Hi everyone.. New...

[Guest guest]

_ my best advice, is to fight for the procedure you want -- you, and not your doc or ins CO have to live with the side effects. You may not have to fight too hard-- you never know-- Start by educating your PMD-- Nan

[Guest guest]

here, and just starting out! I first started researching the RNY a

few months back, and then after coming across heidi's page at

mywls.com (wonderful site, very HELPFUL!) then I started researching

the DGB/DS.. and have decided this is the one for me!! WOOO HOOOO

Ok, but now am on pins and needles! HA! HA! I want to use Dr.

Rabkin/Jossart in San Fransisco. I live in San Diego, and now I'm

hearing that my HMO (Sharp Reese Stealy) may not let me go see

them??!! OMG.. they are the only ones that do this surgery (LAP), my

next choice would be Dr. Anthone in LA. But it's looking like I'm

going to have to have the RNY from Dr. Callery (Sharp's Dr.)... and

I'm getting kinda bummed!

But anyways, I decided WHAT THE HELL! (SFL).. and faxed them my

insurance card Friday (5/25), and was told that they would contact me

in 10 business days.. (6/8)... is it 6/8 yet?!?! LOL Sooooo that is

where I stand!

I guess what I'm thinking ahead about is IF I can't get approved to

go see Dr. Rabkin/Jossart through MY insurance... is it worth

switching Insurance companies?? Or just go for the RNY?? I guess

right now my mind is running 1,000 miles/min! HA! But it's taken me

so long to come to this conclusion as I see my weight increasing...

that I don't want to hit road blocks! (BANG!)Which I realize not all

transitions will be easy... but was kinda hoping they would happen

later rather than sooner! hehe

Anyways, now that I'm rambling, guess I just want to say CONGRATS to

all of those of you who are post op! And GOOD LUCK and BEST WISHES

to those of you who are pre op!

Your Newest Member,

[Guest guest]

Hi . Welcome! My humble opinion would be to keep investigating the

two surgeries and the differences. This is a major life altering decision

we're making. If you decide that you really want the BPD, then fight

tooth and nail for it! It may well be worth changing insurance companies

if that is an option for you. Good luck whatever you decide.

--- blondensweet@... wrote:

> here, and just starting out! I first started researching the RNY a

> few months back, and then after coming across heidi's page at

> mywls.com (wonderful site, very HELPFUL!) then I started researching

> the DGB/DS.. and have decided this is the one for me!! WOOO HOOOO

>

> Ok, but now am on pins and needles! HA! HA! I want to use Dr.

> Rabkin/Jossart in San Fransisco. I live in San Diego, and now I'm

> hearing that my HMO (Sharp Reese Stealy) may not let me go see

> them??!! OMG.. they are the only ones that do this surgery (LAP), my

> next choice would be Dr. Anthone in LA. But it's looking like I'm

> going to have to have the RNY from Dr. Callery (Sharp's Dr.)... and

> I'm getting kinda bummed!

>

> But anyways, I decided WHAT THE HELL! (SFL).. and faxed them my

> insurance card Friday (5/25), and was told that they would contact me

> in 10 business days.. (6/8)... is it 6/8 yet?!?! LOL Sooooo that is

> where I stand!

>

> I guess what I'm thinking ahead about is IF I can't get approved to

> go see Dr. Rabkin/Jossart through MY insurance... is it worth

> switching Insurance companies?? Or just go for the RNY?? I guess

> right now my mind is running 1,000 miles/min! HA! But it's taken me

> so long to come to this conclusion as I see my weight increasing...

> that I don't want to hit road blocks! (BANG!)Which I realize not all

> transitions will be easy... but was kinda hoping they would happen

> later rather than sooner! hehe

>

> Anyways, now that I'm rambling, guess I just want to say CONGRATS to

> all of those of you who are post op! And GOOD LUCK and BEST WISHES

> to those of you who are pre op!

>

> Your Newest Member,

>

>

>

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

>

[Guest guest]

> Ok, but now am on pins and needles! HA! HA! I want to use Dr.

> Rabkin/Jossart in San Fransisco. I live in San Diego, and now I'm

> hearing that my HMO (Sharp Reese Stealy) may not let me go see

> them??!! OMG.. they are the only ones that do this surgery (LAP),

Actually, several docs are doing the DS lap, just not in California.

And remember, those docs who do it lap only do so for those who are

relatively thin.

Plus the surgery isn't any safer by lap, it's just that with the lap

you have a somewhat shorter recovery from the actual procedure.

Regardless of open vs lap, most people can expect to be anywhere from

uncomfortable to downright miserable for 2-12 weeks after the surgery

as we adjust to our newly reconstructed digestive systems.

> my next choice would be Dr. Anthone in LA.

I just checked, and USCUH doesn't list your insurance as one they

accept, so it looks like Dr. Anthone would be out too. But be sure

and check for yourself, if necessary.

> But it's looking like I'm

> going to have to have the RNY from Dr. Callery (Sharp's Dr.)... and

> I'm getting kinda bummed!

I can see why!

> I guess what I'm thinking ahead about is IF I can't get approved to

> go see Dr. Rabkin/Jossart through MY insurance... is it worth

> switching Insurance companies??

I would, in a heartbeat!

And check back here before you choose, so folks can tell you which

ones are easier to work with.

> Or just go for the RNY??

IMHO, the RNY is less worthless than a lot of other WL surgeries, but

that's not saying much. Yes, I am extremely biased, with what I

think is very good reason.

Welcome to the list,

Tom

Panniculectomy, Dr. Anthone, 11/10/2000

Open DS, Dr. Anthone, 03/30/2001

11/10/2000....384

03/30/2001....360

04/19/2001....338

04/22/2001....334.5

05/03/2001....328

05/14/2001....319

05/18/2001....316

68 Ugly Pounds, GONE FOREVER!!!!!!!!!!!!!!!!

[Guest guest]

" And remember, those docs who do it lap only do so for those who are

relatively thin. "

Just want to add a different prespective here.

I am not by any means " relatively thin " and I am having a lap. My BMI

is 68. I think its all based on a surgeons experience and comfort

level with larger patients.

When I went to a surgeon to have my Gall Bladder out when the GB Lap

was still relatively new, the surgeon said he didnt know if he could

do it on me because of my size... a year later and a bit heavier I

finally had my LAP done by him... he told me in the year since he saw

me,he had done a lot more surgeries and was comfortable with a

patient of my size. Some Drs have a limit of 300 or 350 or 500 lbs !

What does that tell you?.. its all due to the comfort/experience

level of the surgeon.

" Plus the surgery isn't any safer by lap, it's just that with the lap

you have a somewhat shorter recovery from the actual procedure. "

I guess that depends what you mean by " safer " , there is no doubt that

a lap procedure has less post op complications than an open

procedure. In my mind thats safer.A lap procedure could take a lot

longer in the the hands of an unskilled surgeon, but then again I

wouldnt have a DS lap or otherwise done by anyone who has just done a

few of them... the complication rates go up in direct perportion to

the skill and number of surgeries the Dr has done.

Check this out:

" North American Association for the Study of Obesity (NAASO) 2000

Annual Meeting

Surgical Management of Obesity

Open vs Laparoscopic Bariatric Procedures:

Gastroplasty and other surgeries require a large abdominal incision,

which increases stress hormones, energy expenditure, oxygen demand,

and pulmonary function. All of the organ systems are affected

adversely to some degree by such a major incision, including the

immune system, heart, lungs, and kidneys. By contrast, laparoscopic

bariatric surgery reduces the catecholaminergic central nervous

system stress responses both during and after surgery. Additionally,

patient pulmonary function is less affected compared with open

surgery, the immune system is improved, and fewer adhesions are

formed; wound healing has obvious benefits in the absence of a large

midline upper abdominal scar.

In clinical studies, the advantages of laparoscopic over open surgery

have been well documented. For example, mortality rates for

gallbladder surgery in land have dropped 28% since laparoscopic

cholecystectomy became available.[14] Numerous studies have

demonstrated the clear advantages to less invasive surgery, including

reductions in postoperative recovery time, overall wound healing

time, overall morbidity and mortality, wound complication rate,

perioperative complications, and postoperative complications.

