Re: Memorial Site Nick? DS verse RNY

[Guest guest]

The removal of the stomach is not as major a deal as cutting it up and

leaving a tiny ball. It is certainly not an anastamosis.

I think that your information from Dr. Baltasar was from his first study on

the DS. He has a more recent one that negates his prior study. I have no

idea about Dr. Herron. Is he surgeon who also does the RNY by chance?

You have now changed the ground rules of the discussion. You started by

talking about mortality, not complexity of the surgery. In the hands of a

marginal surgeon, there isn't much doubt that one would be safer with an RNY

surgeon. In the hands of a competent DS surgeon, the added risk is minimal.

You bet the DS is more complex. That's why so few surgeons do it. The RNY

surgeons aren't willing to abandon their gravy train and update their skills

for the most part, although, there are some who appear to be starting a

budding DS practice. Working in the upper right quadrant requires a lot

more skill, especially around the biliopancreatic tree. That's why people

need to really find out about their surgeon's track record and choose one

with a good one and one who has done a whole bunch of DS surgeries. Being a

patient of a surgeon early on his or her learning curve is absolutely risky.

The surgeons who focus only on the DS are pretty skillful people. They are

up to the task of performing their complex surgery. Their superior skills

go a long way to limiting the danger for their patients. As far as

mortality is concerned, the figure of 0.5% seems pretty standard for any

major surgery performed upon the morbidly obese. Is that statistic actually

lower for the RNY?

Cutting the stomach doesn't require that much skill. It is done with the

stapler that cuts and staples at the same time. This isn't a part of the

procedure where they bring out their Exacto knife and have at it. There is

more stapling with the DS where around nine cartridges of staples are

required. The RNY uses but 3. The actual cuts and staples are done

virtually by pulling the trigger on the stapling device. The best practice

is for the surgeon to oversew along the staple line. Surgeons who have

implemented this practice have reported almost no leaks since they began

doing the oversewing.

I think you are missing something if you don't compare the stoma with a

directly attached chunk of intestine versus the DS stomach that still

empties into the normal plumbing.

The measurements that you talk about are highly imprecise. Marceau studied

that issue by measuring the intestine, leaving the room and having his

associate go in and remeasure. The results varied substantially. Dr.

Keshishian likened the procedure to measuring a coiled phone cord with a

piece of string. The exactness with which we describe our common channels

is probably the wrong approach as we should say " Our common channel is

approximately 100 cm. "

The time under general anesthesia is definitely an issue. Usually it

correlates to a longer recovery time. That is one of the reasons that I

elected to have my DS done open. I haven't seen any studies relating to

mortality rates and time under anesthesia, though. Have you seen any? I'd

be interested in that if you have. How much longer is an open DS than a lap

RNY? Baltasar does the DS rather quickly, as does Rabkin. Baltasar even

has more than one assistant surgeon, too. I assume that each has their own

contribution to make.

My surgery was around three hours - not a big huge deal in the world of

surgery.

Thanks & happy holidays -

Nick in Sage

" Memorial Site " Nick? DS verse RNY

> Hi Nick,

>

> You need to count better...........

>

> You forgot to count the largest one.....the sugical vertical cutting

> and complete removal of the greater curvature of the stomach!

>

> Yes, I did mean mortality not morbidity.

>

> The " informant " of the double the mortality risk...was Dr. Herron as

> well as Dr. Baltaser in Spain.

>

> Yes, The DS is a superior WLS, but it is a more complicated, and

> ALWAYS longer operation. Period! Gallbladder in or out...DS is

> tougher and longer for the surgeon. A few examples might be the

> obvious danger and critical nature of cutting the stomach very close

> to the esophagous inorder to give the volume of the stomach its

> proper 4-6 ounce volume capacity. In the DS, the surgeon must

> critically cut the Duodenum and resect in this area, which is very

> fragile. In the DS, the surgeon must measure and judge the three

> lenghts of intestines to a much tougher standard. The closing off of

> an approx. 12 inch vertical removal along the greater

> curvature...with no leaks.

