Difference in SIPS-DS lifestyle

OMG! this is unbelievable! I agree with @DianaCox - he may be military, but his license comes from the state governing board and they would be interested in the assault. It sounds like they are still trying to lay it on you - like it is your fault or that you agreed to it. Don't perpetuate their BS.

Hugs to you honey, it does sound like you are doing great, but assault it assault.
 
OMG! this is unbelievable! I agree with @DianaCox - he may be military, but his license comes from the state governing board and they would be interested in the assault. It sounds like they are still trying to lay it on you - like it is your fault or that you agreed to it. Don't perpetuate their BS.

Hugs to you honey, it does sound like you are doing great, but assault it assault.
He may be licensed by WA state but if a complaint is filed, all they will do is send it to Madigan and it will get lost in the government bureaucracy never to see the light of day. As long as he is not in private practice, the state where a physician is licensed has very little say in how they behave.
 
I suspect @southernlady has the right of it, but it's possible that if you do complain, at least someone in the chain of command will issue an order that pre-ops henceforth must be better advised as to what surgery they will be getting. It won't help you but you might be helping others.
And for the record, informed consent is more than signing the form. Informed consent includes the discussion you had with the surgeon, and this discussion is also supposed to be documented by the surgeon in your medical record. If there was no discussion, there was no informed consent. From a legal point of view, I don't know if you have any recourse with care provided by the military. Probably not, though I'm not an attorney and I don't really know. But for anyone not receiving care through the military or VA, the informed consent discussion would be much more important legally than the form you signed.
 
In your letter of complaint, I would recite facts, including:
  • You have been studying everything you could about the DS surgery for X months
  • You were very aware of the EXPERIMENTAL procedure variously called SIPS or SADI or loopDS, and fully understood that it was EXPERIMENTAL, and involves not only a variant of limb lengths, but also that it only has ONE anastomosis, and does NOT have selective fat malabsorption, which is what you wanted
  • The fact that the procedure is still EXPERIMENTAL can be seen from the following evidence:
  • The duodenal switch has CPT code 43845, which reads as follows - noting that it EXPRESSLY includes TWO anastomoses:
    • Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch)
  • It is beyond question that the procedure you were given was NOT a duodenal switch, which is what you were led to believe
  • You were NOT NOT NOT informed that you were going to be given an EXPERIMENTAL procedure, and therefore there was a complete failure to receive the information necessary to give fully informed consent, and that there is NO WAY that you would have consented to this procedure
I would also say that you feel that you have been subjected to malpractice, as well as treated illegally and immorally, and that you want to be given the opportunity to have your surgery corrected by a COMPETENT DS revision surgeon OUTSIDE of the military system which you no longer trust, at a time selected by you when you are up to having that surgery done. And I would also say that the practice at Madigan MUST revise their procedures for providing sufficient information for patients to give fully informed consent, and that this goes triple for procedures which are EXPERIMENTAL.
 
In your letter of complaint, I would recite facts, including:
  • You have been studying everything you could about the DS surgery for X months
  • You were very aware of the EXPERIMENTAL procedure variously called SIPS or SADI or loopDS, and fully understood that it was EXPERIMENTAL, and involves not only a variant of limb lengths, but also that it only has ONE anastomosis, and does NOT have selective fat malabsorption, which is what you wanted
  • The fact that the procedure is still EXPERIMENTAL can be seen from the following evidence:
  • The duodenal switch has CPT code 43845, which reads as follows - noting that it EXPRESSLY includes TWO anastomoses:
    • Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch)
  • It is beyond question that the procedure you were given was NOT a duodenal switch, which is what you were led to believe
  • You were NOT NOT NOT informed that you were going to be given an EXPERIMENTAL procedure, and therefore there was a complete failure to receive the information necessary to give fully informed consent, and that there is NO WAY that you would have consented to this procedure
I would also say that you feel that you have been subjected to malpractice, as well as treated illegally and immorally, and that you want to be given the opportunity to have your surgery corrected by a COMPETENT DS revision surgeon OUTSIDE of the military system which you no longer trust, at a time selected by you when you are up to having that surgery done. And I would also say that the practice at Madigan MUST revise their procedures for providing sufficient information for patients to give fully informed consent, and that this goes triple for procedures which are EXPERIMENTAL.


I know you are outraged, but this surgery was brought to you by the lovely folks who did experimental LSD on folks, too. It's a different world...
 
I will be there for prescription refills as I prefer when it comes to those people, better to do it in person. I will stop by the patient advocacy to discuss the issue as I don't want someone else to have the same thing happen. What sux even more to me is I am short and weigh more than half the others that got the actual DS, why the hell did they decide I needed to be the lab rat?! I really don't care to have another surgery, this was to be my last attempt at the weightless game which even frustrates me more. Hubby wasn't too crazy about doing another one and thought I was just thinking about it when I asked him what he thought. Not that I have to have his permission but I just don't want another surgery unless absolutely necessary. I never liked doctors to start with and grew up rarely ever going even when there was a possible broken bone and the previous pcm was an ass who didn't care about his patients which resulted in half my body being 'asleep' because of nerve damage and old spinal chord injury I didn't know I had. Took me a year to finally decide to try a new primary care doc and this one cared. Didn't take no time to get my neck surgery done cause it was so bad they were worried i'd be paralyzed if I just tripped and fell in the yard or something. This little adventure just solidifies my opinion of them. There are good ones out there but I sure don't seem to have much luck!!

