2 stages, twice the risk

[Guest guest]

When you think of how much the surgeons alert us to the risk of surgery; complications and death... there is something else to consider here that I think is being overlooked in this discussion so far... that's consideraton of risking going thru an additional major abdominal surgery and the trauma to the body in such a short period of time. (The risk of anesthesia etc. being higher for the obese, the risk of adhesions in any abdominal surgery etc.)

Well, true, but I am doing two surgeries anyway-- the panni, which shouldn't go into the abdominal compartment and probably isn't as MAJOR as the other surgeries, just major because of my bmi in the first place.-- but I keep thinking if I have to be knocked out and cut up, I would really like the first time to count for more than just the removal of a big lump of fat.

Then, if all goes well after the ds, I get to look forward to at least one more surgery-- the brachioplasty-- and maybe more, depending on how Sharpei like everything else is. Oh well, as they say, in for a penny, in for a pound (or maybe a couple hundred)-- Nan E.

[Guest guest]

<

>

When you think of how much the surgeons alert us to the risk of

surgery; complications and death... there is something else to

consider here that I think is being overlooked in this discussion so

far... that's consideraton of risking going thru an additional major

abdominal surgery and the trauma to the body in such a short period

of time. (The risk of anesthesia etc. being higher for the obese, the

risk of adhesions in any abdominal surgery etc.)

All that to consider.. twice, an important factor to include in the

equation.

Some Drs. wont consider doing laps on pts with previous abdominal

surgeries because of the inherent complications with repeat abdominal

surgeries... in certain circumstances then one might have the idea of

two open surgeries.

I think only time will tell if this new policy (experimental?) of two

surgeries with the inherent increased risk involved proves in the

long run a better route to go than the risk of one surgery on pts

with higher BMIs. In the future the published reports, stats and

conclusions on this new way to handle DS will be an interesting read.

Hard choices for those in the mean time wanting surgery now but not

knowing how this works out, when not enough 2 stage surgeries have

been done to draw any real conslusions.. but then again the choice to

have DS is hard period. Maybe Gagner will have a report with this

bariatric conference coming up that will shed more light on all of

this.

Best of luck to all who decide to go this route!

mary bmi 68

corona, ca

pre op 6/27/01 dr rabkin

cigna ppo

[Guest guest]

Here's a question I've never seen addressed re: the two stage

technique.

What if you have the first surgery and lose just enough weight to put

you at a BMI of 39 or so, and at the same time your co-morbidities

clear up? Doesn't it seem like there is a risk that at least some

insurance companies would refuse the second surgery because you no

longer qualify as morbid enough anymore?

I actually had a very easy time with my insurance co., (they make up

for it by paying about 7.5% of the billed amounts), but the stories

I've heard from other people are real nightmares.

Just a thought.

Tom

[Guest guest]

The people with very high BMIs probably couldn't get down below a BMI of 40

that quickly.

in Seattle

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

> What if you have the first surgery and lose just enough weight to put

> you at a BMI of 39 or so, and at the same time your co-morbidities

> clear up? Doesn't it seem like there is a risk that at least some

> insurance companies would refuse the second surgery because you no

> longer qualify as morbid enough anymore?

[Guest guest]

Hard choices for those in the mean time wanting surgery now but not knowing how this works out, when not enough 2 stage surgeries have been done to draw any real conslusions.. but then again the choice to have DS is hard period. Maybe Gagner will have a report with this bariatric conference coming up that will shed more light on all of this.

I know that my surgeon feels as though if you are a healthy individual with no major co morbidities and have the procedure done in 2 parts that you may wind up not needing the 2nd half. In other words you have 160 lbs to lose and with the VG you lose 100 lbs, by then you may have control over your eating and won't want surgery for 60 lbs more that you may be able to lose the rest with eating modification and exercise. But on the other hand you always have that option. But he feels strongly that a healthy person ( other than being MO ) may not need to put themselves at a nutritional risk ( due to the malasorptive factor of the DS ) and may benefit from just the VG.

Kathy B

Dr. Elariny

[Guest guest]

So I dont think its the initial weight loss I'd be concerned about... most WLS do work for the initial weight loss.. some better than others.

Its the long term stats I'd be concerned about if I didnt have the second part of the prodedure ie the bottom part of the DS... what are the long term stats for a VG? how many pounds are you likly to gain back in five yars 30, 50 more? What is the % of patients maintaining excess weight loss if 5 years 50%, 60%? How many failed VG pts end up as revisions to DS?

Not enough data to show yet, unfortunately.

Kathy Dr. Elariny

[Guest guest]

< no major co morbidities and have the procedure done

in 2 parts that you may wind up not needing the 2nd half. >>

If you think of it this way.. there are two goals to weight loss

surgery; getting the weight off and keeping it off. Many methods of

weight loss work... but that isnt the biggest problem is it. Its

keeping it off thats the problem.

