Calling all Dr. Roslin pre- or post-ops...(or anyone who can offer insight)

My surgeon from my lap-band, Dr. Blackstone in AZ, is going to be trained by Dr. Roslin in NY for the DS.  She'll be doing my DS, in fact I'll be one of her first patients of the DS (yes, I know that's risky, but someone has to be first). 

My question/concern is that I jus****ched a video by Dr. Roslin on the Lenox Hill website (link - make sure you click on the ds video, the link may be on a different one)  where he's explaining the DS procedure and something he said concerns me a bit.  He said that they used to do the DS w/ bigger pouches and common channels of about 100, but he was finding a lot of his patients were having bathroom issues.  So now they're doing a much smaller pouch "not much bigger than the RnY pouch" and a common Chanel length of "at least 125."  He said he's been finding that the less malabsorptive rout is causing less bathroom issues and is closer to the RnY. 

Perhaps I misunderstood him? But I don't want a DS that's basically a RnY, I want a DS!  So if that's how he does it, that's what my surgeon will learn.  I'm just a little concerned.  I want more malabsorptive, I don't want a pouch close to the RnY pouch  

The video appears to have been filmed in 2009, so I was hoping anyone who went with Dr. Roslin recently can tell me what he did for you?  I hope I'm misunderstanding.  I'll talk to my surgeon too, but I'd love to hear from some actual patients.

Thanks!!

Dear Stephanie,  you are not just getting a DS, you are getting a revision.  Please reconsider who does this revision.  They a risky at best and only a few surgeons will take on a revision.  They know how complicated they are.  This is a bad idea to be her first case.  Unless she is paying you some large sum of money (like 6 figures) to be her guinea pig RUN do not walk away from this. 

Thank you for your concern, and I'll have to ask her about those 6 figures  

I'm a revision from a band so it's not as complicated as a revision from a RnY would be.  I'm confident in Dr. Blackstone's abilities.  She's very experienced with revisions of all kinds, her profile on OH isn't updated.  She will also have an experienced proctor with her during the surgery.  I will not literally be her very first DS surgery, as she will be preforming surgeries during her training.  I also believe there are a few patients who will be ahead of me.

Please everyone, I know it's risky, but every one of your surgeons had to have someone go first to get to the hundreds of surgeries they've preformed now.  Dr. Blackstone is a very capable and experienced surgeon with the RnY, VSG, lap-band, and revisions.  In a very complicated way, a revision from a band to a DS is sort of like all of those combined...kinda sorta.

There are risks involved with any surgery done by any level of experienced surgeon.  I've seen many members on OH that have been their surgeon's "first" for whatever surgery and they all seem to be doing great.   Thank you all for your suggestions and concerns. 

While Blackstone is experienced with the band and RNY I am not sure how experienced she is with the sleeve or how many of them she has done. I think she has only been doing them for less than 2 years. You may want to check that out.
I am not knocking her as a surgeon just questioning her experience with the sleeve

On August 25, 2010 at 3:07 AM Pacific Time, StephOinAZ wrote: Thank you for your concern, and I'll have to ask her about those 6 figures  

I'm a revision from a band so it's not as complicated as a revision from a RnY would be.  I'm confident in Dr. Blackstone's abilities.  She's very experienced with revisions of all kinds, her profile on OH isn't updated.  She will also have an experienced proctor with her during the surgery.  I will not literally be her very first DS surgery, as she will be preforming surgeries during her training.  I also believe there are a few patients who will be ahead of me.

Please everyone, I know it's risky, but every one of your surgeons had to have someone go first to get to the hundreds of surgeries they've preformed now.  Dr. Blackstone is a very capable and experienced surgeon with the RnY, VSG, lap-band, and revisions.  In a very complicated way, a revision from a band to a DS is sort of like all of those combined...kinda sorta.

There are risks involved with any surgery done by any level of experienced surgeon.  I've seen many members on OH that have been their surgeon's "first" for whatever surgery and they all seem to be doing great.   Thank you all for your suggestions and concerns. 


