Dr. Gagner no longer able to accept American patients in Canada-Need new revision surgeon

Cross-Post from revision forum-

Hello all-

To give you a little background:

I had RNY (Foby Pouch) in 2001 with Dr. Marema in Fort Lauderdale, FL and did well with it at first, losing from 417 to 195 and feeling pretty good. Like many however by 2010 I had numerous problems with severe dumping, and regain to 270.

I decided to have a revision to DS and researched many surgeons including Dr. K, Greenbaum, Pomp and Gagner. In the end I decided to go with Dr. Gagner in Montreal because he was only one who offered a totally laproscopic approach and seemed confident he could complete the revision in one step and amazingly my insurance agreed to let me go to Canada for the surgery as well.

I went for the revision and surprise, surprise he was not able to complete the entire revision due to operative time, adhesions etc. So, he completed the reversal of the RNY and and formed the new wide sleeve as stage 1 of the DS. Everything went well and he advised me to return in six months for stage 2 of the DS.

During those six months we lost the insurance coverage as my life was laid off and had to go on my plan which would not cover anything and cash pay was not a viable option so I was not able to return for stage 2. I did my best to live with just the wide sleeve and managed to drop 50 lbs again down to 220. Over the last four years however it has become apparent that the sleeve which was made larger than a traditional VSG sleeve in order to accommodate future malabsorption offered very little restriction and I began to regain.

So, last may I contacted Dr. Gagner and asked him what the cash price was to have him complete stage 2 in Canada. He responded quickly and told me I had the option of completing stage 2 of the classic DS for $15,500 or the SADI-S for $13,000. I was happy with that as it certainly a great price for a world class surgeon with his safety record and I was very happy with the care at Sacre-Couer in Canada during my first stage. I began to save and look for ways to finance the completion of the DS or SADI-S.

Just this week I was finally able to proceed and I contacted Dr. Gagner to ask about scheduling stage 2. I was shocked when he responded that he could not complete my surgery this year as the CMPA (Canadian Medical Protective Association) will no longer allow surgeons there to accept Americans for "elective" surgery and basically his hands were tied.

He suggested that I contact Dr. Roslin or Dr. Pomp in NYC. I did so and Dr. Roslin's office quoted me $41,000  and I am awaiting a quote from Dr. Pomp's office. So, it's pretty obvious that the broken medical system in the US may leave me again seeking care out of the country.

I have identified two seemingly viable options and would like feedback from the community here concerning them. Option one is to travel to Madrid, Spain where Dr. Pernaute has quoted me a price of $12,000 US to complete stage two as a SADI-S, this seems very fair and in line with other surgeons outside of the U.S.A. He also seems to have a very good reputation although I don't see him listed here under the list of DS revision surgeons. Option two is Dr. Ungson in Mexico for revision to either the classic DS or SADI-S, his pricing is about the same as well.

So, does not anyone know of any other reasonable cash pay options? Any reason why I should not consider one of these two surgeons? Am I making the right choice of procedure? (I am somewhat concerned that since the intial sleeve revision was done four years ago and does not offer much restriction I may have trouble losing the weight as the restriction from the sleeve usually helps with initial weight loss and the switch with maintenance.) It has been suggested to me by a surgeon here that I should have revision back to RNY with a 150 cm alimentary channel???????? Any and all input is welcome and appreciated. Thank you.  

I would go with Ungson if it were me and ask if he can tighten your sleeve. And why anyone would consider the SADI I have no idea. You have had too many failed surgeries to consider an unknown quantity IMO. 

Thr rny has already failed you.  The SADI is unknown and new.  Me personally, I would go to Ungson and get the real DS.

The SADI, or SIPS, or Loop DS - all the same thing - all experimental, so you're walking into the unknown.  Some are seeing good results, while another is not, and there is absolutely no long term data on this procedure.  Just the fact that so many surgeons that never before did DS can do SADI in no-time concerns me.

Dr. Dennis Smith in Atlata or Dr. Bonnani in Conyers GA both do DS.  If you must travel out of the country, I would recommend talking to Dr Gilberto Ungson in MX, Dr. Jao Marchanesi in Brazil or Dr. Baltazar in Spain.   They are long-term vetted DS surgeons with many happy patients with good results.