mean that DS patients must take calcium and vitamin

supplements and be careful to eat sufficient protein for the rest of

their lives. The same

would hold true for those who have had a distal RnY. But, that is a

small price to pay for

being able to shed the medical and physical limitations of morbid

obesity ***and*** being

able to eat normally (with the DS, for instance, steak without having

to chew it 20+ times

before swallowing, celery, and other crispy foods that could clog the

slit between the RnY's

abbreviated stomach pouch and intestine). Also, because the DS

leaves the pyloric valve

functional, we do not experience the distress of the " dumping

syndrome " that afflicts many

RnY-ers whey they ingest sugar-laden substances.

May I invite you to look into the DS procedure and to report on that

at a later date? If

you do, I would also like to introduce you electronically to some of

my fellow DS-ers who

have carefully studied the available medical literature. For

example, there are myths

among medical professionals that the DS causes liver damage. This

is based on

experiences with operative procedures that preceded the DS and which

were considered

in a 1991 NIH study (that is scheduled to be updated this fall).

There have been very few

instances reported for the DS itself (one among 400 patients in a

10-year retrospective

analysis), but uninformed physicians continue to perpetuate the

outdated biases.

Thank you for your attention and consideration.

N. Goldstein, Ph.D.

Daytime phone:

======================

--

Steve Goldstein, age 61

Lap BPD/DS on May 2, 2001

Dr. Elariny, INOVA Fairfax Hospital, Virginia

Starting (05/02/01) BMI = 51

BMI on 07/17 = 43 (-50 lb.)