Re: Doing the BPD/DS in two parts--how widespread?

May 2, 2001

I am having my bpd/ds is 2 parts with dr inabnet at mt sinai in nyc--

it doesnt have anything to do with him being skittish about his

surgical abilities. I had already heard & read about this prior to

my consult with him. His recommendation, for me, & it makes sense to

me is because of recent medical history (stroke, congestive heart

failure, severe sleep apnea)..now all of these things are under

control, but the stress of keeping my already morbidly obese body

under anesthesia for the complete surgery at once increases my risk

fo complications---not because of my surgeons ability, but because of

my own body's ability to handle the stress.

2 part is for me because I will be under anesthesia for about 2hrs

for my 1st part, then i will come home, follow a food plan & then in

about 6 months (this fall)--i will have lost about 100 lbs & then

will be ready for my 2nd part. With my doctor the 2nd part is not

optional--the finishing what we started. If I dont have the 2nd part

then there is nothing to keep me from regaining my weight down the

road a ways--so why would I not go back for the rest? Wouldnt make

sense to me. I trust my choice of surgeon & trust his recommendation

on the 2 parter. A bonus, for me, is that I now get to have the

surgery laproscopically.

And, finally, to answer you question about insurance----YES< YES they

do approve it in t 2 parts---as a matter of fact, I was just approved

today, within 15 minutes of paperwork being submitted & am trying to

get all the last minute stuff done to be in nyc this friday at 8am

for surgery. My real date is may 11th.

ogretta

pre-op

dr inabnet

may 11, 2001-------****maybe may 4th--will let you know tomorrow

n duodenalswitch@y..., kaybeekaybee@h... wrote:

> I've seen a couple of posts lately from patients who've been told

in

> consultation that they should consider having the BPD/DS in two

parts–

> that is, having just the sleeve gastrectomy done at first, and then

> returning a year or so later for the remainder. The posts that

I've

> seen have been from Hazem Elariny's patients. Because Elariny also

> suggested this to me before I parted company with him, I'm

wondering

> how many other DS surgeons are suggesting this to their patients,

and

> whether they're doing so frequently.

>

> On the night before my scheduled surgery date, in the same

> conversation in which he told me that the EKG he had just read

> indicated very serious heart problems (which proved to be a

> misdiagnosis), Elariny asked if I'd be willing to agree to have him

> do " just the top " of the surgery on me the next morning. Already

in

> shock from the pronouncement about my heart, I was taken aback to

> hear Elariny trying to sell me this " tubularization of the

stomach, "

> as he put it, as " a superior operation " to the BPD/DS. I still

don't

> get that part. A DS surgeon who thinks that purely restrictive

> operations (like the old stomach-stapling) are " superior " to

> malabsorptive procedures like the BPD/DS?

>

> Elariny's reported reasons for recommending the procedure to the

two

> others don't apply to me. A man in his twenties said it was

> suggested to him because of his age and his high BMI (65). One

young

> woman apparently was advised to have one because she's in her

> twenties and has not yet had children; she has a BMI of 50. I'm

not

> in my twenties, my starting BMI was in the 40's, and Elariny

thought

> I'd already had several children (he'd confused me with another

> patient).

>

> I'm wondering if Elariny's interest in doing " top-only " surgery

> doesn't reflect an increasing conservatism (skittishness, perhaps)

on

> his part. At my consultation with him in December of last year,

> which was attended by several other people, he talked about

limiting

> himself in the future to doing weight-loss surgery laparoscopically

> only on those weighing 300 pounds and under. That was the lowest

> threshold among the three laparoscopic WLS surgeons that I

> consulted. That limitation didn't exclude me, and I don't know if

> he decided to go with this or not.

>

> I worry about Elariny's vague offer to get the " second half "

done " in

> a year or so, if you still want it, " as he put it to me. Purely

> restrictive operations don't produce the best weight loss or

> sustained weight loss (isn't that why gastric-bypass operations

were

> developed in the first place?), but the failure of the procedure to

> produce the hoped-for result might not be apparent after a year.

On

> the other hand, because the sleeve gastrectomy would leave one with

a

> larger stomach than the pouches of the old stomach-stapling, there

> might not be much weight loss, even temporarily. Better to go with

> the proximal RNY.

>

> Planning a second trip to the operating room was simply out of the

> question for me, as I told Elariny that night. Although I don't

> presume to know Elariny's reasons for recommending " just the top "

of

> the BPD/DS to such dissimilar patients, I wouldn't want someone to

> agree to submit to general anesthesia twice because of a surgeon's

> growing discomfort with malabsorption as a means to weight loss, or

> his doubts about his own prowess in operating laparoscopically, or

> his fear of increased malpractice-insurance premiums, or other

> reasons that have more to do with the doctor than with the

patient.

> I'd rather see the patient find a different doctor.

>

> So I'd like to hear from you: how many non-Elariny patients have

been

> advised to get the BPD/DS in two parts, and what reasons were you

> given? And does anyone have experience with an insurance company's

> approval of a two-part BPD/DS?

>

> KayBee

> Laparoscopic BPD/DS - 3/2/01

> Dr. Ren

May 2, 2001