So I dont think its the initial weight loss I'd be concerned

about... most WLS do work for the initial weight loss.. some better

than others.

Its the long term stats I'd be concerned about if I didnt have the

second part of the prodedure ie the bottom part of the DS... what are

the long term stats for a VG? how many pounds are you likly to gain

back in five yars 30, 50 more? What is the % of patients maintaining

excess weight loss if 5 years 50%, 60%? How many failed VG pts end up

as revisions to DS?

mary bmi 68

corona, ca

pre op 6/27/01 dr rabkin

cigna ppo

[Guest guest]

I had this 2 part as an option to me also. I truly don't think it will work in the long run....maybe for the 1st year or so but weight gain or not enough weight loss is a HUGE possibility. Remember....we got this way because we LOVE to eat.....and eat the wrong foods. Just like the VBG that was done so often years ago, there are a lot of people gaining from it.....and their stomach was a LOT smaller than the Vertical 1st part. I would like to see how things turn out for people willing to see if this will work for them and I hope they are happy with it. For the 1st 2 weeks I wasn't able to eat much and thought for sure that I probably could've done it with only the 1st part.....but then the hunger came back and I am able to eat a LOT of food....but I never have to worry because I have that 2nd part backing me up. If I could've lost weight with dieting and eating less than I never would have had to have surgery. This is just my opinion ....I do wish these 1st part patients all the best and hope they stay on the list and keep in touch to let us know if it works or not....

Bobbi-jo

4-30-01

-26 lbs

[Guest guest]

Hi....what they are talking about is doing only the 1st part of the DS....some are calling it VG-Vertical Gastroplasty....not the VBG. Some people are getting this done only in hopes that they will not need the 2nd part of the DS.....

Bobbi-jo

[Guest guest]

> Not enough data to show yet, unfortunately.

check out the weight lost stats here:

The vertical banded gastroplasty (VBG) is a restrictive operation. A

small vertical pouch is made at the upper portion of the stomach

using staples. This pouch can hold about 20 ml. The outlet of the

pouch is reinforced with a silicone tubing. This operation is

performed only by the conventional open technique and not

laparoscopically.

Advantages:

There is no anastomosis (or re-connection) of intestine. This

decreases the risk of intestinal content leakage.

Since there is no re-routing of food, or bypassing of intestine,

there is no risk of nutritional problems.

In a highly selected group of patients, weight loss reaches 50%-60%

excess weight loss (EWL). Otherwise, weight loss may only be 40%-50%

EWL.

Disadvantages:

The silicone tubing used as the restrictive band can slip from its

original position and cause vomiting. Slippage of the silicone tubing

may cause the outlet to tighten and result in blockage. This would

require additional surgery to remove or re-position it.

Break-down of the staple line can lead to weight regain.

Overeating can result in vomiting, or if continued, can lead to

stretching of the pouch and weight regain.

http://thinforlife.med.nyu.edu/operations/vbg.html

____________________

and compare to these:

Lap DS

Advantages:

Weight loss ranges from 70%-90% of excess body weight in patients

with a BMI 35-85 kg/m2, over the first 2 years. This equals roughly

100-300 pounds, depending on your original weight. After that, there

is almost no weight regain. It is one of the most powerful operations

to achieve a large amount of long-lasting weight loss.

http://thinforlife.med.nyu.edu/operations/typetwo.cgi

_________________

Gastroplasty:

Weight Loss:

Unpredictable. May plateau early and regain weight as diet changes.

Advantages:

Shorter operative time (about 1 hour), lower complexity. Can be

performed via laparoscope. Adjustable bands can be resized without

reoperation.

Problems:

Band (ring) may be too loose causing inadequate weight loss, or too

tight resulting in obstruction and vomiting, may migrate up or down

when placed laparoscopically, or may erode through the stomach wall

causing pain or bleeding. Staple line disruption can lead to weight

regain.

Summary:

Least complex procedure, may be performed laparoscopically. Lowest

potential for metabolic complications. Shorter anesthesia time,

reduced operative risk. High re-operation rate. Diminished quality of

eating with pain or vomiting of pouch volume exceeded. Weight loss

unsatisfactory in many series.

http://www.pacificsurgery.com/Obesity_Surgery/History/history.html

[Guest guest]

....I agree with you 100%....there isn't ANY evidence out there at all that shows that people can lose and keep it off after just the 1st part of surgery....it does it's work with making the higher bmi patients lose some before the 2nd part.....but there is nothing proving that it will stay off if you do not finish it.....I am 4 weeks out and can eat a LOT of food.....but I am losing at a healthy pace....very happy!!! :-)

Bobbi-jo

[Guest guest]

> Hi....what they are talking about is doing only the 1st part of the

> DS....some are calling it VG-Vertical Gastroplasty....not the VBG.

Some

> people are getting this done only in hopes that they will not need

the 2nd

> part of the DS.....

