LOOP Duodenal Switch

Jen -- what stage are you at?  I've decided to move ahead and am just deciding when I want to get on Dr R's OR schedule?  Deciding on summer or fall?

I have appointments set for the endoscopy and CT scan, as well as the nut. the psychologist, all this month.
Then I guess after all that they will summit to insurance for approval.

I am hoping to have it the 3rd week in Oct. as that is right when i get back from a expo for work, and before the holidays.

I want to have it done before the end of the year, because as we all know...insurance can change each year and I don't want to take the chance that they won't cover it next year.

When would be better for you to take off from work? I would say the sooner the better, you can always recoup on the boat, lol :)

I'm trying to schedule for mid-August -- his last week in the office before he goes on vacation for two weeks (8/22 and 8/29); a little concerned about if anything happens while he is away, but for my job -- that is best time for me to be out....

Wow that is quick :)  great news!!

Who is covering for him while he is out? I would think the Dr. would also be involved in any surgerys that occur a week before Dr R leaves for vacation.

I'm so excited for you! Plus as always I get the benefit of learning from you!!! :) you make a wonderful mentor

It's either then -- which works best for my employer -- or wait till early september or late october (after Avon Walk), so I figure if I'm gonna do it, I may as well do it!

I'm still nervous about the complication issue as a self-pay, etc --

Both Dr Shah and Dr Yatco cover for him while he is out -- don't know about prior invovlement, but a good question to ask.  I tend to not think of these things till 'after the fact' ---

I learn from all of you too!

My thoughts:  I wouldn't want to be a guinea pig with this new operation.

I have great concerns about Roslin's apparent increasing unwillingness to do a DS as a revision procedure, and instead recommending ERNY and this pseudo-DS.  I am not going to recommend him to anyone for a revision.  My opinion, of course.

ETA: specific concerns:

The loop intestinal structure itself:
1) Food/chyme going directly into the ileum 200 cm from the ileocecal valve -> dumping?
2) Only 200 cm of alimentary tract = more protein and vitamin malabsorption?  That is a REALLY short gut.
3) But, a 200 cm common channel - MORE fat absorption.

Your specific situation:
HE ISN'T GOING TO TOUCH YOUR STOMACH, SO WHAT YOU HAVE IS STILL AN RNY OF SOME SORT, AND NOT A DS.  Presumably, he's going to attach your pouch through a small piece of what intestine is currently attached to your stoma and anastomose it to the ileum??  You still have no pylorus, no portion of the proximal duodenum in the alimentary tract - what is the benefit of that arrangement??  Looks to me like once again, another worst-of-both-worlds "solution" to his reluctance to touch an old RNY pouch. 

I have a lot of questions to ask him, but he absolutely, 100% pro-sleeve.  That much I know.   He has done lots of  research and published reports on why the pouch is bad and how it contributes to reactive hypoglycemia and, in turn, weight regain.   I only want the real thing at this point, the one surgery that has been proven to be the most effective at long-term loss.  

See you all on the other side in a few days!!!!

Sandy

It is my understanding that Roslin is loath to touch an RNY pouch, and that this is at least one way he is avoiding doing it.  If I'm wrong, I'd be happy to retract that part of my objection.

But I still think the intestinal construction is problematic as noted above.

There were a couple of other people who were in the preoperative class with me who were sort of "lightweights" with their weight regain, like high 30's or very low 40's BMI.  He would only agree to do the first half of the surgery on them, the sleeve revision, to get them away from their dysfunctional pouches.  I think he reserves the "complete" surgery with the intestinal part for those of us *ahem* who have regained most of their weight back.  In my case it was 90% regain.  I'll be drilling him tomorrow!!!  

Sandy