Duodenal Switch: Bariatric Surgeons' Ethical and Legal Obligations

I hope your daughter makes the right choice for her and finds a way to lose the weight.  I have two little kids myself and can speak to the fear. It can be paralizing. 

Hi Elina,

I'm a lightweight too.  I had 85 lbs to loose.  I also could loose the weight with Atkins or WW or whatever, but never could keep it off.  I knew that restriction (dieting) was not going to keep the weight off any different from all the times I dieted it off.  I know my DS is going to help me keep the weight off for the first time in my life.

Becky

Hi Becky, I am sure that you know yourself best and you have made the best possible, informed choice for you surgery.  I did the same thing.  I know that I was a volume eater and I felt hungry most of the time.  After VSG I no longer crave food.  I am satisfied with very small amounts of protein, and I feel almost no hunger.  Now it is possible that with time, I will be able to eat more and some of my hunger will return.  I would be OK with that since right now I eat such small quantities and as long as the ravenous hunger did not return, I can easily deal with minor hunger.  The stats from my doctor, especially for low BMI patients are pretty outstanding.  Granted, they are only four years out.  I weighed all of this against my fear of long term malabsorption.  I am 39 years old, and that is a long time to deal with malabsorption.  If I was a heavyweight, my risk, reward calculation would have been different, and I would have choses DS over RNY.  It has been 5.5months, and I am at 123lbs., almost at my goal of 110lbs.  Only time will tell if I made the right decision, but it felt right in my "gut" so to speak.  I wish you success and piece with your choice.  I do believe that everbody should be fully informed before making their choice.

 Hi Elina,

I am not Kimberley, so I can't speak for her, but here is some of what I've been seeing pop up on the DS board lately.

A patient will go to a surgeon requesting a DS. The surgeon does not perform the DS, but does perform the VSG. The surgeon will advise the patient to get a VSG, since it is the "first step of the DS anyway". They will then tell them that if they don't lose all their excess weight, they can always convert to a full DS. What the surgeon fails to mention to the patient is:

--That they don't do the DS.
--That insurance will not pay for the conversion to the DS, if needed
--That the 2-part DS tends to be less effective than having it done all at once.
--That having a secondary surgery can, in many cases, be more risky than having it done at once.

Even more disturbingly, some of these patients have diabetes and/or really high BMIs. 

You can speak for me anytime you want to Jenna -- you do it more eloquently than I do!

All the things you mentioned sound so unethical.  You are right, a surgeon that does this is a liar at least by omission.  My doc did not do this.  He talked to me about all of the surgeries.  He did feel that the VSG would be best for me, and I agreed with him.  If my BMI was higher, my second choice would have been DS.

If I had your starting weight/BMI,  I think I would have opted for the sleeve too. Your doctor actually does the DS, so it sounds like you were well-informed about your options.

What gets my blood boiling is when a surgeon lists that they do the DS on their website, but have never done a single one.  So, an unsuspecting 350 lb diabetic patient who wants the DS goes to see them and is counseled that a VSG or 2-stage DS would be "safer". The patient fully believes that they are getting sound medical advice about their options, since this doctor claims to perform all the surgeries. 

It is unethical in the extreme. 

Although I know a few 350 lb. or even more, that have done well with the VSG, so far, I would not have chosen it for myself.  I think the DS is a much better option at that weight.  I agree that surgeons who do not tell their patients about DS should be sued for malpractice. 

 Hello,
I have seen many patients who lost some weight with the VSG and maintained it. The down side was that the significant increase in the incidence of reflux that follows after a tight VSG. You are correct that there are no long term studies.
As a surgeon we need to look at the long term outcomes and assess them agains the short term "solutions". I am not saying that VSG is a short term solution, I am saying that I do not know at this point. I have done VSG in cases that I was planning to do on follow up surgeries or there were very compelling reasons that DS would not be appropriate. 
With regards to the weight loss and DS, I have performed DS exclusively as the primary operation in the majority of the cases. By adjusting the length of the common and the alimentary limbs, we can accommodate patients with different amounts of weight loss needed. 
Thanks
Ara

Dr. K.. I am so glad to see you on here.. You don't know how much I appreciate your valuable time and expertise! 

I had Thanksgiving with one of your patients, by the way.. Loyce P from San Antonio.  I told her I'd seen you posting recently and she was thrilled.. her DS is still working perfectly, too.  I'll email her the link to this thread.

I was a RNY to DS revision by Dr. Husted/Dr. R. Rabkin in 06.  My DS is still working perfectly, too. 

All hail the DS!  lol