types of surgery

does anyone know how it is determined which procedure one gets, does the
surgeon decide which one is best or my GP or oneself??

Hello again :)

There are several factors that determine which surgery you will receive. 

First and foremost, it should be the one that YOU want to have, pending any physical or OHIP reasons that you cannot.  Please do your research and learn about all 4 surgeries (Lap Band, RNY, DS and VSG) so you are well informed.

Second would be your surgeon's recommendation of what he/she feels would be best for you, physically.  Some people have requested an RNY, but will also consent to a VSG if it cannot be performed for medical reasons, once the surgeon gets inside.

Third is what OHIP will fund.  Currently most people in Ontario are receiving the RNY.  There are some people who wish to have the VSG and for medical reasons, have been approved to have it.  Lap Band is completely self-pay and not covered at all.  The DS is very rarely performed unfortunately and requires a great deal of persuasion, medical necessity, and basically a "fight" to get this.

Lastly, it depends on what you are willing to do to get the surgery that you feel you need.  Sometimes there is a fight and sometimes people choose to self-pay out of province (or even out of country) to get the surgery they want if OHIP will not approve.

As an aside, I've responded to a few of your posts letting you know that I am also from Mississauga, offered my support, and invited you to join my support group.  I hope you have seen those posts as it would be great to connect and I would truly love to help you out.

Best,

Karen

Hi Karen I'm very interested in joining your group...when do you hold meetings??
Tammy
PS..I look forward to meeting you..

Wonderful!

Here's a link to the next 2 get togethers.  Also, if you would like to meet for coffee, just the two of us, I'm totally available to do that. :)

http://www.obesityhelp.com/forums/ON/4470613/Mississauga-Caw fee-Talk-events/

your surgeon decides. It's their area of expertise. the GP has no say in it, unless they're providing evidence of your need for long term nsaid use or some such thing.

Ultimately, it is up to the surgeon, but he is required to make his decison within the guidelines set out by OHIP. OHIP assumes that everyone should get a RNY unless the RNY is medically inappropriate (patient needs to take NSAIDs, prior abdominal surgery makes RNY impossible, etc.). Then the assumption is that they should get the VSG if the RNY is not an option. The DS is only considered an option for SMO individuals (BMI over 50) who cannot have RNY, or as a revision for people who had the RNY or VSG and lost insufficient weight or regained significantly. This position is not based on medical evidence or on the most recent studies on bariatric surgery.

I'd like to see this all change. The standard of care in the US and Quebec is that if you qualify for bariatric surgery, you qualify for them all. There is no medical reason to restrict access to certain surgeries based on BMI alone, as OHIP asserts. Their surgery restrition is based on the cost to OHIP, not on what is best for the patient.

If you want a surgery other than RNY, speak to your surgeon about it and explain your reasons. If he says no, ask for a second opinion. Make sure that you research and educate yourself as much as possible before your meeting with the surgeon.