Re: : Re: Lap procedures for those with BMI > 60

[Guest guest]

In a message dated 8/18/01 3:16:01 PM, duodenalswitch writes:

<< Hmm, doing the DS in 2 parts laprascopicaly would seem to meet to

defeat its purpose (short recovery time). So the question in my mind

becomes, is doing it laprascopicaly in 2 parts safer then doing it

open in one part. Personaly I doubt it, but I haven't seen any

studies on this. The lap procedure is just too new at this point to

draw any dramatic conclusions. Dr. Ren felt that the cutoff should

probably be 65.

>>

For someone who immensely would prefer a lap over an open procedure, I don't

think it would defeat the purpose at all. The person would benefit greatly

from losing a significant amount of weight initially before the second

procedure. The stress to the body is quite a bit less in two parts than it

would be in one (even in comparison to an open procedure), so I think the

recovery time for each portion is even less than it would be for a lap total

BPD/DS procedure (although this would vary from individual to individual).

In other words, the lap recovery time for each portion is less, the stress to

the body each time is less even though in total the recovery time would be

more (when added together) than if one got the procedure done in one part

laparoscopically.

I think the two part lap procedure would carry similar risks, etc. vis a vis

an open procedure as a one-deal BPD/DS. In other words, I do think that a two

part lap DS would carry similar advantages over open that a lap DS would

(and, of course, these advantages vary from person to person). The patient

would be under for much less time in most cases than a full-lap DS or perhaps

even an open surgery. So, for someone whose risk would rise with the time

under anesthesia, a DS in two parts may be better because each time under

anesthesia would be less than a full open or laparoscopic procedure.

I think that either the safety issues would be comparable with a full lap DS

and/or comparable to an open (certainly not greater risk than an open DS

surgery). You are correct that there aren't any studies on this (yet?)

because only some surgeons are offering this option to people.

I think it's really a personal choice -- If someone prefers laparoscopic

surgery, can come for two parts (a long distance patient may find this more

trouble than it's worth), why not? I certainly think it is a viable option

for those who would prefer NOT to have an open procedure done. One might say

the only risk that's increased is in the fact that somone will have to be

under twice instead of once but each portion is less complex and the time in

the OR is lessened so I guess people could really evaluate it both ways.

Whether people would choose it or not over an open BPD/DS, it IS a viable

option for higher bmi patients among a few surgeons here in the US.

I think Dr. GAgner et al's designation is 60 bmi. They've noticed a marked

increase in complication rates with a bmi of 60 and above.

all the best,

lap ds with gallbladder removal

January 25, 2001

Dr. Gagner/Mt. Sinai/NYC

six months post-op and still feelin' fabu!

pre-op: 307 lbs/bmi 45

now: 228

[Guest guest]

In a message dated 8/18/01 3:16:01 PM, duodenalswitch writes:

<< Hmm, doing the DS in 2 parts laprascopicaly would seem to meet to

defeat its purpose (short recovery time). So the question in my mind

becomes, is doing it laprascopicaly in 2 parts safer then doing it

open in one part. Personaly I doubt it, but I haven't seen any

studies on this. The lap procedure is just too new at this point to

draw any dramatic conclusions. Dr. Ren felt that the cutoff should

probably be 65.

>>

For someone who immensely would prefer a lap over an open procedure, I don't

think it would defeat the purpose at all. The person would benefit greatly

from losing a significant amount of weight initially before the second

procedure. The stress to the body is quite a bit less in two parts than it

would be in one (even in comparison to an open procedure), so I think the

recovery time for each portion is even less than it would be for a lap total

BPD/DS procedure (although this would vary from individual to individual).

In other words, the lap recovery time for each portion is less, the stress to

the body each time is less even though in total the recovery time would be

more (when added together) than if one got the procedure done in one part

laparoscopically.

I think the two part lap procedure would carry similar risks, etc. vis a vis

an open procedure as a one-deal BPD/DS. In other words, I do think that a two

part lap DS would carry similar advantages over open that a lap DS would

(and, of course, these advantages vary from person to person). The patient

would be under for much less time in most cases than a full-lap DS or perhaps

even an open surgery. So, for someone whose risk would rise with the time

under anesthesia, a DS in two parts may be better because each time under

anesthesia would be less than a full open or laparoscopic procedure.

I think that either the safety issues would be comparable with a full lap DS

and/or comparable to an open (certainly not greater risk than an open DS

surgery). You are correct that there aren't any studies on this (yet?)

because only some surgeons are offering this option to people.

I think it's really a personal choice -- If someone prefers laparoscopic

surgery, can come for two parts (a long distance patient may find this more

trouble than it's worth), why not? I certainly think it is a viable option

for those who would prefer NOT to have an open procedure done. One might say

the only risk that's increased is in the fact that somone will have to be

under twice instead of once but each portion is less complex and the time in

the OR is lessened so I guess people could really evaluate it both ways.

Whether people would choose it or not over an open BPD/DS, it IS a viable

option for higher bmi patients among a few surgeons here in the US.

I think Dr. GAgner et al's designation is 60 bmi. They've noticed a marked

increase in complication rates with a bmi of 60 and above.

all the best,

lap ds with gallbladder removal

January 25, 2001

Dr. Gagner/Mt. Sinai/NYC

six months post-op and still feelin' fabu!

pre-op: 307 lbs/bmi 45

now: 228