RNY to DS: How to help?

I'm very concerned about the state of RNY to true DS conversions based on recent conversations. Although all is based on heresay, both Greenbaum and Roslin (qualified surgeons) are not often granting RNY to DS conversions. Husted is, well, Husted. Which leaves the population of needing RNY'er with a diminshing population of RNY to DS conversion surgeons, even worse for those living outside of CA (most of us).

The population of disappointed RNY'ers is growing, but the population of RNY to DS surgeons seems to be diminishing.

WE NEED TO DO SOMETHING (anything, really).

Questions:

1. What can we do to get current trained surgeons to do true RNY to DS conversions? We cannot lower their insurance premiums, but can we help them to publish? Can we help them in terms of patient reporting and compliance? Goodness knows that this bunch here is pretty good in terms of knowledge and compliance, even in front of front-line physicians.
2. What can we do to understand the unwillingness to do true RNY to DS conversions. Is it death rate? Surgical non-payment? Length of surgery? Really, what is it?
3. We have to change the "one surgery per lifetime" clause. That is a recent dodge by the insurance industry to account for the poor results of RNY and band surgery. Goodness. It's not a patient's fault when this crap fails. 
4. How can we get younger surgeons to train under masters to do this complicated procedure?

I want to focus on the big picture. How can we improve the future?

Recent threads of concern:
@font-face { font-family: "Times New Roman"; }p.MsoNormal, li.MsoNormal, div.MsoNormal { margin: 0in 0in 0.0001pt; font-size: 12pt; font-family: "Times New Roman"; }a:link, span.MsoHyperlink { color: blue; text-decoration: underline; }a:visited, span.MsoHyperlinkFollowed { color: purple; text-decoration: underline; }table.MsoNormalTable { font-size: 10pt; font-family: "Times New Roman"; }div.Section1 { page: Section1; }

http://www.obesityhelp.com/forums/ds/4471154/RNY-to-DS-Revis ion-DR-Greenbaum/

 

http://www.obesityhelp.com/forums/ds/4469986/meeting-with-Dr-Roslin-today/

 

http://www.obesityhelp.com/forums/ds/4470386/ANYONE-KNOW-WHERE-DR-HUSTED-IS/

Thanks for this.

I am in the process of getting insurance approval, for a revision to DS with Dr. Roslin.

However it does seem like there are not many surgeons will to become DS vetted surgeons.

Maybe there is lack of training available??

I think we just have to emphasize how important it is to get the RIGHT surgery the first time.  That is something we can control.   Information is key.  We need to be honest and vocal about the benefits and pitfalls of the various surgeries.  I did not discover all the statistics about regain until after I started gaining my weight after the RNY.  Maybe if I had made a better choice initially I would not need a second surgery.    

I made a bad surgical choice the first time  based on the information that was available to me. I knew about the DS but was assured I would have similar results with the RNY. I guess we often give newbies the wrong impression that it is easy to get a revision. There are so many people on the revision boards and even on this board  it makes a revision appear almost easy or commonplace. 

I wish more surgeons would be honest about these surgeries and their outcomes.  Perhaps if they were compensated appropriately they might be more interested in performing the more difficult surgeries the first time instead of performing quick and easy surgeries that "might" have good outcomes. 

Unfortunately I think the onus is on each of us to research our options and choose the best surgery the first time. Knowledge is power and we need to arm ourselves in an appropriate manner.   We may not have an opportunity to "fix' a bad surgical choice.

Vee

One of the biggest blocks to this kind of surgery is the bottom line. RNY to DS revisions are risky, and bean counters want to limit liability. Add to that the fact that insurance companies give such small reimbursal amounts that the hospitals don't make nearly as much as they would from other surgeries, they have less incentive to offer them. I believe that these health care organizations actively discourage their doctors from pursuing this kind of surgical technique.

I'm glad I had my revision with Dr. Greenbaum when I did, and I am sorry that he's not comfortable performing as many of these revisions now, but I can understand where he (and Dr. Roslin) are coming from with this.

1) Requires high level of skill and training to do a true revision
2) Takes more time to do
3) Risks of complication high

For this, you don't want to force a doc uncomfortable with doing this type of revision to do it, for fear of what could possibly go wrong.  It's best to travel to get one who is willing and able, and even better if they knew about the DS the first time around.

It is a high risk, complex surgery. 

Rabkin and Dr K in California are the rock Gods of the revisions. 

Besides them, I think there is another "tier" of revision surgeons.  You mention Greenbaum and Roslin.  Greenbaum used to be the third part of the Rabkin, Dr K, Greenbaum revision elite list, but due to complications, possible hospital issues, whatever, he's really pulled back on doing them.  That's cool if that's what it is, but what is not cool is that there have been stories of him stringing people along and pusing an ERNY.  Roslin (he's my surgeon so I talked to him about this), is more up and coming on the revision front, but wont take too complex of a case.  As he builds his experience he probably will, but I respect that he works within his own boundries now.  I'd be surprised that he'd offer an ERNY to anyone because he's very vocal against the RNY and bypassing the pyloric valve.

Along with that second "tier" of revision surgeons, I would mention Dr Stewart in Texas and Dr Elairny (sp?) in the DC area.  I know both are starting to do revisions but none have the experience of Dr Rabkin and  Dr K.

No way in hell would I get an RNY to DS revision by anyone other than those I mentioned here.  Maybe Gagner but I dont know that he's doing them.

Joanne,

Gagner IS doing them.  I have been in contact with him in the last 12 months.

I have also heard Buschwald in Minnesota is doing RNY to DS revisions as well.


But I agree that this IS too SMALL of a list!!!!!!



-Jamie

This is certainly a growing trend as more people who had the RNY and Lap Band surgeries start to regain the weight it is definitely going to create an increased need for doctors to perform revision surgery.  I still think one solution is preventing the need for revisions by increasing the number of surgeons that provide DS surgeries as a first option.  I think if a surgeon is comfortable performing the DS on a regular basis then perhaps they would be more open (less intimidated) by the possibility of doing a revision.

Perhaps bariatric surgeons should have rankings based on the types of surgeries they are able to perform.  The top tier surgeons would all be required to demonstrate competency in all 4 weight loss surgeries and  they would be reimbursed from the insurance companies at a higher rate based on their expertise.  This would encourage bariatric surgeons to offer all 4 surgeries. That would level the playing field when we examine the surgical stats.  The problem with just looking at the stats is that unless the surgeons are all performing similar surgeries aren't we comparing apples to oranges when we compare their complication rates?

I really do not know how we can convince more surgeons to provide this life saving surgery without some system in place to reward them for the extra level of skill that is required.


Vee