Re: Re: Surgeon switching back to Scorpinaro

[Guest guest]

In a message dated 10/19/2001 8:29:42 PM Central Daylight Time,

romanstenseventeen@... writes:

> This will still be lap. And my surgeon is ! She gave me

> very good arguments...

>

>

Yes, I understand that she is staying lap. But I believe in order to stay

lap she has to give up on the DS. The DS is a more complicated procedure

because you have more delicate work to do around the duodenal area. Instead

of just cutting it out, you have to maticulously cut the intestine just below

the duodenum but before the entrances of the bile fluids. That end has to be

sewn shut. Then intestine has to be brought up and attached to the stomach.

She may have given you good arguments but did she give you clinical evidence

to back it up. Is the evidence based on DS patients everywhere or just the

patients of HERS that have had problems. The problem may be HER and not the

procedure.

Make sure you aren't going along with this just because it would be terrible

to put off you wls any longer! I know that would be terrible, but you are

going to live your whole life with this procedure.

There is a good chance you will never know the difference. But a lot of this

is I would be leary of this doctor saying these things.

Also in a BPD procedure the common channel was made smaller because the

patient can eat more. Is she going to do this? Is she going to go by what

the research says a BPD should be, or is she making up her own??? Also will

you end up with NO restriction. Standard BPD patients say they usually end

up eating MORE than they did preop. This can be o.k. because they still lose

weight, but this also means increased bms. If the doc did not bring all this

up in the discussion, I am not sure she is being forthright. That is what

would concern me. I wonder if she is offering the BPD just so people will

turn it down and go with the RNY.

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]

I do have a good idea of what you've been through, which is why I think you

should have the surgery *you* want to have, not the one the doc decides she

feels like doing. You've been through hell to get this, and I don't blame

you one bit for taking whatever version of the BPD you can get and running!!

If you want the BPD/DS, pressure the doctor, but if you're thrilled with the

BPD, that's totally fine. No one has the right to make a decision for your

body but YOU.

Good luck, Lee Anne...you deserve the best of everything after the fight

you've fought!

~alyssa

Re: Surgeon switching back to Scorpinaro

> Forget that I posted anything... I am feeling bashed... and like I'm

> being told that I am ignorant. If you known the crap that I have

> gone through to get this approved... you would be thrilled that I am

> having this at all.

[Guest guest]

In a message dated 10/19/2001 10:52:06 PM Central Daylight Time,

romanstenseventeen@... writes:

> Forget that I posted anything... I am feeling bashed... and like I'm

> being told that I am ignorant. If you known the crap that I have

> gone through to get this approved... you would be thrilled that I am

> having this at all.

>

Lee Anne,

I was concerned about it sounding like an attack. I think what we are all

trying to do is make sure YOU are making a decision that you want. Don't

settle. Your approval can possibly be switched to another doctor. This has

to be very difficult for you. However, you also did bring it to this list,

so you must have doubts. There are some very important issues to straighten

out with your doc. Like I posted before if she is going with the standard

BPD then is she REALLY going with it.

How long of a common channel? If she is going with a longer common channel,

then she is not going by what a standard BPD is.

How big will your pouch be? As I said before a lot of BPD paitents indicate

they can eat more than they did preop? But also you don't want to end up

with a tiny stoma in order to have restriction? Make sure she isn't just

doing a very distal RNY. Did she tell you what your post op

instructions/restrictions will be?

If the BPD is really, really what you want then go for it. However, since

you posted about it here, I have my doubts.

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]

In a message dated 10/20/2001 11:19:49 AM Central Daylight Time,

romanstenseventeen@... writes:

> **she gave me percentages from research. Her bpd/ds people are doing

> fine... so it is not 'HER' problem.

>

>

If you share the research, we can understand more>

**The intestinal tract stuff is all the same. Same measurements.

This is the point! Is it the same as the BPd or the BPD/DS. If she is

making it the same as the BPD./DS, then she is making up her own procedure.

****I eat a normal

amount and still lose weight.

So you want to be able to eat more than you do now. Because BPD people often

eat MORE than they did before they had surgery.

Lee Anne, I don't want you to feel attacked. I just want to help you think

for yourself.

