A suggestion: Stop responding to the posts that say negative things about VSG. Let them...
on 2/8/09 11:42 pm - Woodbridge, VA
I will agree that if you don't like them, then ignore the "aggressors." Everyone is entitled to use the block button if they so choose. But I also see pre-ops frequently making their way to the DS board (as I'm sure it also happens with the VSG since it is less "mainstream" than the RNY or band) because they saw something mentioned in a heated thread somewhere else, and they are now interested in learning more.
But as long as I'm responding....
It is a statistically proven fast that high BMI patients who do DS as a two-stage, with VSG first, have fewer complications and deaths. Advising people to do it in one stage, ignoring their medical conditions, is grossly irresponsible.
Second, the DS is a great operation if I wanted to eat 3000 calories per day. I have no problem with people who make that choice. However, I do not want to eat like that. I realize that years down the road, if I don't control myself, I might have to have a revision. I want to try to do it with restriction only.
Why can't you respect my choice like I respect yours? We can have plently of reasonable discussions here with people who don't need to disparage or name-call.
"It is a statistically proven fast that high BMI patients who do DS as a two-stage, with VSG first, have fewer complications and deaths."
WRONG AGAIN! You've gotta keep up with the research if you're going to spout it as fact!
Ann Surg. 2008 Oct;248(4):541-8.
Duodenal switch operative mortality and morbidity are not impacted by body mass index.
Buchwald H, Kellogg TA, Leslie DB, Ikramuddin S.Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA. [email protected]
OBJECTIVE: This report examines the < or =30-day postoperative mortality and morbidity in our first 190 duodenal switch (DS) patients. BACKGROUND DATA: DS is the most weight loss effective and the most difficult to perform bariatric procedure. Indeed, certain surgeons have advocated a 2-stage approach to minimize complications, especially in the super obese (body mass index [BMI] > or =50 kg/m(2)). METHODS: DS procedures were performed (n = 190) by either open (n = 168) or laparoscopic/robotic surgery in an academic setting: common channel 75 to 125 cm, sleeve gastrectomy (approximately 100 mL gastric pouch), closed duodenal stump, end-to-side duodenoileostomy hand-sewn in 2 layers, with most staple lines oversewn, and all mesentery defects closed. RESULTS: For the 190 patients, 149 were female (78%) and the mean age was 43 years (range, 16-71). Mean preoperative weight 151.4 kg (range, 74.1-332.7); mean preoperative BMI 53.4 kg/m(2) (range, 32-107), with 100 (52.6%) of the patients super obese (BMI > or =50 kg/m(2)). Seventy-four patients had concurrent procedures, eg, cholecystectomy (n = 22), ventral or umbilical hernia repair (n = 19), and hiatus hernia repair (n = 10). Mean operating room time was 337 minutes (range, 127-771); mean hospitalization time was 6 days (range, 2-38). There were no deaths. Serious < or =30-day complications (n = 18 in 14 patients) consisted of 2 leaks (1.0%), which responded to drainage, and intra-abdominal bleeding (n = 3), splenectomy (n = 1), acute pancreatitis (n = 2), gastric outlet obstruction (n = 1), acute renal failure (n = 2), pneumonia (n = 2), respiratory failure (n = 3), acute myocardial infarction (n = 1), and duodenoileostomy stricture requiring endoscopic dilation (n = 1). The serious complication rate in patients with a BMI <50 kg/m(2) was 6.7% (6 of 90) and 12% (12 of 100) with a BMI > or =50 kg/m(2) (NS). Surgical site infections occurred in 7 patients with a BMI <50 kg/m(2) and in 12 with a BMI > or =50 kg/m(2) (NS). Overall complication rate in patients with a BMI <50 kg/m(2) was 14.4% (13 of 90) and 24% (24 of 100) with a BMI > or =50 kg/m(2) (NS). CONCLUSIONS: With attention to careful surgical technique, DS can be performed relatively safely in the morbidly and super morbidly obese, and does not require a 2-stage procedure.
As for your not wanting to at 3000 calories per day -- I call BULL**** You just WISH you could. You sure stuffed as much as you could down your pie-hole before your surgery -- do you REALLY think your desire to eat yummy high fat food is going to go away for good because of your surgery? I know mine wasn't. So I got a FIX -- and not a tool -- to make that a healthy way of eating for me. I didn't need to get "right" with food -- food needed to get right with me. And now it is.
There are some patients who weigh so much, they can't get the DS done laparoscopically. An open version of a surgery is riskier than doing it lap. For example, your risk of incisional hernias goes up dramatically with an open surgery.
For those patients, having the DS done in two stages makes sense. They can lose enough weight to be able to have the second part done lap too.
Also, since risk goes up with weight, then having a VSG, losing enough weight to only be MO instead of SMO and then getting switched also makes sense.
A third group is so sick that they shouldn't be under anesthesia for a long time, not as long as doing the DS takes. So they get the VSG, a much shorter operation, and then when they lose weight and are healthier, they get switched. Again, that makes sense.
Btw, the study you posted was designed to show that doing the DS in two stages isn't necessary for everyone, not that it isn't sometimes necessary for some. It didn't compare the outcomes between those who had the DS in two stages to those who did not, either. It just listed the complications for those having it in one stage and said they were acceptable. I would be interested in seeing that comparison.
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