Second-guessing my choice of DS surgeon

[Band to DS]

I started the process of getting a lap band to DS revision in May 2011. I live in North Carolina, so Dr. Sudan at Duke University is the closest vetted DS surgeon. I've met some of his patients in real life and have conversed with others online. Everyone I've spoken with says that he's a skilled surgeon and they've been happy with their care. During my first appointment with Dr. Sudan, I asked him lots of questions about his experience level, complication rate, patient deaths, etc. I was satisfied with his answers.

That was 8 months ago. It seems like a number of his recent DS patients haven't done so well. One got his liver nicked in the OR and ended up in acute renal failure in the ICU. Another developed a leak and posted here about it. A 3rd person is currently in the hospital with persistent nausea & vomiting and his explanation for the cause of her problems doesn't make much sense to me. And a very recent patient is in the ICU. I haven't heard why. These events have led me to question whether I should stick with Dr. Sudan or look for another surgeon.

I know that the DS is a complex surgical procedure and there are risks associated with it. I also know that being morbidly obese and having comorbidities puts people at a greater risk for complications. But where do you draw the line?

Maybe I'm just anxious because the process is taking so long & my insurance company is being a pain in the ass. Maybe he's had lots of other DS patients during the same time period who've done well & I just haven't heard about them. I don't know.

I'd appreciate any input, reassurance, or advice you can offer.

Thanks,
Shelli

[Joanne]

Maybe some of Dr Sudan's patients will chime in, but as far as I know he has a great reputation. Complications happen even in the hands of the best surgeons and the most compliant patients. I think as surgery draws nearer, it's natural to focus on that. I did. Before my DS AND my plastics. We lost a dear, dear DS'er to a plastic surgery incident only a few weeks before mine, and my first reaction was to cancel my surgery. My best advice is to try to put it in perspective. As I said, I've only heard good things about Sudan but some of his other patients will probably chime in as well.

[Deleted]

Yeah, you generally don't hear much about the ones who do fine. It's one of the reasons I'm devoted to staying involved in the WLS community.

Remember that Heidi Whateverelseisinherusername is not a reliable source of information about ANYTHING. Her stories get more out there every time she turns on her computer. If you're reading her stuff, I recommend not reading.

[Dudette]

I don't know how helpful I can be because I know absolutely nothing about your particular surgeon. However, I know that if I were in your situation I would be a little freaked out too. If I had heard about one or two people with complications I think I would have chalked it up to "statistics" and not worried about it. But FOUR? Ouch. It's a little harder to ignore that number. Esp. in such a small window of time. And these are just the ones you know about.

It also makes me wonder if something else is going on. Why so many problems recently? This is a University surgeon, correct? I wonder if he uses residents to perform parts of the surgery like some other well-known University-based DS surgeons do? Does he take on a disproportionate number of high risk patients? That could explain it too.

Anyway, I'm not suggesting you bail on him. However, I think your nervousness is understandable. I wouldn't like the situation if I were in your shoes. Hopefully someone else will jump in here with the voice of calm and reason. Until then... hang in there.

Edit: Typo

[beth28]

Isn't Duke a teaching hospital? Is he letting residents do the actual surgery with himself just directing? If I'm paying a particular surgeon for an operation he/she damn well better be the person performing it. That's a question I would ask if a surgeon's "quality" of work has suddenly gone wonky.

Discuss your concerns with him. See if he can satisfactorily address your concerns.

[sandyv63]

I swear, the only thing that got me through the last week pre-op was knowing I had the best surgeon. That was the one thing I knew I didn't have to worry about. I have been on the boards about three years now and while I've read plenty about Dr. Sudan being a fine DS surgeon, most of those surgeries were virgin. Since you are a revision, you might want to at least consider a surgeon with more experience doing revisions. Maybe you should speak with Dr. Keshishian and/or Dr. Rabkin or Dr. Roslin and see if you feel more confident with one of them. If you don't feel any different then perhaps you can stay with Dr. Sudan. But if you do click with another surgeon, you'll have the peace of mind that comes with feeling like you've done everything you could to ensure the best possible outcome.

