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Category: Duodenal Switch revision Forum information

November 08, 2009 9:00 am

I am not sure what has happened over the past two weeks or so, but I have received a number of inquiries from patients who have had questions about the revision of RNY or Lap Band® for weight regain, inadequate weight loss, or other complications. I finally had to ask one of the patients where he got his information and heard about our practice. His source of information was the website.

I have spent some time looking over and responding to several postings on the forum sites. I have referred to a number of publications in some of my postings on

Nishie (Obesity Surgery, 17, 2007 1183-1188) reported:
“Pouch size area, measured by routine UGI on the first postoperative day does not influence short term postoperative weight loss. “

Cottam (Obesity Surgery 2009, 19:13-17) concluded:
“The level of restriction or the presence of stenosis achieved by different stapler sizes does not have a significant role in weight loss.”

O’Connor (Surgery for Obesity and Related Dis. 4(2008) 399-403) summarizes:
“With construction of divided, vertical, lesser curvature based small-volume (less than or equal to  20 cm gastric pouches, the actual size of the gastric pouch did not correlate with the %EWL at 1 year laparoscopic GB.”

I am a firm believer that the best patient is the most knowledgeable patient. It is always safer to spend as much time as needed to ask questions and investigate all options. If I can provide any information, please contact us at

Get informed

September 26, 2009 6:56 pm

As a surgeon, one of my duties is to discuss Informed Consent. There are two components to this, one of which is the consent part. This is where the discussion of risks, benefits, and complications takes place. It is also where options are discussed. A patient cannot give consent if he or she is not informed, which is the second component. The patient should only grant his or her consent if provided with details and every available option.
In my clinical practice, I routinely discuss all the surgical options with a prospective patient. It is my duty to explain in great detail what the surgical alternatives are, what their relative risks are when compared to each other, and the pros and cons of each procedure. Once this information is presented, I would then discuss the rationale as to why certain procedures are superior in certain clinical conditions. It is ultimately the patient who makes the decision as to which procedure is right for the treatment of morbid obesity. In some cases, however, if I do not believe that the procedure the patient has decided on will serve the patient’s long or short-term health needs, I will ask that the patient seek another surgeon.  One of the most common examples of this situation is when patients are seen in my office for surgical treatment of morbid obesity and inquire about the Lap Band®. They have seen an advertisement on television, radio, or even on a billboard. There are even those patients that are told by the primary care physicians that they should ONLY have the Lap Band® done because it will solve all of their problems. The promotional marketing material is only a small portion of a large body of information that is made available to patients and their primary care physicians. To most patients, Adjustable Gastric Banding (Lap Band®, Realize Band®) are “drive-thru” procedures.  They have been advertised as a procedure in which a patient goes to a surgeon’s office, gets examined, operated on, loses weight, and lives happily ever after. This is untrue on a number of fronts and far from the way it actually works for the overwhelming number of patients that get the Lap Band® done. I am not against the adjustable gastric banding procedures. I only advocate that the expectations be set for the patients on an appropriate level.  First of all, the Lap Band® is not for everyone. The scientific information on this matter is overwhelming. The educational booklet that is available and published by Allergan (the manufacturer of the band) has a list of conditions in which the band should not be used. Then there is the relative efficacy of the banding procedure compared to the Duodenal Switch and the Gastric Bypass operation. The questions a patient and a primary care physician should ask:
Are the treatment options effective in both treating and resolving the specified conditions of each patient? 
What are the chances that a patient suffering from diabetes, high cholesterol, or high blood pressure will be cured of these conditions if they have the Gastric bypass, Duodenal Switch, or the Lap Band done. 
The reality is that, in my opinion, most patients opting for the Lap Band procedure have not been educated and provided with the information necessary to make an informed decision. When you consider how little most patients will lose with the Lap Band, one has to realize that the risks, as little as they may be compared to other procedures, are not worth taking. 

Weight loss information

September 22, 2009 4:22 am

I have posted a new newsletter to our web site. It is located here. I will continue to update the information both here and on our website.
I also read an interesting article in Newsweek Magazine dated September 21, 2009. While I know it is not a scientific journal, this particular article had medical sources quoted as the basis of the content. For anyone who believes obesity is just about overeating and lack of exercise, I encourage you to read it. Does overeating and lack of activity contribute to obesity? Yes, but there is much more to it than that. We should stop blaming the patients for a condition over which they may have little control.
Different weight loss surgical procedures have different outcomes, independent of the type of surgical procedure. The long term success and complications of these procedures is summarized on our website.