Complicating factors to my DS

Okay, we did NOT discuss a pouch, but you guys are very wise to suggest that I get that in writing, because I agree, I DON'T want one! A big part of the attraction of the DS to me is that I will have a fully functioning mini-stomach.

Unfortunately, Medicare, which is my primary, will not pay for a two-part surgery. period. At least, that is my understanding.

Past patients of his have told me that he went through "plans B and C " with them, too. I am hoping that it is his personal style with patients. Then, he did perfect DS's. I think I will go to his office forum, and inquire among folks there, as well.

Thanks for all of the suggestions. I am taking every one quite seriously

Lisa

I had Dr. Simper, I also did not have any of the issues you have.. BUT I do want to mention that Dr. Simper is very open to further explanations and really helping his patients understand what he is saying..I wrote down questions in a book and topics that I wanted more info, everytime I thought of something that way when I saw him I had everything wrote down and then could write my answers down and then later sit down and read the information with a clear mind.. It sounds to me like maybe you need more information and understanding of what he is saying..then by all means get a second opinion. Good luck!

I have what it sounds like you're at risk of getting - a VSG stomach with only about proximal RNY intestinal bypass. What it means is that today, I believe I have NO caloric malabsorpion. I never had a single sign to lead me to believe I was malabsorbing fat, not even early out (at least, not enough to show signs).

I did not plan for this to be what I woke up with - my surgeon chickened out about some adhesions I had from a prior open abdominal surgery (removal of a 10-inch ovarian cyst, additional smaller cysts, and the ovary they strangled). From that surgery, I had an open incision from just under my belly button all the way down to my pubic area. 

I am confident that, had I gone with a more experienced or determined surgeon, I would have gotten a true DS.

That said, it's not the end of the world. I still wound up with VSG restriction and a little bit of temporary malabsorption, which brought me from my morning of surgery weight of 308.5 to my lowest of 175. I also watched my type 2 diabetes slink away to remission, which was my primary objective in getting any WLS in the first place. I am now pregnant and have the utmost confidence that I will have a healthier pregnancy and baby as a result of having had my WLS than if I'd had a baby while morbidly obese. So, despite not waking up with what I wanted, I can't say it's been all too terrible. Do I wonder how things would have been different had I actually gotten a true DS? Absolutely! But it is what it is, and I'd rather keep what I did get than to not have had any WLS at all. And I'd MUCH rather keep what I have than to have ended up with a regular RNY!

Jill, thanks for letting me know what it is like to have the hybrid operation!

I definately will write things down, and write down the answers, and get it in writing when I sign papers that I do NOT want a pouch. I would rather try to lose weight the old fashioned way than have my stomach mutilated like that!. It really seems like more of a Junction than a Pouch!

I do think, however, that this is my one chance to have wls, and that if he can only do a hybrid, then that is what I will get. I do want to ask him, however, what the purpose would be of a proximal switch like in the RNY if it would only get me minimal malabsorption. Perhaps it would be better to leave it as a fastric band -- oh, I forgot -- Medicare won't pay for those ARGHHHH!

Anyway, thank you all so much for weighing in on this. I really appreciate the advice and help!

Lisa

WHAT YOU DI SCRIBE IS CALL A NISSAN FUNDIPLICATION, IT IS A MAJOR SURGERY,  FAR MORE COMPLEX THAT A DS WHEN IT WAS DONE IN THE EARLY NINETIES, AND WASN'T APPROVED FOR LAPROSCOPI****IL 1995 WHEN I HAD IT DONE. 
  ONLY TWO DOCTORS THAT I KNOW ARE WILLING TOO HANDLE A DS WITH THIS IN PLACE, DR GAGNER WHO RX IT FOR ME IN 04 AND DR ANTHONE WHO DID IT FOR ME ONE YEAR AGO TOMORROW.  HE DID A VERY SPECIAL VSG, PORK CHOP SHAPED SLEEVE LEAVING THE WRAP IN PLACE PREVENTING ANY REFLUX AND PROTECTING MY ESOPHAGUS FROM EROSION AS I HAVE BARRETT'S.  I HAVE ACHIEVED GOAL,  LIFE IS GOOD.  

Yeah - that's it - the fundoplication thingie. Dr. Simper said that it was a big deal to undo one. I even suggested that maybe, if it all would be easier to do with an open incision, perhaps it would be better to open me up and do it that way... I told him I would be willing.

But he said that he wasn't willing - that the chances of complications were so much greater with an open surgery, that he would only open me up if it was needed to save my life. 

SO - I guess I'm having a laparascopic un-fundoplication/DS with possible hybrid intestinal re-routing.

That is interesting about the porkchop-shaped sleeve. I will mention it to him.

I'm going to call his office after I get my questions all worked out on paper.

Thanks,

Lisa

I PROFOUNDLY disagree with this assessment of open surgery. I call it BULL**** especially in a situation like yours.

DR ANTHONE DOES THE revision and all his surgeries open,  and he doesn't undo the Fundy, i have all the benefits of the Fundy and the ds.  total comfort.  this is the same as what Dr gagner also prescribed,  in 04 and i like you went through many surgeons who talked and walked liked simper , i refused , until i was able to have Dr Anthone care for me.
 no complications, and surgery only took 45 mins.

 A more experienced surgeon should be able to do this for you, even with adhesions.  Prior to my DS I also had my gallbladder removed, tubes tied, ectopic pregnancies, and a total hysterectomy.  My DS took over 6 hours and my surgeon said my intestines were fused together like concrete, but he got it done.

I would absolutely refuse a pouch.  You're better off having him close you back up and do nothing than to get a pouch.  

I think the most important things are:

1. as Diana said, make it crystal clear in advance and in writing that no matter what difficulties your surgeon finds, you do not want a pouch done. Write it on your consent form. Even if all he can do is take down the Nissen and leave everything else for later, at least that wouldn't burn any bridges. Disappointing, yes, but maybe then you could have a real DS in 3-6 months.

2. You mentioned that your insurance doesn't cover a 2 stage DS. But there is a difference between a planned 2 stage DS and a planned one stage that, for medical reasons and based on the judgement of your surgeon while he's in there and in the interest of your safety, turns into an unplanned 2 stage DS. Discuss this with your surgeon and/or his insurance people and see if maybe the unplanned 2 stage would still be covered.

3. I think you need more info on exactly what he was talking about with the intestinal stuff. I bet after he told you about the difficulties he now expects and how you might not get your DS you didn't hear half of whatever else he said. Perfectly natural! Now that you've had a change to catch your breath, get more info. Personally, I would, if needed, just get the VSG and go back later rather than creating something with minimal caloric malabsorption that will provide, at best, a little bit of short term benefit and no longterm benefit, and that would have to be taken apart to create a real DS later on. But get more info and then make your decisions.

Larra