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Post by pennyl on Jun 10, 2012 11:15:38 GMT -5
I went on the 5th of June for my second stage of the DS in Montreal. Due to adhesions and the structure of my abdominal anatomy, Dr. Gagner could not complete the DS. He did the surgery mentioned in the subject line.
He told me that with this surgery there is less malabsorption than with the DS, but I am still to follow the DS diet.
There is not much info available online about this type of surgery. Dr. Gagner is going to send info that he has available, but I would really appreciate it if there is anyone who is familiar with this procedure or knows of any links that would be helpful to me.
It has been only 5 days since my surgery and I am doing well.
Take care.
Penny
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Post by Joanne on Jun 10, 2012 11:43:13 GMT -5
Do you have a copy of your surgical report? If not, you should get a copy so you have one, and also post it here for some help.
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Post by Joanne on Jun 10, 2012 11:56:38 GMT -5
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joanlaptods
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DS Mar 9,2011 Dr Gagner
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Post by joanlaptods on Jun 10, 2012 12:12:20 GMT -5
Michelehei also came out recently with a variation of DS. Search her under members to read about it, not sure if it is what you have though.
Joan
Hope you continue to heal well penny
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Post by michelehei on Jun 11, 2012 12:10:29 GMT -5
I had a Lap Single-Anastomosis Duodeno-Ileal Bypass With Sleeve Gastrectomy.
Not sure how that compares to the Biliopancreatic Diversion with Bipartition.
Maybe Diana is around to chime in. She might know!
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Post by Deleted on Jun 11, 2012 13:53:40 GMT -5
I'd need to see the op report.
And I'm wondering why Gagner is the only one who suddenly finds he "needs" to do these on his revision patients. Although I understand Roslin may be doing them too?
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Post by Joanne on Jun 11, 2012 13:59:40 GMT -5
I might be wrong, but I don't think it's the same thing as the Loop DS. I just emailed Dr R to ask him
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Post by Deleted on Jun 11, 2012 14:14:59 GMT -5
Reading about this surgery is very interesting, sounds like less food issues... and still very good loss numbers
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Post by michelehei on Jun 11, 2012 14:17:34 GMT -5
My surgery has some malabsorption and very, very little restriction. I lost very little weight and continue to struggle just as I did pre op. This is not a good surgery.
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Post by Joanne on Jun 11, 2012 16:07:07 GMT -5
I asked Dr Roslin He doesn't think what is meant here is the Loop DS. He believes the bipartion refers to something called the Santoro procedure: journals.lww.com/annalsofsurgery/Abstract/publishahead/Sleeve_Gastrectomy_With_Transit_Bipartition__A.98796.aspxMichelehei, I think you do have what is called the Loop DS, which I have also seen referred to as SADI. If the OP has what I put the link to above, that is something different. Although for you, I don't think your lack of restriction is because of the loop configuration, it would have more to do with the size and construction of your sleeve. |
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Post by Deleted on Jun 11, 2012 18:10:26 GMT -5
This is just my non-medical opinion: if I were asked whether it was OK to do this procedure on me, my answer would be a resounding NO: it has a stoma AND a pyloric exit to a sleeved stomach. In my opinion, NO STOMAS, EVER! "TB creates a *gastroileal anastomosis* in the antrum after the SG; nutrient transit is maintained in the duodenum, avoiding blind loops and minimizing malabsorption. The stomach retains 2 outflow pathways. A lateral enteroanastomosis connects both segments at 80 cm proximal to the cecum." For the stuff that falls through the stoma before getting to and going through the pyloric valve, there is only an 80 cm common channel. Check out the pic, third slide from the end of the presentation: www.e-med.co.il/emed/new/Usersite/Presentations/Diabetes0211/Keidar0950.pdfAgain, that's my OPINION. I would not want to be relying on, much less having, a stoma. |
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Post by pennyl on Jun 11, 2012 18:13:46 GMT -5
I received an email from Dr. Gagner. In the email he states: "You are now an unique case in Canada (of Transit bipartition), but not alone in the World, as more than 1000 patients have had this surgery now. You have an intact pyloric valve." He sent me part of an article that has not been published yet. Dr. Sergio Santoro of Brazil has pioneered this surgery and it has impressive results. It behaves like a duodenal switch, so I need to follow the DS diet take the same supplements as DS'ers and have the same blood tests every 3 months.
I have a sleeve gastrectomy (SG) with transit bipartition (TB) as a metabolic intervention for obesity.
TB creates a gastroileal anastomosis in the antrum after the SG; nutrient transit is maintained in the duodenum, avoiding blind loops and minimizing malabsorption. The stomach retains 2 outflow pathways. A lateral enteroanastomosis connects both segements at 80 cm proximal to the cecum.