All bariatric surgical procedures can be done laparoscopically. As

Dr. Schauer described, open RYGB generally requires 2 to 4 hours to

perform, 4 to 8 days for inpatient hospital stay, 6 to 12 weeks for

recovery, 2.5% to 10% major complications, up to 15% wound

infections, 17% to 23% hernias, up to 1% mortality, and 65% to 72%

weight loss. By contrast, closed laparoscopic RYGB procedures

generally use 5 access ports, the surgery lasts for approximately 2

hours, and the patient is discharged from the hospital 2 days

postoperatively. For well-experienced, skilled, laparoscopic

bariatric surgeons, the major complications of laparoscopic RYGB are

similar to those of open RYGB, such as peritonitis, abscess, and

small-bowel obstruction, but there is a lesser (3.3%) incidence and

recovery sufficient to return to work occurs after 2 weeks. Minor

complications and the amount of excess weight loss are also similar

to open surgery.[15]

In a follow-up discussion, concern was expressed that the skills

required for open bariatric surgery and for laparoscopic surgery were

different. In support of this contention, it was stated that recovery

and complications following laparoscopic bariatric surgery may

approximate those of the open procedure unless the surgeon possesses

sufficient skills and experience. It was agreed that the benefits of

laparoscopic surgery improve as the surgical laparoscopic techniques

of the surgeon improve. "

http://www.medscape.com/medscape/CNO/2001/NAASO/NAASO-02.html

________________________________________________________________

" Regardless of open vs lap, most people can expect to be anywhere

from > uncomfortable to downright miserable for 2-12 weeks after the

surgery > as we adjust to our newly reconstructed digestive systems. "

Statistics show recovery from a lap vs open procedure is much less

traumatic in comparison pain wise and length of time wise in the

hands of a skilled surgeon. That doesnt mean a lap recovery will be

painless or not have its own level of misery but its just not the

same as from and open procedure.

For me, waking up with an NGT tube in ICU (nasal/gastric) and having

it 24 hrs post op, staying in the hosp 7 days vs 4 and going home

with a feeding tube are all relative miseries I would just as soon do

without when there is a less truamatic alternative with less

documented complications.... just my 2 cents.

Each to his own misery! LOL Hey, whatever it takes to get there!

" 68 Ugly Pounds, GONE FOREVER!!!!!!!!!!!!!!!! "

congratulations Tom that is just fantastic!

mary bmi 68

corona ca

pre op 6/27/01 dr rabkin

cigna ppo

[Guest guest]

> I am not by any means " relatively thin " and I am having a lap.

> My BMI is 68.

Hmm... I had no idea Dr. R was doing lap on patients so large. I

sit corrected.

> I guess that depends what you mean by " safer " , there is no

> doubt that a lap procedure has less post op complications

> than an open procedure. In my mind thats safer.

First off, my assertion that lap is no safer than open was based on

the quote from Dr. Baltasar on the DS website. Dr. Baltasar is

quoted as saying, " it (lap) is not easier nor safer than open

surgery! "

http://www.duodenalswitch.com/Procedure/Open_vs__Lap/baltasaropen_vs_

_lap.html>

Without belaboring the point too much, I'll point out that NONE of

the four people quoted on that page says that lap is safer, and two

of them say that it is more dangerous.

But, yes, I guess it does depend upon what one means by " safer. " You

seem to be concerned only with post-operative complications. I, on

the other hand, am more concerned with leaving the operating room in

one, correctly functioning, piece.

Case in point: Deb & Dr Ren.

My understanding is that Dr. Ren was unable to figure out where the

blood supply for Deb's lower stomach and upper duodenum came from.

As a result, the blood supply to that area was lost, and Deb lost her

entire pyloric region. IMHO, if Deb had been open, Dr. Ren could

have used her fingers to trace Deb's blood supply, thus avoiding the

near-destruction both of Deb and of this list.

Personally, I will gladly accept the slightly higher risk of wound

infection, the longer time recovering, etc., in order to be sure I'll

leave the OR with all of my organs functioning the way they are

supposed to. But then I tend to be extremely conservative when it

comes to things that might kill me or leave me crippled for life.

Also, there are other considerations. My surgeon, as a regular part

of the process, removes each patient's gallbladder and appendix.

This is another topic on which there has been endless discussion and

no agreement on this list. The way I look at it, I got three

surgeries for the price of one!

Plus, if ever I have severe pain on the right side of my abdomen, I

will automatically know that it cannot be either my appendix or my

gallbladder, since I don't have either of those. I rest easier

knowing that this little tidbit of info might someday save my life by

preventing some emergency room doc from looking for the wrong

ailment.

Furthermore, he doesn't begin or end with removing the gallbladder

and appendix. First off, he likes to run his fingers along the

entire length of the digestive tract, just to make sure that

everything is connected and/or works the way is is supposed to. (See

my comment regarding Deb & Dr. Ren for why I think this is

important.) He also checks out, (I think " palpate " is the neato

medical term), the liver, spleen, and all those other squishy things

that hang out down there. With female patients, he even palpates the

ovaries, just to be sure that there's nothing wrong with them that

the patient should know about. Try to do all of that with one of

those camera-on-a-stick-thingies!

> A lap procedure could take a lot

> longer in the the hands of an unskilled surgeon,

ANY surgery could take a lot longer in the hands of an unskilled

surgeon!

> but then again I

> wouldnt have a DS lap or otherwise done by anyone who has just

> done a few of them... the complication rates go up in direct

> perportion to the skill and number of surgeries the Dr has done.

I absolutely agree with you on that point, but I must caution you

that you are putting yourself in danger of being mobbed by the

fanatical followers of a certain relatively young and inexperienced

doctor in Delano!

> Check this out:

I'm sorry, but the examples used in that (enormously long) quote just

were not convincing. The first example they used was of gallbladder

surgery. PLEASE! That's like comparing building a bicycle to

building the space shuttle. It's meaningless.

The second example they use isn't much better, since it involves post-

op complications of the RNY. IMHO, many of the doctors performing

the RNY are hacks. It is only natural that those RNY docs who decide

to perform the more difficult lap procedure would be the most skilled

surgeons (among the RNY group), since fear of malpractice suits would

tend to keep down the numbers of the aforementioned hacks attempting

the lap procedure.

We who have chosen the best surgery, on the other hand, are blessed

by that fact that there is only a small group of surgeons who do the

surgery at all, and that these surgeons are pretty uniformly

excellent docs. (A couple of them need a little bit of seasoning,

IMHO, but that is another matter entirely.)

> " Regardless of open vs lap, most people can expect to be

> anywhere from uncomfortable to downright miserable for 2-12

> weeks after the surgery as we adjust to our newly reconstructed

> digestive systems. "

>

> Statistics show recovery from a lap vs open procedure is much less

> traumatic in comparison pain wise and length of time wise

GOD! I wish people would READ what I wrote before disagreeing with

it!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Who said anything about pain or length of time to recover from the

surgery? I was talking about how long it takes to ADJUST TO OUR

NEWLY RECONSTRUCTED DIGESTIVE SYSTEMS.

In other words, I was talking about the common post-op problems that

plague us all to one degree or another, e.g., vomiting, diarhea,

inability to eat, having trouble getting enough liquid down, painful

gas, extremely smelly poops, etc., etc., etc., etc!

> For me, waking up with an NGT tube in ICU (nasal/gastric)

> and having it 24 hrs post op, staying in the hosp 7 days vs 4

> and going home with a feeding tube are all relative miseries I

> would just as soon do without

What do the NGT and/or the feeding tube, (or lack of either one),

have to do with whether the surgery was done open or lap?

The NGT just empties the nasty crud from your stomach. What's that

got to do with open vs lap? I suppose some docs may just think it's

not necessary, and that's okay.

As for the feeding tube, I found it to be a godsend! I, like so many

other post-ops, had trouble drinking enough water for the first few

weeks after surgery. Rather than risk a trip to the emergency room

due to dehydration, however, I was able simply to inject all the

water I wanted into my feeding tube.

