Larra
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Hi Everybody
- Thread starter camprman
- Start date
What is EF?
EF = ejection fraction? Losing weight will increase it? But you can't have WLS until your EF is higher? Ugh - is this possibly a situation where a 2-part DS might be best, perhaps the intestinal rearrangement first? That would cause some weight loss, as well as almost certainly address your type II diabetes.
I don't have the full article, but Marceau et al. 2014 published a study in which they showed the intestinal part of the DS (without the sleeve) as a staged procedure was preferable to doing the sleeve first: https://www.ncbi.nlm.nih.gov/pubmed/24839191
Obes Surg. 2014 Nov;24(11):1843-9. doi: 10.1007/s11695-014-1284-0.
Biliopancreatic diversion-duodenal switch: independent contributions of sleeve resection and duodenal exclusion.
Marceau P1, Biron S, Marceau S, Hould FS, Lebel S, Lescelleur O, Biertho L, Kral JG.
Author information
1
Department of Bariatric Surgery, Quebec, Laval Hospital, IUCPQ, University Institute Cardiology and Pneumology, Laval University 2725, Chemin Ste-Foy, Québec, QC, G1V 4G5, Canada, [email protected].
Abstract
BACKGROUND:
The choice of first-stage operation in bilio-pancreatic diversion with duodenal switch (BPD-DS) is controversial. There are no published long-term comparisons of one- and two-stage BPD-DS outcomes.
METHODS:
During 2001-2009, among 1,762 patients scheduled for BPD-DS 48 had duodenal switch (DS) and 53 sleeve gastrectomy (SG) as first-stage procedures. We compared prospectively updated outcomes of 42 DS (100 % open) and 49 SG (88 % laparoscopic), 13 of whom completed their second stage, to a control group of 91 patients with open one-stage BPD-DS.
RESULTS:
One-year mean percent excess weight loss (%EWL) was greater after SG than DS (47 ± 19 vs. 39 ± 13 SD; p = 0.01) with earlier nadir (16 ± 10 vs. 45 ± 30 months; p < 0.0001) but more rapid significant weight regain. After 5 years, %EWL was 12 ± 35 for 9 SG, 45 ± 19 for 30 DS (p < 0.0006), and 70 ± 18 for the first-stage BPD-DS (p < 0.0001). Weight loss was less after two- than one-stage procedures (p < 0.02). Comorbidities improved progressively between SG, DS and BPD-DS (p < 0.001 for trend). HbA1C decreased by 10, 19, and 31 %, respectively (p < 0.0001). Dyslipidemia was cured in 41, 82, and 100 %, respectively. Systolic and diastolic blood pressure decreased only after DS (12 %; p < 0.0002). Patient satisfaction was similar for SG and DS but greater after BPD-DS overall (p = 0.04).
CONCLUSIONS:
SG and DS independently contribute to beneficial metabolic outcomes after BPD-DS. Long-term weight loss and correction of metabolic abnormalities were better after DS favoring its use as first stage in BPD-DS; one-stage BPD-DS outcomes were superior to two-staged.
I don't have the full article, but Marceau et al. 2014 published a study in which they showed the intestinal part of the DS (without the sleeve) as a staged procedure was preferable to doing the sleeve first: https://www.ncbi.nlm.nih.gov/pubmed/24839191
Obes Surg. 2014 Nov;24(11):1843-9. doi: 10.1007/s11695-014-1284-0.
Biliopancreatic diversion-duodenal switch: independent contributions of sleeve resection and duodenal exclusion.
Marceau P1, Biron S, Marceau S, Hould FS, Lebel S, Lescelleur O, Biertho L, Kral JG.
Author information
1
Department of Bariatric Surgery, Quebec, Laval Hospital, IUCPQ, University Institute Cardiology and Pneumology, Laval University 2725, Chemin Ste-Foy, Québec, QC, G1V 4G5, Canada, [email protected].