Dawn

[Guest guest]

Same size as the gastric sleeve or banana, just a different shape.

She does NOT do distal RNY. Post-op instructions will be the same as

the bpd/ds'ers. I did ask about the connection and how I do NOT want

to have to chew the hell out of my food... and I do not want a

stoma. She basically said that everything is bigger in this surgery>>>>>>

Lee Anne,

According to my friend on the other list, Dr P puts her Dsers on the same

diet plan as the RNY post opt! I think Ive been her lifeline thru her

recovery period on what to do, what to eat, what to avoid etc as that follow

up care is not what we DSers are accustomed to getting. She isnt very happy

with all of this.

She is generally going by my experience and what Dr Welkers patients do.....

Judie

Re: Surgeon switching back to Scorpinaro

> I posted here to find out if anyone else had this specific version

> not because of doubts.

>

> >

> > How long of a common channel? If she is going with a longer common

> channel,

> > then she is not going by what a standard BPD is.

>

> **answered in a previous question... intestinal tract stuff is all

> the same.

>

> >

> > How big will your pouch be? As I said before a lot of BPD paitents

> indicate

> > they can eat more than they did preop? But also you don't want to

> end up

> > with a tiny stoma in order to have restriction? Make sure she

> isn't just

> > doing a very distal RNY. Did she tell you what your post op

> > instructions/restrictions will be?

>

> **Same size as the gastric sleeve or banana, just a different shape.

> She does NOT do distal RNY. Post-op instructions will be the same as

> the bpd/ds'ers. I did ask about the connection and how I do NOT want

> to have to chew the hell out of my food... and I do not want a

> stoma. She basically said that everything is bigger in this surgery

>

>

> > If the BPD is really, really what you want then go for it.

> However, since

> > you posted about it here, I have my doubts.

>

> **I posted because this is a support egroup... and as I said before,

> I wanted to find someone who has had the same thing.

>

> > 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]

> Dr and Dr Ren trained as a lap fellows with Gagner. That

> would have predicted that they would go on to do the srot of surgery

> he does. However, they both are having trouble doing the lap DS and

> are trying to sell people on other options.

I have been in touch with one Lap DS surgeon who feels that Ren and

are taking a huge step backward. This surgeon opines, " If they

follow their BPD patients carefully they will either abandon bariatric

surgery or eventually come full circle back to the DS. In the meantime a

great deal of bridges will have been burned. "

M.

---

in Valrico, FL, age 39

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

Starting weight 299, now 155

Starting BMI 49.7, now 25.8

Starting size 26/28, now 10/12

http://www.duodenalswitch.com/Patients/_M_/melanie_m_.html

Direct replies: mailto:melanie@...

_________________________________________________________

[Guest guest]

In a message dated 10/20/01 2:39:03 AM, duodenalswitch writes:

<< Forget that I posted anything... I am feeling bashed... and like I'm

being told that I am ignorant. If you known the crap that I have

gone through to get this approved... you would be thrilled that I am

having this at all.

>>

{{{{{Lee Ann}}}}}: I really don't think people are thinking you are

ignorant at all. And, yes, many of us who read the AMOS boards know what you

have been through (hell and back) to get this procedure done. You have only

pretty recently started posting more regularly here so the fact that people

aren't fully aware of your background and issues regarding approval, etc. is

to be expected to some degree.

I really honestly do NOT think anyone wants to bash you --- and I am really

sorry you feel that way. Obviously, you are under a LOT of stress (as anyone

would be) right before surgery. Add that your surgeon has just informed you

that you will be getting a different surgery than you had intended and I'm

sure you're about to explode!!!!

I think if you sense any reticence, it is towards the surgeon not you.

People have had various experiences of being misinformed by the medical

establishment in general and I myself have a gut reaction to anyone who would

just 'switch' a surgery on me without mentioning ALL the pros and cons

involved. No one is saying the BPD is an awful surgery, but generally

speaking, all evidence points out (so far as we know) that the DS was meant

to improve the various side effects presented by the earlier BPD. It is

still being performed (maybe it's coming back in vogue with Dr. REn/NYC also

only performing it instead of the DS???) and those who have had it lead

successful, happy lives (Sharon is one long term post-op and her mother as

well who have had the BPD). Sure, there may be bumps in the post-op road (in

re nutrition, etc. but this is also true of the DS).

