Re: Why surgeons are changing from the DS

December 10, 2001

In a message dated 12/10/01 12:59:56 PM, duodenalswitch

writes:

<< >

> *** thais is exactly what dr. ren in NY told me. she said the

pyloric valve was over rated and she is only doing the bpd without

the ds. i drove all the way to ny for that.. so off to spain i went

to have dr baltasar do my operation. boy am i glad i did!

>>

It is quite important to note that the surgeons who have been making these

claims, however talented, do NOT have extensive experience with the DS

surgery. Both Ren and are relatively new to the field, opening

practices within the past year (or two?). I am not as sure about the other

surgeon mentioned, but I think the patient did say that he had not performed

many DS surgeries.

It is pretty insideous because these newer surgeons are at an advantage to

taking patients who do not wish to wait extraordinarily long waits for

consults and surgery dates and their popularity is partially based on their

good reputations and availability. They started out advertising the DS but

now there is quite a bit of confusion over whether they will continue to

offer this or not to future patients. It's almost as if they are blurring

the distinctions or minimizing the differences between the DS and BPD

intentionally yet they are NOT providing clear clinical evidence for these

claims that there is such a little distinction.

What I really don't understand is how these surgeons can profess that the

'pylorus' is overrated, etc. but NOT HAVE any clinical data that has been

published (why don't they publish some?) to back this information up. Also,

I too find it disturbing that these surgeons seem to try a 'switch and bait'

technique on patients. A pre-op who is already nervous is more apt to feel

pressured into the decision to have a traditional BPD because they feel they

don't have any other options.

It is very clear from my correspondence with my surgeon (Dr. Michel Gagner,

Mt. Sinai - who pioneered the lap DS and the main person under whom both Dr.s

Ren and studied) that he views the DS as CLEARLY being a better

surgery in almost all cases. I wonder what the other, more established and

experienced DS surgeons feel about this issue?

Elle: I thought there was a study done by Marceau (Canadian) that does

compare Hess's surgery to the earlier BPD... It can be found on the

duodenalswitch.com website, but I could be confused about this. or

Hull or anyone else - can you set me straight on this?

all the best,

lap ds with gallbladder removal

January 25, 2001

Dr. Gagner/Mt. Sinai/NYC

10 months post-op and still feelin' fabu

preop: 307 lbs/bmi 45

now: 198/bmi 28/size sweet 16, but squeezin' into a 14

December 10, 2001

In a message dated 12/10/01 12:59:56 PM, duodenalswitch

writes:

<< Dr and Dr Ren are new at the DS and lack years of

experience doing this or any other procedure. They are also friends

and former Lap Fellows with Dr Gagner of NYC. Dr Gagner has been

quoted previously responding to the information coming from them

about prefering to do the BPD over the DS. As I recall his comment

was that neither of them had the years of experience to make the

statements they were mnaking.>>>>>

Yes, : I am the one who mentioned this via my correspondence with Dr.

Gagner. He stated that the DS has been proven to be a marked improvement

over the BPD and that he would choose the DS hands down if he had to make a

decision.

<<<<<What he failed to say was other DS lap surgeons are experienced in

doing the DS open and in doing many other surgeries. Neither Dr Ren

or are experienced at doing open DS surgeries and are both

fresh out of training. It's a pity that Dr 's comfort in

doing this this surgery lap gets translated into it being too

difficult to do. Better she should admit that she finds it too

difficult rather than say the tissue is too fragile. There are other

surgeons doing the DS lap and do not find it so daunting. And the

pancratitis link is congecture as far as I can tell. >>>>>

Well, Dr. Gagner is a lap surgeon and we were discussing Dr. Ren and

's claims that the DS doesn't really have any advantage over the

BPD. Yes, there are many talented surgeons who perform the DS open and

honestly I would personally look into that over having a lap BPD. It does

sound like this option is overlooked since Drs Ren and are lap

surgeons (and perhaps don't have the open surgery skills --- I know that

those at Mt. Sinai do both. Even though Dr. Gagner is almost exclusively

lap, the other surgeons have performed Ds/RNY, etc. open and/or converted to

open during a difficult surgery).

I find the issue that the pylorus tissue is too 'sensitive' or 'fragile'

quite disturbing and suspect it may be related in some way to the ongoing

legal battle between Dr. Ren and a former patient (Deb Mullins) (I think

Lisbeth mentioned this before?). Deb was scheduled for a Lap DS with Dr. Ren

but it turned into a lap BPD because of supposed lack of blood flow to the

duodenum area during surgery. So, I know that Dr. Ren has experienced at

least one difficult case with the lap DS and it now involves some kind of

legal battle. I honestly haven't seen any studies or indications mentioned

by other surgeons that the lap DS (or the open DS since tissue fragility

would be a concern in either method, I assume) poses a great risk to the

pylorus or duodenum area.

You are right, that many other surgeons are routinely performing this

and I'm sure difficulties have been encountered in this area (Dr. Ren's case

and I think MacGuiure? and perhaps others), but it isn't like it's occuring

at such a rate as to be alarming or to reconsider the earlier BPD as an

equivalent surgery....

IMHO.

all the best,

lap ds with gallbladder removal

January 25, 2001

Dr. Gagner,mt. Sinai, NYC

10 months post-op and still feelin' fabu

preop: 307 lbs/bmi 45

now: 198 lbs/bmi 28/size sweet 16 but squeezin' into a 14 LOL

December 10, 2001

> My surgeon, Dr , has also auit doing the DS after 6

successful Ds laproscopic surgeries.

> Generally her feelings are that the tissue around the pylorus is so

fragile it's difficult to suture it without fear of damage, and

> that the DS has some (minimal) statical problems concerning

pancreatitis.

