Re: Who Has Had BPD/DS Surgery Weighing Over 400 Lbs?

April 28, 2001

In a message dated 4/28/01 1:46:11 PM, duodenalswitch writes:

<< However, Doug's recent post indicates that Dr Gagner does very MO folks.

He

started at 500 lbs. And I think Dr G does lap for many of those very MO

folks.

>>

Yes, Dr. G did not have any weight limits (or bmi limits) for lap surgeries

in the past. HOwever, research he had gathered from that time to the present

have showed a strong tendency for those with a bmi of 60 and above to

experience the greatest and most severe (in terms of escalation, etc.)

complications with lap surgeries. So, now they are offering the option of

having the DS procedure done laparoscopically but in two steps. The

intestinal procedure is performed once the person loses a certain percentage

of excess weight.

I remember him mentioning such studies and research to me when I went for my

consult in November '99. I really don't know if Dr. Gagner has an open or

only two part policy now for those with higher bmis ... I would think he (and

his associates) determine this on an individual basis. However, I think

their interest in preferring the lap two part (or open) DS for those with

higher bmis shows they are taking precautionary measures while still offering

lap DS to everyone.

all the best,

teresa

lap DS with gallbladder removal

Dr. Gagner/DR. Quinn assisting/Mt. Sinai/NYC

January 25, 2001

pre-op: 307 lbs/bmi 45 (5'9 " )

now: 263 lbs (it's still coming off! Yahoo! LOL)/bmi 40?

April 28, 2001

In a message dated 4/28/01 1:46:11 PM, duodenalswitch writes:

<< However, Doug's recent post indicates that Dr Gagner does very MO folks.

He

started at 500 lbs. And I think Dr G does lap for many of those very MO

folks.

>>

Yes, Dr. G did not have any weight limits (or bmi limits) for lap surgeries

in the past. HOwever, research he had gathered from that time to the present

have showed a strong tendency for those with a bmi of 60 and above to

experience the greatest and most severe (in terms of escalation, etc.)

complications with lap surgeries. So, now they are offering the option of

having the DS procedure done laparoscopically but in two steps. The

intestinal procedure is performed once the person loses a certain percentage

of excess weight.

I remember him mentioning such studies and research to me when I went for my

consult in November '99. I really don't know if Dr. Gagner has an open or

only two part policy now for those with higher bmis ... I would think he (and

his associates) determine this on an individual basis. However, I think

their interest in preferring the lap two part (or open) DS for those with

higher bmis shows they are taking precautionary measures while still offering

lap DS to everyone.

all the best,

teresa

lap DS with gallbladder removal

Dr. Gagner/DR. Quinn assisting/Mt. Sinai/NYC

January 25, 2001

pre-op: 307 lbs/bmi 45 (5'9 " )

now: 263 lbs (it's still coming off! Yahoo! LOL)/bmi 40?

April 28, 2001

I am having " open " aaltho I'm under 400 lbs. My BMI is 69. My understanding

is that research from Dr. Gagner at Mt Sinai is showing people with BMIs 60+

are better off having open or 2 part lap.

From my point of view, I'm going to one of Gagner's team. I chose them

because of reputation. If that's the way they want to do it, then that's the

way I'm gonna have it. I have to trust their judgment or why did I choose

them?

I'd rather have lap but at this point I just want to get on with it as

safely as possible.

n

n Boden (maboden@...)

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April 28, 2001

It might help if you post the name of the surgeon so that we can understand

who is restricting surgery based on your weight. We are seeing more and

more surgeons talking of a 2 stage surgery for some folks. I think the

inabdominal pressure post op for folks who already have abdominal

compartment syndrome can be deadly. I suspect that the 2 stage surgeries

are being done to reduce the post op morbidity and mortality risks.

However, Doug's recent post indicates that Dr Gagner does very MO folks. He

started at 500 lbs. And I think Dr G does lap for many of those very MO

folks.

in Seattle

----- Original Message -----

> I'm trying to find out who has had BPD/DS Surgery and weighed over 400

> lbs.

>

> A doctor I saw yeserday told me he could only do it open (not lap) and

> besides its being a complex operation (aren't they all?) it is HIGHLY

> risky since I'll be under on the table so long, yet a lap BPD/DS is

> the same amount of time. His point was he feels the cardiac and

> pulmonary stress is higher on a person above 400 lbs. than on one

> below and I'm trying to find out how true this feeling/statement of

> his is.

>

> For those over 400 that had this done, I'm trying to find out what

> complications (if any) happened and who/where the doctor was that yous

> used. I'm willing to travel.

>

> The doctor I saw yesterday offered doing a lap BPD now and a lap DS in

> a year, but not only will that leave me losing just 100 lbs (not the

> 200+ I need to lose) but it subjects me to risks and pain that I'd

> rather not repeat a year later. Plus, open has the advantage of

> removing the gallblader, thus avoiding a future surgery to do so.

April 28, 2001

Here is an excellent snippet on this. Dr Sugarman is a highly respected

surgeon who does the RNY

http://members.nbci.com/diabetesm/advances_in_surgical_management_.htm

Dr. Harvey Sugerman[20] presented compelling data showing that morbidly

obese people have what he refers to as " chronic abdominal compartment

syndrome. " This syndrome of extreme central obesity leads to intra-abdominal

hypertension and is associated with all of the familiar comorbidities of

obesity such as hypertension, hypertriglyceridemia, type 2 diabetes, and

atherosclerosis. In addition, his data suggest that the abnormal abdominal

pressure leads to urinary incontinence, pseudotumor cerebri,

gastroesophageal reflux disease, venous stasis, abdominal hernias, and

obesity hypoventilation syndrome. In his studies, patients examined 34

months after gastric bypass surgery had lost 69% of their excess weight,

with a decrease in BMI from 52 to 33. In addition, urinary bladder pressures

and lumbar cerebrospinal fluid pressures had dramatically decreased.