REally -- we all just want you to feel totally comfortable with your choice

(and if you do -- GREAT MORE POWER TO YOU!). But, the fact that you wrote

and were wondering about the situation is what we responded to. It is normal

to have doubts, questions, etc. We just want you to be totally satisfied

with your choices and experience.

I'm sure Dr. has good reasons to choose the BPD --- the problem is

most of us who have researched and read just about every study known to

mankind on the subject have not really heard of them. Perhaps these are

newer issues that haven't been published yet? I would definately ask for the

sources of the claims. I would also hope that Dr. included all the

cons of the BPD as well as her perceived advantages. Like I said, there is

another surgeon here in NYC (Dr. Ren) who has made a similar decision

regarding the DS. So, is by no means alone. We also heard of

another surgeon who routinely performed the BPD but mislead patients by

claiming it was a DS. He also cited that the pyloric valve is 'overrated'

and may not totally function post-surgically. To me, the issue isn't the

pyloric valve per se but the removal of the antreum (lower stomach). This

HAS been clearly linked to an increased risk of pancreatic cancer. This does

NOT mean that every BPD patient will get it but surgeon should inform of this

risk. Also, a clear, detailed post-op routine aftercare that ADDRESSES this

risk and attempts to screen for pancreatic cancer really should be in place,

IMHO.

all the best and hugs to you,

Noverr-Chin

co-moderator, duodenalswitch

lap ds with gallbladder removal

Dr. Gagner/Mt. Sinai/NYC

almost 9 months post-op and still feelin' fabu!

preop: 307 lbs/bmi 45

now: 213 ???

[Guest guest]

Once again, Marty, I have to gently disagree with you. I can't answer for

Dr, , but Ren did my surgery FLAWLESSLY. My recuperation has been

totally uneventful except for the fact that I've lost 74 lb. In 3 months. As

I understand from Dr. Ren's NP, she will do the DS if you are totally

committed to it (as well you should be!). If you are not totally committed

or have doubts, then the less complicated surgeries might be better for that

mindset. Please don't make the assumption that she is exploring other

avenues of WL relief because she CAN'T do DS, rather that not all morbidly

obese people SHOULD have DS.

This is only MHO

Respectfully,

Marcia

Re: Surgeon switching back to Scorpinaro

Dr and Dr Ren trained as a lap fellows with Gagner. That

would have predicted that they would go on to do the srot of surgery

he does. However, they both are having trouble doing the lap DS and

are trying to sell people on other options.

I imagine that Dr Gagner is gritting his teeth now if he has heard

about the crap coming out of the mouths of his former fellows.

, Seattle

> > She is very wrong. From the time she got out on her own (she was

a

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

[Guest guest]

In a message dated 10/21/01 2:42:47 PM, duodenalswitch writes:

<< Please don't make the assumption that she is exploring other

avenues of WL relief because she CAN'T do DS, rather that not all morbidly

obese people SHOULD have DS. >>

Marcia: This is a good and valid point. I know that Dr. Ren has performed

the DS before but someone recently said that it is now her policy to perform

the BPD NOT the DS. We're not talking about other surgical options like the

lapband or RNY but a discontinuation of the DS and a strong preference (maybe

absolute?) for the BPD instead. This is what many of us find perplexing and

perhaps rather troubling.

all the best,

lap ds with gallbladder removal

January 25, 2001

Dr. Gagner/Mt. Sinai/NYC

almost 9 months post-op and still feelin' fabu

preop: 307 lbs/b mi 45

now: 213 ????

[Guest guest]

Marcia,

I had my consult with Dr. Ren on Sept. 19 2001 and

after telling me about the DS she then said that soon

she would only be doing the BPD. She brought up the

fact that the BPD is easier to do Lap and hence less

risk. She talked a lot about how the Dr. from Italy

has been doing this surgery successfully for 20 yrs.

