Pre-Surgery Meeting Concerns

I just got home from my pre-surgery meeting with my surgeon. He's a vetted surgeon and I've met many of his successful DS patients.

He explained my surgery very well, telling me I was getting a DS and illustrating how he would do the operation. He plans to make the sleeve 40fr in size. He likes to make a tight sleeve, and allow a bit more for the common channel which my case will be 150cm. I'm good with that. He does measure everything so there's no guessing there. He sews all the connections on the intestines by hand and uses a double layer technique to avoid leaks. I'll get a leak test, and MRI to make sure everything is fine before I'm released from the Hospital.

So far so good. Then he begins telling me that because I have had previous gall bladder surgery, there is a very slight chance that there *may be* excess scar tissue that involves the Duodenum. If this occurs, the scar tissue could have blocked part of the blood flow to the Duodenum. He further explained that because of this, if the Duodenum is separated, and its blood flow is compromised, he may not be able to continue with the DS.

On top of that, he might not be able to re-connect the duodenum back to itself and leave me with a sleeve. He said in that case the only option would be an RnY. He said there way no way to tell if the Duodenum was viable until they cut it.

After I picked myself up off the floor, I told him No Way, it's the DS or nothing. He said that of course he would do everything he could to make sure I had a DS, but, if the Duodenum was compromised there would be nothing he could do. He couldn't even leave me with a sleeve since the Duodenum could not be re-connected.

He did tell me that it was a very very small chance of that happening, and when asked, he said it only happened once in all the years he has been doing WLS, but he had to let me know about it since it could happen.

He told me he loves the DS, and has created a very successful DS practice so he would never compromise his reputation by doing something like that unless it was absolutely necessary.

So there it is.
This guy can tell me about complications, possible transfusions, even the possibility of death and I'll be fine, but tell me I might wake up with an RnY and it scares the hell out of me.

If I hadn't met dozens of his happy healthy DS patients that absolutely love him, I would have backed out already.

Can anyone tell me, have you heard of this? Is this standard fare for someone who previously had their Gall Bladder removed and then pursues a DS or am I being railroaded.

 

I don't think I've heard of someone coming out with an RNY due to scar tissue. I've heard of folks coming out with a VSG or longer common channels. I think you were pretty clear with him and he knows his way around. You can still be firm with him in what you might be willing to settle with if it comes to that, such as a VSG or having him open you up if he needs to rather than continue trying to do you laparoscopically.

--gina

I had multiple abdominal surgeries prior to the DS.  My surgeon told me that he might have to leave me with a sleeve because of adhesions.  I told him to switch from lap to open if he had to, but that I wanted the full DS. Period.  It took him 7 hours to clear the adhesions and get the DS done but he did it.  I think you need to make it very clear as to what you expect.

Another surgeon I talked to would not even attempt to do the DS because of my previous surgeries.  He told me upfront that he would only do the sleeve.

I have made it very clear to him that the DS is what I want, and told him that if there were unforeseen problems to just back out and leave me with a sleeve. He says the problem is that if he splits the duodenum and finds the blood flow has been compromised he may not be able to re-connect it in which case the RnY is the only option.

Sounds like your surgeon knows his stuff & you'll more than likely be fine with exactly the surgery you want. Even 'if' the reconnection of the duodenum was an issue you still won't have the RNY pouch & you will also have the rerouting of the liver bile tube to your common channel - so wayy different results than the RNY.  

My surgery may be something that could (kind of) happen in your situation  - I do not (Thankfully) have the RNY. But I do now have what was known as the BPD. Not by choice. I flew across country from NJ to WA state to have the DS, but during the laparoscopic procedure the staple gun misfired & they had to open me up to fix the damage - whi*****luded taking my duodenal stump (would have been left with correct DS procedure) & my pyloric valve - to get into healthier tissue that was not damaged to make the seals hold. I still have the elongated stomach (banana shaped - not a 'pouch' according to my doctor description) have lost 118 lbs, and have maintained at just under 140 lbs for over 2 yrs.

Thankfully, I still have the results I was hoping for without a lot of major side effects I have heard others talk about.

Sorry to hear that.

Tell me, with the way you are configured, do you have to follow an RnY diet? Even though you don't have a pouch, do you still have dumping?

Thanks

Have no fear. Srikanth put the fear of God in me at my last pre-op visit too. He has to talk through the worst case scenario with his patients.

I tugged on his sleeve as I was going under for surgery and reminded him to "give me a DS, or zip me up!"

Ultimately, I did have major scarring and found that the last surgeon who worked on me used metal clamps instead of sutures.  (Lazy SOB). Dr. Srikanth spent nearly 8 hours cutting out my scar tissue and skillfully stitching me back together.  I am almost 1 month post op and have had 0 leaks etc.  I am grateful he took the time to work on me.  Many surgeons would not have completed the procedure.

Have faith, he is very talented, and very determined to give you the very best surgery possible for your body.

Srikanth puts the fear of God in all his DS patients in his pre-surgery meeting.  He is trying to give you a very real look at what a worse case scenario looks like. Have no fear, on surgery day he will work VERY hard to give you exactly what you want surgically.

He gave me a revision from Lap Band to DS on 11/6/12.  I too received a scary pre-surgery meeting and went home terrified I would wake up from surgery with an RNY.  During surgery it was discovered that the last surgeon to operated on me had used metal clamps rather than sutures which created a lot of scar tissue...Needless to say it all had to be cut out and gingerly sown back together.  Dr. Srikanth spent nearly 8 hours working on me, any other surgeon would probably have stitched me up and told me to come back in 6 months for the rest of the procedure.

Know that you are in good hands, pray hard, sleep hard, and pound your protein and vitamins.

Best of Luck!

~Em

Thanks Em,

Since we share the same surgeon, you know what I'm talking about. I searched diligently and couldn't find even one negative post about him so I guess I just need to relax and trust him to do the right thing.

You've eased my mind quite a bit but with only one more day to go, I'm still freaking out! (about the surgery in general)