Having hard time finding surgeon in my area that does SADI or DS

Larra - I had heard he cherry-picked patients years ago - wouldn't take SSMO at all. It appeared to be in order to keep his stats good. Maybe he got more confident recently.
 
Diana - somehow, I've never had the impression that he did this to keep good stats, but rather that he's a bit on the conservative side, which would fit with his thorough pre-op evaluations as well. I don't know him and have no personal experience with him so I could be mistaken. Certainly, though, I've never seen any complaints about his surgical abilities or quality of care.
 
I'm glad to hear there are such dedicated members and friends on this board. In the end we all have our personal reasons why we choose the surgery we did, and its a great board like this that helps us along the way! Straight forward advice appriciated. But to insinuate if you don't get one surgery over an other, your doctor is going to be inexperienced, lazy and a crook, I thought was a bit unfair.
 
1) Inexperienced: there is a flood of non-DS surgeons rushing in to offer the SADI/SIPS/loopDS - so inexperienced in the duodeno-ileal anastomosis, as well as anything remotely related to DS nutrition.

2) Lazy: Adding the second anastomosis to provide a proven surgery is not that difficult, from what DS surgeons have said. They seem to be hoping to not have to do the extra step, and not have to provide the necessary patient education and nutritional followup.

3) Crook: if they are submitting to insurance companies under DS codes, and if they are describing the surgery to their patients as a DS, when it is not, I think that could easily be charges as malpractice and/or fraud. And we have seen multiple instances of both. See this thread:
http://bariatricfacts.org/threads/duodenal-switch-report-from-asmbs-nov-2015.3735/
  • There may be a number of patients who have contacted lawyers about consent issues related to these variant EXPERIMENTAL procedures (presumably, based on failure of the patient to receive sufficient factual information to allow them to give fully informed consent).
  • There was also a suggestion of at least one state licensing agency investigating a surgeon related to performing a single anastomosis procedure and calling it a DS.
  • At least one surgeon may have received a demand to refund payments made for a SADI surgery from insurance companies
  • In addition, there were a number of surgeons who have been personally told by third party payers that SADI or other single anastomosis procedures are not the DS, and 43845 cannot be used for coding for these variant procedures..
    • If there is any doubt why, just look at what the descriptor for the code says – it CLEARLY has two anastomoses! “Biliopancreatic Bypass with Duodenal Switch: CPT code 43845—gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileosteomy [50 to 100 cm common channel] to limit absorption [biliopancreatic diversion with duodenal switch]
So I don't think there is no basis for these assertions, nor that they were unfair.
 
@
Diana - somehow, I've never had the impression that he did this to keep good stats, but rather that he's a bit on the conservative side, which would fit with his thorough pre-op evaluations as well. I don't know him and have no personal experience with him so I could be mistaken. Certainly, though, I've never seen any complaints about his surgical abilities or quality of care.

@Larra the patient I'm thinking of was a tall, good looking (gorgeous) blonde whose dad was an MD and really liked Smith. Because her dad approved of Smith, she went with having a two-step revision...band-to-nothing with a band surgeon (maybe Ponce in Dalton, but I'm not sure on that) and then "virgin" DS with Smith. She was not high risk or SSMO or any of that. It WAS a while back...and she wasn't complaining, just explaining what "had to be done." This was an OtHer place happening.
 
Think what you choose, just try to deal with the reality of what is happening in Bariatric Surgeonland.

Band patients, by the thousands, need revisions. The DS is time-consuming and so are DS patients. If you were used to the quick cut-and-run the band provided, why bother learning the real DS? It doesn't pay any more than the RnY. It is time to find something else...and they have.

And SOME of them misrepresent their offering to the patient and to the insurance companies.

There's your lazy and your inexperienced and your crook.


But, frankly, I got no dog in this fight...get a substandard procedure if that makes you happy. You asked, answers were provided. Use the info or don't.
 
@Spiky Bugger I was not aware of that case. Perhaps that was early on and he expanded his practice since then, because I recall people going to him for band to DS revisions. IDK.

@Cyndi, with all due respect, you have no idea what can happen with a vulnerable patient population like the morbidly obese. Desperate people will latch on to any doctor who says he is willing to help them (often after years of shaming and humiliation by the medical profession). Those of us who have been around awhile know actual people who have been deceived by their surgeons. We have seen operative reports calling the surgery "duodenal switch" when the operation was actually SADI. We have encountered at least one person who thought she had a DS, really had a SADI, and then received bills from the insurer for what she had thought was a pre-authorized operation because what she got wasn't covered by the insurer (the DS was covered, SADI was not, and the insurer found out what she really got). We have reviewed websites of some surgeons with diagrams showing the DS, but what they were doing was SADI.

Now, if the surgeon is honest with the patient and discusses the differences between these operations, and is honest about the SADI being experimental and that the long term results are not known and that it can't just be assumed that it will have the same long term results as the DS (which are well documented), that the SADI is not considered standard of care in the USA, and is also honest with the insurer (or if the patient is self-pay) and the patient then chooses SADI as an informed decision, that's fine. But unfortunately that isn't the reality of what is happening in the bariatric surgery world.

Do what you want, but don't say you weren't warned.
 
I did not physically see my surgeon before I went there for surgery, so he had my p.c.p. do pre-op tests before I left. He needed to know I was healthy enough to be operated on before I traveled. Post op, my pcp, and now endocrinologist have my annual labs drawn, and while I do email my DS surgeon the results, my endo and I are really the ones calling the shots in adjusting my labs, if/when necessary.

It's probably best to have a great surgeon a stones throw away from you, but at least for me, I've realized he's he least important person on my "medical team" that I want to access now. Any issue I may have, I prefer a dr that is an expert in that area, which is never my DS surgeon.
 
I will add one thing to wha @bearmom said. It is extremely important that you get this surgery right (and the DS is the best and only option for most) and that you have a great surgeon doing, because if you don't you will need a second surgery like me screw years down the line. I am blessed with an incredible 2nd surgeon who takes emails or calls from me on his cell virtually anytime of the day or night (I try very hard not to abuse that privilege) . I need him because the first surgery was botched enough that it really screwed me up so my second surgery was a bit of unchartered territory as there are no rules for what he needed to do on my revision, only his experience (there are rules to doing the DS that if had been followed none of the rest of this would be needed). I tell you all of this not because of me but to point out what I have learned. It is critical to choose the right surgeon and procedure or you will need a great team nearby as bearmom said because you will be a mess.

Do your research and I am sure you will find the best Dr for you and that you will see that the DS is the best procedure for the morbidly or super morbidly obese patient.
 
Good advice Bearmom and DSRiggs. Because of the responses here I have extended my surgeon search.
And thank you Larra for your approach to explaining that to me.
 
@Cyndi, you are very welcome. I think most of us go into this expecting everyone we encounter to be above board. Despite all our complaints about the "health care system", most people like and trust their own doctors. But we have seen so much exploitative misuse of bariatric patients, honestly, you couldn't even make up this stuff if you tried. I think the worst has been with lap band, but there is plenty of crap with all the different operations. Let's face it, there is a never ending supply of potential bariatric surgery patients, and while most bariatric surgeon are legit (I hope) there are some who see us as a cash crop. Maybe we shouldn't be surprised by this. After all, doctors and non-medically trained quacks have promoted tons of ineffective weight loss products for years. Even now, there are new products to separate us from our money every year.
The number of pre-ops we reach here, and on similar websites, is a drop in the bucket compared to the almost 200,000 people having bariatric surgery each year in the USA alone. You are fortunate to have found this group, and I hope you will take what you read here to heart.
 

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