Surgeon wants VSG vs Roux-en-Y
- Thread starter Clematis
- Start date
aaa
Well-Known Member
As I recall one of my surgeons worked there (years ago). I do see it listed on their website.
Last edited:
DSRIGGS
Yes, that is chocolate covered bacon
- Joined
- Nov 19, 2014
- Messages
- 4,635
Okay I am biased, very biased.....and you will also note that I just had a revision because I was malaborbing too much and suffering from malnutrition (will talk about that later). That being said, going into this it was all about getting rid of my type II diabetes that was gettting out of control. Even with the troubles I had I do not regret my choice to have a DS, just my choice in DS surgeons because even though I though I researched enough I did not understand that all DS's are not created equal.
The only reason I had the DS is because a friend had one and the results were amazing, then I learned you could eat and live like a normal person and I said, where do I sign! No way was I having a procedure that is very likely to fail (RnY gastric bypass) and likely cause dumping. The band, no way, they just don't work...so I would never had WLS if not for the Duodenal Switch.
The DS provided your best chance for resolution of your co-morbidity's and expected weight loss. My hgb A1C was 9 before surgery, cholesterol was 180-200 and BP was 125/90 and I was on meds for all (3 different diabetes meds). 2 days after surgery I stopped all forms of diabetes, cholesterol and hypertension meds. My A1C is now 4.3, my cholesterol is 110 and my BP is 100/63. I weighed 361 before surgery and now way 175 (I need to get to 200 and should within 3-5 months now that I had my revision).
The bottom line is if you want the best chance for a normal life, with good health at a great weight then the DS is THE ONLY WAY TO GO.
The only reason I had the DS is because a friend had one and the results were amazing, then I learned you could eat and live like a normal person and I said, where do I sign! No way was I having a procedure that is very likely to fail (RnY gastric bypass) and likely cause dumping. The band, no way, they just don't work...so I would never had WLS if not for the Duodenal Switch.
The DS provided your best chance for resolution of your co-morbidity's and expected weight loss. My hgb A1C was 9 before surgery, cholesterol was 180-200 and BP was 125/90 and I was on meds for all (3 different diabetes meds). 2 days after surgery I stopped all forms of diabetes, cholesterol and hypertension meds. My A1C is now 4.3, my cholesterol is 110 and my BP is 100/63. I weighed 361 before surgery and now way 175 (I need to get to 200 and should within 3-5 months now that I had my revision).
The bottom line is if you want the best chance for a normal life, with good health at a great weight then the DS is THE ONLY WAY TO GO.
DSRIGGS
Yes, that is chocolate covered bacon
- Joined
- Nov 19, 2014
- Messages
- 4,635
Okay, why did I have a revision and why do I say I should have chose surgeons better.
There are two schools of thought on how to do the DS
One Size Fits All/Cookie Cutter
This procedure the surgeon gives every patient regardless of size, personal history, height (correlation between height and total small intestine length which is very important) the same sleeve size, same common channel length and the same alimentary limb length.
This procedure works for some, but fails others. Maybe I was just on the tail of a normal distribution curve but the cookie cutter failed me. My surgeon is an excellent cutter but frankly I think he should stop doing the DS if he continues the cookie cutter.
The Hess Method
This is where the surgeon measures the patients small bowel length and along with the patient's personal history taken into account makes the common channel 10% of the small bowel length, the alimentary limb 40% of the total small bowel length and that leaves the Bilpancreatic limb at 50% of the total small bowel length. See this study from Dr Ara Keshishian, widely renowned as one of the best bariatric surgeons in the world, that shows the effectiveness of this method for maintaining nutrition (as measured through total protein and albumin numbers). NOTE: Dr K has done over 2,000 DS procedures and will not do a RnY gastric bypass as he told me during his residency all he did was fix gastric by passes that eventually failed.
http://www.dssurgery.com/about/publications/albumin-abstract.pdf
So I had a DS in 2013 and had the cookie cutter. My CC was made at 100 CM and my AL was 150 cm. A little over a year out I started feeling like passing out and ended up in the hospital for a week with a resting heart rate between 35-40 bpm and BP of 75/40. NOT GOOD! They checked my heart and thought I might need a pacemaker which I did not ..my heart is healthy. Eventually they figured out I was anemic and had other issues like Total Protein and albumin at roughly half of the minimum value! I was extremely malnourished. I was put on a pancreatic enzyme (CREON is the brand name of the drug) and I took the highest dosage pill you could get (36,000 IU) two with a meal and one with snacks so up to 400,000 IU a day (that is a metric shit ton) just to struggle to get back to the bottom of range. FYI - CREON has some unpleasant side effects.
I was advised to wait until the 2 year post surgery mark as that is when I should have reached pretty much the maximum absorption under my new system (some debate about that but that is common thought). A few months ago I lost 17 pounds over about 2 weeks. That did it for me and I decided it was time to go see Dr K. On the 18th of August I was revised and my small intestine measured (btw while doing this Dr K found a massive hernia in the mesentery portion of the small bowel - that caused my sudden weight loss and many unpleasant issues). The total length of the small intestine wsa measured at 750 CM. That means that had my DS been performed correctly in the first place I would have had a 300 CM AL and 100 CM CC (Dr K say he typically rounds up to the next 50 CM mark) and 350 CM BPL. For the revision DR K took my AL to 275 CM and my CC to an effective 125 CM (complicated but the way he performed the side by side anastamosis yields 125 CM absorption equivalency).
