Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 Pam, The long term failure rate for DS is about 2%. That is, about 2% of the patients fail to loose and keep off more than 50% of their excess weight. No patient has every been reported to have lost no weight or to have gained weight (in contrast, some patients with the RNY actually weigh more 10-15 years after surgery then they did before surgery). Hull > > << The VGB has > a 60% failure rate and of the 40% who have success with it the excess > weight loss is around 50%. For example; if you are 100 pounds over > weight you with the VGB you have a 40% chance of losing and maintaining > a 50 pound weight loss long term. >> > > The success rate and loss is much better with the DS, I know. Has anyone > heard of anyone who did not have a success with the DS? And if so, why > wasn't it a success? ie didn't lose enough weight, didn't keep it off, etc. > I read about some people thinking their surgery isn't successful, when after > 3-6 months they " only " lost 40-60 lbs. and where on a plateau. I would not > consider that a failure. Especially after such a short amount of time! > Pam in PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 Judie, I don't know if most RNY surgeons are even aware of the long term consequences. Most RNY surgeons have not been doing it for 10+ years. The most recent report by shows that 3 out of 100 patients weiged more than at the time of surgery (in one case 13.6 kg or about 30 lbs more). Most RNY surgeons blame failure on patients compliance regarding proper eating choices. RNY surgeons will emphisise the surgery as a " tool " rather than a cure. On the other hand the DS is a far better tool and comes as close to a cure as we have at the current time. The short term success (2-4 years) of the RNY can blind surgeons into thinking that this thing really works well. I could only find a few studies that looked at results for more than 5 years. These studies consistantly showed the long-term excess weight loss of the RNY is about 50% compared with about 70% for the DS. Short term the RNY patient will loose about 60-70% of excess weight, but the regain is so common and consitant that it cannot be blamed on technical failings of any one surgeon. The best results I was able to find on the RNY were from Wittgrove and (ironically) Rabkin. Both of these reports were preliminary (2-4 years). Since Rabkin has basically abandoned the RNY in favor of the DS, it really is incumbent upon Wittgrove to show that he can get good long term results. The big problem for RNY surgeons is that they don't like follow-up. It is more lucrative to funnel new suckers (I mean patients) in then to worry about how old patients are doing. Therefore, the studies of RNY often have poor follow-up rate. On the other hand the DS surgeon understands the requirement of keeping up with all his patients, and thus has better response rates when they do long term follow-ups. As a result, I was able to find as much good data on DS and on RNY depite the latter procedure being older and more prevalent. For very long term (>10 year) weight loss results we currently have to depend on the results of BPD, as BPD/DS is only a little more than 10 years old. This will change in the next few years. Hull > some patients with the RNY > actually weigh more 10-15 years after surgery then they did before > surgery). >>>>>>> > > really, Chris? Why dont the RNY docs tell their patients that? Or are they > indivudually taking patients in their own practice and hoping it wont happen > that way? > Not sure Im clear on my question lol > > Judie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 Mel, Thanks for the info, that sure explains it. So Wittgrove is the only one with unusally good RNY results (albeit shorter term). I have found 3 papers on very-long term RNY resutls and they quote something like 47% EWL, 48%, and 49% (all about the same). I did find one abstract claiming 62% EWL for RNY after 10 years, though the full length paper does not appear to be published yet (the abstract was presented in 1999 ASBS conference). Marceau published a couple of abstracts at the 2001 ASBS conference including one on bone density (quite positive) and one that summerizes the results of his first 1000 patients! I think these two papers should really put to rest any long term concerns about the DS. Dr. K is going to publish on his first 100 cases soon, and I hope Dr. Anthone will publish sometime next year, though he wants to have more data before publishing. Dr. Sugerman is conducting clinical trials comparing the RNY and DS with 20 patients in each group - randomly selected the morning of the surgery. I have qualms about the small size of this group, yet I am also concerned about 20 patients winding up with a procedure that may have not been their first choice. I suspect in the end that the DS will be more effective, but without a wide enough variance to " prove " statistical signifigance with such a small group. Still, it is a step in the right directon. I understand that Dr. Marceau is going to work with Dr. Sugerman. Hull > there's a reason that Dr. Rabkin's " RGB " results were as good as > they were. It's not readily apparent without a careful reading, but if > you look at his published article, it's there. He reports on BPD, RGB, > and DS, and explains that the RGB series actually received a modified > BPD. > > I learned this myself because I specifically asked Dr. Rabkin how he > achieved such good results with his " RNY " . It was then that he explained > to me that after his initial 32 BPDs, he just wasn't comfortable with > the removal of the stomach/pylorus, which left no " fallback " for > reversal in case of problem. He subsequently went to a modified > Scopinaro (that he termed " distal RGB " ) which was essentially the same > as a BPD except that it left the bypassed stomach inside. (I don't > recall offhand if these patients were stapled or transected, but it may > say in his report). > > Ultimately, Rabkin found that in order to see good long-term results, he > had to progress to a smaller stomach pouch than he was comfortable with, > so he abandoned his RGB in 1994ish, in favor of the Duodenal Switch. In > addition, the RGB folks, despite good overall results, saw too many > ulcerations and other ongoing " pouch " -related side effects for Rabkin's > comfort. > > If you compare Rabkin's " RGB " numbers to Scopinaro's BPD stats, they are > very similar, and we know that the DS gets similar stats too, so that is > why Rabkin's numbers are so similar from his three compared procedures. > > Hope this illuminates a bit. > > 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@t... > > > _________________________________________________________ > Quote Link to comment Share on other sites More sharing options...
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