She drew a picture and showed me all the differences

including a shorter common limb (50cm)and the change

in dietary requirments post op. I respect her right

to alleviate the stress that performing the BPD/DS

causes her before during and after sugery. She fully

admits that its a much more difficult procedure to do

Lap and only wants to do what she feels is safer for

her patients. It was very obvious to me that she

cares greatly about her patients and in fact she even

said she takes each patient home with her each day.

Being a retired nurse I totally understand where she

is coming from. she gave me the option since I came to

her specifically for the DS from out of state and had

prior approval. Just thought I'd add my experience.

BE HAPPY

=====

B 36yrs

Pre-op 11-13-01

Wt.308 BMI 49

BCBS of MI Blue Choice POS

__________________________________________________

[Guest guest]

In a message dated 10/21/2001 1:09:29 PM Central Daylight Time,

msnoaccess@... writes:

> What I wonder is, if these Dr's aren't comfortable doing DS lap, why

> not do it open rather than pushing BPD?

I think they are " lap " surgeons. Not that they can't do open, but they have

chosen to specialize in lap.

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]

Theresa,

One correction: as I said before, I can't speak for . Dr. Ren did

my surgery, superbly. We each have different needs; You, I, and the others

on this list feel strongly that, for us, the DS was not only the only way we

could go, but we also feel we can prove it is a procedure far superior to

others. There are other people who feel differently: are they wrong, for

their own reasons, and do we have the right to deny them the procedures they

feel comfortable with? I have a friend who underwent RNY; as of now, she is

thrilled with her lifestyle and the results of her procedure. Will she feel

the same 2 years down the road? I don't know. I pray she will. I can only

tell anyone seeking my advice my experiences with a superb surgeon, an

excellent facility, and a procedure I wholeheartedly believe in.

Marcia

Re: Surgeon switching back to Scorpinaro

Marcia,

I am sure Dr. did a fantastic job for you. My only

question would be, if compliance is an issue, then NO WLS should be

done. Every form of WLS has a strict level of compliance necessary,

regardless of type. If compliance is not an issue, then, what type

of surgery is better than the DS?

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

[Guest guest]

,

Justa question. Will she do the DS for you, despite the fact that she

believes the BPD is safer?

Marcia

RE: Re: Surgeon switching back to Scorpinaro

Marcia,

I had my consult with Dr. Ren on Sept. 19 2001 and

after telling me about the DS she then said that soon

she would only be doing the BPD. She brought up the

fact that the BPD is easier to do Lap and hence less

risk. She talked a lot about how the Dr. from Italy

has been doing this surgery successfully for 20 yrs.

She drew a picture and showed me all the differences

including a shorter common limb (50cm)and the change

in dietary requirments post op. I respect her right

to alleviate the stress that performing the BPD/DS

causes her before during and after sugery. She fully

admits that its a much more difficult procedure to do

Lap and only wants to do what she feels is safer for

her patients. It was very obvious to me that she

cares greatly about her patients and in fact she even

said she takes each patient home with her each day.

Being a retired nurse I totally understand where she

is coming from. she gave me the option since I came to

her specifically for the DS from out of state and had

prior approval. Just thought I'd add my experience.

BE HAPPY

=====

B 36yrs

Pre-op 11-13-01

Wt.308 BMI 49

BCBS of MI Blue Choice POS

__________________________________________________

[Guest guest]

,

As a staunch Ren supporter, I, too, find it troubling. However, as I stated

in an earlier post, according to Dr. Ren's NP, she will still do the DS if

the patient is totally committed to it.

Marcia

Re: Re: Surgeon switching back to Scorpinaro

In a message dated 10/21/01 2:42:47 PM, duodenalswitch

writes:

<< Please don't make the assumption that she is exploring other

avenues of WL relief because she CAN'T do DS, rather that not all morbidly

obese people SHOULD have DS. >>

Marcia: This is a good and valid point. I know that Dr. Ren has performed

the DS before but someone recently said that it is now her policy to perform

the BPD NOT the DS. We're not talking about other surgical options like the

lapband or RNY but a discontinuation of the DS and a strong preference

(maybe

absolute?) for the BPD instead. This is what many of us find perplexing and

perhaps rather troubling.

all the best,

lap ds with gallbladder removal

January 25, 2001

Dr. Gagner/Mt. Sinai/NYC

almost 9 months post-op and still feelin' fabu

preop: 307 lbs/b mi 45

now: 213 ????

