Introducing myself, VBG to DS Revision, and Med Tourism Insurance

Hi all,

I've been lurking for a little while. I've decided on getting a revision surgery. I live in Alberta, Canada - they don't do DS here and they don't pay for out of province surgeries. I first looked into Mexico as I saw that Dr. Ungson was highly recommended. But he will only do a VBG to RNY revision and not a DS. My VBG is old (1988) and I have mesh instead of silicone which makes the surgery slightly more tricky.

IMO, if I'm going to go through bariatric surgery again, I'm going to get the DS. I contacted Dr. Gagner, Dr. Lutrzykowski (as he sees a lot of Canadian patients from Ontario) and Dr Marchesini.

I'm not going to lie, price is a factor. $20,000 is a lot of money to me. These 3 surgeons seem to be the most skilled for their prices. There's Keshishian also, but he's way out of my price range.

At first, I thought Gagner would be my best choice. He's one of the best bariatric surgeons in the world. But there are varying reports on rescheduling, the two phase surgery (first creating a VGS, and then doing the DI) into 2 surgeries, convincing people that the SADI-S is just as effective or people waking up with the SADI when they wanted a DS.

Dr Lutrzykowski seems nice, but he wants me to come for a pre-op appointment. I've emailed back asking for a compromise, as a face to face meeting would cost me thousands of dollars in travel and lost wages.

Dr Marchesini seems like the best choice. The major drawback is that he's in Brazil. That's a long way to travel for surgery. But he's very nice, and all the anecdotal information that I have is good.

A little about me. I got he VBG in 1988 at the age of 18. I was 225 and lost about 40-45 lbs. I didn't keep it off. I am now between 290-300. I did hCG for the past 2 years and got down to 235, but I couldn't keep it off. My highest weight has been 336.

I work as a medic in the oilfield, and I have the type of job where getting time off work is something you have to plan ahead for. I live in the middle of the bush for weeks at a time, and usually have 4 days off between rotations.

I have only been doing this for less than a year, and I should have enough money for a DS in a few months.

Also, has anyone used Medical Tourism insurance. I found this one that looks like it covers bariatrics, up to $50,000 in complications - anyone used it? https://www.sevencorners.com/insurance/bordercross/

Thanks,

Jill

Marchenesi is very well respected.  Also seek out Gilberto Ungson in Hermisillo MX.  You can't go wrong either way.  They both have staff that helps you with the details, so you don't need the medical tourism package (but insurance is a wonderful idea) that will add more $$ to your costs..

I come from an insurance background, so if there's insurance, I think it's a small price to pay for the coverage I would get. The quote I have is approx $1,300 for up to $50,000 in complications and up to $100,000 in sending you (or your remains) home.

Ungson won't do it, unfortunately. As much as that would simplify things. On the other hand, I don't want a surgeon to go into my surgery with reservations.... 

Thanks!

Jill, converting VBG to DS isn't "slightly" more difficult than conversion to RNY. It's far more difficult. The mesh is designed to allow tissue ingrowth, which means that the tissue of the outer wall of your stomach has grown into the mesh. Likewise, whatever other parts of the intestine are near your stomach, probably a loop or two of small intestine, have also grown into the me**** can be extremely difficult and hazardous to separate all that scar tissue. Both the small intestine and the stomach can be injured. The stomach that is left after getting everything dissected apart may not be in good enough condition to do a sleeve gastrectomy.

I'm saying all this not to discourage you, but to warn you that even the best surgeon might not be able to give you a DS with an acceptable level of risk.

By all means contact Dr. Gagner and Dr. Marchesini. With Dr. Gagner you will need to be very, very specific about what you want and don't want, and what he should do if a DS, or even a 2 stage DS, isn't safe. With Dr. Marchesini, yes he has an excellent reputation and his patients love him, but last I heard he was discouraging patients from having RNY to DS revisions and offering ERNY instead. My guess, and I admit it's just that, is that he would recommend RNY for you as being so much less risky.

