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

[Guest guest]

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