Articles in Mayo Clinic Proceedings, July 2000, Vol.75, No.7, 669-672

[Guest guest]

I don't see much discussion of these recent articles.

I have the Harvey J. Sugarman M.D. (Medical College of Virginia,

Richmond, VA 23298-0519) Editorial " The Epidemic of Severe Obesity:

The Value of Surgical Treatment "

He refers a lot to the 1991 NIH panels (they will be updated this

October, BTW, so maybe we ought to be focusing there, too) as well as

an article by Balsiger, et al., in the same issue " Prospective

evaluation of Roux en Y gastric bypass as a primary operation for

clinically complicated obesity " pp 673-680 [no bias there--SG].

Sugarman encourages insurance companies to look beyond the bottom

line and pay for WLS, but,

" We agree with the authors that the most effective operation for this

disease is gastric bypass [which, from context means RnY--SG] . . . "

Then he refers to a 1998 article by Kellum, De and Sugarman,

" The surgical treatment of morbid obesity " Curr Prob Surg. 1998; 35:

791-858 as a " useful review of the different operative procedures and

he overall efficacy of obesity surgery. "

And then he drops the bomb: " We are concerned with the malabsorptive

procedures, including the partial biliopancreatic bypass and the

duodenal switch operations, which may be associated with steatorrhea

[frothy, floating and stinky poops with greater than normal amounts

of fat--SG], fat-soluble vitamin deficiencies,and osteoporosis from

calcium and vitamin D deficiency. "

Sugarman is also highly respected. My guess is that his editorial

may have also weighed in the decision-making.

--Steve (g'nite--it's way past my bedtime; I arise at 5AM)

--

[Guest guest]

My understanding is that Dr Sugarman is preparing to start offering the DS

surgery. I have much respect for him and have been eagerly awaiting

announcement of this change-- if it is true.

in Seattle

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

> I don't see much discussion of these recent articles.

>

> I have the Harvey J. Sugarman M.D. (Medical College of Virginia,

> Richmond, VA 23298-0519) Editorial " The Epidemic of Severe Obesity:

> The Value of Surgical Treatment "

> He refers a lot to the 1991 NIH panels (they will be updated this

> October, BTW, so maybe we ought to be focusing there, too) as well as

> an article by Balsiger, et al., in the same issue " Prospective

> evaluation of Roux en Y gastric bypass as a primary operation for

> clinically complicated obesity " pp 673-680 [no bias there--SG].

>

> Sugarman encourages insurance companies to look beyond the bottom

> line and pay for WLS, but,

>

> " We agree with the authors that the most effective operation for this

> disease is gastric bypass [which, from context means RnY--SG] . . . "

>

> Then he refers to a 1998 article by Kellum, De and Sugarman,

> " The surgical treatment of morbid obesity " Curr Prob Surg. 1998; 35:

> 791-858 as a " useful review of the different operative procedures and

> he overall efficacy of obesity surgery. "

>

> And then he drops the bomb: " We are concerned with the malabsorptive

> procedures, including the partial biliopancreatic bypass and the

> duodenal switch operations, which may be associated with steatorrhea

> [frothy, floating and stinky poops with greater than normal amounts

> of fat--SG], fat-soluble vitamin deficiencies,and osteoporosis from

> calcium and vitamin D deficiency. "

>

> Sugarman is also highly respected. My guess is that his editorial

> may have also weighed in the decision-making.

>

> --Steve (g'nite--it's way past my bedtime; I arise at 5AM)

> --

[Guest guest]

At 8:41 PM -0700 6/28/01, Montgomery wrote:

>My understanding is that Dr Sugarman is preparing to start offering the DS

>surgery. I have much respect for him and have been eagerly awaiting

>announcement of this change-- if it is true.

>

> in Seattle

If it **IS** true, then we may soon be able to score one big one for

the DS. But, his editorial seems so pessimistic, or, at best,

foreboding, about the malabsorptive aspects of the DS, with hardly a

mention about similar consequences from a distal RnY. --Steve

--

[Guest guest]

In a message dated 6/29/01 11:51:31 AM, duodenalswitch writes:

<< If it **IS** true, then we may soon be able to score one big one for

the DS. But, his editorial seems so pessimistic, or, at best,

foreboding, about the malabsorptive aspects of the DS, with hardly a

mention about similar consequences from a distal RnY. --Steve

>>

Steve: This is something that I just don't GET. The distal RNY has roughly

equivalent malapsorption issues but is even WORSE in the fact that, due to

the pouch, the patient is often unable to get enough nutrients in to

counteract the malabsorption. Yet, no one so far has come out in criticism

of the distal RNY and talk about these surgeries as if they were identical.

Even surgeons who perform RNYs often do not inform their patients which type

of RNY they have planned --- To me, this is hideous because the post-op care,

etc. is radically different. Many patients are receiving distal RNYs and

nothing is said about the nutritional aspects of this. Yet, the DS is

considered 'experimental'... This does NOT make any logical sense at all. If

one is going to argue that a distal procedure is potentially dangerous, ok.

But to blatently attack one while allowing another to routinely be performed

(often without proper patient notification, IMHO) is ridiculous. Also, if I

had to chose between the two distal procedure, it would be DS hands down!

all the best,

lap ds with gallbladder removal

January 25, 2001

five months post-op and still feelin' fab!

pre-op: 307 lbs/bmi 45

now: 241 lbs/bmi 34

[Guest guest]

At 12:47 PM -0400 6/29/01, ruisha@... wrote:

>In a message dated 6/29/01 11:51:31 AM, duodenalswitch writes:

>

><< If it **IS** true, then we may soon be able to score one big one for

>the DS. But, his editorial seems so pessimistic, or, at best,

>foreboding, about the malabsorptive aspects of the DS, with hardly a

>mention about similar consequences from a distal RnY. --Steve

> >>

>

>Steve: This is something that I just don't GET.

>

>... This does NOT make any logical sense at all. If

>one is going to argue that a distal procedure is potentially dangerous, ok.

>But to blatently attack one while allowing another to routinely be performed

>(often without proper patient notification, IMHO) is ridiculous. Also, if I

>had to chose between the two distal procedure, it would be DS hands down!

>

. It's not about logic. It's about ego and money. They

always trump logic.

--Steve

--