[Deleted]

Jan 27, 2012 17:58:55 GMT -5 Band to DS said:

I started the process of getting a lap band to DS revision in May 2011. I live in North Carolina, so Dr. Sudan at Duke University is the closest vetted DS surgeon. I've met some of his patients in real life and have conversed with others online. Everyone I've spoken with says that he's a skilled surgeon and they've been happy with their care. During my first appointment with Dr. Sudan, I asked him lots of questions about his experience level, complication rate, patient deaths, etc. I was satisfied with his answers.

That was 8 months ago. It seems like a number of his recent DS patients haven't done so well. One got his liver nicked in the OR and ended up in acute renal failure in the ICU. Another developed a leak and posted here about it. A 3rd person is currently in the hospital with persistent nausea & vomiting and his explanation for the cause of her problems doesn't make much sense to me. And a very recent patient is in the ICU. I haven't heard why. These events have led me to question whether I should stick with Dr. Sudan or look for another surgeon.

I know that the DS is a complex surgical procedure and there are risks associated with it. I also know that being morbidly obese and having comorbidities puts people at a greater risk for complications. But where do you draw the line?

Maybe I'm just anxious because the process is taking so long & my insurance company is being a pain in the ass. Maybe he's had lots of other DS patients during the same time period who've done well & I just haven't heard about them. I don't know.

I'd appreciate any input, reassurance, or advice you can offer.

Thanks,
Shelli

As has been mentioned, sometimes there are problems even with an experienced surgeon. Let's look at the 4 examples you have given:

Nicked liver - That one would get my attention but could probably put that into the "complications sometimes happen" category;

A leak - it is a rare complication but can happen. However, did it happen due to something the surgeon did, or was it just a matter of the patient's tissue not bonding together? Hard to know but if there isn't a repeated history of leaks then I'd probably put that into the "complications sometimes happen" group;

Patient hospitalized for nausea and vomiting - Most often that is the result of the patient being dehydrated and setting off a chain of circumstances that leads to this. It can also be excess acid production. Do you have any information that these problems are the result of something the surgeon did or didn't do? That might make a difference;

Most recent patient in ICU - Is this Cheryl_______? What is she in ICU for? A specific problem or standard post-op ICU stay? This could make a difference too.

As for the teaching hospital comment - I don't know the protocol at that university but I can speak to my experience at a teaching university. I spoke with my surgeon about this in advance and his protocol is to perform the actual gastrectomy and intestinal configuration but he allows his residents to do the closing. I would encourage you to discuss this with Dr. Sudan in advance.

That said, the most important thing here is that look at all of the available information and then make an informed decision. Sudan enjoys a good reputation but it never hurts to ask questions to make sure that he still gets to have that reputation.

[scoob]

I have noticed that there are several patients who have some kind of complication with my surgeon also. A lot actually. I was one of them. A small abscess that caused an inflamation of the bowel. I think this was from the drain being pulled too soon. That of course is MY OPINION!

It scared the hell out of me as a pre op. I won't even lie! BUT I took a long look at it. Most of these complications were treated and said patients were happy as larks with their DS's. I guess I was just willing to take that leap. I knew I HAD to do something and I was sure as hell going to get the BEST!

So after 2 years of waiting and jumping through a gawd awful amount of hoops, I had the DS. Best decision I ever made. Even when I had my complication, which was by far the worst pain I've ever had. Worse then waking from the DS, I just had my muscles tightened in a hernia repair, 2 c sections, a tubil and an ablation. This was the worst. Through it all I never felt regret. Every day I just did what I had to to get better. I made the best of a bad situation. I kept my eye on the prize and got through it!

Mind you, in the grand scheme of things, I had a very small complication compared to others.

Sometimes you just gotta take a leap of faith and hope for the best. This is MY OPINION! I felt like this was my last hope. Turns out it was a bumpy start to a new, wonderful life! I literally thank God EVERY day I had this surgery. It saved my life in more ways then one!

Do what is best for you. What you gotta do for you. Good luck and we're here for you! HUGS

Ruby

[Band to DS]

Thank you so much for your thoughtful replies. I appreciate everyone's input & personal stories.

I work in a teaching hospital, so I made sure to ask Dr. Sudan lots of questions about how he performs the DS and how he uses residents during surgery. He told me that residents usually remove the gall bladder & appendix (which are pretty routine procedures), but that he does the gastric sleeve & small bowel reconfiguration himself. I also asked him how many lap band to DS revisions he's done and have spoken with one of his revision patients. (For the record, he does not do RNY to DS revisions.) I was satisfied with all of his answers & didn't have any concerns until I became aware of the recent series of complications.