Dr K told me after surgery that I should expect to lose weight or at a minimum not gain for a while. That has been true as I went in at 180 roughly and am now 172-174 lbs. This was exacerbated by the fact that my surgical wound became infected and a CT showed I had a significant amount air in my abdominal cavity so it was highly suspected that I had a perforated bowel. It ended up that I did not have a perfed bowel (thank goodness) but I spent 3 days in the hospital on a high powered IV antibiotic and am still on a antibiotic at home for another 5 days or so (oh joy, not really). That being said DrK expects that in 3-5 months I should be at goal weight, and he believes 200 is optimal for me (note I am 6'2" and weighed 220 lbs which was almost all muscle when I graduated high school).
The bottom line is I went through a bunch of shit that I shouldn't have had to go through. If you note it was my alimentary limb that was too short and not really the common channel. There is a prevalent thought out there, even by my original surgeon, that the AL really doesn't absorb much protein or vitamins...to which Dr K says Booool Sheeet. We do absorb protein and vitamins, in addition to carbs in our AL. I was not absorbing enough carbs and that was a huge reason for my malnutrition.
Why the long winded history? I feel it is my duty to educate potential DS patients of the dangers of an improperly performed DS, while strongly advocating for a properly executed DS as the Best Bariatric surgery one can get.
Good luck with your choice!
There are two schools of thought on how to do the DS
One Size Fits All/Cookie Cutter
This procedure the surgeon gives every patient regardless of size, personal history, height (correlation between height and total small intestine length which is very important) the same sleeve size, same common channel length and the same alimentary limb length.
This procedure works for some, but fails others. Maybe I was just on the tail of a normal distribution curve but the cookie cutter failed me. My surgeon is an excellent cutter but frankly I think he should stop doing the DS if he continues the cookie cutter.
The Hess Method
This is where the surgeon measures the patients small bowel length and along with the patient's personal history taken into account makes the common channel 10% of the small bowel length, the alimentary limb 40% of the total small bowel length and that leaves the Bilpancreatic limb at 50% of the total small bowel length. See this study from Dr Ara Keshishian, widely renowned as one of the best bariatric surgeons in the world, that shows the effectiveness of this method for maintaining nutrition (as measured through total protein and albumin numbers). NOTE: Dr K has done over 2,000 DS procedures and will not do a RnY gastric bypass as he told me during his residency all he did was fix gastric by passes that eventually failed.
http://www.dssurgery.com/about/publications/albumin-abstract.pdf
So I had a DS in 2013 and had the cookie cutter. My CC was made at 100 CM and my AL was 150 cm. A little over a year out I started feeling like passing out and ended up in the hospital for a week with a resting heart rate between 35-40 bpm and BP of 75/40. NOT GOOD! They checked my heart and thought I might need a pacemaker which I did not ..my heart is healthy. Eventually they figured out I was anemic and had other issues like Total Protein and albumin at roughly half of the minimum value! I was extremely malnourished. I was put on a pancreatic enzyme (CREON is the brand name of the drug) and I took the highest dosage pill you could get (36,000 IU) two with a meal and one with snacks so up to 400,000 IU a day (that is a metric shit ton) just to struggle to get back to the bottom of range. FYI - CREON has some unpleasant side effects.
I was advised to wait until the 2 year post surgery mark as that is when I should have reached pretty much the maximum absorption under my new system (some debate about that but that is common thought). A few months ago I lost 17 pounds over about 2 weeks. That did it for me and I decided it was time to go see Dr K. On the 18th of August I was revised and my small intestine measured (btw while doing this Dr K found a massive hernia in the mesentery portion of the small bowel - that caused my sudden weight loss and many unpleasant issues). The total length of the small intestine wsa measured at 750 CM. That means that had my DS been performed correctly in the first place I would have had a 300 CM AL and 100 CM CC (Dr K say he typically rounds up to the next 50 CM mark) and 350 CM BPL. For the revision DR K took my AL to 275 CM and my CC to an effective 125 CM (complicated but the way he performed the side by side anastamosis yields 125 CM absorption equivalency).
Dr K told me after surgery that I should expect to lose weight or at a minimum not gain for a while. That has been true as I went in at 180 roughly and am now 172-174 lbs. This was exacerbated by the fact that my surgical wound became infected and a CT showed I had a significant amount air in my abdominal cavity so it was highly suspected that I had a perforated bowel. It ended up that I did not have a perfed bowel (thank goodness) but I spent 3 days in the hospital on a high powered IV antibiotic and am still on a antibiotic at home for another 5 days or so (oh joy, not really). That being said DrK expects that in 3-5 months I should be at goal weight, and he believes 200 is optimal for me (note I am 6'2" and weighed 220 lbs which was almost all muscle when I graduated high school).
The bottom line is I went through a bunch of shit that I shouldn't have had to go through. If you note it was my alimentary limb that was too short and not really the common channel. There is a prevalent thought out there, even by my original surgeon, that the AL really doesn't absorb much protein or vitamins...to which Dr K says Booool Sheeet. We do absorb protein and vitamins, in addition to carbs in our AL. I was not absorbing enough carbs and that was a huge reason for my malnutrition.
Why the long winded history? I feel it is my duty to educate potential DS patients of the dangers of an improperly performed DS, while strongly advocating for a properly executed DS as the Best Bariatric surgery one can get.
Good luck with your choice!
DSRIGGS
Yes, that is chocolate covered bacon
- Joined
- Nov 19, 2014
- Messages
- 4,635
You sound like a very bright lady so I am sure you will make the best choice for you.