>

> *** thais is exactly what dr. ren in NY told me. she said the

pyloric valve was over rated and she is only doing the bpd without

the ds. i drove all the way to ny for that.. so off to spain i went

to have dr baltasar do my operation. boy am i glad i did!

December 10, 2001

Dr and Dr Ren are new at the DS and lack years of

experience doing this or any other procedure. They are also friends

and former Lap Fellows with Dr Gagner of NYC. Dr Gagner has been

quoted previously responding to the information coming from them

about prefering to do the BPD over the DS. As I recall his comment

was that neither of them had the years of experience to make the

statements they were mnaking.

What he failed to say was other DS lap surgeons are experienced in

doing the DS open and in doing many other surgeries. Neither Dr Ren

or are experienced at doing open DS surgeries and are both

fresh out of training. It's a pity that Dr 's comfort in

doing this this surgery lap gets translated into it being too

difficult to do. Better she should admit that she finds it too

difficult rather than say the tissue is too fragile. There are other

surgeons doing the DS lap and do not find it so daunting. And the

pancratitis link is congecture as far as I can tell.

Drs Ren and have a perfect right to select which surgeries

they will perform. I take issue with the rationale given for not

doing the lap DS. And saying the BPD is equal or better is 100%

nonsense. There are folks with great outcomes from the BPD. But how

is keeping the pyloric valve not better?

/Seattle

> My surgeon, Dr , has also auit doing the DS after 6

successful Ds laproscopic surgeries.

> Generally her feelings are that the tissue around the pylorus is so

fragile it's difficult to suture it without fear of damage, and

> that the DS has some (minimal) statical problems concerning

pancreatitis.

>

> Dr held a meting (which I did not attend) to explain the

differences between the 2 surgeries and from what others

> who did go say the DGB is a not quite as good alternative (from the

patients point of vies) but is better than the rny.

> There does not seem to be dumping involved, one of our biggest

fears, however patients who have had the DGB also say they eat

> much more than DS patients do.

December 10, 2001

Re: " My surgeon, Dr , has also auit (sic) doing the DS after 6

successful Ds laproscopic (sic) surgeries.

Generally her feelings are that the tissue around the pylorus is so fragile

it's difficult to suture it without fear of damage . . . "

There is absolutely no validity in this statement if you look to the many

other surgeons who do this successfully. If Dr. is suturing

around the pylorus, I'm glad that she is stopping her efforts to do the DS.

After all, other surgeons have great success - and - they suture the

duodenum, not the pylorus. Also, six lap surgeries do not an expert make.

I imagine that the word " pylorus " was erroneously used and that Dr.

has a hard time suturing the duodenum. There are plenty of

surgeons who can do that with great success. Run, don't walk, to one of

them!

It is a shame that surgeons who aren't up to handling the complexity of the

DS spend their time bashing it instead of perfecting their techniques.

Best -

Nick in Sage

December 10, 2001

> It is a shame that surgeons who aren't up to handling the

> complexity of the DS spend their time bashing it instead

> of perfecting their techniques.

I asked Dr. Rabkin not long ago about the statements I've seen on this

list comparing the DS to open heart surgery (saying that DS is a 7 out

of 10 difficulty, with a 10 being open heart). His response was as

follows: " We both recognize that the argument is artificial. There is,

of course, no recognized yardstick with which to settle the issue. Heart

surgery is a complex specialized area, as is DS surgery. DS patients

and open heart patients are both higher risk. In broad terms, Open DS

should rank a solid 10, at least equally as complex as cardiac surgery.

And Lap DS is more complex than Open DS. Significantly more complex. "

So, from this statement, it's safe to deduce that Dr. Rabkin feels that

the Lap DS is very, very complex. Given that, I would be exceedingly

hesitant to go under the knife of any DS surgeon who doesn't have a lot

of experience with the procedure in and of itself -- that's aside from

the whole Lap vs. Open issue.

It is my feeling that people should think twice, thrice and quadruple

before undergoing a Lap DS by any surgeon who isn't VERY experienced

with both 1) the technique of DS and 2) advanced laparoscopic

techniques.

I guess the next question is to define what " very experienced " means.

M.

---

in Valrico, FL, age 39

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

Starting weight 299, now 153

Starting BMI 49.7, now 25.5

Starting size 26/28, now 10/12

http://www.duodenalswitch.com/Patients/M/melaniem.html

Direct replies: mailto:melanie@...

December 10, 2001

Hello.

What Nick said here:

> It is a shame that surgeons who aren't up to handling the

> complexity of the DS spend their time bashing it instead of

> perfecting their techniques.

is so concisely worded that I hesitated (but only for a second!) to

throw in my third? posting of what Dr. Gagner personally said to me

about this issue.

His statement was SOMETHING to this effect: " The old BPD without

duodenal switch that [Ren, , et al] are doing is a complete

and total regression. Maybe they are taking their cues from Dr.

Fielding of Australia. The only reason I can see that they would be

doing this is that the BPD alone is much easier on the surgeon. I am

not interested in 'easy.' I do what's best for my patients. "

Ya know, I have since wondered about this Fielding guy. Didn't

Tracey just report that he, too, was abandoning the D/S, BUT THAT HE

JUST DID SO VERY RECENTLY? If so, then where did Gagner's " Maybe

they are taking their cues from Dr. Fielding of Australia " come from

in October of this year? Any ideas? Has Fielding been

researching/writing about BPD vs. BPD/DS for a while??

Best,

December 10, 2001

Dr Fielding is very Gastric Band orientated. That is his MO weapon of

choice. He spent time trying to convince me to have the band and when my

husband and I raised a united front and said that we would both prefer the

BPD/DS for me after a lot of in depth research. Now I find out 3 weeks

later that he is no longer doing DS and is trying to pull that on me as

well. What a WLS nightmare!

Tracey