Hoping for some help.

I'm pretty much new here and have made a few post on the VSG forum but I'm researching other surgeries while I wait for my consult appointment. 

The hospital I'll be having surgery at is a military facility and on the website it says that the surgeon performs Biliopancreatic Diversion. From what little research I've started  there is a difference bewtween the DS and BPD correct? or is the DS being called the BPD? I'm a tad bit confused about the two. 

Thanks

Hi there. The only MTF I'm aware of performing the DS is Madigan in WA state. There is a difference between the old BPD and the new DS, but it may just be a short cut in how they're listing it. Double check to make sure they are doing the BPD/DS, which gives you a sleeve (preserving the pyloric valve) and malabsorptive intestinal rerouting (approx 100cm common channel, depending on the surgeon). Good luck in making your decision.

--gina

 Thanks for replying. I'm hoping that it's a short cut they have listed on the site. Thanks I will be double checking.

The DS is sometimes called Biliopancreatic Diversion with Duodenal Switch or BPD/DS. This nomenclature issue arose from an ego problem with the guy who figured out the old BPD and it needs to go away.

This is something you need to clarify with the *surgeon* at the MTF. Don't trust anyone else there to give you accurate information. Where are you getting this done and by which surgeon?

Basically, the biggest difference between the BPD and the DS is the way the stomach is done. In the BPD, they do a horizontal gastrectomy. They cut away the bottom part of your stomach and get rid of your pylorus. You are left with basically a larger RNY pouch and no chance of revising EVER. This is a Very Bad Thing and you want to avoid it at all costs. There are also differences in how the intestinal procedure is done. The old BPD can be done without the duodenal switch, and that is not nearly as good about creating the metabolic changes that cure type II diabetes, for one thing.

(Sorry, I'm just writing this off the top of my head from memory, don't have links to better explanations handy. Others will be along who have that stuff, I'm sure.)

The old BPD is also known as the Scopinaro procedure. Try looking that up on Google, and look at the various links provided on www.dsfacts.com and www.duodenalswitch.com .

The DS the way it SHOULD and MUST be done has good illustrations on www.dshess.com . There's a Powerpoint about it there that I think is easy to follow. (Hess method of configuring limb lengths is IMNSHO the very best way to go, but it can be done with standardized limb lengths with good results as well. The main thing is which parts of the small intestine are bypassed for food.) I think www.paclap.com also has some good explanations of this.

Bottom line to remember for now is: You want your stomach part to be a subtotal vertical gastrectomy and your pylorus left intact. You want your intestinal configuration to include the duodenal switch. (I can't explain the difference between with/without off the top of my head, sorry.)

 Thanks for all the information you have posted. The MTF I'll be going to is Naval Medical Center San Diego, on the Bariatric Program page it says they perform Biliopancreatic Diversion so I'm not sure which one it will be until my appointment. 

I'm not sure who the surgeons are yet until my first appointment. 

Thanks for clarifying the information for me. I will be looking at the links and getting all my facts and info together.

Well, here's hoping they do the real thing. That would be wonderful news indeed if we could recommend a second MTF! Madigan AFB in WA has a real DS surgeon, so if you are not able to get the real thing in SD, walk away and push for Madigan. Or come back and talk to us about self pay options.

As you know, Tricare does NOT cover the DS or VSG in a civilian setting. However, if you should elect to self pay for either of these procedures within CONUS or in the theater where you are with your spouse on an accompanied tour (like the European theater, where there are three or four decent options), Tricare *does* kick in to cover for any complications or basically anything that is not coded as part of the DS procedure.

For example, I needed a little extra pulmonology supervision during my hospital stay that was coded under pulmonary hypertension, so that got covered. I also needed someone working on blood sugar stuff, I believe internal medicine, which also got covered. I had already met my annual catastrophic cap on copays (in the first week of December, which should tell you how sick I was before my DS), so I paid nothing additional for that stuff.

My surgeon isn't working at the moment, as he is still recovering from a lengthy illness, but perhaps by the time you are ready to consider consulting with a civilian surgeon, he'll be back in the saddle. There are a couple of other surgeons who offer good self pay rates in all inclusve packages. Dr. Daryl Stewart in Denton, TX comes to mind, and Dr. Kemmeter in MI.

If you should choose to go outside the USA or your overseas theater (when applicable) for surgery, Tricare does NOT kick in for anything. As you probably know, Tricare does not cover us in foreign travel at all. (So be sure to get at least a catastrophic medical policy if you travel out of country for any length of time as long as you have Tricare. Very important.)

Your followup care, if coded correctly ("rule out" type codes are very dicey for coverage), will be covered, as it is not coded under the DS.

Here are a couple of pics to make things clearer. You might want to send these pics on to whomever and ask them which one they actually do.

If you have a Scopinaro BPD, you have a very large pouch, distal RNY. It looks like this:



A true DS (sometimes called a BPD with DS/duodenal switch) looks like this:

 Thanks for the pics I will defiantly be taking these along with me.

Nice pics, Ms Batt!
Karen