I have no idea who Heidi Whateverelseisinherusername is & it sounds like that's a good thing. LOL And yes, Cheryl is the person who's in ICU. Her partner posted on FB that she had complications during surgery. I don't know anything else about the situation.

Because I'm appealing my insurance company's decision to deny coverage, I have plenty of time on my hands. (Maybe that's part of the problem.) It wouldn't hurt research my options with Keshishian, Rabkin, and/or Roslin. I can also talk to Dr. Sudan about intra-op & post-op complications again and make sure that I'm okay with his responses to my questions.

Thanks again for your support.

Shelli

[Girlrocker]

Jan 27, 2012 18:59:39 GMT -5 Joanne said:

Complications happen even in the hands of the best surgeons and the most compliant patients. I think as surgery draws nearer, it's natural to focus on that.

Hi Shelli, I would echo this, adding that it's the hazard of any major surgery. I'm from the other perspective, I had complications after my RNY in 2002 that required hospitalization for 4 weeks, a second surgery that resulted in more problems - wound infection, internal seroma. I was in one of the best teaching hospital in the country. Nearly 10 years later I researched revising to a DS, which I had done with Dr. K on Dec. 15. I was nervous, but just hoping I'd settled my complications account already and I'd get a free pass this time (I did) Struggling all these years with obesity, failed procedure, was worse. I purposely avoided reading complication stories before surgery, decided there was a line - I was as informed as I could be about the risks and reading any more would only freak me out. Can't hurt to check out other surgeons and use this time to learn more. Wish you well with your insurance approval.

[honeybadger11]

Me personally, i think i would be freaked the hell out!!! But i do think a lot of us question our surgeons as we wait for approval. Dr. Smith had NO complications when i was having mine done and i questioned using him. I believe Dr. Houston in Tennessee does lapband to DS revisions. Ann M from the OtHer board had hers done with him (she had a cartoon girl w a bunny ear hat for an avatar)

Its a hard call but i would say make sure you are 100% comfortable with your decision.

[smscott7]

I just wanted to encourage you to follow your gut. You need to be completely comfortable with your decision.

I will say that when I went to San Francisco to have my DS with John Rabkin, I met 2 patients that had their DS's the day before. I visited them in the hospital...they both had complications. It freaked me out a bit (one patient's surgeon was actually Robert Rabkin) but complications are a possibility and I had complete confidence in my surgeon.

[Seeking Healthy]

If you decide to stay with Sudan (his reputation is good) I would simply request that an intern does not perform any of the procedure on you. Can you request that only he does the entire procedure? I think you have the right to request this and he may have to honor it.

Good Luck
SH

[Eileen_nc]

Jan 27, 2012 17:58:55 GMT -5 Band to DS said:

I started the process of getting a lap band to DS revision in May 2011. I live in North Carolina, so Dr. Sudan at Duke University is the closest vetted DS surgeon. I've met some of his patients in real life and have conversed with others online. Everyone I've spoken with says that he's a skilled surgeon and they've been happy with their care. During my first appointment with Dr. Sudan, I asked him lots of questions about his experience level, complication rate, patient deaths, etc. I was satisfied with his answers.

That was 8 months ago. It seems like a number of his recent DS patients haven't done so well. One got his liver nicked in the OR and ended up in acute renal failure in the ICU. Another developed a leak and posted here about it. A 3rd person is currently in the hospital with persistent nausea & vomiting and his explanation for the cause of her problems doesn't make much sense to me. And a very recent patient is in the ICU. I haven't heard why. These events have led me to question whether I should stick with Dr. Sudan or look for another surgeon.

I know that the DS is a complex surgical procedure and there are risks associated with it. I also know that being morbidly obese and having comorbidities puts people at a greater risk for complications. But where do you draw the line?

Maybe I'm just anxious because the process is taking so long & my insurance company is being a pain in the ass. Maybe he's had lots of other DS patients during the same time period who've done well & I just haven't heard about them. I don't know.

I'd appreciate any input, reassurance, or advice you can offer.

Thanks,
Shelli

I haven't heard much about Dr. Sudan and complications; all I heard about was his office staff was not settled in, but that was a couple years ago. Because of that and other reasons, I opted to go to Ohio (where I'm from) and went with Dr. Maguire.