And I don't really understand why anyone would be in such an all-

fired hurry to get out of the hospital and go home. The way I

figured it, if something was going to leak, it would probably happed

pretty soon after surgery. I guess this is just another matter of

personal preference, but if I'm going to have a massive hemmorage, or

perhaps have digestive fluids flooding my insides, and therefore have

to be rushed back to surgery, I'd much rather start out just two

floors up, rather than at home.

Besides, my day nurse was just plain beautiful, and it was not

exactly unpleasant having her fuss over me all day every day. I

certainly don't get that at home, or anywhere else for that matter.

> when there is a less truamatic alternative

ly, I think that the trauma many lap patients are most worried

about is the psychological trauma of having somebody cut a gigantic

slit down the front of their bellies. But then I really should learn

to keep my amateur psychoanalysis to myself. (;

> with less documented complications....

I'm just not convinced that this is true. Even the evidence you

offered, (which was not really relevant, since it was based on the

RNY, rather than the DS, i.e., a different surgery and a different

group of surgeons), talks in terms of general surgical related

stresses on the body, but concentrates for the most part on post-op

complications. IMHO, post-op problems are just not that big a deal,

unless they are the result of a MAJOR during-op problem, as is the

case with Deb.

Tom

[Guest guest]

I heard from someone that Rabkin's lab surgery does still give you a 4 inch

incision. Is this still true? I was told they still get their hand in there

to assist with some things? Just wondering?

Dawn

Dr. Hess

BPD/DS

4/27/00

267 to 165

size 22 to size 10

no more high blood pressure sore feet or dieting!!

www.dudoenalswitch.com

[Guest guest]

That's how my surgery was done by Dr. Kim in Ocean Springs. It was called

Lap Hand-Assisted. I have the two lap incisions at the top and one four inch

incision on the bottom. I call it the Great Compromise and was very thankful

for it.

Best of Luck,

Joann in Mobile

[Guest guest]

" I had no idea Dr. R was doing lap on patients so large. "

They operated on a woman who was 620 pounds with a BMI of 116 and a

man who was 526 pounds with a BMI of 73. They even welcome revisions

from other WLS surgeries when other Drs wont touch them.

> First off, my assertion that lap is no safer than open was based on

> the quote from Dr. Baltasar on the DS website. Dr. Baltasar is

> quoted as saying, " it (lap) is not easier nor safer than open

> surgery

Yeah Baltasar did a few laps and didnt like how long it took him to

do them, so doesnt do them anymore. I have found many times that

Drs's sites where the drs can only do one kind of surgery arent

always the best places to judge objectivity... thats why I quoted :

North American Association for the Study of Obesity (NAASO) 2000

" You seem to be concerned only with post-operative complications. I,

on the other hand, am more concerned with leaving the operating room

in > one, correctly functioning, piece. "

You can find instances of any surgeon not having a surgery go well...

again I point to the Obesity Study:

" In clinical studies, the advantages of laparoscopic over open

surgery have been well documented. "

" But then I tend to be extremely conservative when it

comes to things that might kill me or leave me crippled for life. "

I know its like all of those who prefer the surgery with less

complications are more readily willing to risk thier life! LOL!

If lap surgery had horrible or even worse stats for complications and

intra opreative moridity than open then that might be a valid point,

but the stats dont say that at all:

" Numerous studies have demonstrated the clear advantages to less

invasive surgery, including reductions in postoperative recovery

time, overall wound healing time, overall morbidity and mortality,

wound complication rate, perioperative complications, and

postoperative complications. "

" Also, there are other considerations. My surgeon, as a regular part

of the process, removes each patient's gallbladder and appendix.

This is another topic on which there has been endless discussion and

> no agreement on this list. The way I look at it, I got three

> surgeries for the price of one! "

My surgeon does DS lap and also removes the GB and the appendix

routinely.

" Try to do all of that with one of

> those camera-on-a-stick-thingies! " "

They do it all the time, its no big deal for them at all.

" First off, he likes to run his fingers along the entire length of

the digestive tract "

OK one surgeon likes to go in there and manually manipulate all the

organs and intestines... some drs argue the less manipulation,the

less truama to the internal organs the better. Each surgery has its

pros and cons... listen to the lap surgeons describe what they are

able to see via the power magnification about what they would miss

with just the naked eye!

" ANY surgery could take a lot longer in the hands of an unskilled

> surgeon! "

I think you might have missed the point I was trying to make -its

that some argue that the lap surgery takes longer... what I was

saying was it depended on the skill and proficiency level of the

surgeon and would take longer in the hands of the inexpereinced.

" I absolutely agree with you on that point, but I must caution you

> that you are putting yourself in danger of being mobbed by the

> fanatical followers of a certain relatively young and inexperienced

> doctor in Delano! "

Everyone has thier own comfort level with their surgeons experience

with numbers and kinds of surgery. I happen to be comfortable with

surgeons I choose who are skilled in both lap and open but prefer to

do lap for the very reasons I think its a better surgery for *me*.

" I'm sorry, but the examples used in that (enormously long) quote

just > were not convincing. The first example they used was of

gallbladder > surgery. PLEASE! That's like comparing building a

bicycle to > building the space shuttle. It's meaningless. " "

Meaningless is in the eye of the beholder.

That particular statement was referring to the benefits of lap over

open procedures regardless of the kind of surgery.

" The second example they use isn't much better, since it involves

post-> op complications of the RNY. "

That segment of the statement was comparing RNY open to RNY lap... it

has value to this arguement also. There are similaritites to the RNY

Lap vs RNY open arguement to that of the DS open vs DS lap.

" IMHO, many of the doctors performing the RNY are hacks. It is only

natural that those RNY docs who decide to perform the more difficult

lap procedure would be the most skilled surgeons (among the RNY

group), since fear of malpractice suits would tend to keep down the

numbers of the aforementioned hacks attempting the lap procedure. "

one might use the same arguement for DS surgeons... docs who decide

to perform the more difficult lap procedure would be the most skilled

surgeons

but I dont think that necessarily follows.. open surgery takes

different skills than does the lap procedure... thats why I was most

comfortable with my surgeons who do both and can quite easily revert

to open if the need arose.

" We who have chosen the best surgery, on the other hand, are blessed

by that fact that there is only a small group of surgeons who do the

surgery at all, and that these surgeons are pretty uniformly

excellent docs. (A couple of them need a little bit of seasoning,

IMHO, but that is another matter entirely.) "

best WLS or best DS surgery?

" best " can be a point of contention as what is best for one person

may not be best for another.

" GOD! I wish people would READ what I wrote before disagreeing with

> it!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

>

> Who said anything about pain or length of time to recover from the

> surgery? I was talking about how long it takes to ADJUST TO OUR

> NEWLY RECONSTRUCTED DIGESTIVE SYSTEMS. "

there are no right or wrongs, I was just adding another

perspective... you made a statement and I added that immeditate

recovery from lap is much less truamtic and therefore recovery in

general from DS surgery is less with the lap... a distiction that may

be important to some if not to others. I have a feeling that those

who have less trauma intraoperatively have less truama post op

(including nausea and vomiting)also but thats just my theory... so

again I feel the lap does make a difference in recovery and not just

in the short term.

" > What do the NGT and/or the feeding tube, (or lack of either one),

> have to do with whether the surgery was done open or lap? "

I had a choice of surgeons... one who only had the skills to do open

DS and his patients needed a day in ICU, had NG tubes and feeding

tubes plus he practiced in a teaching hospital and I didnt want any

anesthesiologist praciticing an epidural skills on me...

My other choice were a team of surgeons (who operated together) who's

expertise was incredible for all WLS surgeries... and offered both

open and lap DS but preferred to do laps because of the quality of

life issues for the patients that included shorter recovery time and

less complications... with no routine ng tubes etc post op, no ICU..

hands down, with the stats they had and thier skill level there was

no choice for me... again I reiterate thats what was best for *me*

" The NGT just empties the nasty crud from your stomach. What's that

got to do with open vs lap? I suppose some docs may just think it's

not necessary, and that's okay. "

Well I guess it comes down to the same conservative views that

require an open procedure, ng tubes and ICU all being necessary had a

lot to do with me choosing surgeons who had great stats without the

more painful longer recovery open procedure, without ng tubes and no

need for prolonged stay in ICU...all stuff I wanted to do with out if

it wasnt necessary.