Okay, as gently as I can say this...


NO ******G WAY! 
Woman, are you MAD?




Alrighty then...so what is this old woman yapping about?  (At least read it.)



So, first the obvious...it COULD work out just fine.   So could a lifetime of diet and exercise. 

Do you send your vintage Pontiac to a very experienced Toyota mechanic?  And expect him to not only do a routine procedure, but to undo something he's never undone before and THEN install some very complicated thing?  And you only get one chance to do this at someone else's expense?

Look...I went to one of the most experienced DS REVISON surgeons on the planet.  He KNEW that it could be messy in there.  He KNEW what stuff he might encounter.  And he KNEW, from experience, what he might have to do to get the band out and do the DS.  He quoted me a 3.5 hour surgery.  It only took two hours.  It only took two hours because I had gone to a primo band surgeon (Rumbaut) and it was placed professionally, but also because Keshishian knew what the **** he was doing.

Lemme tell you why ELSE you might be insane.  The DS takes longer than any other surgery.  And a revision can take longer than that.  And even longer if they are talking lap surgery.  Add in an inexperienced (at these procedures) surgeon and the time goes up even more.  (Remember, my very experieced revision surgeon figured on 3.5 hours as average and your surgeons have a total of ZERO experience with this situation) and your BMI of close to 60 (?) puts you at higher risk for complications such as respiratory problems, deep vein thrombosis and what another member recently survived:
www.obesityhelp.com/forums/DS/4220049/Hey-All-My-first-chanc e-to-post/


So, to cut down on surgery time and prevent those problems, or if they feel that you are at risk, they may not do the whole DS.  More and more patients are waking up with a sleeve and best wishes for a happy future.  And that's with EXPERIENCED DS surgeons.  (And if the proctor is not a very experienced revision surgeon--and they're mostly busy doing their own surgeries--it doesn't matter if s/he is there or not.  And there are only a few bariatric surgeons in AZ who are experienced enough with the DS to proctor anyone else and...well, you need to get the name and run it past the vets here and they can tell you if it's scarier than NOT having a proctor there.)


Now, all of this does not mean that I don't wish you well.  I do.  But you are young enough be still be convinced of you immortality and this is a risk that is just unnecessary.

Sue

You need to discuss your cc and sleeve w her and ask beforehand what you are going to get. Even if it's a smaller sleeve it will never be like rny bc it's not a pouch. You will just have to work a little harder to get fluids and protein in bc your tummy will be smaller. Good luck. I would call and ask this week.

I'm not good with these technicalities, I am sure princess would know better, but the 125 vs 100 is a very small difference in the big picture. The smaller sleeve will help you lose faster and help prevent regain. It is an advancement, not a regression.

Dr. Roslin does tend to be more conservative but trust me, its NOTHING like a RNY.
The stomach is a sleeve, not a pouch. He uses a 38 French bougie to create about a 2oz stomach which is around what a lot of people who get a VSG have (VSG bougie sizes from what I have seen range from about 30 to 40). The VSG stomach might be slightly smaller but really, its such a slight difference it doesnt matter that much. Your sleeve will stretch in time anyway. I actually really like my restriction and don't have a problem at all.

I know Dr. Roslin did Jass's lapband revision and she asked for a larger sleeve because she had issues with the lapband and he gave her a slightly larger sleeve so you can always talk to your surgeon about your concerns but really, its nothing like a pouch at all.

Look at this picture to try and get a better understanding of how slight the differences really are.



Also, every couple of weeks a post about sleeve size and or common channel length comes up and if you scroll a few pages back to find one, you will see that a 2oz stomach is fairly standard. Some have slighly smaller stomachs and some have slightly larger. A lot of people who have larger sleeve sizes or stretched out their sleeve too much actually wished they had more restriction. I am personally very happy with my sleeve size.