Bottom line is you have to be absolutely confident in your surgeon's skills. If you're not, then I say move on and find a surgeon you can have complete faith in. If that involves traveling, then so be it.

[beth28]

"He told me that residents usually remove the gall bladder & appendix (which are pretty routine procedures), but that he does the gastric sleeve & small bowel reconfiguration himself."

Maybe that's how that patient got a nicked liver. Unless you don't mind residents working on you, I would speak with Dr. Sudan and tell him you'd feel better if he did the whole surgery himself.

But it's you who needs to be comfortable with him working on you. Not everyone is complication free, but you need to be confidant in your choice of surgeon. If I (and this is about my hangups) were not completely confidant in my choice of surgeon, I would keep looking.

I was lucky that I only had to drive 2 hours to my surgeon/surgery (still went out of state), but I had complete confidance in my surgeon. If I didn't, he would have never gotten a knife near me. ;D

[Band to DS]

Just for the record, interns are new doctors that are fresh out of medical school. They don't usually get to do too much by themselves in the OR. Residents are doctors who have been out of medical school for at least a full year. They gradually assume more responsibility and independence in the OR. They're supervised by more senior residents and attending physicians. Attending physicians (aka, attendings) have completed years of post-medical school training. The number of years depends on their specialty area. For example, family practice docs spend less time in training than neurosurgeons. I always joke that you can tell a MD's level of training by the length of their white coat. The longer the coat, the higher up they are in the hierarchy. LOL

I honestly don't think it's possible for residents not to be involved in your case at a teaching hospital. I mean, you can always ask. But I suspect that you'd be seen as a fool and politely told to go elsewhere. You get access to the best & most cutting-edge treatment at a teaching hospital, but the trade-off is that you have to deal with people who are new to their profession & still learning. It is what it is, ya know?

Shelli

[Band to DS]

Thanks, again, to everyone who's responded to my post. It helps to hear different perspectives & talk about the issues.

Shelli

[Paula]

Due to HIPPA, there probably isnt a lot that Dr. Sudan can divulge as far as that one patient with the nausea, etc. I guess to my way of thinking, it seemed like the complications you mentioned in your initial message are things I could expect might happen even with some of the other top name surgeons in the field. Especially considering that this is a major abdominal surgery and all. A number of others who have gone to vetted DS surgeons are having to deal with some complications right now. Unfortunately bad things happens sometimes.

Ultimately though, you have to be totally confident in your surgeon and have full trust in him. Ive heard Dr. Sudan is a great surgeon, but if you dont feel confident with him...you should find someone you do feel comfortable with. Do you think all the waiting you are having to do might be messing with your head a little bit?

[reinventingangela]

Suggestion: Since you do have some time on your hands while youre fighting the insurance co issues, how about checking out a "plan b" surgeon like maybe someone from neighboring VA or TN? At least you could interview someone via phone or email and compare notes and see how you feel. Maybe your gut is telling you something and maybe talking to another surgeon will give you more peace of mind and help sway your decision one way or the other.

Counter Argument: I can understand being a little leery (I would be too) but on the other hand, even the best surgeons arent perfect. Maybe its actually better that the 1 complication out of 150 surgeries is already out of the way before you get on the table (not that I would wish that on anyone)?

Its like having a wreck...auto insurers might consider you higher risk but really even if it was your fault, being a relatively intelligent and responsible individual (which most surgeons are), wouldnt you be less likely to make the same mistake twice?

Either way you go, I hope this helps ease some fear and we'll be here for ya...best of luck to you!

[chicarita]

Hey Shelli,

I was feeling a little skeeved out with our surgeon too after hearing about a couple of these issues, I'm so glad you posted this!

BUT I wanted you to know that it absolutely is your right to refuse assistance from Residents. You just have to sign something.

[Fade2Pink]

Not that it may make you feel any better, but my surgeon has a couple of patients with current complications (Dr. Simper). I think he is terrific, but something is going on with these two ladies and I hope that things will improve quickly for them. It happens, I know. But it's got to be concerning. I'd suggest looking into other surgeons, you want to go into that OR with total confidence in your surgeon. I don't think either way you go is right, or wrong. Do what is best for you.

[newsabrina]

I'm a Sudan patient and I freaking LOVE the man! I truly do. He is thorough all throughout surgery and made sure he had someone checking on me (if he wasn't on call) to make sure my pain was being managed etc.