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

[Guest guest]

Hello, -

Your post is quite thoughtful. I have one question, though. You state that

the DS is the most risky. Do you mean more complex? It is only risky

because some of the surgery takes place in the upper right quadrant and in

close proximity to the biliopancreatic tree. However, in the hands of a

competent and experienced surgeon, it should not be significantly more risky

than other abdominal surgery.

Someone asked one of the DS surgeon's nurse what it took to be a DS surgeon.

The response was " balls! "

Congratulations on your upcoming surgery and your new beginning toward a new

life. You will be absolutely amazed how quickly you heal and begin your

journey to a new, slim, you!

Best-

Nick in Sage

Re: Surgeon switching back to Scorpinaro

> Hi to you Nick-

>

> >From what I've heard, from numerous (unbiased)sources, the DS is the

> most complex and risky of the weightloss surgeries currently

> available. As we all know, any time anesthesia is involved, there is

> inherent risk. But as far as the DS versuses the other WLS in that

> regard, and to what degree it is or isn't more or less risky, I

> cannot say. I'm not a doctor (yeah, nor do I play one on t.v.-haha);

> I'm only relaying what I've learned through various forms of research.

>

> However, having said that, I will add that that has NOT changed my

> opinion on the surgery, nor my desire to have it. During my consult

> with Dr. Ren a couple of months ago, I made this very clear and, to

> be honest, got nothing but understanding and compliance from her. She

> did go over all my options, making sure I was an educated consumer,

> so to speak, but did not hedge when I expressed my desire to go

> forward with the DS, while assuring her of my level of commitment

> post-op.

>

> Obviously, I am well aware of her recent decision to move towards the

> BPD and limit the number of BPD/DS surgeries. Personally, I think

> that's a shame. But I do respect her decision; she's the one who went

> to medical school and dedicated her life to medicine(and from what

> I've heard, gives 100% 24/7), and has to live with that decision. I'm

> sure she's not taken it lightly and put a lot of thought into it

> (even if the result is something many of us don't like or agree

> with). I don't think this makes her any less of a good surgeon, just

> one with perhaps more limited options.

>

> So, if a future patient has a consultation with her, and it is

> subsequently decided that she will not perform a DS on them, assuming

> that's what they want, then they should find a surgeon who will

> perform it. That's all. I think this surgery business is serious

> stuff and I personally wouldn't compromise my choice, of which I was

> sure I wanted, merely to appease the doctor. Afterall, I have to live

> with the results the rest of MY life!

>

> Anyway, enough said. We all do need to stick together and support

> each other, pre and post-opers alike. As someone who's due to have

> surgery in 2 weeks (though I'm still waiting to hear if I got the

> okay from Oxford yet), I for one need all of it I can get! And I know

> I'm not alone in that sentiment.

>

> Best to you,

> D. in NYC

> pre-op 11/6/01 Dr. Ren

>

>

>

>

>

> > Hi -

> >

> > You said: " " the lap DS is the most risky of surgeries . . . " If

> that is

> > so, there are other versions of the DS which are far more common

> than the

> > pure lap version.

> >

> > It would seem to me that a procedure that is so risky that it is

> often

> > performed in two stages is, in fact, more risky.

> >

> > Could it be that the open DS and the lap assisted DS are less

> risky? Is the

> > RNY less risky than either of these? I don't think so, myself, but

> it would

> > be interesting to hear other people's comments.

> >

> > When a surgery as superior as the DS is available, I am left with

> the

> > question of why any surgeon would perform it completely lap when

> safer and

> > equally effective versions are more commonly performed.

> >

> > Best -

> >

> > Nick in Sage

>

>

> ----------------------------------------------------------------------

>

[Guest guest]

Well said !

From another satisfied customer.

Sharon M in NY

Lap BPD/DS 8/23/01 Dr Ren

-44 lbs

--- mushnyc@... wrote:

> Hi to you Nick-

>

> From what I've heard, from numerous

> (unbiased)sources, the DS is the

> most complex and risky of the weightloss surgeries

> currently

> available. As we all know, any time anesthesia is

> involved, there is

> inherent risk. But as far as the DS versuses the

> other WLS in that

> regard, and to what degree it is or isn't more or

> less risky, I

> cannot say. I'm not a doctor (yeah, nor do I play

> one on t.v.-haha);

> I'm only relaying what I've learned through various

> forms of research.