" As for the feeding tube, I found it to be a godsend! I, like so

many

> other post-ops, had trouble drinking enough water for the first few

> weeks after surgery. Rather than risk a trip to the emergency room

> due to dehydration, however, I was able simply to inject all the

> water I wanted into my feeding tube. "

lots of pts do prefectly fine without...its a safety precaution for

those surgeons who have a more conservative bent... to each thier

own.. I would rather do with out and feel comfortable with my

surgeons who dont routinely use it... again there is no wrong or

right its surgeons preferances and patient preferances

" And I don't really understand why anyone would be in such an all-

> fired hurry to get out of the hospital and go home. "

The Drs wouldnt release you unless they think you are stable. Its

just that an open procedure *requires* a longer stay. Again if the

complications were worse for lap procedures I would say there is an

arguement for that one but the stats dont show that at all.

" ly, I think that the trauma many lap patients are most worried

> about is the psychological trauma of having somebody cut a gigantic

> slit down the front of their bellies. But then I really should

learn > to keep my amateur psychoanalysis to myself. (; "

For me I could have cared less about the look of the scar... I was

more concerned about the less pain and complications, less lengthy

hosp stay and less truamatic recovery all around. Hey for me, I

figure whats a little scar when you've lived as a morbidly obese

person? No dobut its a consideration for some but it wasnt for me..

the other advantages of the lap are what convinced me.

> > with less documented complications....

>

> " I'm just not convinced that this is true. Even the evidence you

> offered, (which was not really relevant, since it was based on the

> RNY, rather than the DS, i.e., a different surgery and a different

> group of surgeons), talks in terms of general surgical related

> stresses on the body, but concentrates for the most part on post-op

> complications. IMHO, post-op problems are just not that big a

deal,

> unless they are the result of a MAJOR during-op problem, as is the

> case with Deb. "

Please note the words peri operative and post operative:

" Numerous studies have demonstrated the clear advantages to less

invasive surgery, including reductions in postoperative recovery

time, overall wound healing time, overall morbidity and mortality,

wound complication rate, perioperative complications, and

postoperative complications. "

The same arguements were around when the Lap GB surgery was

introduced... a lot of reluctant surgeons who werent trained and

didnt want to do laps pooh poohed it.. but now with the proven stats

about lower risk etc its the " gold standard " for GB surgery... and no

doubt in years to come Lap DS will be the gold standard for all

bariatric surgeries.... just my perspective.

to each his own

mary bmi 68

corona, ca

pre op 6/27/01 dr rabkin

cigna ppo

[Guest guest]

I am not by any means " relatively thin " and I am having a lap. My BMI

is 68. I think its all based on a surgeons experience and comfort

level with larger patients. >>>>>>

I definately agree that many patients were/are being discouraged because of

the surgeon's discomfort or lack of experience. HOWEVER, that being said,

Dr. Gagner, one of the top in the field (and the pioneer of laparoscopic

BPd/DS), is now recommending the Ds surgery in two parts for heavier bmis.

Why? He explains that, in his experience (which is quite extensive) he's

seen an alarmingly higher rate of complications that 'spiral' out of control

among those with higher bmi's. Not that everyone with a higher bmi will

always experience complications and those that have 'lower' bmis don't (we

all know they can happen to anyone), but that those with higher bmis have a

higher risk. This risk was/is high enough that Dr. Gagner now offers a 'two

part' lap DS for those with higher bmis.

I've also heard of other surgeons who are beginning to offer this.

all the best,

lap DS with gallbladder removal

Dr. gagner/Dr. Quinn assisting/Mt. Sinai/NYC

January 25, 2001

four months post-op and still feelin' fab!

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

now: 253 lbs

[Guest guest]

Your assumption about Dr Baltasar is incorrect. I think his web page needs

updating. He routinely does the lap DS at the state hospital where citizens

of Spain go. He has all the eqpt there and he and his team to do laps

there. What he does not do is the lap DS in the hospital where Americans

and other non citizens of Spain go. He lacks the total eqpt there for this

and chooses not to do this procedure there for a number of reasons.

He will undoubtedly be at the ASBS meeting next month in DC and hopefully

there will be a lot more information coming out about the experiences and

findings of those doing the DS.

in Seattle

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

> > First off, my assertion that lap is no safer than open was based on

> > the quote from Dr. Baltasar on the DS website. Dr. Baltasar is

> > quoted as saying, " it (lap) is not easier nor safer than open

> > surgery

>

> Yeah Baltasar did a few laps and didnt like how long it took him to

> do them, so doesnt do them anymore. I have found many times that

> Drs's sites where the drs can only do one kind of surgery arent

> always the best places to judge objectivity... thats why I quoted :

[Guest guest]

> " I had no idea Dr. R was doing lap on patients so large. "

> They operated on a woman who was 620 pounds with a BMI of 116 and a

> man who was 526 pounds with a BMI of 73.

They did this lap? Wow. That took big brass ones.

> They even welcome revisions

> from other WLS surgeries when other Drs wont touch them.

Yes, we are blessed in California, in that three out of our four

surgeons do revisions for those poor folks who had one of those lousy

surgeries.

> > First off, my assertion that lap is no safer than open

> > was based on the quote from Dr. Baltasar on the DS website.

> > Dr. Baltasar is quoted as saying, " it (lap) is not easier nor

> > safer than open surgery.

>

> Yeah Baltasar did a few laps and didnt like how long it took him to

> do them, so doesnt do them anymore.

I'm wondering, what would I have to do to get you to respond to what

I actually say instead of making up a straw-man in your mind and then

responding to it.

Once again: Dr. Baltasar said that lap " IS NOT EASIER NOR SAFER THAN

OPEN SURGERY. "

Notice, he did not say lap is MORE dangerous, nor did he say that it

is HARDER.

He simply said that lap " IS NOT EASIER NOR SAFER THAN OPEN SURGERY. "

This was my original point to which you responded, and you have yet

to offer a shred of evidence to the contrary.

> North American Association for the Study of Obesity (NAASO) 2000

Once again, that quote concerned GALLBLADDER surgery and the RNY.

Different surgeries, different group of surgeons.

> You can find instances of any surgeon not having a surgery

> go well...

So what. Again you refuse to respond to what I said.

> " In clinical studies, the advantages of laparoscopic over open

> surgery have been well documented. "

1. Still the same problem as above, i.e., different surgeries,

different surgeons.

2. I never said that lap does not have advantages. I simply said

that the DS by lap is not SAFER than the DS by open.

> I know its like all of those who prefer the surgery with less

> complications are more readily willing to risk thier life! LOL!

Not knowingly, but I think that those of you who chant the " lap is

the only way " mantra often fool yourselves into think that because

your incisions are smaller, then somehow the surgery is LESS

dangerous. This logic certainly didn't do Deb any good, did it?

> If lap surgery had horrible or even worse stats for complications

> and intra opreative moridity than open then that might be a valid

> point, but the stats dont say that at all:

1. I am talking about the DS, not surgery in general. The DS is a

very major surgery. I would guess that only major organ transplants

are more technically demanding.

2. The " stats " you cite say NOTHING about the DS.

> " Also, there are other considerations. My surgeon, as a regular

> part of the process, removes each patient's gallbladder and

> appendix.

> My surgeon does DS lap and also removes the GB and the appendix

> routinely.

Well good for him!

> " Try to do all of that with one of

> > those camera-on-a-stick-thingies! " "

> They do it all the time, its no big deal for them at all.

Oh really? I notice how neatly you chopped of my comment about the

surgeon palpating all of the internal organs WITH HIS FINGERS to

check for tumors, etc. Are you saying he sticks his fingers down

that little tube, or are you just ignoring what I say, yet again?

> " First off, he likes to run his fingers along the entire length of

> the digestive tract "

>

> OK one surgeon likes to go in there and manually manipulate all the

> organs and intestines...

Two actually that I know of for sure.

> some drs argue the less manipulation,the

> less truama to the internal organs the better.

What, no thirty page quote from the Journal of Tonsilectomies?

> Each surgery has its

> pros and cons... listen to the lap surgeons describe what they are

> able to see via the power magnification about what they would miss

> with just the naked eye!

