I'm really confused now. More than usual!!

Hello all. I really need some advice. After learning that my insurance most likely will not cover  the VSG, I have been researching my butt off and I believe that the DS is the right procedure for me...I have a very long list of pros and con's but the pros won hands down.

Anyways, I had my 2nd appointment with my surgeon today. I asked him if he preformed the DS and he said he did, but people rarely ask him about it because it is not well known. He referred to it as "the gold standard of WLS". I told him about all of my research, and that I have read that it is the most complicated and complex surgery out of them all. He kinda looked at me sideways and said "It is no more complicated than the RNY, it is just different". OK, his opinion I guess. Then I asked the million dollar question "Have you done many of them?" He flat out told me no, because it was not as well known as the other 2 major surgeries. He didn't seem the least bit concerned about preforming the surgery on me. He did say I could experience gastrointestinal issues, but in order to combat that he makes the common channel longer, 150 cc. He seemed so confident, but it is contradicting to my own research. He specializes in WLS revisions which are often more complicated than the original surgery. He told me of a recent revision of a DS in which the patient was experiencing severe nutritional deficiencies. He explained that her common channel was only 35 cc. He is also a cancer surgeon which requires much precision and skill. So, since I trust his abilities as a surgeon, do I let him do my DS? Even though he has not done many of them (but has revised poorly done ones from other surgeons).

Thank you for your help!!

That's a tough on. You might also want to check www.dsfacts.com The list of DS surgeons there are vetted pretty thoroughly. Perhaps you might want to talk with one of them as well and then make your decision.

Keep us posted.

--gina
 

Last time I looked they didn't have any from AZ, even though I  know of a few. I really like this doctor and he makes me feel very at ease but this is my life and I need to be sure. Would a doctor feign confidence of something he wouldn't be good at?? You would think  if he had doubts he wouldn't touch it with a ten foot pole. He currently has a zero mortality rate. I should probably ask him the exact # of DS's he  has done cause I really don't want to be his first...or even his 10th!!!

 Would a doctor feign confidence of something he wouldn't be good at?? 

Uh, yes! if that' what it took to hook you.  This may well be his "bait" protion of the routine.  "Sure I do that one, no problem, blah, blah, blah" then you get to know him, you like him, and it' convenient.  If he later says you insurance wont cover it or the or chedule wont allow it, or there will be a delay for a DS and why dont you just go with RNY, it will be no be shocker, right?

Some red flags:
A) if the reported revision patient had a 35cm common channel, then that patient likely did not have her DS done by a reputable surgeon. I've never heard of a contemporary urgeon who makes CCs that infantesimally small.

B) a 150cm would not, in my opinion, be considered long for a contemporary DS CC

I have no knowledge of this doctor and did not do a single instant of research.  I have no idea if he's legit or not.  But yes, absolutely, many many many surgeons have led patients to believe that they do all WL surgeries including DS when that was simply not the case.

Good Luck
d2k

Now if he recognizes (correctly, IMHO) that the DS is the gold standard, and believes it is no more difficult than RNY, just different, and believes he hasn't done many because people don't know about it, WHY isn't he TELLING his patients about it? That way, they WOULD know about it. Some would choose it, not all, but it really bugs me that bariatric surgeons know there is this great option available and don't bother to tell people it exists, let along recommend it.
     I would recommend getting a second opinion, just avoid Schlesinger.

And while anyone would agree that a common channel of 35 cm is way too short and should never have been done, my personal opinion is that 150 cm is quite long, though there are some very reputable DS surgeons doing this. The classic DS is a 100 cm common channel, or some surgeons use the Hess method to base limb and cc lengths on the total length of small intestine.

Larra

Funny you should mention Schlesinger cause my insurance only contracts with 3 bariatric surgeons. One of which is Schlesinger and the other does not do them (to the best of my knowledge). I have read mixed reviews on him. Do you have personal experience?

Larra, while 100 cc is "classic", many surgeons prefer to tailor the cc to the individual...esp for lightweights. A cc of 150 is not too long for the right person. Example, my husband's is 150 and he has had NO trouble losing to goal and below. Mine is 175 cc and I am way below my surgeon's goal of 140, which would have given me a 24.8 BMI (I weighed 123 yesterday). As some say in the diabetic world "your milage may vary".

Liz

Liz, I agree, 150 may be just right for some people. I think taking it's appropriate for the patient's individual picture to be taken into account. It just sounded like this surgeon might have a "one size fits all" concept with 150 cm being the one size, and I would disagree with that.
    Definitely something for the OP to discuss with the surgeon while she's still pro-op.

Larra

This is really tough. I know that a surgeon has to start somewhere, but I would want someone who's been mentored by another DS surgeon and who has done more than a couple.

You're right. There's no one in Arizona, I'm in OK and there's none here either. Since mine was a revision from a RNY to DS, I only had a choice of a few physicians.....I traveled.

I know it's a hassle, but in your place, I would look to travel too. Just my 2 cents,

First and foremost, most physician's are very arrogant.  He sounds (to me) over confident, especially with the comment that it's no more difficult than a RNY.   Hmmm.

Personally, I would seek a second opinion OR I would travel out of Arizona to a vetted physician.  I wouldn't trust my life and health in the hands of a physician who seems way over confident for someone who hasn't performed this surgery routinely.

Just my 2 cents...I wish you the best.