You're right of course.. got my letters mixed up! thank you

Still though, the DS was not designed to be a one parter... the two

parts make it what it is. Neither alone are even suggested to be

sucessful for the twin goals of initial and long term weight loss.

The " top " part of the surgery.. the Gastroplasty will get the weight

off no doubt during the early part of the weight loss window.. but

its the " bottom " part the DS switch part of the surgery that allows

for continued weight loss and maintain weight loss after

stabilization.

The stomach does go back to a near normal size by the end of the

weight loss window which accounts for the weight loss stablisation...

How many of us can maintain weight loss with out any help (2nd part

of the surgery) after that? To me that would be just like losing a

bunch of weight after dieting only to regain when the dieting

ends...unless you want to be on a diet the rest of your life...but

thats what we are trying to overcome with this surgery... to reach

the goal of maintainence without yet another diet failure...

mary bmi 68

corona, ca

pre op 6/27/01 dr rabkin

cigna ppo

[Guest guest]

*sigh* I was thinking the very thing! I want to have a baby (or 2) in the

next couple of years and the 2 part surgery might be nice for that, but

really, I don't imagine that I'll have a chance to keep the weight off if I

don't do the other part too.

waterlilys@... wrote:

>

> How many of us can maintain weight loss with out any help (2nd part

> of the surgery) after that? To me that would be just like losing a

> bunch of weight after dieting only to regain when the dieting

> ends...unless you want to be on a diet the rest of your life...but

> thats what we are trying to overcome with this surgery... to reach

> the goal of maintainence without yet another diet failure...

>

> mary bmi 68

> corona, ca

> pre op 6/27/01 dr rabkin

> cigna ppo

>

> -

[Guest guest]

Kathy, I hope your surgeon is right, but the research so far says the odds are against you. Neither surgery alone produces enough long term weight loss in the MO. If "getting the eating under control" was all it took, then the RNY would never fail-that is one surgery that enforces behavior modification with a vengeance, but folks still manage to defeat it. You may be one of the lucky ones -- more power to you.

Nan E.

[Guest guest]

> people are getting this done only in hopes that they will not need the 2nd > part of the DS.....

Sorry, but you must have missed the earlier posts-- folks with very high BMI's are being offered the BPD/DS in 2 stages lap because they won't do the whole thing Lap on high BMI's. One doc suggested his paitent might not want the DS part if she was happy with what she lost with part one only. I am not aware that anyone is actually out looking to have only the one thing done-- I don't think anyone on the list was out to get that done-- they are just hopping that they might be able to skip part 2 if part one does the trick based on something their doc said.

Nan e.

[Guest guest]

I am having the second part done at the end of June and never did I think I

would stop after just the first part. Like others have said, if I could have

done it on my own, then the surgery wouldn't have been needed in the first

place. I am sure that after having lost almost 90 pounds I am less of a risk

for the surgery. Would still like to lose another 10 before June 26.

I am still looking for a good protein powder and bar. Will order some

luna bars today. Hopefully, I will like those.

Terry

[Guest guest]

Dr G. explain to me that without the Ds portion of the surgery your stomach can

go back to a large size with overeating. Meaning the outcome would be weight

gain.

[Guest guest]

No....I did not miss the earlier posts....I am well aware of the higher bmi patients getting it done in 2 parts for their own health safety. There are some patients now that are ONLY getting the 1st part done and hoping to lose enough weight. I know because I was offered this from my surgeon. He said because I am 27 and weighed 300 that I might want to opt just for the 1st part and hope that I lose enough.....I admit, I did think about this for awhile but chose to go for the full DS because I didn't feel that you could lose AND keep it off in the long run...and if diets or cutting back would have worked in the first place then I would never had to have any surgery done.....I may be wrong. I do wish everyone going the 1st route only the best of luck... :-)

Bobbi-jo

[Guest guest]

Bobbi-jo,

How is your weight loss going ? I always interested because we're the

same age and pretty much the same weight, although I unfortunately

just gained up to 305 lbs (nurse said it might have been my jeans,

but I don't think my jeans weigh 5 lbs!), plus I'll turn 28 in

September, but it's close enough for me

Anita

Pre-pre-op in Denver

> No....I did not miss the earlier posts....I am well aware of the

higher bmi

> patients getting it done in 2 parts for their own health safety.

There are

> some patients now that are ONLY getting the 1st part done and

hoping to lose

> enough weight. I know because I was offered this from my surgeon.

He said

> because I am 27 and weighed 300 that I might want to opt just for

the 1st

> part and hope that I lose enough.....I admit, I did think about

this for

> awhile but chose to go for the full DS because I didn't feel that

you could

> lose AND keep it off in the long run...and if diets or cutting back

would

> have worked in the first place then I would never had to have any

surgery

> done.....I may be wrong. I do wish everyone going the 1st route

only the

> best of luck... :-)

>

> Bobbi-jo