surgeon willing to do DS??
Hi everyone, I was wondering if any of you know a surgeon willing to do DS on me with a "low" BMI? I had VSG done 2 years ago, and lost weight the first 6 months, but been with the same 20-25 lbs to go for a year and a half now! I exercise 5 days a week, and try to watch what I eat, but can never get to my goal! I which I had the DS in the first place, but since I lost 30 lbs with the VSG, no surgeon will touch me because I no longer meet the criteria for WLS. PLEASE HELP!! Thanks :)
Sigh. This is one of the reasons I kept warning the pre-op VSGers about why they should go for the whole enchilada (and get to eat it too) and get the DS from the git-go. I think they are being sold a bill of untested -- and unlikely to work -- goods.
1) No insurance company will cover it, that's for damn sure.
2) I know LapSF in San Francisco will do the LapBand for self-pay foiks with a BMI under 35, and they do the DS, so maybe you can talk them into letting you self-pay for the swtich.
Even if they are willing to do the switch, however, you may be past the window of opportunity for your sleeve -- which is now stretched out -- to work synergistically with the switch. And re-sleeving you is VERY much more dangerous revision surgery than your initial sleeve, unlikely to be justified if you don't even qualify for WLS anymore.
1) No insurance company will cover it, that's for damn sure.
2) I know LapSF in San Francisco will do the LapBand for self-pay foiks with a BMI under 35, and they do the DS, so maybe you can talk them into letting you self-pay for the swtich.
Even if they are willing to do the switch, however, you may be past the window of opportunity for your sleeve -- which is now stretched out -- to work synergistically with the switch. And re-sleeving you is VERY much more dangerous revision surgery than your initial sleeve, unlikely to be justified if you don't even qualify for WLS anymore.
Thanks Diana,
That's what I figured...I know I would have to pay for it, but to me it's worth it. People are allowed to pay for boobs, liposuction, whatever they want...just seems unfair that if you are willing to pay for this service that you still need to "qualify". I emailed a place in Mexico...maybe outside the US they aren't so strict on the guidelines.
That's what I figured...I know I would have to pay for it, but to me it's worth it. People are allowed to pay for boobs, liposuction, whatever they want...just seems unfair that if you are willing to pay for this service that you still need to "qualify". I emailed a place in Mexico...maybe outside the US they aren't so strict on the guidelines.
mew6495
on 12/13/08 10:38 pm - MI
on 12/13/08 10:38 pm - MI
If you're just looking to get the "switch" part of the intestinal portion done you might want to check into Dr. Schlesinger in Phx Arizona. I had a low BMI and had my original RNY in 2001. I started gaining weight back and went for a revision before I gained it all back. I chose to go with the ERNY simply because I did not want the higher risk with reconstructing the pouch. Dr. S was willing to look at my situation and make recommendations. He did not treat me as a number (BMI). The revision gave me the shorter common channel. Like Dianna mentioned some doctor's don't like to revise the "stomacH" portion due to the elevated risk. So there are some options out there. Nice to see you are doing your research.
Good Luck to you.
Good Luck to you.
Just to be clear: the ERNY is VERY different from the switch. Dr. Schlessinger does revisions and very occasionally does the DS, but I have NEVER heard of him agreeing to revise an RNY to a DS -- I consider him one of the "bait-and-don't-switch" surgeons on that account.
However, since you already have the VSG, he MIGHT be one who could do the switch for you, if you are willing to pay his price.
However, since you already have the VSG, he MIGHT be one who could do the switch for you, if you are willing to pay his price.
Hi Jane,
With the original 50 pounds you had to lose in the first place, malabsorption with such a low BMI seems really radical. I am not trying to make light of the fact that you want to lose another 20 lbs, but I have never heard of a doc doing a DS on a patient with 50 lbs to lose total. I know the DSers will chime in here and disagree with me, but it would seem if you were able to lose and maintain your weight loss, that means you have been successful with a 55% EWL at two years post op with the sleeve. Better than the band statiscally and almost equal to RNY. It could have also been possible that you would have lost way to much with a malabsorptive procedure and been crying about malnutrition and a BMI that is scary low too. There is always a trade off I know that being malnourished and underweight can be a problem for really low BMI's I wish you much success though!
