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There are many different labels for what we call DS or BPD/DS .. what

Ive come to call it is gastric reduction with DS. That is more

accurate in my opinion and self explainatory. Good luck with your

search.

Sue

Post op 9/11/01

Dr. Warden

> I am so confused, I need help choosing between the bpd

> and bpd/ds. Some tell me that there is no proof that

> the pyloric valve and stomach continue to work

> normally after the bpd/ds and that the risk are higher

> with the bpd/ds of major complications. But then I

> read that the bpd is the old way and that the bpd/ds

> is an improvement over the bpd and offers less risk.

> What to do? Any and all thoughts will be appreciated.

> thank you

> Be happy

>

>

> __________________________________________________

>

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In a message dated 9/23/2001 6:31:53 PM Eastern Daylight Time,

duodenalswitch writes:

> It has the malabsorptive properties. What it doesn't have are the

> restrictive properties. The trouble with this is that you are more likely

> (but not absolutely) to have diarrhea because you can eat high volumes of

> food.

I had the BPD because the blood supply to my duodenum died. But I don't have

trouble with diarrhea at all. In fact early on I was constipated. Go

figure. Now by BM's are pretty normal for most DSers. I do eat more volume

of food than some but my stomach started out at 5 oz. It just empties

quicker and I noticed that in about 4 hrs. I need to eat something.

Also because the duodenum (small portion in the Ds) does not come in

> contact with the food, the absorbtion of iron and protein aren't as good

> with

> the standard BPD.

I was concerned about that but so far my protein levels are fine. A tad on

the low normal side but still okay.

The BPD is a good procedure, but if the BPD/DS is

> available, I don't see why you wouldn't go for that.

>

>

I don't know why you wouldn't choose the BPD/DS either. It's a very good

surgery. I just had an unforeseen complication and am thankful that my Dr.

was good and that so far at least my results have been great.

Jackie Ward

Dr. Maguire

BPD Surgery 3/19

6 months and down 93 lbs.

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No need to be confused-- ignore the lables-- look at the pictures:

what you want is to have most of your stomach removed leaving a hot-

dog shaped stomach WItH the pyloric valve intact. Then you want your

duodumum snipped just before the bile duct and connected to a portion

of the small intestine. This will create a bile limb of the intestine

and an alimentary (food) limb of the intestine. The intestines are

then joined up at a point between 50 and 100 cm up from the large

intestine. If the surgeon does not do the hot dog shaped stomach

with the pyloric valve, RUN. If the surgeon does not do a 50 to 100

cm common channel, but makes it longer (like 250 cm) RUN.

Simple?

Nan E. waiting for a Date with Dr. A in CA

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No need to be confused-- ignore the lables-- look at the pictures:

what you want is to have most of your stomach removed leaving a hot-

dog shaped stomach WItH the pyloric valve intact. Then you want your

duodumum snipped just before the bile duct and connected to a portion

of the small intestine. This will create a bile limb of the intestine

and an alimentary (food) limb of the intestine. The intestines are

then joined up at a point between 50 and 100 cm up from the large

intestine. If the surgeon does not do the hot dog shaped stomach

with the pyloric valve, RUN. If the surgeon does not do a 50 to 100

cm common channel, but makes it longer (like 250 cm) RUN.

Simple?

Nan E. waiting for a Date with Dr. A in CA

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Thanks Nan,

My surgeon that procedure..... hes says with Cigna Healthcare I'm gonna get

a denial because these insurance companies feel that the DS is still a

controversial procedure.I will not give up!

In South Carolina

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What I'm confused about is why anyone would want just the BPD, which doesn't

have the malabsorptive properties (as I understand it) that the DS does.

It's the combination of the two that makes the BPD/DS so attractive...add to

that that it doesn't have the tiny pouch and non-functioning stomach that

the RNY has, and why would anyone go with anything else? :)

alyssa

Help!

> I am so confused, I need help choosing between the bpd

> and bpd/ds. Some tell me that there is no proof that

> the pyloric valve and stomach continue to work

> normally after the bpd/ds and that the risk are higher

> with the bpd/ds of major complications. But then I

> read that the bpd is the old way and that the bpd/ds

> is an improvement over the bpd and offers less risk.

> What to do? Any and all thoughts will be appreciated.

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I know of several Cigna patients who have been approved for the BPD/DS...and

I'm going to be one of them soon! Keep in mind that every Cigna plan is a

little different, and they do not refuse the DS as a sweeping policy.

alyssa

Re: Help!

> Thanks Nan,

> My surgeon that procedure..... hes says with Cigna Healthcare I'm gonna

get

> a denial because these insurance companies feel that the DS is still a

> controversial procedure.I will not give up!

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In a message dated 9/23/01 2:39:02 PM, duodenalswitch writes:

<< Some tell me that there is no proof that

the pyloric valve and stomach continue to work

normally after the bpd/ds and that the risk are higher

with the bpd/ds of major complications. >>

: I don't see how the risks are so much higher with the BPD/DS... the

BPD and DS are basically similar surgeries (with three animonestes -

spelling/or conjunctions between the intestines) except for the stomach

portion. Well, this isn't totally accurate. The upper portion of the

intestines are different, too: The intestines are directly attached to the

stomach wall with the BPD whereas about 5 cm of duodenum remains intact until

the intestines are divided into two 'limbs' and reconnected at the 'common

channel'. The traditional BPD involved a 50 cm common channel whereas the DS

has been modified by many surgeons to a length of 70-100 cm, noting that

diahhrea and nutritional deficiencies are reduced while the weight loss

remains comparable. The extra duodenum of the DS is meant to enhance calcium

and other mineral/nutrient absorption).