Oh, I get it now! The lap is better because it's just IMPOSSIBLE to

use a magnifying lens during an open operation! Wow, why didn't I

think of that?

> " ANY surgery could take a lot longer in the hands of an unskilled

> > surgeon! "

> I think you might have missed the point I was trying to make -its

> that some argue that the lap surgery takes longer...

Yeah, so? Once again you are responding to things in your own head,

rather than what I have written. Me thinks this is not a very good

way to have a dialogue.

> what I was

> saying was it depended on the skill and proficiency level of the

> surgeon and would take longer in the hands of the inexpereinced.

DUH. Lap surgery takes longer with a surgeon inexperiened in lap

surgery. Open surgery takes longer with a surgeon inexperienced in

open surgery. Balancing a checkbook takes longer when one is

inexperienced at balancing a checkbook. Cooking a meal takes longer

for an inexperienced cook. Blah-blah-blah ad nauseum. SO WHAT?

> Everyone has thier own comfort level with their surgeons experience

> with numbers and kinds of surgery. I happen to be comfortable with

> surgeons I choose who are skilled in both lap and open but prefer

> to do lap for the very reasons I think its a better surgery for

> *me*.

Ah, at last, some truth comes out! You simply LIKE the lap procedure

better, and are more comfortable with it. That's fine, especially

since your surgeon is Dr. Rabkin -- a quite excellent surgeon.

> That particular statement was referring to the benefits of lap over

> open procedures regardless of the kind of surgery.

Oh really? How about brain surgery? Hip replacement? I don't think

so. And I doubt that any of the statistics it cited came from the DS

either.

> That segment of the statement was comparing RNY open to RNY

> lap... it has value to this arguement also.

It might if the surgeons in the study were also the surgeons who do

the DS. Otherwise, I want some evidence that the RNY surgeons, as a

group, are as talented, well-trained, and experienced as are the DS

surgeons, as a group. Otherwise we're back to space shuttles and

bicycles, or at least apples and oranges.

> one might use the same arguement for DS surgeons... docs who decide

> to perform the more difficult lap procedure would be the most

> skilled surgeons but I dont think that necessarily follows..

Of course not, because then you would have to admit that the lap DS

is more difficult than the open, and it's a very short logical leap

from " more difficult " to " more dangerous. "

> " We who have chosen the best surgery, on the other hand,

> are blessed by that fact that there is only a small group

> of surgeons who do the surgery at all, and that these

> surgeons are pretty uniformly excellent docs.

> > best WLS or best DS surgery?

Best WLS, of course.

> > " best " can be a point of contention as what is best for

> > one person may not be best for another.

I don't buy that lilly-livered crap at all. If the patient is

morbidly obese, the DS will give the best quality of life. Period.

I note that in Dr. Rabkin's practice, the " RGB is offered when

indicated, although this is uncommon, " but he performs the DS on

everybody else.

>

>

> > Who said anything about pain or length of time to recover

> > from the surgery? I was talking about how long it takes to

> > ADJUST TO OUR NEWLY RECONSTRUCTED DIGESTIVE SYSTEMS. "

>

> there are no right or wrongs, I was just adding another

> perspective...

In the English language, when one quotes another person and then

places a comment directly after that quote, it is customarily assumed

that the following comment is a RESPONSE to the quoted material.

> I have a feeling that

> those who have less trauma intraoperatively have less truama post

> op (including nausea and vomiting)also but thats just my theory...

You're darn tootin' that's just your theory, at least as far as

nausea and vomiting are concerned. I didn't have one episode of

nausea or vomiting until I was about six weeks post-op. Then I ate

the wrong food, and/or didn't chew it quite well enough, and back up

it came...

> " > What do the NGT and/or the feeding tube, (or lack of either

> one), have to do with whether the surgery was done open or lap? "

>

> I had a choice of surgeons... one who only had the skills to

> do open DS and his patients needed a day in ICU, had NG tubes

> and feeding tubes plus he practiced in a teaching hospital and

> I didnt want any anesthesiologist praciticing an epidural skills

> on me...

Gee, that sounds rather like a snide reference to USC, except that

the facts just don't quite fit. You see, both of the surgeons at USC

TEACH laparoscopic surgery, and one of them, Dr. Crookes, is a

permanent faculty member in lap surgery.

Also, their patients don't " need " a day in ICU any more than any

other morbidly obese person who has undergone complete anesthesia. I

see the fact that all of their patients are routed through ICU

(before going to a regular room) as a sign of caring on the part of

the doctors.

As Dr. Rabkin puts it, " Morbidly obese patients are at higher risk

for all surgical and anesthetic complications. Accordingly, extra

precautions are taken before, during, and after the operation. "

Putting the patient into ICU is simply another " extra precaution. "

OH THE TUBES ISSUE AGAIN. This still doesn't have anything to do

with open vs lap, but let me explain nonetheless.

NGT -- If you are so attached to your stomach slime, well, more power

to you, (I guess?!). As for me, I'd rather have it go down the tube

into a jar than risk barfing it up and inhaling it.

FEEDING TUBES: Actually, there are two tubes sticking out of one's

belly post-op, but neither one is used for feeding while one is in

the hospital. I forget the names, but here is what they do.

Tube #1 is on the right side of the belly, about 3 inches off center,

and ends in the bottom of the abdominal cavity. It has a little

plastic bulb on the end of it. When the bulb is compressed, it

causes very slight negative pressure which allows it to suck out any

body fluids and/or blood that accumulate in there. It's just

another " extra precaution " to prevent infection, as well as to give

the hospital staff a visual heads-up if you develop a leak.

Tube #2 is on the left side of the belly, also about 3 inches off

center. This one sticks into the side of the bilio tract, and

extends down it about a foot or less. While you are in the hospital,

this tube collects bile into a plastic bag-like thing. I'm not sure

why this is done, it's just another of those " extra precautions " that

Dr. Rabkin refers to.

Tube #1 is taken out a few days after surgery. Tube #2 stays in, and

becomes the feeding tube. As I pointed out, the feeding tube is

quite useful for those who have problems drinking enough liquid,

which can be a real problem. Dr. Hess, who originated the BPD/DS as

we know it today, puts it this way:

" Some people will have difficulty taking fluids

in the very beginning because there is a lot of

swelling around the stomach and different portions

of the small bowel hook-ups. Patients occasionally

have to be admitted to the hospital for a day or

two to have some IV's until they get re-hydrated

again. "

So, leaving the feeding tube in is yet another " extra precaution. "

> without the more painful longer recovery open procedure

Granted that the recovery from open is longer, but who says it's more

painful?

> > " ly, I think that the trauma many lap patients are

> >most worried about is the psychological trauma of having

> >somebody cut a gigantic slit down the front of their bellies.

>

> For me I could have cared less about the look of the scar...

I wasn't referring to the look of the scar. I was referring to the

fact that many people have a very deep fear of having that big

incision cut into them -- of having their internal organs exposed and

vulnerable. I'm sure it's quite Freudian, and has to do with things

like fear of penetration and stuff like that. Probably a topic for

some other board. (;

I hope for your sake that your recovery is as pleasant and uneventful

as you seem to have yourself convinced it will be.

[Guest guest]

who did your surgery in california

[Guest guest]

> who did your surgery in california

Not sure who you're talking to, but it seems like it might be me?

Tom

Panniculectomy, Dr. Anthone, 11/10/2000

Open DS, Dr. Anthone, 03/30/2001

11/10/2000....384

03/30/2001....360

04/19/2001....338

04/22/2001....334.5

05/03/2001....328

05/14/2001....319

05/18/2001....316

68 Ugly Pounds, GONE FOREVER!!!!!!!!!!!!!!!!

[Guest guest]

Hi Tom -

I think that you are diverting your focus from where it should be

because the article mentioned gallbladder surgery. What is germane

is that what restated was the opinion of " North American

Association for the Study of Obesity (NAASO) " at the 2000 Annual

Meeting on the topic of Surgical Management of Obesity. They, at

least, seem to feel that there is some relevance of lap gallbladder

surgery to the lap DS. They clearly are of the opinion that the lap

procedure is a better choice.

