Re: why controversial?

[Guest guest]

In a message dated 09/29/2001 2:42:39 PM Central Daylight Time,

ljbrandy@... writes:

> BUT I don't want to put myself through this only to be

> morbidly obese again in 10 years (my fear of having the RNY) OR

> having to have other surgeries b/c I can't stop losing weight and go

> to the other extreme....

>

>

I would say that the likelihood of these things happening is not equal. I

considered both of these when deciding on my procedure. I decided gaining

the weight would be much more devastating than having to have a revision due

to losing too much. Also the likelihood of gaining weight with the RNY

(proximal) is much higher than the likelihood of losing too much with the DS.

Also malnutrition problems with the DS are no more likely (or less so) than

with a distal RNY. Does the NIH support distal RNY procedures??? If yes, (I

don't know) then they just have not added the Ds to the list yet.

I would pinpoint the doctors you mention more specifically about the

revisions. What procedure, who did the procedure, how much weight did the

person need to lose to begin with, BMI of the person, wouldn't a distal RNY

do the same?? etc, etc,

Dawn--South Suburban Chicago area

Dr. Hess, Bowling Green, OH

BPD/DS

4/27/00

www.duodenalswitch.com

267 to 165 5' 4 "

size 22 to size 10

have made size goal

no more high blood pressure, sore feet, or dieting

[Guest guest]

> Can anyone tell me why the DS is so " controversial " even within the

> bariatric community?

RNY doctors can perform several procedures per day and make a lot more money

because of the volume. It is a technically more simple surgery. It is

cheaper to perform. For example, the staples for the RNY cost about $600

per surgery. They use far more staples for the DS - about $2,700.00 worth.

Beyond that, it is much more difficult for surgeons to work near the

biliopancreatic tree. The RNY doctors don't need that level of skill.

Fewer surgeons, then, are able to perform the DS than the RNY.

Insurance companies want to save money. The savings on staples alone in a

given procedure mean that the RNY is their surgery of choice, but that

savings is only the begninning.

> My doc's answer wasn't really satisfying (he

> stated he thinks its mostly b/c they don't know how to do it, but

> based on my friend's experience, her doc had more against it than

> that). Am I missing something about this whole thing?

Your friend's doctor is the one missing something. He likely is confusing

the DS with another older surgery that is no longer performed. Your doctor

is on the money! Current DS procedures have tended to go to a longer common

channel (100 cm.) which has decreased the malabsorbtion from the previous 50

cm. common channel. The revision to a longer channel is far less frequent

than are revisions from the RNY to the DS. Her doctor is plain

intellectually dishonest. Did he tell her about late weight regain with the

RNY? Did he tell her about marginal ulcers with the RNY? Did he tell her

about blockages of the stoma that come from not chewing enough?

No surgery is without risk, the DS included. However, for me, it was the

clear choice - the ONLY choice!

> Also, did anyone have huge problems getting insurance to pay for DS

> v. RNY?

Not me, fortunately.

Best-

Nick in Sage

[Guest guest]

Sounds like RNY doc urban myths to me. That is to say, frankly I do

not believe this to be true. Sorry. Facts, articles, documentation

please. (not you, the docs)

Reminds me of car salesmen

in Seattle

> > and was told not to go with the DS b/c of the " dangerousness "

and

> that he and folks in his practice have done a bunch of revisions

b/c

> people either get malnourished or can't stop losing weight (she

said

> he told of one woman who was 76 lb. when she came for a revision).

>