Looking for surgeon for hiatal hernia repair and...

[Beverly N]

I live in the Chicago area and am looking for a DS surgeon who does hiatal hernia repair post-DS. The local surgeon won't touch me due to having had the DS and told me to see a bariatric surgeon.

In addition, I have rather large abdominal hernias in need of repair again. Don't know if they can be done at the same time.

I also may ask about "correcting" my DS as I was given the following:
Total small bowel length: 660 cm
Alimentary limb length: 400 cm (61%)
Biliopancreatic limb length: 260 cm (39%)
Common channel length: 200 cm (30%)
Stomach volume: 100 ml
Looks to me like the only thing that was done right was the stomach volume. I had very slow weight loss beginning around month 6, and it never really picked up - only 13 lbs. in months 7 - 12, only 2 lbs in months 10 - 12.

Anyway, I am considering Dr. Alverdy or Dr. Prachand at the University of Chicago. I would appreciate any feedback regarding these doctors, the UC, etc. or other potential surgeons. Thanks for your help!

 

[DSRIGGS]

Are you sure you don't mean 200 CM AL? Who did your initial DS?

Those guys should be able to address hiatal hernia if you are having bad GERD or swallowing issues. Regarding revising your channel's I dont know that would be covered by insurance since I am assuming you didn't lose enough weight. The guys you mentioned are standard limb length guys so I don't know that they would adjust those for you.

 

[Larra]

Beverly, hi and welcome! You have already had my feedback elsewhere, so I'll just sit back and let others speak. Hopefully you will get some useful answers.

 

[southernlady]

Welcome @Beverly N

 

[hilary1617]

@Beverly N , Hi and welcome. Dr. Alverdy was my DS surgeon and is a very talented cutter. I'm not a huge fan of U of C hospital system itself, which treats patients more as numbers than people, but I think very highly of Dr. Alverdy.

I've used him post DS to assist with non-DS related cancer challenges as he has a great mind and skilled hands.

 

[Beverly N]

Are you sure you don't mean 200 CM AL? Who did your initial DS?

Those guys should be able to address hiatal hernia if you are having bad GERD or swallowing issues. Regarding revising your channel's I dont know that would be covered by insurance since I am assuming you didn't lose enough weight. The guys you mentioned are standard limb length guys so I don't know that they would adjust those for you.

Nope - those are the figures right off of my operative report.
I am sure a revision would be covered as 1) I never lost properly; 2) I'm still at a BMI of about 38; 3) with my co-morbidities I would still qualify for surgery today.
Since I never had "standard length" limbs, I would hope they could correct this.

Oh, original surgery done by Dr. Anthone.

 

[Beverly N]

@Beverly N , Hi and welcome. Dr. Alverdy was my DS surgeon and is a very talented cutter. I'm not a huge fan of U of C hospital system itself, which treats patients more as numbers than people, but I think very highly of Dr. Alverdy.

I've used him post DS to assist with non-DS related cancer challenges as he has a great mind and skilled hands.

Thanks for the feedback, it's really appreciated. And yeah, that's kind of what I figured about the UC system. ***sigh***

 

[Clematis]

Your operative report has to be wrong. If your total bowel length is 660 (a normal bowel length, btw), the AL, BL and CC can only add up to 660 unless they grafted in somebody else's bowel on to one of your limbs. So I am guessing your lengths are: (AL is 200 + CC 200), BL 260 for your total length of 660. Not exactly 50/50 but acceptably close.

 

[DianaCox]

No matter what some people say about the Hess method, it doesn't always work. Hess says 40% of the entire length in the alimentary limb (meaning the whole length from pylorus to ileocecal valve), 10% for the common channel (which would be about 25% of the alimentary limb); and 60% in the biliopancreatic limb. Doctors adjust all the time for the variables of age, health, length of time morbidly obese, how many strict diets the patient has done, diabetic or not, weight, sex - so Anthone's measurements for someone who was only a BMI of 37 to start with doesn't seem outlandish. But - sometimes, the best estimate is just not right, despite fitting the "objective" criteria. The patient gets too much or not enough weight loss. And that's still a matter of medical art and informed guesswork.

 

[Beverly N]

No matter what some people say about the Hess method, it doesn't always work. Hess says 40% of the entire length in the alimentary limb (meaning the whole length from pylorus to ileocecal valve), 10% for the common channel (which would be about 25% of the alimentary limb); and 60% in the biliopancreatic limb. Doctors adjust all the time for the variables of age, health, length of time morbidly obese, how many strict diets the patient has done, diabetic or not, weight, sex - so Anthone's measurements for someone who was only a BMI of 37 to start with doesn't seem outlandish. But - sometimes, the best estimate is just not right, despite fitting the "objective" criteria. The patient gets too much or not enough weight loss. And that's still a matter of medical art and informed guesswork.

FYI, my CURRENT BMI is 37 - my BMI at the time of my surgery was 51.

@Clematis - you may be right, but all I can go by is the operative report.

 

[DianaCox]

FYI, my CURRENT BMI is 37 - my BMI at the time of my surgery was 51.

@Clematis - you may be right, but all I can go by is the operative report.

I'm certain Clematis is right. DS surgeons sometimes use the term alimentary tract to mean the entire part that food goes down, including the common channel, or sometimes just from the top to the beginning of the common channel.

As for the first thing - um, no, that doesn't seem right to give someone with a BMI of 51 such a long common channel. My BMI was 49, and I got a 100 cm common channel from Rabkin with about the same total length of bowel. I was a few days short of 50 years old, relatively healthy, had been on several prolonged diets - pretty typical.