Or, are you suggesting that your knowledge somehow is superior to

that of such an august body?

Just an observation - I have noted that so many people actually deify

their surgeons. ( " Dr. Xxxxx is a god. " is not an infrequent thing to

find posted.) Could this be happening here? Dr. Anthone is,

unquestionably, on of the finest. However, there are others who are

equally successful, if not more so. Each has his or her own ideas.

The good one's all have good ideas and they are not necessarily the

same. Exclusive franchises on knowledge are rare, even for surgeons.

Have a great evening!

Best-

Nick in Sage

[Guest guest]

" Try to do all of that with one of

those camera-on-a-stick-thingies! "

Doesn't that cause excessive unesscesary stress to the

other organs? You would think it would. I trust that

with the right research and knowledge choosing a

surgeon is best left to individual preferences. Of

course we all think OUR way is better. That is why we

chose that way, if we didn't we would think we had/are

making the wrong decision. (I am going through this

with a friend that just had the RNY about 6 weeks ago

and can tell that she is kicking herself but instead

of admitting that she simply puts down the DS all the

time.) Soooo, everyone has their reasons for choosing

the surgeon, and procedure they are choosing.

Personally for me, here are my big factors:

Recovery time: I will loose my job if I am out too

long. I am fairly new and frankly, no matter what the

law says they can find SOME reason to fire you if they

want to. They wouldn't SAY it was because you had

surgery and were out for too long.

Incision Pain: I have had both Orthoscopic and open

surgeries in the past, and have had significantly less

pain from the Scopes than the open. Not internal

pain, external.

Surgeon Preference: I think that if you have a

surgeon that does both the Scope and the Open, as well

as the DS and the RNY that you can get a good view of

what would be best for you and for what is important

to you. If ease in approvals is one big thing for you

on a time factor, then the RNY is probably better for

instance. If quality of life post op is more

important, possibly the DS. So you see, there are

advantages and disadvantages to any choices we all

make and I think we should simply respect those

choices of other list memebers, offer support where

needed and answer and ask all the questions we can so

we are all as informed as possible with our new

chapter in our lives.

Oh and by the way, does anyone know if this was the

case with Dr. Ren and the Deb situation? (LAP couldnt

find something or something along those lines) And if

so, how long had she been doing the procedure LAP?

__________________________________________________

[Guest guest]

> I think that you are diverting your focus from where it should be

> because the article mentioned gallbladder surgery. What is germane

> is that what restated was the opinion of " North American

> Association for the Study of Obesity (NAASO) " at the 2000 Annual

> Meeting on the topic of Surgical Management of Obesity.

That's certainly how made it SOUND, wasn't it. Unfortunately,

it's just NOT TRUE. This is NOT a policy or opinion statement of the

NAASO. It is merely a summary, written by K. Buffington,

PhD, (note she is not even an MD!), of ONE-HALF of one two-hour

segment of the conference.

Here is an excerpt from the conference schedule:

" 3:30 – 5:30 Long Symposia

Update on Surgical Management Harvey Sugerman & Ed Livingston,

Chairs

Patient Evaluation And Indications For Obesity Surgery -- Klein

Gastric Restrictive Procedure -- Livingston

Malabsorptive Procedures -- Anthone

Laparoscopic Procedures -- Philip Schauer

Effect Of Surgical Weight Loss On Obesity Co-Morbidity -- Harvey

Sugerman "

The quote used was nothing more than Ms. Buffington's summary of

Dr. Schauer's presentation at the conference. The articles referred

to in Dr. Schauer's presentation are as follows:

FN13

Schauer PR. Laparoscopic procedures: update on surgical management.

Presented at the North American Association for the Study of Obesity

(NAASO) 2000 Annual Meeting; October 31, 2000; Long Beach,

California.

FN14

Steiner CA, Bass EB, Talamini MA, Pitt HA, Steinberg EP. Surgical

rates and operative mortality for open and laparoscopic

cholecystectomy in land. N Engl J Med. 1994;330:403-408.

FN15

Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J.

Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid

obesity. Ann Surg. 2000;232:515-520.

> They, at least, seem to feel that there is some relevance

> of lap gallbladder surgery to the lap DS. They clearly are

> of the opinion that the lap procedure is a better choice.

THEY are not of any such opinion. Dr. Schauer, who performs only the

RNY, is of that opinion.

> Or, are you suggesting that your knowledge somehow is superior to

> that of such an august body?

I am not suggesting anything. I am stating categorically that my

surgeon's knowledge is far superior to that of Dr. Schauer when it

comes to the DS procedure (at the very least). And he thinks the

open DS is safer.

> Just an observation - I have noted that so many people

> actually deify their surgeons. ( " Dr. Xxxxx is a god. "

> is not an infrequent thing to find posted.) Could this

> be happening here?

Certainly, but I fear you are writing this to the wrong party. In my

original post -- the one that set off on her flights of fancy --

I made three points:

First, I said that most docs only did the Lap DS if the patient was

under a certain weight. corrected my mis-impression from her

personal experience. Fine and dandy, I sit corrected.

Second, I stated that the Lap DS is NOT SAFER than the open DS.

responded to this by mis-citing MS Buffington's summary of Dr.

Schauer's presentation to make it look like it was the official

opinion of the organization, rather than what it is, i.e., the

opinion of ONE DOCTOR WHO HAS NEVER PERFORMED A DS OPERATION IN HIS

LIFE.

Third, I stated that all post-ops can expect to have certain

digestive related miseries to one degree or another. responded

to this with yet another load of crap based on her mis-reading, (to

be charitable), of Buffington's summary of Dr. Schauer's

presentation.

It's all fine and dandy for everybody to state their opinions, but

when somebody starts shoveling mis-information labeled as " truth " I

feel the need to object.

either cannot or will not admit that she is simply less afraid

of the lap rather than the open procedure. Instead she deludes

herself into thinking that, by having lap instead of open, she will

trot out of the hospital and head for the nearest nightclub to dance

the night away. If she needs to delude herself in order to get

through this, that's okay by me. It's just when she tries to delude

other people that I object.

And notice, when I pointed out that her " evidence " was flimsy at

best, she switched tactics and started naming the list of horrors she

would have gone through if, instead of choosing the Good Doctor of

the North, she had gone to the Evil Doctor of " that Teaching

Hospital. "

That ticked me off, because she wouldn't just say that she has some

pathological fear of tubes and ICU's. Instead, she had to claim that

surgeons who send their patients to ICU after surgery, and who insert

drainage tubes to prevent infections and nausea, as well as to catch

leaks more quickly, are somehow less competant than surgeons who

don't take these extra steps.

I have to wonder how in the world she knows that these tubes are SO

HORRIBLE, given that she HASN'T HAD HER SURGERY YET?!

When I woke up from surgery, I had a wrist IV, a central line IV, two

tubes in my abdomen, and one up my nose/down my throat. You know

which one bothered me? None of the above, as I was barely aware of

them. BUT, every time I got up to take a walk, I guarded my catheter

tube and bag with my life, out of fear that someone would step on it

and yank off my best pal. (;

Now THAT would be a SERIOUS " complication! "

[Guest guest]

<

>

Tom I did respond you just didnt like my answer.. I reiterate,I think

some Drs arent always objective regarding the surgeries they dont

do... Plus its only his opinion vs the objective opinion (in my mind

of the anyway) of the " North American Association for the Study of

Obesity (NAASO) 2000 " and its many documented sources.

Here is yet another opinion using bariatric lap vs bariarric open

procedures as a basis for conclutions:

" Minimally invasive techniques have been used in bariatric surgery

since 1993. (14, 15). Laparoscopic bariatric procedures rely on

videoscopic technologies to allow surgeons to perform accepted

bariatric operations in a minimally invasive fashion. The benefits of

a laparoscopic approach appear to be similar to those realized with

laparoscopic cholecystectomy, including but not limited to a shorter

recovery with an earlier return to normal activity. In addition,

wound complications such infections, hernias and dehiscences appear

to be significantly reduced.