----- Original Message -----

> Could you please explain " abdominal compartment syndrome " .

>

> - In duodenalswitch@y..., " Montgomery " wrote:

> > It might help if you post the name of the surgeon so that we can

> understand

> > who is restricting surgery based on your weight. We are seeing

> more and

> > more surgeons talking of a 2 stage surgery for some folks. I think

> the

> > inabdominal pressure post op for folks who already have abdominal

> > compartment syndrome can be deadly. I suspect that the 2 stage

> surgeries

> > are being done to reduce the post op morbidity and mortality risks.

> >

> > However, Doug's recent post indicates that Dr Gagner does very MO

> folks. He

> > started at 500 lbs. And I think Dr G does lap for many of those

> very MO

> > folks.

> >

> > in Seattle

> >

> > ----- Original Message -----

> > From:

> > > I'm trying to find out who has had BPD/DS Surgery and weighed

> over 400

> > > lbs.

> > >

> > > A doctor I saw yeserday told me he could only do it open (not

> lap) and

> > > besides its being a complex operation (aren't they all?) it is

> HIGHLY

> > > risky since I'll be under on the table so long, yet a lap BPD/DS

> is

> > > the same amount of time. His point was he feels the cardiac and

> > > pulmonary stress is higher on a person above 400 lbs. than on one

> > > below and I'm trying to find out how true this feeling/statement

> of

> > > his is.

> > >

> > > For those over 400 that had this done, I'm trying to find out what

> > > complications (if any) happened and who/where the doctor was that

> yous

> > > used. I'm willing to travel.

> > >

> > > The doctor I saw yesterday offered doing a lap BPD now and a lap

> DS in

> > > a year, but not only will that leave me losing just 100 lbs (not

> the

> > > 200+ I need to lose) but it subjects me to risks and pain that I'd

> > > rather not repeat a year later. Plus, open has the advantage of

> > > removing the gallblader, thus avoiding a future surgery to do so.

>

> ----------------------------------------------------------------------

>

April 28, 2001

>

> I remember him mentioning such studies and research to me when I

went for my

> consult in November '99.

Woops, I meant my consult in November 2000... I did not wait an entire

year for my surgery! LOL

>

> all the best,

> teresa

> lap DS with gallbladder removal

> Dr. Gagner/DR. Quinn assisting/Mt. Sinai/NYC

> January 25, 2001

>

> pre-op: 307 lbs/bmi 45 (5'9 " )

> now: 263 lbs (it's still coming off! Yahoo! LOL)/bmi 4

April 28, 2001

I just wanted to let you know that I have a bmi of 65--weighed

399.6lbs when i completed my paperwork for dr inabnet--have lost

14.5lbs pre-op. Prior to my consult with dr inabnet at mt sinai, i

had myself convinced that i would be having an open bpd/ds, but at my

consult we discussed the 2 part surgery--both parts can be done

laproscopically..i realized during the consult that he knows what he

is doing & would not be recommending the 2 part process for me if he

thought the surgery could be completed in 1 procedure without

increased risk of complication. I know that i trust him as my

surgeon & he does have a personal interest in the healthy outcome of

my wls. the plan we have at this point is that i will have the

stomach restrictive portion of the surgery on may 11th--will return

home to lose about 100lbs & then in the fall, yes, the fall of this

year I will return for the 2nd part of my surgery. With a higher bmi

there appear to be increased risks when under anesthesia for extended

periods of time (i also have some health issues--chf, recent stroke,

sleep apnea that add an additional risk factor)

I know that I have to choose the surgeon that I believe is going to

respect my opinions, offer me options & still follow through with the

plan. I found that surgeon in dr inabnet.

It is a very personal thing, this patient/doctor relationship & it is

very important that you are comfortable with your choice & not 2nd

guess yourself or your surgeon. Just my opinion.

good luck in your pursuit of your new life..take good care

ogretta

pre-op

may 11, 2001

dr inabnet

mt sinai

> Hi:

>

> I'm trying to find out who has had BPD/DS Surgery and weighed over

400

> lbs.

>

> A doctor I saw yeserday told me he could only do it open (not lap)

and

> besides its being a complex operation (aren't they all?) it is

HIGHLY

> risky since I'll be under on the table so long, yet a lap BPD/DS is

> the same amount of time. His point was he feels the cardiac and

> pulmonary stress is higher on a person above 400 lbs. than on one

> below and I'm trying to find out how true this feeling/statement of

> his is.

>

> For those over 400 that had this done, I'm trying to find out what

> complications (if any) happened and who/where the doctor was that

yous

> used. I'm willing to travel.

>

> The doctor I saw yesterday offered doing a lap BPD now and a lap DS

in

> a year, but not only will that leave me losing just 100 lbs (not

the

> 200+ I need to lose) but it subjects me to risks and pain that I'd

> rather not repeat a year later. Plus, open has the advantage of

> removing the gallblader, thus avoiding a future surgery to do so.

>

> PLEASE HELP, Thanks!

April 28, 2001