The BPD removes the lower stomach (antreum) and pyloric valve. I would

seriously consider the ramifications of this since those with severe peptic

ulcers (they are given a procedure very similar to the stomach portion of the

BPD to alleviate their symptoms) have experienced an elevated incidence of

pancreatic cancer and this HAS been linked to the removal of the antreum. I

would think that this fact alone would make the BPD riskier than the DS. I

don't see how the BPD/DS involves more risk except perhaps for the surgeon

since they must carefully remove 2/3 of the stomach in a 'horizontal' sleeve

gastrectomy....

I'm not saying the BPD is a terrible surgery at all. In fact, there are some

instances in which it would be preferable (pre-existing conditions, etc.).

Post-op lifestyle is certainly managable and one can be healthy with a BPD

(taking similar cautions as a post-op BPD/DS in terms of nutrition, regular

bloodwork, etc.). However, the DS was meant to alleviate certain side

effects of the BPD that have been noted (even if not experienced by every

post-op to the same degree): The sleeve gastrectomy can eliminate the bad

breath/halitosis that a BPD can present; Leaving the pyloric valve intact can

help to prevent 'dumping syndrome' that is experienced by those who have

surgeries in which the intestines are attached to the stomach wall via an

artificial 'stoma' or opening; Although the stomach size is larger with a

BPD, the lack of the pyloric valve can cause the stomach to empty quicker,

thus possibly causing post-ops to feel more 'hungry' or feel hunger faster.

I would think that one would have to chew more thoroughly and may have

certain dietary restrictions due to the stoma (similar to the RNY).

Now, I would really like to see the studies that state that the pyloric valve

may not work properly after a DS. This may be the case with *some* patients

but I think overwhelmingly post-ops experience saiety (partially due to the

presence of the pyloric valve and the cascade of neuro-chemical signals that

occur when it shuts off for the stomach to process food), don't have dumping

episodes and the like. I would think that the pyloric valve may be

'sluggish' or partially non-functional in two cases: First off, a patient's

body may need to 're-cync' immediately post-op and it may take awhile for the

stomach to coordinate itself again. Swelling may prevent the pyloric valve

from functioning totally normally in the first weeks/month post-op.

Secondly, perhaps the pylorus would have problems if the nerve endings in the

lower stomach are damaged in some way during the surgery? Otherwise, I

think that the valve does remain functional in most (if not all?) cases.

This surgery is NOT like the RNY where the pylorus is left intact but remains

non-functional. It is totally working and the lower part of the stomach is

not removed (only the storage or 'fundus' of the stomach is removed in a

sleeve gastrectomy).

I hope this helps a bit for you to make your decision. If your surgeon is

telling you that there isn't evidence that the pyloric valve remains

functional, ask for HARD STUDIES OF THIS. What is he/she basing his/her

opinion on? Also, how is the BPD considered to be 'safer' or 'less riskier'

than the DS? I would get exact facts about why this is so. I honestly

think with the greater risk of pancreatic cancer and other potential post-op

problems the BPD may be considered a bit riskier.

all the best,

lap ds with gallbladder removal

january 25, 2001

Dr. Gagner/Mt. Sinai/NYC

eight months post-op and still feelin' fabu!

preop: 307 lbs/bmi 45

now: 215

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In a message dated 9/23/01 6:31:52 PM, duodenalswitch writes:

<<

What I'm confused about is why anyone would want just the BPD, which doesn't

have the malabsorptive properties (as I understand it) that the DS does.

It's the combination of the two that makes the BPD/DS so attractive...add to

that that it doesn't have the tiny pouch and non-functioning stomach that

the RNY has, and why would anyone go with anything else? :)

>>

I think the BPD has high malapsorptive properties comparable to the DS: The

stomach size is larger but this is why traditionally the common channel

length was 50 cm... Whereas the DS has a sleeve gastrectomy and longer common

channel. It also leaves a portion of the duodenum intact for

calcium/mineral/nutrient absorption.

The BPD also has the intestines arranged into two 'limbs' (bile and

alimentary/food). The DS is just a modification meant to address certain

post-op issues faced by many BPD patients: lower calcium/nutrient absorption

and the potential for higher malnutrition issues, halitosis/dumping sydrome

due to the lack of pylorus. There is also the issue of pancreatic cancer

with the removal of the antreum (lower stomach).

all the best,

lap ds with gallbladder removal

January 25, 2001

Dr. Gagner/Mt. Sinai/NYC

eight months post-op and still feelin' fabu! :)

preop: 307 lbs/bmi 45

now: 215

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  • 1 year later...
Guest guest

I am one year and 4 months post op. I had the VBG done I started at

427 pounds and at my one year mark I weighed 285. Six weeks ago I

have surgery on both feet. I could not walk for about 2 weeks and I

just started wearing shoes.

Anyway I stepped on the scale and to my dismay, I weighed 308

pounds. I wanted to cry. I know I am to blame, because while I was

off of my feet I did not exercise and I ate the WRONG things.

I need help getting started again. I fear that I may have stretched

my pouch, because I can eat more than I could 3 or 4 months ago.

Please I need motivation and advice on getting the weight to come off

again.

Thanks in advance for your comments.

Carol

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