SG + TB is a simple procedure that results in rapid weight loss and remission or major improvement of comorbidities. Strictly aiming at physiological correction, TB avoids prostheses, narrow anastomoses, excluded segments, and malabsorption. Weight and comorbidities are much improved. Diabetes is improved without duodenal exclusion. TB is an excellent complement to an SG.
I now have a better understanding of my surgery.
Thanks to everyone who replied to my post.
I hope you will follow me on my journey with this unique form of WLS. I am sure we will all learn from my progress on another WLS option.
Penny
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Post by pennyl on Jun 11, 2012 18:34:49 GMT -5
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Post by pennyl on Jun 11, 2012 18:49:00 GMT -5
I went in for the second stage DS and came out with transit bipartition. Dr. Gagner did the best that he could with what he had to work with. I trust his judgement and as I had no say in the matter, I will do the best that I can with what I have.
Some doctors would have just closed me up and left me with just the sleeve, or they would have tried to do the DS anyway and I would have had complications or even possibly died on the operating table.
I feel blessed that I had a vetted surgeon who I trusted completely to make a difficult decision at the time.
This is just my feelings about the situation.
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Post by patxyz on Jun 11, 2012 19:35:50 GMT -5
I'm so glad you were able to get good information over here... I sent you the link here before I realized you had already posted over here. I'm glad you're feeling positive. I'll be in touch again soon!
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Post by kyal on Jun 11, 2012 19:39:18 GMT -5
This is an interesting procedure indeed and I hope it works very well for you Penny.
I'm really not sure about Gagner though. I am starting to understand why a surgeon here in Australia told me his a loon.
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Post by Band to DS on Jun 11, 2012 21:29:59 GMT -5
I wish you all the best, Penny. I really admire your positive attitude. I believe it was unethical for Dr. Gagner to perform this type of experimental procedure without your consent. He should have told you that it was a possibility before surgery & you should have been allowed to say "yes" or "no." I would advise people to stay far away from this surgeon.
Shelli
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Post by Deleted on Jun 11, 2012 21:44:00 GMT -5
I, too, wish you everything good, Penny, and I applaud your positive attitude. I will do everything I can to help you as you move forward in learning to live with this procedure. It is not your fault, and I hope that you will understand that we support you in moving forward.
I will, however, never, EVER allow anyone to go to that lunatic surgeon without my strongest possible warnings about him. This kind of cavalier butchery, combined with the other reports of his outrageous misbehavior, is unforgivable. The degree of misconduct on his part is truly egregious.
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Post by Deleted on Jun 11, 2012 23:33:09 GMT -5
Results from five year study: Adequate follow-up data were collected in 59.1% of patients from 4 months to 5 years. The average percent of excess BMI loss was 91%, 94%, 85%, 78%, and 74% in the first, second, third, fourth, and fifth year, respectively. Patients experienced early satiety and major improvement in presurgical comorbidities, including diabetes (86% in remission), following surgery. Two deaths occurred (0.2%). Other surgical complications occurred in 6% of patients. Signs of malabsorption were rare. www.ncbi.nlm.nih.gov/sites/ehelp?&Ncbi_App=entrez&Db=pubmed&Page=abstract&Snapshot=/projects/entrez/Entrez@2.98&Time=2012-06-12T00:29:49-04:00&Host=portal103Ann Surg. 2012 May 17. [Epub ahead of print] Sleeve Gastrectomy With Transit Bipartition: A Potent Intervention for Metabolic Syndrome and Obesity. Santoro S, Castro LC, Velhote MC, Malzoni CE, Klajner S, Castro LP, Lacombe A, Santo MA. |
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Post by zix on Jun 11, 2012 23:48:23 GMT -5
I wish you all the best, Penny. I really admire your positive attitude. I believe it was unethical for Dr. Gagner to perform this type of experimental procedure without your consent. He should have told you that it was a possibility before surgery & you should have been allowed to say "yes" or "no." I would advise people to stay far away from this surgeon. Shelli I totally agree with Shelli. My surgeon and I discussed what would happen if for some reason (surgical adhesions in my case due to prior abdominal surgery) he could not complete the DS and we decided that he would do the sleeve alone as a 2nd option. I would have been very upset to wake up and find out that I had had a surgery that had not been talked about nor had I given informed consent to. That said, what's done is done and I truly wish you the best Penny! |
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Post by goodkel on Jun 12, 2012 0:14:36 GMT -5
Yes, we're going to have to remove him from the DS Surgeons list. He's not a DS surgeon if you go in for a DS and come out with something completely different. Talk about bait and don't switch. This is like waking up with an RnY.  If there are problems, you fix those problems and save the bariatric surgery for later. |
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Post by jenniferd on Jul 25, 2012 11:03:53 GMT -5
I also believe that I did not get the real DS. I am currently waiting for my 2nd op report but I don't even know if I can trust the information there. Dr. Gagner did say I that's what I had but my weight loss (or lack thereof) is really convincing me that I had one of the other procedures. I think I am going to ask my doctor to send me for a scan to see what everything in there really looks like. Is it an MRI that would even show the biliopancreatic limb?
