Re: St. 's University Hospital (Tom)

[Guest guest]

"For example, the surgeons at NYU had these results with their first fourty patients: "There was one 30-day mortality (2.5%). Major morbidities occurred in 6 patients (15%), including 1 anastomotic leak (2.5%), 1 venous thrombosis (2.5%), 4 staple-line hemorrhages (10%) and 1 subphrenic abscess (2.5%)." (1)

This is taken from the paper that Dr Gagner, Dr and Dr Ren wrote. It is Mt Sinai not NYU. This was from the study on Dr Gagner's 40 patients where Dr Ren and Dr were his fellows.

Your own references: "Here are the references cited above: "(1) Ren CJ, E, Gagner M, "Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients." Obes Surg (Canada), Dec 2000, 10(6) p514-23; discussion 524"

These were the first laparoscopic patients. These surgeon's developed the technique and have perfected it. Unfortunate for the first 40 patients of the laparoscopic procedure but the problems these patients had helped to perfect the technique. If you look at things in this perspective it does not look as bad. But if you just quote the statistics without giving the background it looks very grim.

Has Dr Rabkin published a paper on his patients? I would be interested in seeing it. I know there are a lot of surgeons that have not published the results of their surgeries. So, the ones that have published papers are subject to critism.

As far as the measurement of limbs, I do not think that applies to the BPD/DS. The ileum is transected from the jejunum. So the proportion of one's ileum limb depends upon each individual. The ileum is attached to the duodenal remnant while the jejunum is bypassed and connected to the last 70-100 of the ileum forming a common channel. Measurement of limbs in not necessary except for the final portion. The RNY is the procedure that is dependant on the measurement of the two limbs.

I would like to see a study on the morbidly obese that might show the possibility that extremely long duodenum and jejunum (hence a good reason to measure these limbs) might have an impact on the inability of keeping the fat off as that is where most of our digestion occurs and we absorb all our calories, fat and vitamins/minerals. If a direct correlations between these factors and morbid obesity occurs that would be the convincing study to effectively fight the insurance companies.

Viau http://www.angelfire.com/on/wannabemagic/WLS.html 3/29/01: 3167/01/01: 255 (-61 lbs)Dr Ren, NYUMC http://www.thinforlife.orgTo join the new group for Dr Ren click on the link belowhttp://groups.yahoo.com/group/NYUMC-thinforlife

[Guest guest]

> As far as the measurement of limbs, I do not think that applies to

the BPD/DS. The ileum is transected from the jejunum. So the

proportion of one's ileum limb depends upon each individual. The

ileum is attached to the duodenal remnant while the jejunum is

bypassed and connected to the last 70-100 of the ileum forming a

common channel. Measurement of limbs in not necessary except for the

final portion. The RNY is the procedure that is dependant on the

measurement of the two limbs.

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

Actually there is no way to tell where the jejunum ends and the

ileum begins, same with the duodenum. One would have to study the

cell types in order to know that. We do know averages of lengths of

the sections of small intestines but by simply looking at it you

can't tell.

B.

July 6th, open DS with Dr. Anthone

Less than 48 hours to my switch!

[Guest guest]

Hi :

> It is Mt Sinai not NYU.

OOPS! Sorry. My typo.

> Has Dr Rabkin published a paper on his patients?

He has published one paper on a mix of surgeries, but that was prior

to his beginning to do lap. (That paper is on the Duodenalswitch.com

site.)

He also has another paper which is under consideration for

publication by SAGE.

Jossart GH, Nuglozeh-Buck, D, Rabkin RA., " A laparoscopic technique

for duodenal switch: Experience with 77 patients. " Submitted to

Society of American Gastrointestinal Endoscopic Surgeons, St. Louis,

MO April, 2001.

There are also a lot of facts regarding his success rate scattered

around his web site. This is where I got the information saying that

he has had ZERO deaths and only SIX PERCENT major complications among

his lap patients.

> As far as the measurement of limbs, I

> do not think that applies to the BPD/DS.

If it applies to the BPD, (as the article clearly states it does), I

can't see why it would not apply to the BPD/DS, since the BPD portion

of both surgeries is nearly identical.

" With the equal limbs the incidence of hypoproteinemia was reduced

from 8% to 2% and the incidence of iron deficiency anemia decreased

from 20% to 10%. "

According to the Medscape Medical Dictionary, " hypoproteinemia " means

an " abnormal deficiency of protein in the blood. " It seems to me

that a 75% reduction in the rate of protein malabsorbtion and a 50%

reduction in iron deficiency is most significant, particularly in

terms of the insurance companies, since these are two of their

standard excuses for being against malabsorbtive procedures.

Tom

Panniculectomy, Dr. Anthone, 11/10/2000

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

11/10/2000 . . . 386

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

06/03/2001 . . . 301

06/15/2001 . . . 299

06/25/2001 . . . 293

07/03/2001 . . . 286

100 Ugly Pounds, GONE FOREVER!!!!!!!!!!!!!!!!

USC DS Support Group: http://groups.yahoo.com/group/ds_usc>

[Guest guest]

He presented the findings from this paper at the recent conference. I

understand that the findings were so fantastic that the RNY docs were pretty

snide about it.

in Seattle

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

>

>

> Hi :

>

> > It is Mt Sinai not NYU.