It's a very unfortunate situation. What has already been done may limit your present alternatives. I think your best chance for a DS would be with one of the surgeons who does the difficult revisions on a regular basis. I totally understand about the financial realities, but financial realities can sometimes be changed with time, and the surgical realities aren't going to change. The last think you want is to spend what money you do have, and end up with an operation you don't want.

Larra

Larra,

Thanks - I do realize the dangers of the surgery, with the mesh involved. Dr Marchesni has not tried to discourage me. He quoted a price for the revision either open or lap. Are you saying that he would try to convince me to do another surgery once I got down there? Because he hasn't said anything so far, and I've forwarded him my VBG surgical report which he said was very helpful.

I did get a response from Gagner's assistant today, Xavier. It basically said that a 2 stage surgery is likely.

Although, I have heard that in many cases, an RNY to DS is a more difficult procedure as the stomach has been bypassed. I'm not questioning your opinion, but reports do vary. 

I will not get the RNY. If I'm going to do this, it will be the DS.

Thank you so much for your input, Lara, I really appreciate it.

Jill

Talk to Dr. Ungson.  Dr. Aceves was killed in a plane crash and Dr. Ungson has taken over his practice.  Some of the things he will or won't do probably have changed in the last 6 weeks or so.  However, Dr. Marchesini is a great choice too!

Thanks for the advice Patty - I did talk to Nina at Mexicali Bariatrics and asked her to double check with him -still a no, unfortunately.

Jill, you are doing a great job with your inquiries. Regarding Dr. Marchesini, no, I don't think he would offer you a DS and then pull a fast one on you. I don't know him personally, but his reputation is stellar. If he says DS, I think he will make every effort to do a DS.

You are right that RNY to DS can be a very difficult operation in its own right. It is possible that in some cases it could be just as difficult as VSG to DS, maybe even more so, depending on how the original RNY was done and how the original VBG was done. I would still say though that on average, VBG is tougher to convert to DS due to the problems created by that damn mesh.

Lastly, it's good that you know what you want and what you don't want. No matter which surgeon you end up with, be sure to communicate very clearly that RNY is unacceptable to you if that is how you feel, and if your only options (once the surgeon sees what things look like inside) are either RNY or nothing, what should the surgeon do in that unfortunate cir****tance. You might wake up disappointed but hopefully not with any unwanted surprises.

Larra

Thanks Larra - I agree about Marchesini - everything I've read about him, heard about him through a FB group of his patients, and from my own interactions with him give me the impression that he's an honest and straightforward individual. I was just wondering if you had heard/experienced anything differently.

Yeah, the mesh is an issue. Unfortunately when I got it, silicone wasn't used. I'm going to have to ask Marchesini about the specifics of the VBG to VGS portion of the surgery.

I suspect that although my pouch is stretched, the mesh is still there. What shape it's in, I'm not sure. I do know that I still get obstructions if I eat too quickly or eat the wrong thing. I haven't had pork (besides the ever-delectable bacon) since about 1990. :)

I don't think my staple lines have been disrupted, but I don't know. I do know, according to the surgical report, there were two rows of staples put in. 

I will have to ask about the method they use. I used to be an RMT, am now an industrial medic and was brought up by an R.N. Although my no means is my knowledge great, I have a better than average understanding of the human anatomy and medicine, which has been very helpful so far.

Thank you so much for your advice, it is truly appreciated. I agree that I'd rather wake up from anesthesia without any changes to my anatomy than waking up with changes that I didn't want. As disappointing as former would be, I think the latter would feel like a violation.

I think some people tend to be intimidated by doctors, especially surgeons. They are providing us with a service, just like anything else. Although Dr. Marchesini seems like a wonderful man; it's more important to me that he's a skilled bariatric surgeon with many revisions under his belt, that he's a member in good standing with the ASMBS, and that he is accredited with a Center of Excellence in Metabolic and Bariatric Surgery by the International Bariatric Surgical Review Committee (IBSRC), which is recognized by the ASBMS.

It's a bonus that he's a personable man though. But if he weren't it wouldn't be a deal breaker as long as he was skilled and did the agreed upon surgery.

Thanks again - Jill