Re: The fallibility of surgeons

[Guest guest]

Doctors can be very good with one patient and not so good with others. When I

was trying to have children and lost 3 pregnancies in a row, the OB I was seeing

at the time treated me terribly. I won't go into details, but I feel my last

loss was due to his neglagence. I couldn't imagine anyone thinking he was a

good doctor, but there were. A woman in the waiting room had just had her baby

and was talking about how great the doctor had been. Her husband had died in a

freak accident when she was 2 months pregnant and the doctor stood by her side

and supported her all the way through.

When I went to another OB, I felt it was because of him that my son and daughter

are here. I almost died after my son was born and my daughter nearly died due

to the cord being around her neck 3 times. Both times he was there 100% and

saved my family. I couldn't imagine anyone thinking poorly of him, but I was

wrong. I ran into a guy whose wife had lost 2 babies under my new OB's care.

I guess my point in all of this is that sometimes bad things happen and doctors

don't handle things the way we want them to. Doctors are people too and they

make mistakes. I am a systems analyst and if I make a mistake, no one gets

hurt. If a doctor makes a human error, it can cost a life.

If I were a doctor and I didn't feel comfortable doing a particular procedure

for whatever reason, I wouldn't want to do it either. Everyone is entitled to

their opinion and if you don't agree with the opinion of your doctor, find

another one. I would imagine that in 30 years there will be email lists of

people who couldn't imagine how any surgeon in their right mind would do a DS

surgery. At this point they really don't know everything about the surgery and

in that amount of time a lot could be learned. Let's be honest with ourselves,

no one really knows all the long term consequences of this surgery or any other

WLS. If some surgeons feel that DS isn't the way to go, then we should respect

that and find another doctor who does the procedure we want. I would rather do

that than have a surgeon do a procedure on me that they weren't comfortable

with.

[Guest guest]

At 10:11 PM +0000 10/30/01, kaybeekaybee@... wrote:

> Dr. Elariny's stand-alone sleeve gastrectomy has come in for

>comparatively little criticism on this list, even though it tries to

>force the reduced stomach to carry the full burden of weight loss and

>maintenance, a function the BPD/DS's creator says it can't carry by

>itself. If we care that people who come to Drs. Ren and

>for the BPD/DS will now be offered only the BPD instead, we should

>care that Elariny is persuading increasing numbers of those who come

>to him for the BPD/DS to opt for the unadorned sleeve gastrectomy.

>Some of them (as I've seen on the Elariny list) even come away with

>the impression that the sleeve gastrectomy is " minor " surgery, which

>it is not. And if we care that the BPD leaves the patient without

>the pylorus, we should care that Elariny is reported on the DS-

>Elariny list to be offering his sleeve-gastrectomy patients the

>option of intentionally disabling the pylorus. If there has been any

>discussion of that on this list, I've missed it.

At 7:42 AM +0000 11/2/01, marym@... wrote:

>Thank you for your thoughtful, insightful post. I was not aware of

>the decision that Dr E made not to do the DS now. If this is true,

THIS IS MOST CERTAINLY NOT TRUE!!!

Dr. Elariny is cautious about doing the entire DS in one procedure in

super morbidly obese patients because of the risks. He counsels the

patient to have the vertical gastrectomy ( " sleeve " ) first, then lose

about 100 pounds, and then come back for the intestinal part of the

switch. In several cases, prospective patients have insisted in

having the full procedure all at once, and Dr. E. has agreed to do

that. He has also done several successful revisions from RNY to DS.

I am not aware that Dr. E. has offered anybody the option of

intentionally disabling the pylorus.

Here is a recent note from Dr. Elariny to me (he had previously given

me permission to post it):

At 12:28 AM -0500 10/29/01, Hazem A. Elariny wrote:

>I have also had a discussion with another surgeon who stopped doing the DS

>in favor of the Scopinaro operation. He also quoted a higher leak rate and

>pancreatitis rate and had one patient who died as a result of pancreatitis.

>I have had one case of mild pancreatitis, no deaths, and since I have

>started hand-sewing the duodeno-ileal anastamosis (probably the last 50

>cases), I have not had a single leak. I think alot of surgeons' problems

>come from two things done during Lap-DS surgery. 1) stapled duodeno-ileal

>anastamosis; 2) devascularizing the pylorus to get the duodenal stump

>disected. If you devascularize the pylorus, and totally detatch it from its

>surrounding structures, then you are asking alot to expect it to continue to

>function. Another thing is the extent of gastrectomy performed adjacent to

>the pylorus and adjacent to the esophagus. The closer you go to these

>structures, the more likely they are to affect the gastric emptying. We

>avoid doing any of these things. In any case, the Scopinaro procedure is

>still a good operation, but it does increase the risk of B12 and Iron

>deficiency compared to the DS, and there may be a higher stomal ulcer rate.

>

>Of course, I do either, so I have no personal bias toward one or the other.

>

>Sincerely,

>

>Hazem A. Elariny, MD, PhD, FACS

To me this indicates that Dr. E. is well aware of the sensitivity of

the pyloric structure to operational trauma, and that he continues to

work very carefully and skillfully in that area.

Kay, do you still have legal proceedings underway against Dr. Elariny?

>then I trust that will remove his name from the DS list and

>his happy post op DS patients will not refer more patients to see him.

What's going on here? Folks are getting awfully trigger-happy.

--Steve

--

Steve Goldstein, age 61

Lap BPD/DS on May 2, 2001

Dr. Elariny, INOVA Fairfax Hospital, Virginia

Starting (05/02/01) BMI = 51

BMI on 10/25 = 39 (-75 lb.) -- No longer M.O.

Losing more slowly than most, but enjoying renewed health and life in general.

[Guest guest]

> > This will be a long-winded post, because I've had two DS

surgeons,

> > both of whom have generated some controversy.

> >

> > I've been bemused in recent months to see that both the surgeons

> with