Re: Dr. Welker--NY LEAKS????

[Guest guest]

What high rate of NY doctor leaks? And what NY doctors are you

referring to? Is this just a sweeping generalization of all the NY

doctors? Hmmmm. I know Dr. Welker has had a few leaks himself. He was

even asked to leave his position in Idaho and Oregon. In his last

position in Oregon he could only practice under the supervision of

another surgeon.

Jill K

> -- In duodenalswitch@y..., chull1@s... wrote:

> >

> >

> > I agree with Welker's opinion regarding the stapled anistomosis,

> and

> > that explains the high leak rate that the NY doctors have reported.

> I

> > think that Dr. Rabkin (who uses lap " assist " ) does not staple,

> though

> > I am not sure.

> >

> > Hull

[Guest guest]

Jill,

The authors of the paper I am referring to are Gagner, Ren, and

(now in Portland, OR). Their major complication rate was

15%, including one leak and 1 staple line hemorrage out of only 40

patients. Dr. Anthone has 1 leak out of over 500 patients!

Also noteworthy is that the complication rates for patients with

BMI >65 was 38%!

In additon to the major complications, minor complication were

reported 9 out of 40 patients, and thre was 1 operative and 1 late

death.

So lets see, 2 patients died, 6 had major complications, and 9 had

minor complications. That means only 23/40 patients survived with out

complications of some sort.

Hull

> And what NY doctors are you referring to?

[Guest guest]

Judie,

I will privately e-mail you the information I have on Welker if you are

interested. I actually have the report of his dismissal. I am going

away later today until Tuesday. When I get back I will be happy to send

it to you. I was wondering about the NY doctors and the leaks though.

Do you have any info on this?

Jill K

> . He was

> even asked to leave his position in Idaho and Oregon. In his last

> position in Oregon he could only practice under the supervision of

> another surgeon.

>

> Jill K>>>

>

> Jill ,

> Where did you get this information? Welker was chief of surgery at OHSU!

> According to my surgical report HE was the attending surgeon and he had one

> assistant helping him. He did not have anyone supervising him. Dr Welker

> had considered leaving OHSU long before any of the policical ramifications

> occured there and it had nothing to do with his expertise!

>

> Judie

[Guest guest]

WOW! Do you know when this study was from, what year? Where can I read

the study? Also, what were the complications? I'd like to read this

please. Thank you.

Jill K

> > And what NY doctors are you referring to?

[Guest guest]

Hi Jill:

> WOW! Do you know when this study was

> from, what year? Where can I read the

> study? Also, what were the complications?

> I'd like to read this please. Thank you.

posted the entire study to the Files section. Just click on

for " Hull's Folder. " Once you are inside that folder, click on

the file labeled " early_results_bpd_ds.pdf. "

(:

Tom

[Guest guest]

Thanks for the info Tom. This is great Chris. Thanks so much for

posting all of this. I am printing everything out to read now.

Jill K

>

> Hi Jill:

>

> > WOW! Do you know when this study was

> > from, what year? Where can I read the

> > study? Also, what were the complications?

> > I'd like to read this please. Thank you.

>

>

> posted the entire study to the Files section. Just click on

> for " Hull's Folder. " Once you are inside that folder, click on

> the file labeled " early_results_bpd_ds.pdf. "

>

> (:

>

> Tom

[Guest guest]

Dear

That paper refers to the first 40 patients that were done fully Lap.

Dr. Anthone only does open so you really cannot compare stats. There

was a definate initial learning curve for this surgery done Lap.

These 40 patients were the very first Laps. Dr. Gagner (Dr. Ren was

there too) did the first fully Lap BPD/DS. Dr. , like Dr.

Ren was Dr. Gagner's fellow during these first 40.

Jane J.

-- In duodenalswitch@y..., chull1@s... wrote:

> Jill,

>

> The authors of the paper I am referring to are Gagner, Ren, and

> (now in Portland, OR). Their major complication rate was

> 15%, including one leak and 1 staple line hemorrage out of only 40

> patients. Dr. Anthone has 1 leak out of over 500 patients!

>

> Also noteworthy is that the complication rates for patients with

> BMI >65 was 38%!

>

> In additon to the major complications, minor complication were

> reported 9 out of 40 patients, and thre was 1 operative and 1 late

> death.

>

> So lets see, 2 patients died, 6 had major complications, and 9 had

> minor complications. That means only 23/40 patients survived with

out

> complications of some sort.

>

> Hull

>

>

>

> > And what NY doctors are you referring to?

[Guest guest]

Jane,

Your point is well taken, but the fact that they only have 40

patients to report on in a recent paper shows just how new the lap DS

procedure is (lap assist on the other hand has been around a little

while longer). All suregons - even Gagner - are still to this day on

their learning curve for the lap DS. I think that you should not be

part of this experiment unless you are a low risk patient. In

addition I personally have conerns about Gagner, and Ren

because they are not devoted 100% to DS. None of them bothered to

show up to the special evening sesion on DS at the June ASBS meeting

in Washington DC. Ren seems more interested in following the newest

fad (the lap band) then perfecting her technique, and does

many more RNY surgeries than DS. Gagner seems to be converting to a

cash only basis like Rabkin.

Yes Dr. Anthone only does surgery that is open, but what is amazing

is that with over 500 surgeries under his belt, he has only 1 leak,

and that includes the early surgeries. Also, if you exclude

revisions (like Dr. Baltasar does in his paper) then Anthone can

claim ZERO leaks! This man nows how to sew. Dr. Anthone has no

program fee and accepts most insurance (including medcare). Of cousre

there are a number of excellent surgeons out there. My point is that

the lap DS is in its " investigational " period and as they say " caveat

emptor " .

