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Post by Deleted on Mar 30, 2013 21:39:26 GMT -5
I've been looking at the links people have posted elsewhere, which I think you've also seen. My first thought is this: The alimentary limb and common channel are identical in this setup, which means that you are getting something like a 250 cm common channel. All types of food get absorbed all along that length of intestine, unlike the traditional DS where fat and protein are absorbed only in the common channel, which might be anywhere from 50 to 150 cm in most cases. In a Hess method DS, the common channel is approximately 10% of total small bowel length and the alimentary limb (of which the common channel is part) is 40% of the total small bowel length.
So, the malabsorption is going to be a LOT greater with the traditional DS.....And the malabsorption is what keeps the weight off, as long as you eat to make maximum use of that feature.
I'm pretty confident that if I were absorbing food in three times as much of my small intestine as I am now (which is was at 250 cm common channel would be for me), I would have gained back a very scary amount of weight. It would not have been a nearly powerful enough change to my metabolism.
My next concern--and I am not alone in this concern, as docs have said the same thing--is what about bile reflux? What, in this intestinal arrangement, keeps the bile flowing in the right direction? Bile in your stomach is a rather dreadful thing. I would want to avoid that if at all possible.
If I were in your shoes, I would be mega worried about being some surgeon's guinea pig, but especially a surgeon who can't seem to stay in one place and who has a number of reported issues in his availability to his patients. I would also want the tried-and-true procedural option, since the data on it is so good.
I know you don't want to hear speculation, but I kinda think my speculation is fairly well informed. I've been studying this stuff for quite a few years now.
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Post by goodkel on Mar 31, 2013 2:06:36 GMT -5
Yes, that was better than speculation for sure! I will have to ask the Dr. more about this. He seemed so sure it would work. Now I am worried. I am a self payer, so I bet the real DS would be thousands more. I have to find out after this weekend is over. THANKS. Oh my. While Gagner has an excellent HISTORY performing the DS, since my surgery in 2007, he has moved abruptly from New York, to Florida, and then to Canada. In all cases leaving pending patients in the lurch and uninformed. Since moving to Canada he has had more than one patient desiring a DS who received something experimental instead. While at least you know about it before waking up post-op with an anatomy that is not what you you researched and paid for; I agree with EN. There are other, safer, more reliable, more trustworthy self pay DS surgeons available. I was self pay and got a great deal on a world renowned surgeon in Dr. Ungson in Mexico. He will cost you about $15k and airfare. Please think twice about this. Oh, and welcome! I am so glad you found us!  |
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Post by Deleted on Mar 31, 2013 6:58:34 GMT -5
I am concerned that you are getting roped into doing something that Gagner WANTS to do, rather than truly getting what is BEST for YOU.
The procedure he is advocating qualifies as experimental and is NOT endorsed by the various professional societies regarding obesity treatment. The appropriate way to go about practicing such a surgery is in clinical trials. (One of those is currently underway, I believe in Spain.) It is not appropriate for a surgeon to just start doing something on PAYING PATIENTS that he "believes" is a good thing.
This is a serious ethical issue. Diana is not being a bitch by pointing this out. People who make themselves available to be guinea pigs are at the MINIMUM not charged for the privilege. Generally they are compensated in some way.
This procedure has NO data behind it. None, nada, zilch. It is NOT within the realm of evidence-based practice of medicine. That study of 50 patients followed up for just two years? Not. good. enough. Not by a LONG shot. That's hardly any time at all in light of living with something for a lifetime.
That line about fewer chances for intraoperative complications sounds nice, but it doesn't really mean much. Okay, one less anastomosis theoretically means one less spot for a surgeon to screw up. Meh, so? Show me evidence that the risk reduction is meaningful. I don't believe it. It's not something I'd trade for a risk of bile reflux, no way in hell would I do that.
I'd want to see a body of evidence (could be multiple studies and multiple surgeons) that encompassed at least a thousand cases and at least five years' worth of followup before I'd even BEGIN to consider such an option.
Yes, I'm sure Gagner sounds very confident and is absolutely convinced this is the way for you to go. I do not for a second believe he is being altruistic in this.