Without divulging someone elses' business, I will say that I know of another Sudan patient who isn't compliant with his vitamins. He complains to me that he's not feeling well or losing weight like he would like. When I question him about what he's eating and the vites he's taking, his excuse is that he's not taking his iron or other vitamins because his wife got fired again and they can't afford the vites... UMmmmm! When you signed on to the DS, you signed on knowing you'd have to take the vitamins faithfully, dude. No wonder you're "not feeling well." OH! TO make matters worse, he's not drinking enough water. So, basically, there is only so much Dr. Sudan can do, KWIM?

Personally, I can't say enough great things about Dr. Sudan. Other than the initial post op pain meds in the hospital, I was off of all pain meds upon discharge (not saying I'm superwoman or anything ) just that I'm very happy with how I've done in Dr. Sudan's care. I had zero complications and at 15 months post op haven't had a single issue with my surgery.

[renegadeorange]

Hey there, Shelli!
The liver deal freaked me out when I found out about it, but apparently that does happen though pretty rarely. Dr. Sudan didn't even try to chance that with me... he left my appendix in because my liver was all kinds of in the way.

Of course, you know who the nauseated chick was. I will say that it was NOT fun. But... he did the right course of action on me. He personally checked in on me every morning that he was on duty there (and one night he came by around 9pm). He tried to reassure me that everything would be ok when I was sort of freaking out about the feeding tube and length of stay.

I will let Cheryl share what happened to her when she's ready, but I think her case is one of those rare things that can happen as well. I saw her today, and she's finally in a regular room (yay!), and her pain is being managed ok now. I hope she will be up and at 'em in no time!

It's very natural (and GOOD) for us to be nervous and unsure about our decisions. It causes us to ask this type of question and get feedback from others. I'm glad you asked the question, and I hope that the answers you see here will help reassure you some.

Nic

[teetster]

Hi Shelli! Another Sudan patient here; I was a VSG to DS revision. I was also one that had complications, but knew it was possible going into surgery as I had terrible scar tissue issues. I believe my complications would have happened no matter where I had surgery; but I believe I lived through them because of Dr. Sudan's care.

I think Dr. Sudan is absolutely amazing, but that being said, you must be confident in your choice of surgeon. I interviewed several before choosing Sudan. I just had a really good feeling about him that I didn't get from the other surgeons I spoke with. I suggest you interview other surgeons and see which one you feel the best about-that way you have no reservations in your mind that you are making the right decision for YOU.

[Band to DS]

Nic,

Although I was at the hospital this weekend to support you, you're the one who ended up reassuring me. :-) What you said makes perfect sense & helped me see things from a different perspective. I hope that you're doing well at home. Perhaps I'll see you at the next NC DS lunch.

Warmest regards,
Shelli

[Band to DS]

Jan 29, 2012 18:14:43 GMT -5 chicarita said:

Hey Shelli,

BUT I wanted you to know that it absolutely is your right to refuse assistance from Residents. You just have to sign something.

Interesting. I did not know that. Gives me something to think about.

Shelli

[Band to DS]

Thanks, again, to everyone who took the time to read my message & post a reply. I appreciate everyone's input and it's especially nice to hear from other Sudan patients.

Shelli

[divineambrosia]

Hi - I'm the 'leaker'.

I wouldn't blame Dr. Sudan in the slightest for my leak. Like renegadeorange he avoided my appendix, my galbladder was taken out. Unfortunately due to the timing of my surgery Dr. Sudan was out of town by the time my leak appeared. It was no ones fault...just my body, which often has issues healing.

My leak was repaired by two of Dr. Sudan's associates. To this day (just had an appointment with Dr. Sudan on Monday) he profusely apologizes to me about not being around to fix my leak. In fact, the Dr. who waited to call him too late concerning it no longer works with Dr. Sudan (or so I heard through the grapevine). So I would say Dr. Sudan takes his patients pain very seriously.

I also have severe neasuea still. But that's my body. He is helpful and works with me on everything. The only complaint I have of the whole situation was the staff on the actual bariatric floor wasn't all that great (except for Dr Sudan's new cheif resident general surgeon, her name escapes me...but she's awesome).

[Band to DS]

During all of my interactions with him, Dr. Sudan has impressed me as someone who is conscientious & meticulous. I'm really glad that you're doing better. Thanks for sharing your story with me.

Shelli