Sort of new to the boards.

I'm new AGAIN. I had a lapband placed in July 2005. I'm having it revised to a DS - hopefully with the sleeve at the same time. My doctor is Dr. Cooper in Seymour Indiana. Although I still have a LOT to learn and I'm thinking the sleeve is just part of the DS?  Please correct me if I'm wrong. He's talking about doing it in 2 parts, but I'd rather not have 2 major surgeries. He said if insurance won't pay for a 2 part he could do it all at once.  He uses the robotics and he's one of the first doctors that was pushing for laparoscopic surgeries for bariatrics some 20 years ago.  Someone said there is a list of the top 14 doctors for DS?  Maybe someone can point me over there.  My big thing is that I have PCOS/Metabolic syndrome. I have around 200lbs to lose and I'm not sure the sleeve is going to be enough to effect the Insulin issues. I am super diet compliant and have eaten an 800 calorie diet and lost nothing. I am not diabetic, but have extremely high insulin problems.  I'm also having resistant blood pressure, taking 4 pills and they still aren't bringing it down. I NEED this surgery. At 49 years old, it's important for my health, the weight loss will just be a bonus. He wants to do the sleeve first and then wait around 18 months to do the DS.  I will be right in the middle of grad school then. I start it next Fall and it sure would be nice to have a handle on food etc., by the time I start, considering how rigorous it will be. I guess that's enough for now. I'm working towards collecting a strong base of new friends here. I know you all know a LOT more than I do and I love to learn. Thus the reason I'm crazy enough to go to school when I'm almost 50 and start a new career. Thanks for any help you can offer.

Yvonne

If your surgery has to be done in 2 parts you would get the sleeve first and then later they add the malabsorptive component. Not the other way around.

I would do everything possible to have it done all at once. Because you have a lapband, it's sometimes not possible, depending on if there is damage etc from the band. 

Your best chance of losing the maximum amount of weight is have it done all at once. 

If he just wants to do it in 2 parts and there's no physical medical reason why, then I'd find a new doctor. 

Yeah. I'm reading on the dsfacts.com page that sometimes it's because of age or high BMI (mine is 55). But also he mentioned if there is a problem with the band. I have never thrown up even once with my band. I think my port might be flipped over. But I'd think I'd know if I were having serious issues with my band (erosion etc.)?  He's going to have do an Endoscope so he can look around and see how things look inside. He did say also, if the insurance won't pay for it in two steps he would consider doing it at the same time unless there are all kinds of problems with the band. Thanks so much for answering! 

Yeah. He mentioned that would be the biggest reason of not doing them at the same time. He's doing an Endoscope to see how the stomach looks on the inside (where the band is located) to see if there are any problems. But he said ultimately he won't know until he gets inside to see it.  I went to his support group last night and there were over 50 people. I was quite surprised considering we live in a smallish town. The nurse there said to just tell him you want them done together and if he can, he will.

Yvonne

Your surgeon seems to have a lot of excuses for doing 2 surgeries instead of one. Certainly the lap band scarring could be a problem, but your age? At 49?? Come on, that's not that old. And a bmi of 55, while certainly high, isn't crazy high.

Based on your description of having serious metabolic problems and not losing weight on a very low calorie diet, the lap band was doomed to failure as it has no metabolic benefits whatsoever, and sleeve isn't going to be much better. You really need the full DS and should insist on having the full DS unless there is a specific medical reason (such as anesthesia problem) or anatomic reason (horrible scar tissue from the band, for example) that it just can't be done safely. If your surgeon isn't on board with this it's time to find a different surgeon.

Also, make sure he is planning a real DS and not the SADI or whatever other name may be used for this "variation" on a DS. The long term results for the SADI, both for weight loss and for metabolic benefits, are not known, and this the problems you have you should have something with clearly documented, well known excellent results, and that's the DS.

Larra

I probably wrote it wrong, but the only reason he say he wouldn't be able to do them together is if my lapband was really bad with scar tissue that required extensive work OR if the insurance won't pay for it. But I wouldn't go under without the insurance approving it at the same time.  Even the nurse at the support group last night told me to just tell him I want them done at the same time and she said he'd do it if the band isn't a problem. I feel the same way about success with the sleeve alone. Where can I get a list of the "different" DS procedures so I can educate myself and understand what they are. I don't know what the SADI means. Thanks for answering Larra

I've never heard of an insurance company wanting their patients have two surgeries when it can be done in one. Also how many surgeries has he done with the robot? There are a lot of surgeries that the robot is effective on but I haven't heard of many being used for the DS. I myself would seek a second opinion if he insists on doing it in two.

I agree. I don't think they are going to want to pay for two complete surgeries. Oh and I don't either. I have a horrible deductible and that would put a double burden on us as well. He's done a lot with the robot. 

Welcome! You can use the search function here for information about the SADI there are several people that have had it and post here once in a while so they might weigh in. I haven't seen a list of DS variations. It's just that you should be aware of what the Dr. is planning to do.

Generally, the variations have to do with changing the "switch" component to hopefully provide less malabsorption issues. Sometimes you will see the SADI as the SADI loop or the loop DS, and there are a couple of other newer variations out there. There don't seem to be any stats on better or worse which is the real concern that gets raised. Just raise it with your surgeon so you understand exactly what he is going to do. Early on some people got the variation when they thought they were getting a standard DS. 

Barring any real issues with scarring I think you should keep him centered on one operation. When  a surgeon insists on a 2 step (not your case - I know) it is more an indication of his personal appraisal of his own skill level. 

My surgeon was going to do the op in 2 steps unless I lost over 50 pounds and even then he gave me a warning that if for some reason he had trouble with doing it lap I might only get the VSG but I ended up getting it all done in one operation and I was and am very happy with the results.

Pete

I have looked everywhere on how to search the forums. I have been through the help files. Can someone tell me how to search the forums?  So did you have the standard DS or the SADI?  Just curious. Seems wherever I go everyone is kind of negative about it.  My doctor was very specific about me researching it and coming back with more questions. He didn't seem to be hiding anything. Did he use the words SADI?  No, but the receptionist did when I called and asked.

Yvonne