Hull

> > > And what NY doctors are you referring to?

[Guest guest]

Marcia:

> Someone on this site once commented (disparagingly)

> about " one size-fits-all " surgery. Would you have

> bariatric surgeons subscribe to this notion by only

> offering ONE surgical choice.

This analogy just doesn't work, IMHO.

The one-size-fits-all docs ignore basic differences in human anatomy

while performing the DS.

Docs who perform multiple different surgeries for morbid obesity

ignore another very important basic difference, which is that the DS

is a better surgery for morbidly obese patients than anything

else currently available.

So, to my mind, a surgeon who uses the one-size-fits-all method AND

who also performs any of the inferior surgeries on obese folks

demonstrates doubly questionable judgment.

> We all have individual needs and for some,

> those needs lead them to RNY or lap band.

No, we all have the SAME need -- to lose a great deal of weight.

Some of us, due to insurance, financial, or other reasons, may be

FORCED to accept an inferior surgery, but that's not the same thing.

> I can't speak about Gagner or ,

> but I can speak about Dr. Ren: when I had

> my consult with her, in the course of my

> 2 1/2 hours with her (SHE took my history

> and gave me the physical instead of fobbing

> me off on a nurse or PA)

The mere fact that Dr. Ren has huge blocks of time on her hands

speaks only to her inexperience, not her judgment, her abilities or

her humanity.

> As to her expertise, she is well past the

> learning curve; my surgery and recovery

> were textbook perfect.

" I survived okay, therefore my surgeon must be great, " is not much of

an argument, IMHO.

Tom

[Guest guest]

<Docs who perform multiple different surgeries for morbid obesity

ignore another very important basic difference, which is that the DS

is a better surgery for morbidly obese patients than anything

else currently available. >

Tom,

I do agree that the DS is a better surgery for MOs, but not everyone is capable

of following the guidelines for aftercare. There are those who will stop taking

their supplements, or ignore the need for protein we have.

It is true that other surgeries have similar needs, but not as drastic as the

DS. I remember one case last year where the woman had stopped taking her

vitamins and was so protein deficient that when the doctor saw her at a support

meeting, told her to come to his office the next day. She didn't and within a

short time got a systemic infection which killed her. Her body had nothing to

fight it with. (Sorry, I don't remember the woman's name)

Would she have been better with a RNY? Maybe, maybe she would be alive.

Don't put blinders on because you found the type of surgery that is best for you

and think it is the only one that is worth while. I do know several people who

had the RNY years ago and have kept most of their weight off and live a decent

life. If asked they say they would do it again.

Rita Black

Open DS, Dr. Macura

4/23/01 400lbs, BMI 63

5/1/01 391lbs, BMI 61

5/22/01 368lbs, BMI 58

6/21/01 350lbs, BMI 55

7/31/01 328lbs, BMI 51

5/22/01 368lbs, BMI 58

6/21/01 360lbs, BMI 55

7/31/01 328lbs, BMI 51

8/23/01 320lbs, BMI 50

[Guest guest]

Dear Rita,

I agree 100% with you. If I never had children and was one day

looking to have them, I personally would never have had the DS and

probably would have opted for the Lap Band instead. Since I have a

son and a daughter already, I could welcome a third child if I chose

to have one down the road and my blood/protein levels were good.

But, if post-op I had ended up with deficiencies through no fault of

my own (think of Joe Frost as just one example) and getting pregnant

was just out of the question, I would not be devasted. Not the case

if I was childless looking to have at least one child. I think the

DS is the best surgery for ME, that doesn't mean that it is the BEST

surgery for everyone. I worry too, about the noncompliant patient who

is always " forgetting " to take their vitamins and calcium. I have

had friends tell me that there is no way they could take all the

vitamins that I down each day. For me, it is no problem but, it is a

problem for alot of folks. If I was a surgeon and my patient told me

they weren't sure if they could stick with a vitamin regime or eat

enough protein on a daily basis, I don't think that I would want to

do the DS on them. Yes, I do remember the patient who died around

December 2000, she posted on the OSSG Metro board. She didn't take

her vitamins or eat enough protein after having a DS and she died

because her body was so run down.

Jane J.

Lap BPD/DS

April 26, 2001

> <Docs who perform multiple different surgeries for morbid obesity

> ignore another very important basic difference, which is that the

DS

> is a better surgery for morbidly obese patients than anything

> else currently available. >

>

> Tom,

> I do agree that the DS is a better surgery for MOs, but not

everyone is capable of following the guidelines for aftercare. There

are those who will stop taking their supplements, or ignore the need

for protein we have.

> It is true that other surgeries have similar needs, but not as

drastic as the DS.

> Don't put blinders on because you found the type of surgery that is

best for you and think it is the only one that is worth while. Rita

Black

[Guest guest]

Marty I want to note your remark about being not fobbed off to a

nurse or PA. In many large medical centers and in sophisticated

practices, a nurse practitioner or a phsyician assistant are the ones

to do the physicals. This generally guarantees a more thorough exam.

When the NP or PA have a practice that focusses on the phsyical

condition of the patient, they are often far better than the

physician to do the physical exam. Unfortunately many surgeons cannot

afford one or can't get one since they are in great demand.

in Seattle

> the course of my 2 1/2 hours with her (SHE

> took my history and gave me the physical instead of fobbing me off

on a

> nurse or PA)