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

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.  

If you haven't cross posted to the DS forum I would advise you do that as they are far more familiar with the best surgeons for any surgery.

Thank you, I will cross post to the DS board as well

doesnt surprise me with Gagner and only doing the VSG, he is a slippery fella, I would stay away from him.  You have a very important question to ask yourself, do you want the SADI?  Make very sure you get the DS if that is what you want.  Lennox hill has the highest price for the entire country....welcome NYC, so stay away from there unless you have deep pockets.  Personally I would do a couple things.  First you say your vsg may have stretched?  so you may need a resleeve at the same time as your DS.  Contact Dr Keshishian in CA, for his cash price.   Personally I would not get the SADI, that will be your choice to make.  I would feel comfortable with Dr Pernaute if he did the DS only.  It is also very important to actually speak to your surgeon, I am sure with Ungson you will have an issue actually speaking with, if that is not important to you, then a resleeve with DS with Ungson is probably your best bet.  Still contact Keshishian.  Good luck in your search for health

Thank you for the reply.  What's done is done so I can't go back but I won't say I wasn't disappointed to have coverage for the revision and then wake up with only the sleeve done, especially since I went to Canada because I was assured it could be done in one stage there.  I could have gone to Dr. Pomp in NYC who told me up front it would be two stages and he was also covered by my insurance at the time. But that was then and this is now so I have to face the cash pay prospect and make the best choice possible.

 I was also thinking that I may need a resleeve at the same time and I will have to discuss that with the surgeon and hopefully if needed he will agree to do it at the same time.  As far as I remember Dr. K was only offering an open approach but I will check with him.  I am hopeful that any revision needed can be completed laproscopically at this point.

I see that you say you would personally not get the SADI.  May I ask why?  From everything I have read it seems to quicker, safer, and offering very good results as a second stage to the sleeve.  I know it is not nearly as vetted as the classic DS but Dr. Pernaute has been doing it for seven years now and that's a pretty good history.  I have had multiple surgerys over the years with rny, sleeve revision and multiple plastics, so the idea of quicker and safer sounds pretty good at this point especially if I am traveling a long distance for the surgery. That being said, if there is something I am missing please let me know.

My inclination as of right now is leaning toward Dr. Pernaute in Madrid for the SADI for experience, track record, and very fair pricing as well. I understand that he has also performed the classic DS for many years as well and that would be an option in his hands as well.  Of course it would be far more convenient to be here in the U.S. but there doesn't seem to be a viable option here and between Dr. Ungson and Dr. Pernaute both would require significant travel so why not go to the inventor of the procedure?

I wonder why he is no longer able to accept patients from america, even though they are paying out of pocket?  Is it because he does the DS in two procedures, making it more money?  Or is it due to his own insurance he covers for his practice that told him he can't?  I've heard a lot of people that went to him, and have woken up with either just a vsg, or some other surgery called a bipartition, which is a sleeve and the stomach has two exits (at least that's what I read).  going in for a DS and waking up with just a partial is just wrong.  Then being told because of all the adhesions, and operating time....well, if he knew that there was abdominal surgery before on the patient, he knows from his EXPERIENCE, that it will take longer laproscopically to get through all the adhesions, so he should book longer OR time.  or, just say because of the expected adhesions, it has to be done open, so the complete DS can be done in one time.  But NO, he has to charge a patient twice.  What's worse is waking up and getting a totally different surgery, not even a DS at all.  

On the side of him being and excellent surgeon....YES, he is the best at revisions laproscopically for weight loss.  But, a bit sneaky to me.

I actually wanted to still use him to complete the revision but he said he can not take american patients for "elective" procedures due to new rules by the CMPA "Canadian Medical Protective Association" which as I understand it covers all Canadian Surgeons for malpractice.  He said it is not by his choice but by obligation due to this new restriction. (Does anyone here know anything about this?)

I went there at the time because I desired a laproscopic approach and he was one of only two (Dr. Pomp in two stages) that I was aware of at that time who would offer it.  I chose him over Dr. Pomp at that time because it was about the same travel time and he seemed certain he could complete it in one surgery where Dr. Pomp told me up front it would definitely be two stages.

I would like to believe that he did his best to actually complete the surgery I went there for in as safe a manner as possible.  I was in surgery for about 5 hours and he did not feel it safe to continue under anesthesia for much longer.  I am thankful that all went well and there were no operative or post operative complications and the laproscopic approach was much easier to recover from than the open RNY was.  I am not sure if anyone has ever had the revision completed laproscopically in one stage as planned however.

I do agree that going in for one surgery and waking up with something completely different would be very wrong.  

He has told that to many of his patients that he can do it in one procedure.  he gives them the same reasoning, many adhesions, takes too long, he did what he thought would be in the safety of the patient, do it in two procedures.  He knows exactly what he is doing.  he is a very skilled surgeon by far.  He has been doing bariatric surgeries for many years successfully.  He moved from NYC, to Florida, then he was supposed to go back to NYC, but went to Montreal and has been there since.  For such a skilled surgeon to say it can be done in one procedure, KNOWING from his many years experience with adhesions and the length in bariatric operations, he knows he can do it twice and get more out of it.  You are not the only one he has done this to.  There have been MANY he has done the exact same thing to with the same talks after the surgery.   He should just be honest from the beginning and say it has to be done in 2 procedures, just like Dr. Pomp did.  But when people make their decision to go to Dr Gagner because he says he can do it in one procedure.  Then they wake up and find out, only half was done.  Very disappointing for the patient I would have to say.   If they work, that means they have to put in for time out again, disability etc.... 

Don't know why Canada enforced that rule.