As for the common channel length, I was a bit concerned about this too, but really 125 cm vs. 100 isnt really that big of a deal. Keep in mind that it isnt just the common channel length but the length of all your limbs that are important and a lot of different surgeons have different views on the matter. There are surgeons that use 75 cm common channels and their patients struggle to reach their goal and others that use 150 cm common channel lengths and their patients meet their goal easily. I would be more interested in the surgeons stats and what percentage of their patients achieve a normal bmi with their configuration rather than focusing on the common channel length. I discussed this quite a bit with Dr. Roslin before my surgery and after talking to him and quite a few of his patients I decided that I am totally comfortable with my common channel. To put things into perspective, your small intestine length is about 700 cm and they are bypassing 600 of those! Those extra 25 centimeters really don't make that much of a difference with how much you malabsorb in the grand scheme of things. I do believe that it helps with the bathroom issues since I have fewer bathroom issues and seem to tolerate foods better than a lot of others and in the long run, that is something that is important to me.

Overall, I love Dr. Roslin, I think he is a brilliant surgeon and I am thrilled with my DS.

I think there are really 2 concerns here:

1. the experience level of your surgeon. I am concerned about this being a revision, even though it's "just" from lap band and thankfully not RNY or VBG. That does make a big difference. Once the band is out, it's back to a standard DS.

    However, the "once the band is out" part could be a snap or a nightmare.  There have been a few lap band revision people lately, with very experienced DS surgeons, who ended up with just a sleeve because getting that damn band out took so long because of all the scar tissue that had formed around it. This could happen with almost any DS surgeon, but I would have to think it's more likely with a less experienced DS surgeon. I would at the very least ask her how many bands she has removed, regardless of what procedures, if any, followed the band removal. If she has extensive experience with removing those damn things, it would be very helpful. Also, will an experienced DS surgeon be assisting during your surgery? That could make a big difference.

2. technical details of the DS - sleeve size, length of common channel, etc. These are things you can, and should, discuss with her ahead of time. Regardless of what she is learning with Dr. Roslin (for whom I have the utmost respect) she could easily use a smaller or larger bougie,  make cc longer or shorter, etc. If she is willing to work with you on these issues, it shouldn't be a concern.

And lastly, I just want to say that I'm always happy to hear that another bariatric surgeon is learning the DS. While I share some of the concerns expressed by others about you being a revision, etc., we need MORE docs doing the DS, and they all have to start somewhere - and being already an experienced bariatric surgeon, and learning from someone like Dr. Roslin, is a great start.

Larra

Darling please please please listen to Sue. 

Please
Please
Please
Please
Please listen to Sue!

We've alllll been here before watching from the sidelines and let me tell you nearly every post like this one that I have read has ended badly.  Try to contemplate the amount of adhesion's you're developed from the crap band, the likely hood that you've erosions or ulcers forming under the band and then add onto the the difficulty of stitching a small bowel and keeping it and your stomach from leaking, add on the MASSIVE risk of rhabdomyalisis from a BMI of 60, sedated and stationary on a table for hour after hour after hour...then add on the extreme complications of anesthetizing a woman of your size for that length of time and you've just lobbed a handgranade into the OR.

Look I'm going to be blunt....You're a surgical night mare NOW.  The fact that someone is willing to do an experimental procedure of such a fragile pre-op in the first place makes me feel a sense of panic. 

I had lots of inter-operative problems and my surgery lasted 11.5hrs, I couldn't read or write for almost a month after and it took me two months to recover sufficiently to go back to work.  My memory is still **** but I am not disabled from a potential extension of a stroke.  I had an excellent, skilled surgeon and an awesome anesthetist who didn't kill me despite bleeding uncontrollably, despite being a BMI of 50 odd.  I didn't lose my spleen which is what would have happened in a less skilled surgeons hands, I didn't get ventilator acquired pneumonia despite almost 24hrs on ventilation.  I lived through a potentially fatal surgical experience because of skill and EXPERIENCE.

You are worth the best care available.

So in summary.....listen to Sue!