New. Probably getting DS

[Webmommy]

I guess my problem is.... I don't know if he brought up the previous surgery as a potential issue as a legitimate obstacle, or to steer me to another surgery. I am afraid if I give him the green light to do a sleeve if he can't safely do a DS,I will justwake up with a sleeve. On the flip side if I say DS or nothing will he do a DS even if he is not experienced at them? He has brought up RNY several times and that is just NOT what I want. He says he does DS. His PA says he does DS, but I feel this is not a surgery you let someone do that occasionally does them. On his website it says it is usually an open surgery, but he keeps saying he does davinci robotic surgery. Why not fix your website? I'm to the point of approval for surgery and don't want to start over with another surgeon, but I don't want to get surgery with the wrong doctor just to get it done.
I've done psych, nutrition, lost 24 lbs, endoscope, all the required visits.... uggggg. Lol
At least I will get my hiatal hernia I didn'tknow I had repaired. My endoscope showed a larger than normal amount of bile juices in my stomach which is another reason I think DS is the best option for me.
Question, is diarrhea that DS patients sometimes get worse than the diarrhea you sometimes get after gall bladder surgery?

Every thing he has said is a red flag. Do a search here for your surgeon and if he isn’t here, or someone else said they tricked them, find someone new. Or no information is just as bad. Bait and switch is some of these people’s MO. These tests can be transferred to a new doctor and he doesn’t own them. I am always suspicious when they say scar tissue or fatty liver can interfere with them doing the surgery so maybe just the sleeve because they’re basically saying they don’t have the surgical skills. Really he can do an RNY despite “scar tissue”? Smells deceitful.

My surgeon told me the post gall bladder surgery diarrhea likely wouldn’t improve but that wasn’t the case for me.

 

[Justme222]

I only found a little bit about him on here. I directly reached out to someone who had mentioned him and did get a reply.

 

[Larra]

For some reason, this name rings a bell from a few years back.... I would want to know exactly what he means by duodenal switch - there are some docs out there who say they do the DS but really do a version with a whole bunch of other names, such as loop DS, SIPS, and others, that involved a "loop" configuration of the small intestine rather than the standard RNY version of the DS. As to whether or not this doc does this and calls it "the DS", I can't say for sure and I don't want to make any accusations. But he's not one of the "regulars" for the DS and you definite want to know what you're getting or not getting.
And just to add to the confusion, people often refer to gastric bypass with a shorthand RNY, but RNY configuration of the small intestine is part of other operations, including the standard DS and some non-bariatric operations.
AND, most DS surgeons do the DS laparoscopically, or lap/hand assisted. Open would be a fall back choice for a patient with some issue that prevents safe use of laparoscopy. So I would be concerned if that is his usual approach to the DS.
You're in a tough spot. I understand about not wanting to start over with a different surgeon at this point, though, as others have pointed out, you can get your records ( you are legally entitled to them, there may be a copying fee) and provide them to another surgeon. You could keep this surgeon and advise him, IN WRITING, or what your acceptable alternatives are if he feels he can't safely do a DS for you. For example, you could say you are ok with a sleeve but not with gastric bypass, or that your preference would be to do nothing - or that if he needs to convert to open surgery to complete the DS you are fine with that. Whatever you feel is best for you.
A note to DianaCox and southernlady - do either or you have any specific memory about this doctor? Mine is too vague, or possibly completely off base.

 

[southernlady]

Open would be a fall back choice for a patient with some issue that prevents safe use of laparoscopy. So I would be concerned if that is his usual approach to the DS.

Greenbaum was famous for doing open on all his patients. I think MacQuire (in OH, retire about 8 years ago) also preferred doing all his open.

 

[Larra]

southernlady you're right, as usual. There are a few genuine, well regarded DS surgeons who prefer to do the operation open. This is certainly a question I would address with any potential surgeon.

 

[Justme222]

He uses the DaVinci robot for surgery from what he has told me. My problem is his website states usually open. I really think it is outdated information, but shouldn't that lack of attention to detail be a concern?

 

[southernlady]

He uses the DaVinci robot for surgery from what he has told me. My problem is his website states usually open. I really think it is outdated information, but shouldn't that lack of attention to detail be a concern?

Not really. Websites tend to get shoved aside and handed off to a webmaster who has to be told what to change.

 

[Justme222]

Okay. That makes me feel a little better. Both of the attached screen shots are from his site.

 

[Remingtonh]

My surgeon has said he might not be able to do the DS because I had my gallbladder out a long time ago and scar tissue might prevent him from doing the surgery. He thinks I should have just a sleeve done as a backup plan, but I am a very all or nothing kind of person so I am leaning toward nothing if he gets in there and can't do it.

My surgeon had me sign off to do backup surgeries if for some reason he couldn't do the DS. Something about length or configuration of the intestine might have precluded the DS (can't remember precisely). So him telling you that is probably just standard procedure. I signed off on RNY as 2nd choice and sleeve as 3rd choice, in that order. Suffice it to say I was relieved to find out I got the DS, it was one of my first questions when I woke up.

