Save the Date!!

[Pugcrazy]

After much research and consideration, my DS surgery date is set!!!! February 4th!!! Like many of you, I'm excited and a little anxious but I think I'm prepared, thats one upside of the process of waiting.

In discussions with my surgeon, he answered all of my questions (I've confident that he performs a TRUE DS, two anastomoses, he is not a fan of SADI/Loop as there is "not enough data to support" long term success) but one concern arose in that I've had abdominal surgeries in the past for endometriosis (oophorectomy, appendectomy) and some of my small intestine was involved. He indicated that there is a possibility that I have significant adhesions which would inhibit his ability to perform the "switch" portion of my surgery. While he assured me that he would do the DS if at all possible, he has to be able to untangle the intestines in order to measure, detach and reattach. He said he would not feel comfortable reattaching a "compromised" intestine.

So, going in, he wants to know my wishes for a "Plan B?" A Gastric Sleeve or Roux-en Y Gastric By-pass, as it uses a different part of the intestine. As you can imagine, I am disappointed and the thought of anything other than a DS is very unappealing to me.

I'd love to get some input from you Veterans?? To review, I am what is considered a "super" absorber and do not lose weight easily. The thought of simply a restrictive procedure is what kept me from pursuing WLS for years! I'm the girl that did the HCG Diet (500 cals a day) and lost a 1/4 lb a week, on a good week, and was miserable. I've gained weight on commercial diets that include simple carbohydrates (Jenny Craig, Nutri-System, etc.). I feel strongly that I need the malabsorptive component aspect of the DS...which brings me back to the RnY - which has consequences that I'd prefer to avoid - ulcers and digestive issues (dumping? No thank you).

I'm past the point of being upset about possible adhesions - it is what it is! Now I need solutions. My surgeon has assured me that if there is ANY way possible to perform the DS procedure, that he will. He reminded me that it will all be on video....

 

[DSRIGGS]

Who is your surgeon? Please read the post where I linked A FB page post from Dr Hess discussing the importance of percentage based channel lengths. If you are concerned about too or too much absorption pay close attention to the potential dangers of NOT DOING the Percentage based channel lengths (the Hess Method).

Best of luck and be positive. The adhesion talk is your SURGEON preparing you for the worst but hoping/ecpecting the best outcome.

 

[southernlady]

Congrats on your date. Want it added to the calendar?

So, going in, he wants to know my wishes for a "Plan B?" A Gastric Sleeve or Roux-en Y Gastric By-pass, as it uses a different part of the intestine. As you can imagine, I am disappointed and the thought of anything other than a DS is very unappealing to me.

My personal opinion on a plan B...close me up and I will find a surgeon who will give me a DS. Other option for a plan B...make it an open procedure so he can see better.

 

[DSRIGGS]

I am with Liz and will add that under no circumstance would I accept a RnY GBP.

Like any walk of life there are not so good, good, and very good bariatric surgeons. There are two guys who are known as the best when it comes to doing surgery on a patient who needs a revision and or is at high risk of significant adehesions. Dr Ara Keshishian in Glendale, CA (performed my revision to improve my absorption) and Dr Rankin in the SF Bay area. They take cases that other DS surgeons won't touch. If you are at that high of a risk if adhesion I would consult with these guys. I traveled from IL to have surgery with Dr K because he is the best there is.

 

[Pugcrazy]

Thanks guys, yes - I'm going in POSITIVE and also gave my Dr a pep talk..."Oh, you can deal with a few adhesions!" in which he said "Indeed, if they are manageable, or contained against the abdominal wall" he also mentioned the possibility of a "hand assisted" procedure (3 inch incision) where he could see and manipulate the intestines more easily. He also said that since I obviously don't have a blockage or severe pain - the chances are good that they are minimal.