>

> However, having said that, I will add that that has

> NOT changed my

> opinion on the surgery, nor my desire to have it.

> During my consult

> with Dr. Ren a couple of months ago, I made this

> very clear and, to

> be honest, got nothing but understanding and

> compliance from her. She

> did go over all my options, making sure I was an

> educated consumer,

> so to speak, but did not hedge when I expressed my

> desire to go

> forward with the DS, while assuring her of my level

> of commitment

> post-op.

>

> Obviously, I am well aware of her recent decision to

> move towards the

> BPD and limit the number of BPD/DS surgeries.

> Personally, I think

> that's a shame. But I do respect her decision; she's

> the one who went

> to medical school and dedicated her life to

> medicine(and from what

> I've heard, gives 100% 24/7), and has to live with

> that decision. I'm

> sure she's not taken it lightly and put a lot of

> thought into it

> (even if the result is something many of us don't

> like or agree

> with). I don't think this makes her any less of a

> good surgeon, just

> one with perhaps more limited options.

>

> So, if a future patient has a consultation with her,

> and it is

> subsequently decided that she will not perform a DS

> on them, assuming

> that's what they want, then they should find a

> surgeon who will

> perform it. That's all. I think this surgery

> business is serious

> stuff and I personally wouldn't compromise my

> choice, of which I was

> sure I wanted, merely to appease the doctor.

> Afterall, I have to live

> with the results the rest of MY life!

>

> Anyway, enough said. We all do need to stick

> together and support

> each other, pre and post-opers alike. As someone

> who's due to have

> surgery in 2 weeks (though I'm still waiting to hear

> if I got the

> okay from Oxford yet), I for one need all of it I

> can get! And I know

> I'm not alone in that sentiment.

>

> Best to you,

> D. in NYC

> pre-op 11/6/01 Dr. Ren

>

>

>

>

>

> > Hi -

> >

> > You said: " " the lap DS is the most risky of

> surgeries . . . " If

> that is

> > so, there are other versions of the DS which are

> far more common

> than the

> > pure lap version.

> >

> > It would seem to me that a procedure that is so

> risky that it is

> often

> > performed in two stages is, in fact, more risky.

> >

> > Could it be that the open DS and the lap assisted

> DS are less

> risky? Is the

> > RNY less risky than either of these? I don't

> think so, myself, but

> it would

> > be interesting to hear other people's comments.

> >

> > When a surgery as superior as the DS is available,

> I am left with

> the

> > question of why any surgeon would perform it

> completely lap when

> safer and

> > equally effective versions are more commonly

> performed.

> >

> > Best -

> >

> > Nick in Sage

>

>

>

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

>

[Guest guest]

,

I have Oxford (liberty) to be exact I had my approval in days! and a few days

later they send me the confirmation via snail mail. I was surprised at fast

Oxford was

Lisbeth

Anyway, enough said. We all do need to stick together and support

each other, pre and post-opers alike. As someone who's due to have

surgery in 2 weeks (though I'm still waiting to hear if I got the

okay from Oxford yet), I for one need all of it I can get! And I know

I'm not alone in that sentiment.

Best to you,

D. in NYC

pre-op 11/6/01 Dr. Ren

> Hi -

>

> You said: " " the lap DS is the most risky of surgeries . . . " If

that is

> so, there are other versions of the DS which are far more common

than the

> pure lap version.

>

> It would seem to me that a procedure that is so risky that it is

often

> performed in two stages is, in fact, more risky.

>

> Could it be that the open DS and the lap assisted DS are less

risky? Is the

> RNY less risky than either of these? I don't think so, myself, but

it would

> be interesting to hear other people's comments.

>

> When a surgery as superior as the DS is available, I am left with

the

> question of why any surgeon would perform it completely lap when

safer and

> equally effective versions are more commonly performed.

>

> Best -

>

> Nick in Sage

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