....Laparoscopic techniques, based on their " open " counterparts, are

available. When performed by appropriately trained surgeons,

laparoscopic approaches appear to hasten the patient's recovery and

return to normal function. " http://www.sages.org/sg_pub30.html

SAGES GUIDELINES FOR LAPAROSCOPIC AND CONVENTIONAL SURGICAL

TREATMENT OF MORBID OBESITY

Society of American Gastrointestinal Endoscopic Surgeons (SAGES)

<

>

I did offer evidence, the report and all its footnotes of other

studies done:

http://www.medscape.com/medscape/CNO/2001/NAASO/NAASO-02.html

in additon to what I offered in the previous quote.

<

>

The scope of the article was baritric surgeries.. all of them and

open vs lap.(as did the one I added above in this post..so there are

two valid documented sources using he same basis of arguement) I am

sorry you dont see the logic in comparing RNY open and RNY lap to the

similar problems of DS open and lap... the two articles do.

Also it compapares a well documented surgery like GB open and lap as

there are such a profound number of stats to go by... again the

article uses that comparison of open vs lap

<

go well...

So what. Again you refuse to respond to what I said. >>

Again Tom, I answered, you just dont like my answer. Balastar is just

one surgeon who has found he doesnt like doing laps after trying

them. ... His opinion is supposed to sway me over all the documented

studies sited in that article?, I dont think so!

I think this justifies my thoughts futher:

" Some bariatric surgeons have been unable to master the techniques of

advanced laparoscopic surgery, and therefore do not offer this

method – or may even try to claim that it is less effective – which

is certainly not true.

.... Our results have been equal to, or better than, those obtained

with the open operation, but with major reduction of discomfort and

disability, and excellent cosmetic results as an additional

benefit. " http://www.gastricbypass.com/

<>

One can quibble over what " safer " means and what the implications of

what " less complications " mean...

To me, safer means less perioperative and post operative

complications, less deaths!

note the words here morbidity and mortalilty:

" Numerous studies have demonstrated the clear advantages to less

invasive surgery, including reductions in postoperative recovery

time, overall wound healing time, overall morbidity and mortality,

wound complication rate, perioperative complications, and

postoperative complications. "

<

>

Lap is the only way? Just to be clear, thats nothing I ever said... I

stated numerous times its a decision on whats best for " me " based on

the offered documented studies and quotes stating the clear

advantages of lap vs open. If others prefer to have a open surgery

then thats best for them... some might consider that reasoning " lilly-

livered crap "

Any surgery can have complicatons open or lap, I dont think what

happened to Deb can be blamed on the lap procedure.

" ... fool yourselves into think that because your incisions are

smaller "

Your focus on the incision over and over again makes me thinks thou

doest protest to loudly about what you dont know.(does yours bother

you?)

This is why I want the lap;

" ... the clear advantages to less invasive surgery, including

reductions in postoperative recovery time, overall wound healing

time, overall morbidity and mortality, wound complication rate,

perioperative complications, and postoperative complications. "

To me less complications and less deaths = safer surgery

(despite what one dr in spain who doesnt like laps says!).

< >

Maybe theres something that is not understood... the point being most

lap surgeries have advantages over thier counterpart open surgeries

for all the same reasons.. dont kid yourself, bariatric lap

procedures are only one classification of the many complicated lap

surgeries done.(see end of post) Less invasive is the prefered method

in many surgeries period, as its been well docummented as stated

previously.

<

>

No, I think its a matter of you missing my point just because you

dont like my answer... I think I countered that view point by saying

Lap surgeons might contend the less manipulation during surgery the

better. My " neatly chopping " has no deceptive intent ... your whole

post is there for everyone to read.. I was trying to counter your

thoughts point by point.. when a bunch are consolidated in one

paragraph its hard not to do so with out isolating each point

Hey we can agree to disagree and can also be respectful of others

differing opinions cant we?

< >

Each surgeon to their own pecadillos ... two isnt any great mandate

toward that point of view either is it?

<

less truama to the internal organs the better.

What, no thirty page quote from the Journal of Tonsilectomies? >>

Tom, is lowering this discussion with the use of this kind of

derogatory sarcasm really necessary to make your point? Cant you try

to make your point without it?

It surprises me that anyone would mind documented studies quoted to

back up their arguements... and then to ridicule such.

" > Each surgery has its

> pros and cons... listen to the lap surgeons describe what they are

> able to see via the power magnification about what they would miss

> with just the naked eye!

Oh, I get it now! The lap is better because it's just IMPOSSIBLE to

use a magnifying lens during an open operation! Wow, why didn't I

think of that? "

Lap surgeons would argue that the magnification advances allow for

getting the job done without the additional truama to the organs...I

dont think a magnifying lens is a credible comparison to the advanced

laparoscopic technology now avialable.

" .... By this means, under high magnification diseased organs are

able to be examined with minimal trauma to the patient . Instead of

making a large cut into the skin and underlying muscles, surgeons are

now able to make small entry ports into the area of interest and

perform all the major maneuvers previously done when a large opening

was present " http://www.sls.org/patientinfo/aboutlap.html

<

>

Gosh Tom you dont like it when I can qualify what I say with quotes

from studies and you dont like it when I make sure the reader knows

the thought was my own... me thinks you dont like a constructive

give and take without being insulting.

" Lap surgery takes longer with a surgeon inexperiened in lap

surgery. Open surgery takes longer with a surgeon inexperienced in

open surgery. Balancing a checkbook takes longer when one is

inexperienced at balancing a checkbook. Cooking a meal takes longer

for an inexperienced cook. Blah-blah-blah ad nauseum. SO WHAT? "

I think you are missing the point. Some argue that lap surgery is not

as good because it takes longer... my statement said thats only the

case in the hands of an inexperienced surgeon, that a lap surgery

doesnt have to take longer.

<

>

" simply like " (your words not mine).

I have investigated greatly and offered documentaion of the

statements I made.. your characteriztion of my simply liking the

surgery attempts to feebly trivialize and negate a well backed up

arguement.. Mind you, I am not saying its the only way or the best

way...or that you have to agree but I have concluded after much

reseach its the best way for " me " ..there is no " simly like " about it.

Let me characterize it my way...I am more comfortable with a lap

because its been proven " In clinical studies, the advantages of

laparoscopic over open surgery have been well documented. "

<

open procedures regardless of the kind of surgery.

Oh really? How about brain surgery? Hip replacement? I don't think

so. And I doubt that any of the statistics it cited came from the DS

either.>>

Excuse me but the title of the article which may have been overlooked

if it was too long to read was:

Surgical Management of ObesityNorth American Association for the

Study of Obesity (NAASO) 2000 Annual Meeting

I quote my source if you disagree thier logic and the other article

from bariatric surgeons I quoted to back it up thats fine...what

sources are you quoting from?

<

>

As soon as the medical community decides to study DS surgeons vs RNY

who do open and lap you can have your probable similar stats (Who

would bother?)... the bariatric community can see the logic in the

arguements offered thats enough for me.

<

>

Each surgery has its own set of challenges. Even though what is

accomplished is the same for both surgeries the methodology and

techniques to arrive at that goal are not. It seems when it comes to

lap surgeries the advanced techniques and skill level of the surgeon

out weigh the overall risk of open vs lap or they might not be able

to say the following:

" Overview of Laparoscopic Procedures

The types of bariatric surgeries and their prevalence in the United

States and Canada are RYGB, 70%; biliopancreatic diversion, 12%; VBG,

7%; gastric banding, 5%; and Silastic ring, 4%. RYGB produces a 60%

to 75% weight loss, but has significant perioperative morbidity

together with a 1% mortality and prolonged recovery. One possible

method to reduce complications and increase ease of use in all

bariatric surgery options is laparoscopy, said Dr. Philip R. Schauer

of the University of Pittsburgh in Pittsburgh, Pennsylvania.[13] "

<

> one person may not be best for another.

I don't buy that lilly-livered crap at all. If the patient is

morbidly obese, the DS will give the best quality of life. Period.

I note that in Dr. Rabkin's practice, the " RGB is offered when

indicated, although this is uncommon, " but he performs the DS on

everybody else. >>

Obviously by his statement there are certain cases when the RNY is

indicated, just because I dont know what the circumstances are that

would effect a Dr to come to that conclusion, logic tells me I

shouldnt assume its " lilly-livered crap " .