When my hubby retired from the military they told us everything has to be done off base and we have to have an off base primary care doc, now 5 yrs later they wanting us back in the system. I think not, I love the doc I finally found and after this, why the hell would I want to go back to them for my medical care?!!

I'm going to try and make this work even if it wasn't what I wanted and still p's me off thinking about it! I'm waiting on the survey they always send also and will let them know how I feel in that also. Usually I just toss them but this will be one that will be filled out and returned!

@Spiky Bugger your damn sure right!!
 
Get your op report. Find out what your limb lengths are. Assuming the alimentary tract is between 250-300 cm, the hard work has already been done. Revising to a proper DS could be a relatively quick laparoscopic procedure - "just" (@Larra?) cutting the ileum just upstream of the duodenoileal anastomosis (and closing the ileal stump at the duodenum) and bringing the BPL down to form the RNY anastomosis 100 cm back from the ileocecal valve. You could call Dr. Keshishian and ask him how much it would cost to fix you up (and remove your gall bladder if they didn't already do that).

You could wait 6 months for that, but I'd do it within the year if possible. And then find a way to make Madigan pay for it. (Yeah, I know, probably not possible, but that's what I'd do - find some way to pay for it, rather than losing the benefit of the honeymoon period.)
 
Last edited:
@good question, @DianaCox ! I haven't yet heard of people having this type of revision, though I'm sure it will happen. I would love to hear from one of the revision DS surgeons exactly how they would go about converting a SADI to a DS, and whether or not the length of duodenum still attached to the pylorus matters.
I do think we will see these revisions in the future. Right now, the people with SADI are all still relatively early out. It's the long term that counts.
 
Edited and uncredited comments from someone who knows what is being discussed, when asked how simple a revision of a single anastomosis procedure to a proper DS would be:

There is no easy way to know if the revision is going to be simple, i.e., by making one division and an anastomosis, or if it will involve complete takedown of the incompatibly cut loop anastomosis. This is because it depends if the first anastomosis is done in front of or behind the colon, and how the bowel was measured and for what length. It would be very hard to just cut one side of the anastomosis and do another one down stream and end up with a typical Hess method type length of bowel for DS. I would suspect that these people are going to get screwed a second time by not losing enough weight.

I have no idea how to approach this blatant lying on consents for replacing one procedure with another one. Do these people think that everyone is an idiot and will not be found out? Still not clear why would any patient fall for it?

Does this patient not have a legal case? I am the last one to recommend anyone getting a lawyer against a surgeon, but this gives all of us a bad name.​
 
This is pretty much what I was afraid of. It sounds so simple, but could be far more complex, or even impossible if there isn't enough duodenum attached to the pylorus to work with.
As to how patients fall for it, that's simple. If you look at the websites for some of the surgeons doing the loop DS, they call it the DS and don't mention that there is even another way to do a DS. they make it appear as though this is the procedure with the documented long term excellent results of the DS, which it isn't. If a patient doesn't do his or her own research (many don't) and/or doesn't have the ability to sort out the differences between these operations for themselves and understand WHY the different anatomy makes a difference, they will just assume they are getting "the DS". And, if a couple years down the line their results aren't what they anticipated, they won't know why, or will just assume that, once again, they are failures.
this is why we are now seeing new people show up here (and elsewhere) excited about their upcoming DS, and it turns out they have a surgeon who only does loop DS and the patient didn't even know there was more than one "DS".
 
I've been reading along on this thread and similar ones regarding this fraudulent "DS, but not really, kinda" BS. It's extremely troubling, I'm surprised nothing has happened legally in a big way that would stop this, yet. In the meantime, more and more patients are getting this, many without full understanding.. will this mean class action cases, or will the sheer number somehow create it's own legal work-around to save so many bariatric practices' asses? I'm not legally savvy, so no clue how this is playing out in real time..
 
They can call it a DS, or a pink poodle, or whatever they want, but that doesn't make it fact. They did have at least one real DS surgeon there (Dr Martin) but it sounds like he's not someone you talked with. I'd be beyond pissed, and consulting an attorney.
 
This is exactly what happened to me! My surgeon portrayed the SIPS as a DS with one anastomosis instead of two but basically identical... it's just that the single anastomosis was a "new way" of doing the procedure. I was under the impression I was getting the traditional DS done the new way... now I know better.... i have NO IDEA what my malabsorption rates are, no idea what it will look like in the future... will I gain the weight back? Nobody knows because there's no data! Right now i'm doing great, 5 months post op and 84lbs down but I'm worried about the future since the surgery wasn't portrayed correctly by my surgeon. Side note: I payed out of pocket. My Insurance does not cover DS in canada.



Welcome @Readyforchange

There isn't a whole lot out there yet.

The reasons:
1) The relative newness of the surgery. At most it's about 5 years out in Turkey...about 2 to 3 years out here in the US. The DS, OTOH has been around since 1988 so we have quite a few out there over 10-15 years out now.
2) Many are calling it "just like the DS but better" so all the potential patients read up on the DS and figured it was the same.
3) As a result of the 2nd item, many patients think they actually have the DS.

We do have a few who have had the surgery...but it's gonna be a few years before things are figured out and the patients discover what the SIPS lifestyle is like.

Good luck with your choice.
 

Latest posts

Back
Top