Re: Re: Hi everyone.. Tom's stuff

[Guest guest]

Why do all of Tom's rebuttals seem to begin with " Jane you ignorant

slut....? " My point is that they appear to be personal attacks rather than

reasonable debate. It makes it hard to take you seriously. Just a little

FYI.

Re: Hi everyone.. New...

<

>

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

----------------------------------------------------------------------