<

>

it was.... again you just didnt like/understand my response.

<

>

The USC Drs offer what they think is best. Just as Drs R&J have

offered various bariatric surgeries they prefer to do what they think

is the best bariatric surgery.. therefore the DSLAP is perfomed more

frequently ... note, its not DS open that is what they do most its

the lap as they have done both and come to the conclusion the lap is

preferable... to quote Dr J:

" The advantages of laparoscopic surgery come from minimizing the

trauma of access to internal organs. By avoiding a long incision

through the muscles, many post-operative problems are eliminated and

pain is markedly reduced. This enables you to breath and cough

better. Use of strong pain medications is drastically reduced so the

drowsiness, fatigue and unsteadiness they cause is minimized. Most

patients have a shorter hospital stay and recover within days instead

of weeks.

Risks of any operation include: infection, bleeding, hernia,

pulmonary embolus (blood clot to the lung). These complications tend

to be less frequent in laparoscopic surgery compared to open surgery "

The Drs as USC have their own preferances for open.. so be it.Does it

make open the best procedure, I think not... Does the fact that Drs

J&R prefer DSLap for most patients make it the best... probably not.

Based on my research I agree with R&J about DS and lap surgery so

thats the best for " me " .

<

>

Let me put it this way.. thier patients are required to be in ICU

after recovery rather than a patient room... this **preferance** on

thier part does not indicate greater caring than other Drs... its

purely their preferance. The way you state that the reader might

conclude a less caring Dr wont insist on ICU. Obviously Anthone is a

more conservative Dr... thats his preferance not a medical necessity.

Since the Drs in SF have equally good stats for pt complications and

mobidity I trust their judgement on what is " needed "

.... and as long as thier patiens dont need to be in ICU or have

NGtubes or Jtubes ... I'm all for a less traumatic recovery and that

fits the bill for me perfectly... again it may not be best for all

and I would never negate anyones or any Drs need for a more

conservative method of treatment but I have all the confidence in my

drs if they dont need to be so conservative and still have excellent

results as thier stats underscore thier logic. Thats not to say

complications dont happen.. but I am comfortable with thier outcomes

to agree with their judgement on this.

I would also not equate more caring to being more conservative, I

think thats a leap in logic. One could say a less painful, less

prolonged hosptal stay, is a less traumatic surgery is more caring.I

dont think caring has as much to do with DR preferance.

<

>

Thats DR Anthones view of extra precautions..its not the only view of

extra precautions.

" OH THE TUBES ISSUE AGAIN. This still doesn't have anything to do

with open vs lap, but let me explain nonetheless. "

no need... more conservative drs use more drains post op, require ICU

stay, and do open procedures, so be it... Maybe the open procedure

and the more manual manipulation of the organs gives rise to the need

for more precuastions.. I dont know. It does appear the lap surgeries

require less need for drains and such.

What I do know is my drs dont feel the need for any of the above and

their judgement is proven sound by their great results and documented

stats... without, so I dont feel the need either.

<

>

Dr J for one does ( note " avoiding a long incision " refers to open DS

here):

" By avoiding a long incision through the muscles, many post-operative

problems are eliminated and pain is markedly reduced. This enables

you to breath and cough better. Use of strong pain medications is

drastically reduced so the drowsiness, fatigue and unsteadiness they

cause is minimized. "

I have no doubt that MOST (not all) patients who have gone thru both

open and lap abdominal procedures would attest to the less pain too.

<>

You are very wrong in your assumption. I am not at all convinced my

recovery will be uneventful and pleasant... you repeatedly

characterize what I am thinking innacurately.

You would be correct to assume that I do feel I have a better chance

of a shorter, less painful, less complicated recovery based on the

surgery and the surgeon... and thats based on their proven stats ..

thats the most I can expect, the better chance of that kind of a

surgical experience with the lap procedure. For all I know they may

end up reverting to the open procedure during the surgery!

RNY and DS are not the only complicated lap procedures accomplshed

thru advanced lap techniques:

http://www.pacificsurgery.com/About_Us/Lap_Surgery/Lap_Procedures/lap_

procedures.html

UPPER GASTROINTESTINAL PROCEDURES

Laparoscopic Fundoplication for hiatal hernia and acid reflux disease

Laparoscopic Paraesophageal hernia repair

Laparoscopic Heller Myotomy for Achalasia

Laparoscopic Gastrectomy for benign and selected malignant stomach

tumors

Laparoscopic Transgastric surgery for small tumors and polyps inside

the stomach

MORBID OBESITY PROCEDURES(BARIATRIC SURGERY)

Laparoscopic Isolated Roux-en-Y gastric bypass

Laparoscopic Vertical Banded Gastric Bypass

Laparoscopic Biliopancreatic Diversion/Duodenal Switch (BPD/DS)

HEPATO-BILIARY PROCEDURES

Diagnostic Laparoscopy and Laparoscopic ultrasound for diagnosis and

staging of tumors

Laparoscopic cholecystectomy (gallbladder removal)

Needlescopic cholecystectomy (incisions less than 3 millimeters)

Laparoscopic common bile duct surgery

Laparoscopic treatment of benign and malignant liver tumors:

Ablation(local tumor destruction): cryoablation and radiofrequency

ablation

Resection(removal of tumor)

PANCREATIC PROCEDURES

Diagnostic Laparoscopy and Laparoscopic ultrasound for diagnosis and

staging of tumors

Laparoscopic palliative procedures for pancreatic tumors

Laparoscopic enucleation of islet cell tumors(insulinoma)

Laparoscopic Distal Pancreatectomy

Laparoscopic Transgastric pseudocyst drainage

LOWER GASTROINTESTINAL SURGERY

Laparoscopic small bowel resection for benign and malignant tumors

Laparoscopic lysis of adhesions for intestinal obstruction

Laparoscopic colectomy for benign and malignant tumors of the colon

Laparoscopic intestinal resection for Crohn's disease and Ulcerative

Colitis

ENDOCRINE SURGERY

Laparoscopic Adrenalectomy

Endoscopic Parathyroidectomy

Laparoscopic enucleation of islet cell tumors of the pancreas

SOLID ORGAN SURGERY

Laparoscopic radical and donor nephrectomy for kidney transplantation

Laparoscopic splenectomy

mary bmi 68

corona ca

pre op 6/26/01 dr rabkin

cigna ppo

[Guest guest]

<

>

If you cannot carry on a discussion in civil tones like a gentlemen,

then I will not subject myself to your unnecessarily crude remarks in

bothering to respond to you.

A good debater does not have to lower the caliber of argument to the

tones you use to win points.

Some people can " respectfully " disagree with each other, obviously

you cant. Your tone is totally uncalled for.

mary

[Guest guest]

" HOWEVER, that being said, Dr. Gagner, one of the top in the field

(and the pioneer of laparoscopic BPd/DS), is now recommending the Ds

surgery in two parts for heavier bmis. " '

I hope it publishes something soon about the stats that made him go

this wayit would be enlightening. Maybe he will talk to this at the

upcoming bariatric conference coming up soon. It will also be

interesting reading about the results of this new police once he has

enough cases under his belt to document is ethicacy or not.

mary bmi 68

corona, ca

pre op 6.27.01

cigna ppo

[Guest guest]

wow, what's up with the hostility, Tom? I see a lot of things is

posting, citing sources, etc., and yet you continue to ridicule and

denigrate anything she says with derogatory and ugly sarcastic

PERSONAL remarks rather than refuting her fact for fact.

--stella

[Guest guest]

oh and where is he located?

[Guest guest]

why two parts?

[Guest guest]

where did you find the list for insurance companies for dr.anthone?

[Guest guest]

Yeah! What SHE said!

Re: Hi everyone.. New...

> <

mis-reading, ...>>

>

>

> If you cannot carry on a discussion in civil tones like a gentlemen,

> then I will not subject myself to your unnecessarily crude remarks in

> bothering to respond to you.

>

> A good debater does not have to lower the caliber of argument to the

> tones you use to win points.

>

> Some people can " respectfully " disagree with each other, obviously

> you cant. Your tone is totally uncalled for.

>

> mary

>

>

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

>