Vets Please Respond Need Education On Planned 2 Part WLS Specifically DS First phase...

Why is the so called gold standard for the heavier BMI DS to be done in 2 phases. I was working on a case which could have been approved for the DS all at once.   However, when I called the doctors office to reinforce revisions must be 2 years apart I was told the above. Now the nurse in me understands the heavy you are the greater concern for the length of time under anesthesia but the other side of me thinks one surgery instead of two is best. Can any of the vets that have been around and noted individual cases with a higher BMI as in >60 why would they do it in 2 part rather then one?  Secondly have you ever heard this is the gold standard or is this just one physicians or approach at WLS?  What I read was if the sleeve was not effective then they would complete the second round of surgery for malabsorption??????????  I would think one would need the malabsorption portion of the DS in order to be successful?  Or is it the MD is reluctant to do the entire DS hoping some pt's would not need it?  OK now I am rambling just very curious! Thanks for any insight. Donna

I think this varies greatly by the comfort level of the surgeon, with the exception of health issues related to the weight.  I know of people with very high BMI's that not only got it all at once, but Lap to boot.  IMO, too much can happen in a year or two to depend on being able to get that second procedure.  Jobs change, insurance is lost, not to mention all of the risks of an additional surgery that concern you, too.  

Doing the DS in 2 phases is not the gold standard. Whoever is telling you this is using this rationale as an excuse. In reality, most DS surgeons try their very best to get the whole thing done in one operation. Not only does this spare the patient two rounds of surgery, anesthesia, and recovery, it seems to work better than doing the restriction and the malabsorption separately.

   It's true that for some patients, for medical reasons, it is necessary to break the operation into 2 parts to get the patient off the table faster. This could be due to weight, or due to, for example, a severe heard problem. But that still doesn't make this approach the gold standard. And even then, most DS surgeons want to get the second part done after maybe 6 months, not 2 years.

Your instincts are right. Someone is trying to sell you a bill of goods.

Larra

Thanks this did not sound right to me!!!

Someone is feeding you a line of baloney!

 

Unless there are VALID health reasons for doing the surgery in 2 phases, a one step surgery is the gold standard.  And if you are hearing the high BMI line, baloney again.  There are plenty of one step DS done on people in excess of 500lbs.  Some surgeons, like the Rabkins, Baltasar, even do it LAP.  And you know most patients over 500lbs have some serious co-morbs too.  

 

Usually the 2 stage DS is indicative of the surgeon's ability/skill level.  Personally, I want a surgeon skilled enough to do the whole op.  I don't want to go through two surgeries/recoveries and pay twice.

 

Gosh I knew my gut was telling me inquire as I could have approved this mbr for the DS automatically.  It is not my place to contact the mbr only the provider who put in the request to let them know if it has been approved.  I am not blowing smoke as my nursing career has not been WLS but rather ICU and Recovery.  Since I have been doing case management I have been exposed to more.  Specifically now I am doing precerts and although WLS encompasses a very small amount of my job and I am thankful as it kind of boring I still want to advocate for the member.  Hence the reason why I called the office unfortunately the individuals I generally speak with have less education then I and are generally the surgeon tech.  I assume the surgeon fills the tech head with what he thinks is best.  I have been at this new job little over 90 days and I have approved everything but the DS.  I was so excited when I read in the record the tentative plan if mbr did not have enough wt loss they would do a DS.  I thought if I made the call perhaps if I explained the little boxes we must check off that the member could be approved for DS they would possible do it but instead I was saddened to hear the above.  I even emphasized the fact the individual would have to wt 2 years to consider a new WLS as that is the guide lines written in this particular plan.  I did a lot of prep work prior to my surgery and forgive me as I cannot think of the phrase at this particular time I read over and over “cut once”.  Just because I have an education I know my limitation and I have been blessed by this site and the advice I have personally received.  I need the job as I must provide for my family but when I see this kind of stuff and this is the first time dealing with a DS I cannot help but want to have more of an impact then if I did not have the personal experience.  At the same time is it because I am a new DS that I think it is the best?  I was a prior failed lap band and I so wish someone would have reached out to me. 

Some people hate to admit they are wrong and it's usually to their own detriment.  Then you have the docs are Gods surgeon worshippers.  Medicine is big business and everyone is out to make a buck.  We all hope our medical professionals have our best interest at heart but too often that's not the case.

 

Part of the patient's responsibility is due diligence.  Too many just accept what they are told by a doctor and don't do their own research.  But there's another side to this.  DSers have to be able to advocate for themselves and educate our medical caregivers.  It's a valid argument that a patient who doesn't do their due diligence is perhaps not capable or inclined to deal with other aspects of the DS and therefore is not a good candidate.

Very interesting response.  Thi**** home and there does come a point when I can only do so much.  If a doc suggested 2 surgeries to me the first thing out of my mouth would be why?  I will do my best to advocate ie calling the MD and emphasizing the person could be approved for the DS up front and if they do opt to do a second surgery make sure they understand there is a 2 year waiting period per the federal portion of the ins company.  At that point I feel I have done my diligence and it true if the member is not asking questions then perhaps they would not be bold enough to advocate for their own health care post DS.  It is just the kick in the pants I needed to put this in perspective. 

Listen to Larra and Patty.  They know what they are talking about.  Cut once is right.  Getting the complete DS gives better results than doing a 2 stage surgery.  Why would you want to undergo TWO different surgeries that will give you less efficacy than ONE surgery.  Your gut is steering you correctly.  Go with your gut.