Truthfully, I'm pretty confident that I do, in fact, have adhesions as sometimes when I turn over in bed I can feel "something" and have always chalked it up to adhesions. I just can't help thinking that I can't be the only person with abdominal adhesions that sought DS surgery? My previous surgeries were over 20 years ago and I can barely remember the details....I know I had ovary, appendix and Fallopian tube removed. I also recall "mesh" being involved. Ugh! Its unfortunate that my endometrial disease was in the exact same area that is utilized in the DS.

I can't imagine ANY reputable surgeon saying he would do a DS procedure "no matter what?" Unfortunately there is no test that can be conducted to show the severity of scar tissue. They won't know what they are dealing with until they get in there.

My surgeon is Dr. Sharma in Jacksonville FL. I'm confident with his skills and experience...he brought in a replica of the human anatomy and we conducted a DS procedure on the model, watched a video, drew a picture, removed and stapled the stomach leaving a sleeve, measured the intestines and determined the proper length of the common channel and detached/reattached duodenum to the ileum intestine. I meet with him again tomorrow for consult/review, and preop tests.

I know that Dr Keshishian is the authority on the DS procedure but at this juncture he is not an option for me as I am self pay. I'm not looking for the cheapest option, as I had looked into Mexicali Bariatric as well, but I need to keep it within reason and have a specific timeline to comply with.

 

[DSRIGGS]

Good deal...that is cool that he had you do that.

 

[DianaCox]

WHO IS YOUR SURGEON? If he is not confident he can do this, I'd go elsewhere.

Why not tell him that not only is hand assist (3" incision) OK (Rabkin, one of the DS stars, ALWAYS does this), you would accept an open procedure if necessary - just so long as you got a PROPER DS.

 

[Susan in Tennessee]

Thanks guys, yes - I'm going in POSITIVE and also gave my Dr a pep talk..."Oh, you can deal with a few adhesions!" in which he said "Indeed, if they are manageable, or contained against the abdominal wall" he also mentioned the possibility of a "hand assisted" procedure (3 inch incision) where he could see and manipulate the intestines more easily. He also said that since I obviously don't have a blockage or severe pain - the chances are good that they are minimal.

Truthfully, I'm pretty confident that I do, in fact, have adhesions as sometimes when I turn over in bed I can feel "something" and have always chalked it up to adhesions. I just can't help thinking that I can't be the only person with abdominal adhesions that sought DS surgery? My previous surgeries were over 20 years ago and I can barely remember the details....I know I had ovary, appendix and Fallopian tube removed. I also recall "mesh" being involved. Ugh! Its unfortunate that my endometrial disease was in the exact same area that is utilized in the DS.

I can't imagine ANY reputable surgeon saying he would do a DS procedure "no matter what?" Unfortunately there is no test that can be conducted to show the severity of scar tissue. They won't know what they are dealing with until they get in there.

My surgeon is Dr. Sharma in Jacksonville FL. I'm confident with his skills and experience...he brought in a replica of the human anatomy and we conducted a DS procedure on the model, watched a video, drew a picture, removed and stapled the stomach leaving a sleeve, measured the intestines and determined the proper length of the common channel and detached/reattached duodenum to the ileum intestine. I meet with him again tomorrow for consult/review, and preop tests.

I know that Dr Keshishian is the authority on the DS procedure but at this juncture he is not an option for me as I am self pay. I'm not looking for the cheapest option, as I had looked into Mexicali Bariatric as well, but I need to keep it within reason and have a specific timeline to comply with.

So, from you saying "measured the intestines and determined the proper length of the common channel" that is same as saying he does the Hess Method? If so, I like the sound of that.

 

[DSRIGGS]

So, from you saying "measured the intestines and determined the proper length of the common channel" that is same as saying he does the Hess Method? If so, I like the sound of that.

The other key part is the alimentary limb measurement for additional protein absorption.

 

[DSRIGGS]

WHO IS YOUR SURGEON? If he is not confident he can do this, I'd go elsewhere.

Why not tell him that not only is hand assist (3" incision) OK (Rabkin, one of the DS stars, ALWAYS does this), you would accept an open procedure if necessary - just so long as you got a PROPER DS.