 

[DSRIGGS]

I'm certain Clematis is right. DS surgeons sometimes use the term alimentary tract to mean the entire part that food goes down, including the common channel, or sometimes just from the top to the beginning of the common channel.

As for the first thing - um, no, that doesn't seem right to give someone with a BMI of 51 such a long common channel. My BMI was 49, and I got a 100 cm common channel from Rabkin with about the same total length of bowel. I was a few days short of 50 years old, relatively healthy, had been on several prolonged diets - pretty typical.

Yeah and those are strange numbers for Anthone from what I was told by others. I was told that he believes that as long as the combination of the AL + CC = BPL that the exact break down of the AL/CC isn't crucial. So I would have expected something more like 330 CM BPL 100 CC and 230 AL.

If the BPL number is correct at 260 CM and her SBL is really 660 CM as the report says than that would mean 400 CM total absorbing path (Which 100/300 CC/AL = 400). That would be an absorbing to nonabsorbing path ratio of 400/260 or 61/39.....which to me means that she wouldn't ever lose all her weight according to the 50/50 absorbing to non absorbing theory which is what Hess or Anthone's reputed numbers today equal.

 

[Beverly N]

Yeah and those are strange numbers for Anthone from what I was told by others. I was told that he believes that as long as the combination of the AL + CC = BPL that the exact break down of the AL/CC isn't crucial. So I would have expected something more like 330 CM BPL 100 CC and 230 AL.

If the BPL number is correct at 260 CM and her SBL is really 660 CM as the report says than that would mean 400 CM total absorbing path (Which 100/300 CC/AL = 400). That would be an absorbing to nonabsorbing path ratio of 400/260 or 61/39.....which to me means that she wouldn't ever lose all her weight according to the 50/50 absorbing to non absorbing theory which is what Hess or Anthone's reputed numbers today equal.

Well, if that is correct, then at least I don't feel like such a (non)total loser (pun intended) for being so unsuccessful. Also, it gives me hope that even "standard limb length" guys might feel a revision is needed. Am I correct that modifying the limbs is not a huge deal? Or is that only as opposed to a revision from another surgery type?

 

[DSRIGGS]

Well, if that is correct, then at least I don't feel like such a (non)total loser (pun intended) for being so unsuccessful. Also, it gives me hope that even "standard limb length" guys might feel a revision is needed. Am I correct that modifying the limbs is not a huge deal? Or is that only as opposed to a revision from another surgery type?

First of all, no you aren't a loser if you were given that much absorption.

Second, I had a revision because a standard limb guy gave me the opposite of what it sounds like you have and it left me severely malnourished. Dr k added mainly to my AL and a little to the CC by doing a side to side anastomosis. That part isn't technically difficult but the hard part is figuring out what to do as far as taking away path from each absorbing limbs. With hypertrophy of the cc an AL limbs over the years the math isn't as straight forward as a virgin ds. I wouldn't trust this to many people, especially somebody who isn't used to doing these things.

Did Anthone do your DS when at USC or back in Omaha? I guess I am asking where are you now? From your Docs mentioned, who by the way have good reputations, it sounds like you might be in chicago. I live in Peoria by the way and traveled to LA for Dr K.

At a minimum I would see if you can get a phone consultation with Dr K to get his opinion. He is a great guy and easy to talk to.

Btw when he did my revision in August of last year he found an internal hernia that I had repaired a year before that had opened back up. He fixed that as well as a chronic anal fissure. He also repaired a ventral hernia in may of this year slapping on an 8 x 10 hunk.of mesh. He also did surgery on my oldest son in 2015 to fix a horrible gastroparesis condition that had Cameron nauseous 24/7 for over a year. He basically saved his life. He also fixed a failed Nissen fundoplication for Cameron (a plication is what you would get to fix your hiatal hernia) and he also found something called a meckels divirticulim and fixed that as well.

I am biased but a consultation with him would be a good start and as mentioned you could do over the phone and then decide what is right for you as fat as procedure and surgeon.

Best wishe's to you and feel free to PM me if you want to talk privately.

 

[Beverly N]

Did Anthone do your DS when at USC or back in Omaha? I guess I am asking where are you now? From your Docs mentioned, who by the way have good reputations, it sounds like you might be in chicago. I live in Peoria by the way and traveled to LA for Dr K.

Best wishe's to you and feel free to PM me if you want to talk privately.

Anthone was back in Omaha when I had my surgery. I live in the far west suburbs of Chicago. At this time I'd prefer to get a consult nearer to home. I'm not even sure that any surgeon is going to want to mess with my DS - even Dr. K. - and seriously I need this hiatal hernia fixed more than anything. To say I have severe GERD is an understatement.

Number 2 on my personal priority list would be to really fix my abdominal hernias. It's one thing to be short and fat, but looking 8 months preggers at 66 is really disheartening!

Third on my list would be fixing my DS. That might seem a bit strange since I'm posting on this site, but with all of my co-morbidities just finding a surgeon to do items 1 and 2 will be difficult.

Am I happy with where I am now? No, not at all. On the other hand, I've come to accept it. The saddest part is that my diabetes never fully resolved, but now I'm almost back to where I was pre-surgery - insulin dependent big time. Cholesterol is great though. Maybe the diabetes would push the doctors toward a revision as much as the lack of successful weight loss. I don't know.

Anyway, thanks for your reply and PM offer. It's much appreciated!