IF you decide you absolutely MUST use him for your surgeon, then make sure you put in writing EXACTLY what you are willing for him to do, and refuse to sign anything that gives him authority to do whatever he deems appropriate for your guts. I've seen him and other surgeons use the "scar tissue" and the "time under anesthesia" excuses for doing whatever the hell they wanted with people's bodies, and I, for my part, would sue his sorry ass off if I were in that position.
Okay, so you have "only" 75 pounds to lose. What is your BMI? 75 pounds on me at 5-7 is a whole different animal than 75 pounds on someone who is 5-0, probably almost 10 BMI points.
I understand cost is a factor. Okay, what's he charging? And is your LIFE worth saving a couple grand? Go to Ungson in Mexico. He's top drawer and darned reasonable.
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Post by Joanne on Mar 31, 2013 10:55:30 GMT -5
I just responded to this on FB. I dont understand why you would want this over the DS. I wont even argue if it's a safe and effective procedure - it may be - it may not be. Who knows? It doesn't have the track record of the DS. What do you hope to accomplish by having this procedure instead of the tried and true DS? Is it purely financial? If so, there are other options 1) travel to Mexico 2) wait and save more money.
Gagner used to have a stellar reputation....years ago. But we have all seen things to the contrary here. Disappearing. Non-standard surgeries that seem to be performed without informed consent...charges for emails and calls.
I would pay careful attention to the warnings here.
I dont know enough about you or your situation, but my first thought is have you checked a self pay price with Dr Ungson in Mexico. or Dr Marchesini in Brazil?
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Post by larra on Mar 31, 2013 11:06:36 GMT -5
The longterm results of the DS, meaning 10 - 15 years post-op, are excellent and well documented. The longterm results for this procedure are completely unknown. It is experimental. There is just no other way to say it.
I don't understand why you, or anyone else, would pick an experimental procedure with unknown results for both longterm success AND for complications when there is such a good alternative available to you. For a few bucks? Not worth the risk.
Having bariatric surgery isn't like having your gall bladder removed, where once it's done, it's done. This is something you live with for the rest of your life. If it only works well for a couple years, you're screwed. If it seems fine at the outset but results on late complications (such as bile reflux), you're screwed.
For me, knowing the track record of the DS for excess weight loss and maintainence of that weight loss and for longterm nutritional health were essential to my decision to proceed. I would hope these are factors you would also find important. Why you would set yourself up as a self-pay guinea pig is a mystery to me.
Larra
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Post by Joanne on Mar 31, 2013 15:58:44 GMT -5
Good for you, I followed this on Facebook as well.
I would also HIGHLY recommend you ask Dr Gagner about his post-op arrangements, both short and long term. And what costs might be associated with needing him, for example will he charge you if you email him a question.
If you're not absolutely confident in his answers and response, you have other choices. Yes, further away, perhaps more expensive, not as convenient - but that's all short term problems. My best advice is don't create a long term problem by trying so solve a short term problem.
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Post by goodkel on Mar 31, 2013 18:52:59 GMT -5
As others have awoken from surgery with something that they did not want, you will also want to be sure you write in on the surgical release/permission that he ONLY has permission for the full and standard Duodenal Switch. Be sure to give your copy of this to a trusted friend or family member before they put you under.
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Post by Deleted on Apr 1, 2013 8:29:18 GMT -5
As others have awoken from surgery with something that they did not want, you will also want to be sure you write in on the surgical release/permission that he ONLY has permission for the full and standard Duodenal Switch. Be sure to give your copy of this to a trusted friend or family member before they put you under. ^^^ Yes this!! I'd also have a lawyer review everything Gagner wants signed. (Although it goes without saying that hell would freeze over before I'd use a surgeon with whom I felt obligated to do that. I'm hot for cowboys, but not in the OR.) |
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Post by weightlosssurgery1 on Apr 1, 2013 14:41:26 GMT -5
I am in similar situation.
Dr. Gagner wanting to do SADI. Ungson rny or bpd. Aceves rny.
What should I do? I want revision from vbg to ds.
I live in northern Alberta.
I can get about 15000 together (including flights and accommodation) by end of September. Otherwise would be in new year
Shawna
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Post by Deleted on Apr 1, 2013 15:06:30 GMT -5
I am in similar situation. Dr. Gagner wanting to do SADI. Ungson rny or bpd. Aceves rny. What should I do? I want revision from vbg to ds. I live in northern Alberta. I can get about 15000 together (including flights and accommodation) by end of September. Otherwise would be in new year Shawna Get a DS. Don't be a guinea pig. Don't settle for RNY. If it takes longer, so what? |
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Post by weightlosssurgery1 on Apr 1, 2013 15:21:01 GMT -5
Ungson said scopinaro/ bpd.