I had my gallbladder out in 2007 - a consequence of years of yo-yo dieting, and WLS in 2018. My surgeon did say he had to repair scar tissues (adhesions) from that previous gallbladder removal during the surgery but it wasn't a problem, it just contributed to the nearly 5 hour operation time.

 

[Justme222]

My surgeon had me sign off to do backup surgeries if for some reason he couldn't do the DS. Something about length or configuration of the intestine might have precluded the DS (can't remember precisely). So him telling you that is probably just standard procedure. I signed off on RNY as 2nd choice and sleeve as 3rd choice, in that order. Suffice it to say I was relieved to find out I got the DS, it was one of my first questions when I woke up.

I had my gallbladder out in 2007 - a consequence of years of yo-yo dieting, and WLS in 2018. My surgeon did say he had to repair scar tissues (adhesions) from that previous gallbladder removal during the surgery but it wasn't a problem, it just contributed to the nearly 5 hour operation time.

Thank you! This is very helpful.

 

[Webmommy]

I wouldn’t say it was standard procedure. I consented to only one surgery and there was no second or third choice either. I have had a few abdominal surgeries with plenty of spots for scar tissue.

 

[Remingtonh]

I wouldn’t say it was standard procedure. I consented to only one surgery and there was no second or third choice either. I have had a few abdominal surgeries with plenty of spots for scar tissue.

Well I'm sure he can tell his surgeon it's DS or nothing, he doesn't have to sign off on a second choice. I'm sure I didn't have to, and looking back probably shouldn't have optioned for a second choice, but after all the rigamarole and hoops I had to jump through to finally get on the operating table, I was determined to walk away with something, even if it was the RNY.

 

[Webmommy]

Well I'm sure he can tell his surgeon it's DS or nothing, he doesn't have to sign off on a second choice. I'm sure I didn't have to, and looking back probably shouldn't have optioned for a second choice, but after all the rigamarole and hoops I had to jump through to finally get on the operating table, I was determined to walk away with something, even if it was the RNY.

I hear ya. I just needed to point out that a second choice isn’t the standard of care and not just because my surgeon didn’t do that. But I see Dr. Now do that to people on My 600 lb Life and find it annoying. There was the option to have my appendix removed if it looked bad but that was the only iffy thing. In fact out of the oodles of surgeries I have had no one has ever done anything like that. It seems shady that some bariatric surgeon’s do it. I am glad you got your DS though.

 

[Remingtonh]

I hear ya. I just needed to point out that a second choice isn’t the standard of care and not just because my surgeon didn’t do that. But I see Dr. Now do that to people on My 600 lb Life and find it annoying. There was the option to have my appendix removed if it looked bad but that was the only iffy thing. In fact out of the oodles of surgeries I have had no one has ever done anything like that. It seems shady that some bariatric surgeon’s do it. I am glad you got your DS though.

In your other surgeries, was there more than one procedure that could have achieved the intended result, though? I mean, if you're going in for a cholecystectomy and for some reason they can't get at the gallbladder, they aren't going to offer to remove something else as a second choice...

Since Dr. Now apparently does it, my surgeon did it, and come to find out the original poster's surgeon offered alternative procedures once he's on the operating table, makes it seems to me that it just might be a pretty common standard of care for WLS. It makes sense to me and I'm glad I was given the option (even if I might have made the wrong choice at the time).

 

[Webmommy]

In your other surgeries, was there more than one procedure that could have achieved the intended result, though? I mean, if you're going in for a cholecystectomy and for some reason they can't get at the gallbladder, they aren't going to offer to remove something else as a second choice...

Since Dr. Now apparently does it, my surgeon did it, and come to find out the original poster's surgeon offered alternative procedures once he's on the operating table, makes it seems to me that it just might be a pretty common standard of care for WLS. It makes sense to me and I'm glad I was given the option (even if I might have made the wrong choice at the time).

Yes my spinal fusion. They could have performed it by going through the side and the back, or just through the back or the 360 degree fusion ( through abdomen and back) with different hardware and then there was a choice between bone morphogenetic protein or cadaver bone to help things grow together. I had the 360 fusion with titanium rods, screws and spacers and with BMP.

This is pretty relevant too because multilevel fusions through the back only do not have as high a success rate as fusions through the front and back. They too wondered about my c section scar tissue in my abdomen causing problems when they went through the belly but it didn’t change the plan. It would just take longer and they would have to be more careful. I didn’t need to consent to three different surgeries just in case.

Then when I had my spinal cord stimulator implant put in they could have just threaded it through my vertebrae or drill in my vertebrae and sew it in with titanium thread. Then when I had an upgrade and they put in another lead in it was pretty difficult because I had a ton of scar tissue but there was no plan a, b or c. These surgeries were done by three different surgeons.