> It would not be honest to tell anyone that the intensity, risk,

> length, complexity of the RNY vis a vie DS is equal. Just the

> mortality involved in the longer time under anesthia is substantial.

> Hoping you and all on this list , have a great and healthy holiday

> season.

>

> Dan

>

>

> > Hi Dan -

> >

> > Let's count the anastamoses -

> >

> > RNY -

> > intestine to stoma = 1

> > small intestine back to itself = 1

> > Total for RNY = 2

> >

> > DS -

> > duodenum to alimentary channel = 1

> > biliopancreatic channel

> > to alimentary channel = 1

> > Total for DS = 2

> >

> > Those anastamoses look pretty similar to me.

> >

> > The morbidity rate is not the mortality rate. Morbidity relates to

> > surgically related complications. I would assume that the memorial

> page

> > relates to mortality and not morbidity. I would take issue with

> the RNY

> > having a lower morbidity rate, too. I would love to see the

> statistics that

> > were being used by whoever " informed " you. Blockages of the stoma,

> dumping,

> > late weight regain, vomiting and marginal ulcers are part and

> parcel of the

> > inferior RNY surgery. DS patients don't have those issues at all

> (except

> > for a person in San Francisco, who will not be reminded of this at

> the

> > present time).

> >

> > The morbidity rate for both is approximately the same as it is for

> any

> > abdominal surgery utilizing general anesthesia.

> >

> > The RNY has far more morbidity and mortality rates from

> complications with

> > the gallbladder because RNY surgeons are not as likely to want to

> take the

> > extra 20 min. to remove the gallbladder. The DS surgeons, at

> worst, will

> > give their patients Actigall. At best, they remove it altogether.

> >

> > Best-

> >

> > Nick in Sage

>

>

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

>

[Guest guest]

Nick,

One thing for sure...............

RNY or DS...both easier than Steves sex change operation....right?

DAN

> The removal of the stomach is not as major a deal as cutting it up

and

> leaving a tiny ball. It is certainly not an anastamosis.

>

> I think that your information from Dr. Baltasar was from his first

study on

> the DS. He has a more recent one that negates his prior study. I

have no

> idea about Dr. Herron. Is he surgeon who also does the RNY by

chance?

>

> You have now changed the ground rules of the discussion. You

started by

> talking about mortality, not complexity of the surgery. In the

hands of a

> marginal surgeon, there isn't much doubt that one would be safer

with an RNY

> surgeon. In the hands of a competent DS surgeon, the added risk is

minimal.

>

> You bet the DS is more complex. That's why so few surgeons do it.

The RNY

> surgeons aren't willing to abandon their gravy train and update

their skills

> for the most part, although, there are some who appear to be

starting a

> budding DS practice. Working in the upper right quadrant requires

a lot

> more skill, especially around the biliopancreatic tree. That's why

people

> need to really find out about their surgeon's track record and

choose one

> with a good one and one who has done a whole bunch of DS

surgeries. Being a

> patient of a surgeon early on his or her learning curve is

absolutely risky.

>

> The surgeons who focus only on the DS are pretty skillful people.

They are

> up to the task of performing their complex surgery. Their superior

skills

> go a long way to limiting the danger for their patients. As far as

> mortality is concerned, the figure of 0.5% seems pretty standard

for any

> major surgery performed upon the morbidly obese. Is that statistic

actually

> lower for the RNY?

>

> Cutting the stomach doesn't require that much skill. It is done

with the

> stapler that cuts and staples at the same time. This isn't a part

of the

> procedure where they bring out their Exacto knife and have at it.

There is

> more stapling with the DS where around nine cartridges of staples

are

> required. The RNY uses but 3. The actual cuts and staples are

done

> virtually by pulling the trigger on the stapling device. The best

practice

> is for the surgeon to oversew along the staple line. Surgeons who

have

> implemented this practice have reported almost no leaks since they

began

> doing the oversewing.