I will look into Rabkin or K.
Thanks
Shawna
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Post by goodkel on Apr 1, 2013 15:25:31 GMT -5
I am in similar situation. Dr. Gagner wanting to do SADI. Ungson rny or bpd. Aceves rny. What should I do? I want revision from vbg to ds. I live in northern Alberta. I can get about 15000 together (including flights and accommodation) by end of September. Otherwise would be in new year Shawna Why does Ungson want to give you a BPD? Are you sure you understood him? DS is sometimes called BPD/DS (I HATE that terminology!), so make sure you understood him correctly, and whatever you do, say NO to a BPD. Oh wait. You have a VBG and not a sleeve. I see. You should contact Rabkin or Keshishian. Your stomach could be a mess. And both will charge a lot more than $15K. Ungson - no. But don't go cheap on this! This will dictate how you will be living the rest of your life! Ungson has been calling the DS the BPD/DS since I first consulted with him five years ago. I told him I only wanted the duodenal switch and he said that that is what he was referring to. And a DS is what I got. He's just using older terminology. |
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Post by goodkel on Apr 1, 2013 15:28:42 GMT -5
Dr. Gagner has agreed without any issue, to give me a real DS. I am pleased!! Then this holds true for you, too: As others have awoken from surgery with something that they did not want, you will also want to be sure you write in on the surgical release/permission that he ONLY has permission for the full and standard Duodenal Switch. Be sure to give your copy of this to a trusted friend or family member before they put you under. Read more: weightlosssurgery.proboards.com/index.cgi?action=display&board=talk&thread=6586&page=1#ixzz2PFHiPVE3 |
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Post by weightlosssurgery1 on Apr 1, 2013 15:53:16 GMT -5
specifically asked for Ds. I will copy the email;
Gmail shawnatwin <shawnatwin@gmail.com>
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Question about revision surgery.
2 messages
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shawnatwin <shawnatwin@gmail.com> 17 March 2013 23:24
To: gungson@hotmail.com
Dear Dr.,
Do you do revision from vertical banded gastroplasty (mesh) to DS? My vbg had staple line breakdown. No complications.
Thank you for your time.
Shawna Twin
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gilberto ungson <gungson@hotmail.com> 17 March 2013 23:27
To: shawnatwin <shawnatwin@gmail.com>
Hello Shawna
Yes, we do revisional surgery and conversions fron vbg to another procedure. Most of thise conversions are to a RNY or Scopinaro ( BPD). If you have a mesh we need to check on the surgery if we can convert to a DS
Thanks
Dr Ungson
Enviado desde mi iPhone
El 17/03/2013, a las 22:24, "shawnatwin" <shawnatwin@gmail.com> escribió:
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Post by weightlosssurgery1 on Apr 1, 2013 16:00:00 GMT -5
I just sent him another email asking for what ungson needed to "check" if he can do ds. I am getting really pissed at the medical professionals who advised me to get the meshed vbg. They effin knew we'd be screwed after...  |
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Post by weightlosssurgery1 on Apr 1, 2013 16:02:17 GMT -5
I would not be able to afford a doctor from the US this decade! Well there always is the lottery lol.
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Post by weightlosssurgery1 on Apr 1, 2013 19:36:52 GMT -5
I sent bariatric records to Aceves today.. Already informed no revision from vbg with mesh to ds.
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Post by Deleted on Apr 1, 2013 19:58:13 GMT -5
That mesh thing is a bugger . Have you checked with Baltasar in Spain and Marchesini in Brazil? |
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Post by weightlosssurgery1 on Apr 1, 2013 20:46:18 GMT -5
Im waiting on second inquiry with Ungson.
I also emailed Greenback - he said he can do the operation but would need all info and tests firsts.
I am worried about cost.
Shawna
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Post by Deleted on Apr 2, 2013 8:03:24 GMT -5
I know that Dr. Greenbaum now has a clear self-pay structure, but have no idea what the prices are like.
Did I read correctly that the band part of your VBG is eroded and the mesh is basically hanging around doing nothing? Or was that someone else with VBG?