>

> OOPS! Sorry. My typo.

>

>

> > Has Dr Rabkin published a paper on his patients?

>

> He has published one paper on a mix of surgeries, but that was prior

> to his beginning to do lap. (That paper is on the Duodenalswitch.com

> site.)

>

> He also has another paper which is under consideration for

> publication by SAGE.

>

> Jossart GH, Nuglozeh-Buck, D, Rabkin RA., " A laparoscopic technique

> for duodenal switch: Experience with 77 patients. " Submitted to

> Society of American Gastrointestinal Endoscopic Surgeons, St. Louis,

> MO April, 2001.

>

> There are also a lot of facts regarding his success rate scattered

> around his web site. This is where I got the information saying that

> he has had ZERO deaths and only SIX PERCENT major complications among

> his lap patients.

[Guest guest]

wrote:

>>> Has Dr Rabkin published a paper on his patients? I would be

interested in seeing it. I know there are a lot of surgeons that have

not published the results of their surgeries. So, the ones that have

published papers are subject to critism. <<<

Rabkin et al haven't published results of their LapDS series in a

peer-review journal yet that I know of. They have given many

presentations, however, such as at the ASBS Meeting in June. They do

publish their results on their website. These stats are not fully

up-to-date, beause I know that as of now they have done over 200 LapDS,

but you can see the results of their first 185 LapDS here:

http://www.pacificsurgery.com/Obesity_Surgery/Our_Results/our_results.ht

ml

>>> As far as the measurement of limbs, I do not think that applies to

the BPD/DS. The ileum is transected from the jejunum. So the

proportion of one's ileum limb depends upon each individual. The ileum

is attached to the duodenal remnant while the jejunum is bypassed and

connected to the last 70-100 of the ileum forming a common channel.

Measurement of limbs in not necessary except for the final portion. The

RNY is the procedure that is dependant on the measurement of the two

limbs.<<<

, I'm not sure if this directly relates to what you're saying, but

I do know that Rabkin and other DS surgeon who have been doing the

surgery for many years have reached a consensus on proportional vs.

predetermines limb lengths. I'll copy the message that Dr. Rabkin sent

to me awhile back on this question:

RE: Limb Length & Common Channel Length

Dear ,

Thanks for forwarding the questions regarding why DS surgeons measure

intestinal limb length. I believe it is quite important to measure the

limb lengths in a reproducible manner, and I find that I when I do

re-measure at various times (such as when repairing a hernia, etc.)

the lengths as a rule prove to be consistent with what was noted in

the original operative record.

Standard lengths for the common limb, enteric limb and biliary limb

that I use are based on my own experience and on the shared experience

of Dr. Hess in Ohio and the group in Quebec City, Canada and were

developed after each of us had carefully followed up of hundreds of

our own patients over many years. The other groups evaluated the best

limb lengths to use independently. That each of the three programs

arrived at and presently use similar values implies to me that the

current guidelines for limb length are not arbitrary. If such

measurements had not been made and recorded there would have been no

way to tailor the DS procedure to best accommodate the metabolic

requirements of individual patients. The " 100 cm " and " 150 cm "

measurements that Bridget quotes didn't materialize out of thin air!

By way of background, my experience in Laparoscopic Surgery goes

back to 1988/1989 when I (and subsequently other surgeons also)

actually had to purchase the laparoscopic equipment personally and

develop the laparoscopic cholecystectomy technique. This was some

years before many hospitals and, for that matter, the majority of

surgeons, got on the bandwagon. In 1989 I performed the first

Laparoscopic Cholecystectomy north of Los Angeles and I continue

to be involved with advanced laparoscopic surgery including

endocrine and esophageal procedures.

My private practice was opened in 1977 and bariatric surgery became

an area of interest to me in 1979. I performed VBG, BPD and variations

of RGB, prior to standardizing on the DS procedure in 1993. (Very

infrequently, when indicated, we do offer RGB.) The LapDS technique

evolved directly from more than 20 years of personal experience in

bariatric surgery, including 8 years of experience with the DS as

my primary procedure. I developed the Laparoscopic Duodenal Switch

Procedure in collaboration with Gregg H. Jossart, MD, Director of the

Minimally Invasive Surgery Program at California Pacific Medical Center

since 1999.

From the very beginning, the procedure specific laparoscopic techniques

and the technical refinements which we incorporate on an ongoing basis

were developed in our San Francisco facility, and not patterned from

another program. Our LapDS series, which I believe is the largest,

includes approximately 150 LapDS patients. I operate as the primary

surgeon for all bariatric procedures, including the LapDS. Recent

statistics are available on our website: www.pacificsurgery.com.

I hope that this helps to answer the questions that were raised.

Sincerely,

A. Rabkin, MD, FACS

-----End of Message-----

Hope this helps!

M.

---

in Valrico, FL, age 38

Starting weight 299, now 156

Starting BMI 49.7, now 26.0

Lap DGB/DS by Dr. Rabkin 10-19-99

http://www.duodenalswitch.com

Direct replies: mailto:melanie@...

_________________________________________________________

[Guest guest]

Where can we get copies of these papers? yours, or graydowney@...