>

> I think you are missing something if you don't compare the stoma

with a

> directly attached chunk of intestine versus the DS stomach that

still

> empties into the normal plumbing.

>

> The measurements that you talk about are highly imprecise. Marceau

studied

> that issue by measuring the intestine, leaving the room and having

his

> associate go in and remeasure. The results varied substantially.

Dr.

> Keshishian likened the procedure to measuring a coiled phone cord

with a

> piece of string. The exactness with which we describe our common

channels

> is probably the wrong approach as we should say " Our common channel

is

> approximately 100 cm. "

>

> The time under general anesthesia is definitely an issue. Usually

it

> correlates to a longer recovery time. That is one of the reasons

that I

> elected to have my DS done open. I haven't seen any studies

relating to

> mortality rates and time under anesthesia, though. Have you seen

any? I'd

> be interested in that if you have. How much longer is an open DS

than a lap

> RNY? Baltasar does the DS rather quickly, as does Rabkin.

Baltasar even

> has more than one assistant surgeon, too. I assume that each has

their own

> contribution to make.

>

> My surgery was around three hours - not a big huge deal in the

world of

> surgery.

>

> Thanks & happy holidays -

>

> Nick in Sage

>

>

> " Memorial Site " Nick? DS verse RNY

>

>

> > Hi Nick,

> >

> > You need to count better...........

> >

> > You forgot to count the largest one.....the sugical vertical

cutting

> > and complete removal of the greater curvature of the stomach!

> >

> > Yes, I did mean mortality not morbidity.

> >

> > The " informant " of the double the mortality risk...was Dr. Herron

as

> > well as Dr. Baltaser in Spain.

> >

> > Yes, The DS is a superior WLS, but it is a more complicated, and

> > ALWAYS longer operation. Period! Gallbladder in or out...DS is

> > tougher and longer for the surgeon. A few examples might be the

> > obvious danger and critical nature of cutting the stomach very

close

> > to the esophagous inorder to give the volume of the stomach its

> > proper 4-6 ounce volume capacity. In the DS, the surgeon must

> > critically cut the Duodenum and resect in this area, which is

very

> > fragile. In the DS, the surgeon must measure and judge the three

> > lenghts of intestines to a much tougher standard. The closing off

of

> > an approx. 12 inch vertical removal along the greater

> > curvature...with no leaks.

> > It would not be honest to tell anyone that the intensity, risk,

> > length, complexity of the RNY vis a vie DS is equal. Just the

> > mortality involved in the longer time under anesthia is

substantial.

> > Hoping you and all on this list , have a great and healthy holiday

> > season.

> >

> > Dan

> >

> >

> > > Hi Dan -

> > >

> > > Let's count the anastamoses -

> > >

> > > RNY -

> > > intestine to stoma = 1

> > > small intestine back to itself = 1

> > > Total for RNY = 2

> > >

> > > DS -

> > > duodenum to alimentary channel = 1

> > > biliopancreatic channel

> > > to alimentary channel = 1

> > > Total for DS = 2

> > >

> > > Those anastamoses look pretty similar to me.

> > >

> > > The morbidity rate is not the mortality rate. Morbidity

relates to

> > > surgically related complications. I would assume that the

memorial

> > page

> > > relates to mortality and not morbidity. I would take issue with

> > the RNY

> > > having a lower morbidity rate, too. I would love to see the

> > statistics that

> > > were being used by whoever " informed " you. Blockages of the

stoma,

> > dumping,

> > > late weight regain, vomiting and marginal ulcers are part and

> > parcel of the

> > > inferior RNY surgery. DS patients don't have those issues at

all

> > (except

> > > for a person in San Francisco, who will not be reminded of this

at

> > the

> > > present time).

> > >

> > > The morbidity rate for both is approximately the same as it is

for

> > any

> > > abdominal surgery utilizing general anesthesia.