BTW Dr K did my DS channel extending revision via hand assisted lap.

 

[Pugcrazy]

I'm seeing Dr Sharma tomorrow and will discuss the issue further with him. Believe me, we were 100% on track for the DS procedure after discussing my weight loss struggles....his position was "I certainly agree that DS is the best fit for you." It wasn't until I mentioned my missing appendix that things took a turn. I'll discuss hand assisted, open, etc. with him tomorrow - I really don't think ANY surgeon would give me a 100% guarantee that they would do a DS given these circumstances. Perhaps the fused portion of the intestine can be removed and resectioned? I'll inquire. I want to go in expecting the best, but be prepared for the worst. Thanks for your input.

 

[southernlady]

I'm seeing Dr Sharma tomorrow and will discuss the issue further with him. Believe me, we were 100% on track for the DS procedure after discussing my weight loss struggles....his position was "I certainly agree that DS is the best fit for you." It wasn't until I mentioned my missing appendix that things took a turn. I'll discuss hand assisted, open, etc. with him tomorrow - I really don't think ANY surgeon would give me a 100% guarantee that they would do a DS given these circumstances. Perhaps the fused portion of the intestine can be removed and resectioned? I'll inquire. I want to go in expecting the best, but be prepared for the worst. Thanks for your input.

If he is still questioning his own ability, ask if open is a possibility?

BTW, I had a hysterectomy and had a virgin DS no issues. And your appendix, while in the general area is not exactly in the same area. It resides at the juncture between both the small and large intestine. The DS moves up some and doesn't get involved right in the same area.

 

[Munchkin]

Seriously...if your doc needs a backup plan, he/she is telling you honestly all about his/her skill level.

My surgeon is retired and he has his own issues but he could do the whole DS on an 800lb person. Think about that. Baltasar and Rabkins have done 600lb people LAP. And the surgeon you want to use might not be able to do the whole procedure because you had previous surgery?

The first thing I would do is tell this surgeon it's OK to convert to open if necessary. Do anything you need to do to do the whole thing. If he/she is still hesitant, I would run!

 

[Larra]

@Pugcrazy do you happen to have an email address for Dr. Sharma? @DianaCox and I hope to someday set up a current list of DS surgeons and we could ask him a few basic questions about his practice. I got his address from his website but didn't see an email address.
And for the record, his diagrams on the website do show a standard, 2 anastomosis DS. Given the description of all the lap operations he does, I would think some adhesions wouldn't prevent him from doing a complete DS unless they're really bad. And like Diana, my surgery was also done lap/hand assisted and the incision for the hand was not a big deal at all. Certainly well worth getting a DS rather than a less effective operation.

 

[Pugcrazy]

Thanks @Larra for your encouragement...I agree, I think Dr Sharma is just being cautious and talking "worst case scenario." When discussing it, he held his hand in a fist and said if my intestines were fused into a ball he would have to unscramble them and straighten them out - and that that may have to be a separate procedure. He said he would need to straighten them out in order to get a good measurement....I really think I'll be okay but it threw me for a bit of a loop (pardon the pun) when my second choice is "none of the above."

I'll get a good email address for you tomorrow - I have his office managers email and have corresponded with her. My conversations with him have been on the phone. I have to say that unlike the other bariatric surgeons that I have consulted (about 9 of them) he has the most streamlined preop procedures. I am having all of my tests conducted tomorrow, with the exception of labs which were done yesterday at Quest - Psych, medical clearance, EKG and Ultrasound, nutrition, surgery consult with him, and pre-admission with the hospital. All of the other surgeons turned this into a 3 month process, they wanted the results of one test before they would schedule the next one (Dr Smith, in Celebration, particularly). I'm about 4 hours away and appreciate them working with me on this. FYI - I inquired as to why all of the tests were required with self pay and he said that he had to conduct all of these exams in order to maintain his status as a "Center of Excellence" by the ASMBS. I assumed it was more of a "CYA" in case of a lawsuit, its probably a little of both!