Dr. Gagner no longer accepting American patients in Canda-Need a new surgeon

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Hello all-

To give you a little background:

I had RNY (Foby Pouch) in 2001 with Dr. Marema in Fort Lauderdale, FL and did well with it at first, losing from 417 to 195 and feeling pretty good. Like many however by 2010 I had numerous problems with severe dumping, and regain to 270.

I decided to have a revision to DS and researched many surgeons including Dr. K, Greenbaum, Pomp and Gagner. In the end I decided to go with Dr. Gagner in Montreal because he was only one who offered a totally laproscopic approach and seemed confident he could complete the revision in one step and amazingly my insurance agreed to let me go to Canada for the surgery as well.

I went for the revision and surprise, surprise he was not able to complete the entire revision due to operative time, adhesions etc. So, he completed the reversal of the RNY and and formed the new wide sleeve as stage 1 of the DS. Everything went well and he advised me to return in six months for stage 2 of the DS.

During those six months we lost the insurance coverage as my life was laid off and had to go on my plan which would not cover anything and cash pay was not a viable option so I was not able to return for stage 2. I did my best to live with just the wide sleeve and managed to drop 50 lbs again down to 220. Over the last four years however it has become apparent that the sleeve which was made larger than a traditional VSG sleeve in order to accommodate future malabsorption offered very little restriction and I began to regain.

So, last may I contacted Dr. Gagner and asked him what the cash price was to have him complete stage 2 in Canada. He responded quickly and told me I had the option of completing stage 2 of the classic DS for $15,500 or the SADI-S for $13,000. I was happy with that as it certainly a great price for a world class surgeon with his safety record and I was very happy with the care at Sacre-Couer in Canada during my first stage. I began to save and look for ways to finance the completion of the DS or SADI-S.

Just this week I was finally able to proceed and I contacted Dr. Gagner to ask about scheduling stage 2. I was shocked when he responded that he could not complete my surgery this year as the CMPA (Canadian Medical Protective Association) will no longer allow surgeons there to accept Americans for "elective" surgery and basically his hands were tied.

He suggested that I contact Dr. Roslin or Dr. Pomp in NYC. I did so and Dr. Roslin's office quoted me $41,000 :devilish: and I am awaiting a quote from Dr. Pomp's office. So, it's pretty obvious that the broken medical system in the US may leave me again seeking care out of the country.

I have identified two seemingly viable options and would like feedback from the community here concerning them. Option one is to travel to Madrid, Spain where Dr. Pernaute has quoted me a price of $12,000 US to complete stage two as a SADI-S, this seems very fair and in line with other surgeons outside of the U.S.A. He also seems to have a very good reputation although I don't see him listed here under the list of DS revision surgeons. Option two is Dr. Ungson in Mexico for revision to either the classic DS or SADI-S, his pricing is about the same as well.

So, does not anyone know of any other reasonable cash pay options? Any reason why I should not consider one of these two surgeons? Am I making the right choice of procedure? (I am somewhat concerned that since the intial sleeve revision was done four years ago and does not offer much restriction I may have trouble losing the weight as the restriction from the sleeve usually helps with initial weight loss and the switch with maintenance.) It has been suggested to me by a surgeon here that I should have revision back to RNY with a 150 cm alimentary channel???????? Any and all input is welcome and appreciated. Thank you.
 
Dr. Greenbaum had a cash pay price for a virgin DS of $15,000, I believe. Maybe contact him and see what he would charge for the intestinal portion only.
 
I would trust Dr. Ungson to do an intestinal switch or a virgin DS with no problem. I no longer recommend him for RNY to DS revisions.
 
Ungson should be OK for conversion (not exactly revision) of adding a switch - but I would NOT NOT NOT accept a SADI - no long term results and after failing two previous bariatric surgeries, you are going to need all the malabsorptive help you can get.
 
I agree with Diana regarding the SADI. While some studies are now being conducted, the long term results are unknown, and you have personally proven that you need the full malabsorption and metabolic changes of the DS. I think Dr. Ungson would be a fine choice, just discuss with him also the idea of a re-sleeve to give you more restriction (of course that's a judgement call and he will need to assess your sleeve to make that determination, AND hopefully your stomach isn't too damaged from all the prior surgery for this).
I don't know anything about Dr. Pernaute.

I hope you won't let a price difference of $2000 or so make the decision as to which operation for you. You have already had 2 failed bariatric operations. It's time to get the operation with the best possible results. It is unfortunate that Dr. Gagner wasn't able to complete your DS due to adhesions but we can't change the past.
 
I am so sorry you are going through this - it's such a damn shame people can't get the health care they need.
 
Greenbaum, Ungson... Pernaute is doing sadi, don't know if he is doing real DS. Check that out very carefully. ETA oops I see you already knew that. I would not want an unproven procedure for my second revision. Pay a little more for a real DS and chill about the open procedure. It's not a bad thing.
 
I went to Ungson for my conversion. It was either $8 or $9k for just adding the intestinal part but I had a resleeve also and it was $14,500.
 

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