If that was you, then I can kind of see why the surgeons are mentioning a Scopinaro procedure, which is a horizontal subtotal gastrectomy instead of vertical. It would presumably leave the mangled part of your stomach alone. But you'd be giving up your pylorus permanently, and if I were in your shoes I'd have big problems with doing that. I think I would opt for a very distal RNY, aka ERNY, before I'd submit to a Scopinaro procedure. You could have a somewhat larger stomach pouch so that you could eat a little more freely (to compensate for the malabsorption of the very long intestinal bypass), I would think.
However, I wouldn't even BEGIN to consider those options until I was convinced that there was no way in the world to get a DS.
Dr. Greenbaum did a DS on a failed VBG of my acquaintance some years ago. She had other complications of her stomach anatomy, I believe including a really horrific hiatal hernia. There was something about it that made it utterly life threatening to go anywhere near her stomach. She had restriction aplenty because of her mangled stomach, and was immersed in the liquid calories syndrome, basically living on milkshakes and stuff. It was a horrible situation, made worse by her super morbid obesity.
So Dr. Greenbaum did the DS with no gastrectomy. She lost a remarkable amount of weight, which in turn improved her stomach issue to make her life more livable. If she has not yet died of malnutrition (she never took any supplements), she might be doing okay.
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Post by weightlosssurgery1 on Apr 2, 2013 20:25:34 GMT -5
Update: Ungson said no to converting my vbg to ds. So thats 3 doctors now. Im not getting the ds. So, my options are as follows: SADI without restriction Scopinaro ( eek )  ?? |
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Post by Deleted on Apr 2, 2013 21:00:24 GMT -5
Why SADI without restriction instead of *cue drum roll* DS without restriction
Did these surgeons comment after seeing your information, or was this a general matter of principle they were stating? |
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Post by weightlosssurgery1 on Apr 2, 2013 21:46:29 GMT -5
I can get bottom half of sadi or ds. Or rny probs.
The did see my bariatric records. :/
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Post by michelehei on Apr 2, 2013 22:33:31 GMT -5
Get the SADI.
I have it and its working out just fine!
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Praying for a DS with Dr. Ayoolah
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Surgery Type: Lap Band
Surgery Date: 2005
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Post by MrsGMO on Apr 2, 2013 22:51:51 GMT -5
Get the SADI. I have it and its working out just fine! Are you the same michelehei that posted the following last June? 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 michelehei on Apr 3, 2013 5:26:45 GMT -5
Last June I was not even one year post op.
I am sure that was posted out of frustration during a weight loss stall.
As we all know that is way too early to evaluate the success of WLS.
Approaching two years post op I can now say that this surgery is fine.
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Post by Deleted on Apr 3, 2013 7:56:45 GMT -5
I'm glad things are working out for you Michele. You're still an "n" of one, and you got a procedure to which you did not consent. It would be profoundly foolish of any reader to move forward with a procedure that is still experimental based on one anecdotal report.
Fine for YOU does not mean there is a body of evidence that supports the viability of this procedure.
Also, the material I am currently reading/reviewing as I design my study for my honors thesis (which is about quality of life outcomes in long-term postops) almost universally shows significant changes in satisfaction (which is subjective) and medical/complication status (which is objective) start to increase significantly in the third or fourth postop year. Because of this, I'll be eager to hear how you continue to fare as more time passes.
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Post by weightlosssurgery1 on Apr 3, 2013 15:09:44 GMT -5
So EN, if one chooses only the malabsorptive part of the surgery, are you specifically concerned about sadi?
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Post by Deleted on Apr 3, 2013 16:04:45 GMT -5
So EN, if one chooses only the malabsorptive part of the surgery, are you specifically concerned about sadi? Because the SADI and the DS are two completely different animals. The DS has some 25 years of evidence behind it and the SADI has none. The differences in the two procedures are all in the small intestine, which is the malabsorption part of the whole thing. |
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Post by weightlosssurgery1 on Apr 3, 2013 16:35:59 GMT -5
Ive sent an email to Dr. Gagner regarding this.
If you dont mind can you please explain the difference in small intestine with regards to the two procedures?
Or can you direct me to a paper or research on the subject. I am quite interested in the details.
thank you for taking the time to share you knowledge and experience.
Shawna
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