Babs
With the original 50 pounds you had to lose in the first place, malabsorption with such a low BMI seems really radical. I am not trying to make light of the fact that you want to lose another 20 lbs, but I have never heard of a doc doing a DS on a patient with 50 lbs to lose total. I know the DSers will chime in here and disagree with me, but it would seem if you were able to lose and maintain your weight loss, that means you have been successful with a 55% EWL at two years post op with the sleeve. Better than the band statiscally and almost equal to RNY. It could have also been possible that you would have lost way to much with a malabsorptive procedure and been crying about malnutrition and a BMI that is scary low too. There is always a trade off I know that being malnourished and underweight can be a problem for really low BMI's I wish you much success though!
Babs
Ignorance is curable.
The switch can be done in a titrated way -- the alimentary and common channels can be made a length that is appropriate to the patient's size and metabolic needs. The malabsorption doesn't actually cause that much weight loss by itself -- it corrects the metabolism and helps MAINTAIN the weight loss.
You're 9 months out with your VSG. You don't know what you are talking about on this topic. Let's see what you are saying at 3 years out.
The switch can be done in a titrated way -- the alimentary and common channels can be made a length that is appropriate to the patient's size and metabolic needs. The malabsorption doesn't actually cause that much weight loss by itself -- it corrects the metabolism and helps MAINTAIN the weight loss.
You're 9 months out with your VSG. You don't know what you are talking about on this topic. Let's see what you are saying at 3 years out.
While I agree with you about the 55% EWL being comparable to the RNY and better than lapband, i disagree that a malabsorptive procedure means malnutrition and a scary low BMI for lightweights.
The DS minus the stomach resection is performed in Europe for cure of diabetes in the NON morbidly obese and the weight loss in those instances is minimal:
Duodenal Switch without Gastric Resection: Results and Observations after 6 Years
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Duodenal Switch without Gastric Resection: Results and Observations after 6 Years
Maria Laura Cossu1, Giuseppe Noya2, Gian Carlo Tonolo3, Stefano Profili4, Giovanni B Meloni5, Matteo Ruggiu6, Patrizia Brizzi7, Franca Cossu8, Luca Pilo9 and Pier Luigi Tilocca10
| (1) | Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy |
| (2) | Dipartimento di Scienze Chirurgiche, Universita' di Perugia, Italy |
| (3) | Servizio di Diabetologia, Istituto Clinica Medica, Italy |
| (4) | Istituto di Scienze Radiologiche, Universita' di Sassari, Italy |
| (5) | Istituto di Scienze Radiologiche, Universita' di Sassari, Italy |
| (6) | Servizio di Diabetologia, Istituto Clinica Medica, Italy |
| (7) | Servizio di Diabetologia, Istituto Clinica Medica, Italy |
| (8) | Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy |
| (9) | Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy |
| (10) | Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy |
Published online: 01 November 2004
Background: The results on metabolic effects of the classical biliopancreatic diversion (BPD) have led us to investigate the operation without gastric resection, thus preserving stomach and pylorus, in patients who are not seriously obese but suffer from hypercholesterolemia, often associated with type 2 diabetes and hypertriglyceridemia. Methods: Between 1996 and 1999, we performed the duodenal switch (DS) without gastric resection on 24 mildly obese patients. Mean preoperative BMI was 36.2 kg/m2. 17 patients (70.8%) suffered from type 1 diabetes, 4 (16.6%) had impaired glucose tolerance, while the remainder had fasting hyperglycemia. In 20 patients (83.3%), hypercholesterolemia and alterations in lipid profile were present. Another 20 patients were taking drugs for arterial hypertension. The pluri-metabolic syndrome was present in 41.6% of patients. Results: Mean follow-up was 4 years. BMI reduction and weight loss were not large. 2 patients who had severe longstanding diabetes type 2 needed a second operation of the classical BPD because of failure in improving diabetes. Another 2 patients were changed to classical BPD because of a relapsing chronic duodeno-ileal ulcer. The incidence of ileal ulcer was 29.1%. Regarding hypercholesterolemia, hypertrigliceri-demia, and type 2 diabetes when there is a good pancreatic "reservoir", the operation seems effective in the long-term. Protein absorption is better than that obtained with the classical BPD. Conclusions: Our long-term results suggest that in carefully selected patients suffering from serious hypercholesterolemia or type 2 diabetes with insulin reserves still at an acceptable level, and with BMI 30-40, DS without gastric resection can be proposed as a surgical treatment for metabolic diseases but not for obesity.
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