> > >

> > > The RNY has far more morbidity and mortality rates from

> > complications with

> > > the gallbladder because RNY surgeons are not as likely to want

to

> > take the

> > > extra 20 min. to remove the gallbladder. The DS surgeons, at

> > worst, will

> > > give their patients Actigall. At best, they remove it

altogether.

> > >

> > > Best-

> > >

> > > Nick in Sage

> >

> >

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

----

> >

[Guest guest]

Well, I'm not so sure after reading about his boycott of Layne !

Maybe he'll be heading back for a new pair of Levi's.

Best-

Nick

" Memorial Site " Nick? DS verse RNY

> >

> >

> > > Hi Nick,

> > >

> > > You need to count better...........

> > >

> > > You forgot to count the largest one.....the sugical vertical

> cutting

> > > and complete removal of the greater curvature of the stomach!

> > >

> > > Yes, I did mean mortality not morbidity.

> > >

> > > The " informant " of the double the mortality risk...was Dr. Herron

> as

> > > well as Dr. Baltaser in Spain.

> > >

> > > Yes, The DS is a superior WLS, but it is a more complicated, and

> > > ALWAYS longer operation. Period! Gallbladder in or out...DS is

> > > tougher and longer for the surgeon. A few examples might be the

> > > obvious danger and critical nature of cutting the stomach very

> close

> > > to the esophagous inorder to give the volume of the stomach its

> > > proper 4-6 ounce volume capacity. In the DS, the surgeon must

> > > critically cut the Duodenum and resect in this area, which is

> very

> > > fragile. In the DS, the surgeon must measure and judge the three

> > > lenghts of intestines to a much tougher standard. The closing off

> of

> > > an approx. 12 inch vertical removal along the greater

> > > curvature...with no leaks.

> > > It would not be honest to tell anyone that the intensity, risk,

> > > length, complexity of the RNY vis a vie DS is equal. Just the

> > > mortality involved in the longer time under anesthia is

> substantial.

> > > Hoping you and all on this list , have a great and healthy holiday

> > > season.

> > >

> > > Dan

> > >

> > >

> > > > Hi Dan -

> > > >

> > > > Let's count the anastamoses -

> > > >

> > > > RNY -

> > > > intestine to stoma = 1

> > > > small intestine back to itself = 1

> > > > Total for RNY = 2

> > > >

> > > > DS -

> > > > duodenum to alimentary channel = 1

> > > > biliopancreatic channel

> > > > to alimentary channel = 1

> > > > Total for DS = 2

> > > >

> > > > Those anastamoses look pretty similar to me.

> > > >

> > > > The morbidity rate is not the mortality rate. Morbidity

> relates to

> > > > surgically related complications. I would assume that the

> memorial

> > > page

> > > > relates to mortality and not morbidity. I would take issue with

> > > the RNY

> > > > having a lower morbidity rate, too. I would love to see the

> > > statistics that

> > > > were being used by whoever " informed " you. Blockages of the

> stoma,

> > > dumping,

> > > > late weight regain, vomiting and marginal ulcers are part and

> > > parcel of the

> > > > inferior RNY surgery. DS patients don't have those issues at

> all

> > > (except

> > > > for a person in San Francisco, who will not be reminded of this

> at

> > > the

> > > > present time).

> > > >

> > > > The morbidity rate for both is approximately the same as it is

> for

> > > any

> > > > abdominal surgery utilizing general anesthesia.

> > > >

> > > > The RNY has far more morbidity and mortality rates from

> > > complications with

> > > > the gallbladder because RNY surgeons are not as likely to want

> to

> > > take the

> > > > extra 20 min. to remove the gallbladder. The DS surgeons, at

> > > worst, will

> > > > give their patients Actigall. At best, they remove it

> altogether.

> > > >

> > > > Best-

> > > >

> > > > Nick in Sage

> > >

> > >

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

> ----

> > >