Abstract
BACKGROUND:
The choice of first-stage operation in bilio-pancreatic diversion with duodenal switch (BPD-DS) is controversial. There are no published long-term comparisons of one- and two-stage BPD-DS outcomes.
METHODS:
During 2001-2009, among 1,762 patients scheduled for BPD-DS 48 had duodenal switch (DS) and 53 sleeve gastrectomy (SG) as first-stage procedures. We compared prospectively updated outcomes of 42 DS (100 % open) and 49 SG (88 % laparoscopic), 13 of whom completed their second stage, to a control group of 91 patients with open one-stage BPD-DS.
RESULTS:
One-year mean percent excess weight loss (%EWL) was greater after SG than DS (47 ± 19 vs. 39 ± 13 SD; p = 0.01) with earlier nadir (16 ± 10 vs. 45 ± 30 months; p < 0.0001) but more rapid significant weight regain. After 5 years, %EWL was 12 ± 35 for 9 SG, 45 ± 19 for 30 DS (p < 0.0006), and 70 ± 18 for the first-stage BPD-DS (p < 0.0001). Weight loss was less after two- than one-stage procedures (p < 0.02). Comorbidities improved progressively between SG, DS and BPD-DS (p < 0.001 for trend). HbA1C decreased by 10, 19, and 31 %, respectively (p < 0.0001). Dyslipidemia was cured in 41, 82, and 100 %, respectively. Systolic and diastolic blood pressure decreased only after DS (12 %; p < 0.0002). Patient satisfaction was similar for SG and DS but greater after BPD-DS overall (p = 0.04).
CONCLUSIONS:
SG and DS independently contribute to beneficial metabolic outcomes after BPD-DS. Long-term weight loss and correction of metabolic abnormalities were better after DS favoring its use as first stage in BPD-DS; one-stage BPD-DS outcomes were superior to two-staged.
Larra
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DianaCox, camprman is higher risk to start with because he is a revision from an ancient stomach stapling, and a low EF (though I don't know his exact EF) is a very serious cardiac risk factor for major surgery. Yes, the surgery would help him lose weight, which in turn would improve his EF because his heart would not have to work quite as hard to push blood forward, but the increase in risk is significant.
Dr. K is not one to hold off on a difficult or high risk revision. If he felt Camprman's cardiac risk was too high, I wouldn't want to question his judgement. Other surgeons - maybe. Not Dr. K. OTOH, if this was not a revision, and he could get in there and do a really quick VSG, maybe this would be a different conversation, but that's not an option here.
Dr. K is not one to hold off on a difficult or high risk revision. If he felt Camprman's cardiac risk was too high, I wouldn't want to question his judgement. Other surgeons - maybe. Not Dr. K. OTOH, if this was not a revision, and he could get in there and do a really quick VSG, maybe this would be a different conversation, but that's not an option here.
My EF is 28. I have a lot of negative things that most doctors would run from, so the fact that he is not looking for a specific weight loss number and rather an overall improvement in my EF, I can logically deal with. I just need to get my emotional crap in order. I'll do it. I've lost weight before and I will do it this time. No poor me attitude. If it was just because of say insurance, yeah I'd be upset, but this is about me waking up when he's done.
The end game is I want to live again. This will just be a little slower than I like, but tough. It is what it is. I'm still alive, so I have options. All of you are awesome. I'm going to need your support going forward. I can lie to myself, but when others are holding me accountable, well, I just do better.
The end game is I want to live again. This will just be a little slower than I like, but tough. It is what it is. I'm still alive, so I have options. All of you are awesome. I'm going to need your support going forward. I can lie to myself, but when others are holding me accountable, well, I just do better.
I had my DS with Dr K last year at the age of 67. He is amazing. I would trust him with my life! (I guess I did) He genuinely cares about each one of his patients. I know he will do what is best for you. Good luck! Please keep us posted on how you are doing.
galaxygrrl
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I would also talk to Dr. Rabkin. He is just as good as Dr. K. They are both very good. But, I'm a Dr. Rabkin fan. I think he is an amazing surgeon too.