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joanlaptods
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DS Mar 9,2011 Dr Gagner
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Post by joanlaptods on Jul 25, 2012 18:18:38 GMT -5
So you were told you had the second part of the Ds. When did you have the surgeries and how much weight have you lost after each?
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Post by Deleted on Jul 25, 2012 20:19:48 GMT -5
I also believe that I did not get the real DS. I am currently waiting for my 2nd op report but I don't even know if I can trust the information there. Dr. Gagner did say I that's what I had but my weight loss (or lack thereof) is really convincing me that I had one of the other procedures. I think I am going to ask my doctor to send me for a scan to see what everything in there really looks like. Is it an MRI that would even show the biliopancreatic limb? Hi Jennifer, glad you found us here. I am very disturbed to hear from yet ANOTHER patient of this surgeon with such concerns  . I hope that other Canadians as well as our medical people can give you some suggestions on how to proceed. |
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Post by goodkel on Jul 26, 2012 11:41:59 GMT -5
I also believe that I did not get the real DS. I am currently waiting for my 2nd op report but I don't even know if I can trust the information there. Dr. Gagner did say I that's what I had but my weight loss (or lack thereof) is really convincing me that I had one of the other procedures. I think I am going to ask my doctor to send me for a scan to see what everything in there really looks like. Is it an MRI that would even show the biliopancreatic limb? If you have the DS, you need a CT scan with contrast. |
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Post by pandykorn on Jul 27, 2012 21:54:05 GMT -5
i find it extremely peculiar that Gagner was basically top of the line, especially in revisions and now all of a sudden whenever i log on i read about incomplete revisions from him and weird procedures- The increase in this type of news has been considerable in the past 6 months (ever since we went to this site). I wonder if Gagner is just "bored" with the DS and attempting to "pioneer" newer things- when in reality the DS has in no way outshined itself like the RNY has. He should just use his skill (which he clearly has) to stick with what has been proven instead of this huge influx of new procedures. Also, why in the world is he doing such a substantial amount of 2 parters all of a sudden when he is one of the most skilled at the DS. it seems so fishy.
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Post by Deleted on Jul 27, 2012 22:01:37 GMT -5
i find it extremely peculiar that Gagner was basically top of the line, especially in revisions and now all of a sudden whenever i log on i read about incomplete revisions from him and weird procedures- The increase in this type of news has been considerable in the past 6 months (ever since we went to this site). I wonder if Gagner is just "bored" with the DS and attempting to "pioneer" newer things- when in reality the DS has in no way outshined itself like the RNY has. He should just use his skill (which he clearly has) to stick with what has been proven instead of this huge influx of new procedures. Also, why in the world is he doing such a substantial amount of 2 parters all of a sudden when he is one of the most skilled at the DS. it seems so fishy. Follow the money and follow the ego, are my guesses. When patients start waking up with procedures to which they did not knowingly consent (beyond the catchall "surgeon can do whatever is medically necessary" clause in the consent forms, which BTW folks should carefully read and annotate), it's time to sound the alarm and get people AWAY from that surgeon. |
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Post by goodkel on Jul 28, 2012 2:29:01 GMT -5
Gagner's pulling a Husted. In four years he's moved from NY to FL and then to Canada. Now he's dabbling in odd surgeries.  |
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Post by Heather on Jul 28, 2012 8:57:05 GMT -5
What is Dr Gagner putting on his consent forms? Is he putting DS or DS with possible adjustments based on his opinions? If someone only signs up for a DS, he gets in, its not possible, he needs to stop the surgery, bring patient out of anesthesia, and discuss options. Let the patient make an informed decision.
Back in 04 there was a woman on the band board who insisted she only signed a consent for an RNY and woke up with the band. I call Bull shit. I am a nurse, I have seen more consent forms than I can count. I don't believe in a million years she did not sign a consent saying RNY OR BAND, or her surgeon could have lost his license.
This is nothing against OP, just my thoughts after reading the thread. I wish you the best of luck and much success with your new surgery.
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Post by KathyF on Jul 28, 2012 11:05:02 GMT -5
Surgeons do sometimes do things without consent. I met a woman years ago in Dr. Rabkin's office who had to have her switch put back. She lived, I think, in Oregon. Had went to a surgeon there to have some adhesions taken down and while he was in there he decided to reverse her DS. He did not discuss this with her before hand and there was no reason for doing so other than he did not approve of the surgery. I can only hope that she sued him. Especially for the cost of coming back to California to have Dr. Rabkin fix her back up with her DS.
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