I have been battling with my weight throughout my entire life. I lost 94# following Health Management Resources (HMR) but have slowly gained back 50#. After finally deciding that WLS was for me, I feel lucky to find the info on vertical sleeve gastrectomy. I am scheduled to have surgery hopefully July 20 or 22. I am scheduled to have it done at Doctors Hospital in Michigan by Dr. Pleatman. If anyone has any info on Dr. Pleatman, I would love to hear from you.:thumbup:

WASA has a lot of information on Pleatman... private message her.

I was able to retrieve the information on Pleatman. As of 2 months ago he has less than 500 staple lines (170 sleeves, 250 bypass), has a 2.4% leak stat (global are less than 1%), and he doesn't do any leak tests on the actual patient. He take the portion of the stomach he removes and has the nurse fill it with air before it goes to the lab.

When having a sleeve you want a surgeon who has done at least 250 procedures, who has a low leak percentage, and who does leak tests to make sure the portion of the stomach that is left IN you does not leak. I know that his prices are low and that he has patients who have done well. Unfortunately, he also has a high leak rate so he's got other patients who did not do well.

You might want to explore other surgeons before making a final decision.

thanks for the info; i'll have to research him further

He's not really my pick of great surgeons. As Elisabeth wrote he is a very high leak stat and I prefer someone that has done at least 250 sleeves and 250 bypass.

He does no leak tests on your stomach, he just has a nurse fill up the portion of stomach he removed with air. With his leak stats he should be doing all the leak tests.

He only has one night in the hospital, since most leaks show up within the first 48 hours you really need more hospital time.

I think he's kinda cheap for a reason. :blink:/

thanks for the info; i'll have to research him further

IMO I think I'd start researching other surgeons too ... doesn't appear his stats are very good ... good luck with your final decision.

Yes, it's true that I have had a couple of leaks after VSG. I am honest about admitting them. Whether or not that makes my leak rate higher than that of other surgeons who deny ever having had a leak is questionable. Certain people on this site push their own surgeon. I suppose that is up to them. Certain people on this site badmouth me based on rumors and misinformation. Certain people on this site give out a lot of medical information in spite of the fact that they are not physicians. This is unfortunate. All I can do is give the facts.

My patients can stay in the hospital as long as they need to. The hospital has agreed to a certain price, and this price is not changed if patients stay longer. My scrub tech inflates the stomach with air and I check it to make sure the staples fired correctly. If there is any question, I will inflate the "real" stomach in the patient or even do an endoscopy. If there is a question of a leak after the surgery, I will get an upper GI series (using gastrograffin, a Water soluble contrast). Though gastrograffin is more expensive, we use it because it will be absorbed if it leaks out. The bad thing about gastrograffin is that it is very harmful to the lungs if aspirated; in addition, it gives lousy pictures. Barium is safer in the lungs and gives much better pictures; we avoid it if there is suspicion of a leak. So you see it's not just about the money.

The only reason my price is low is that there are 3 hospitals bidding for my business. My complication rate is low and my patients do well. They like having me there.

Finally, if you have a question about me or anything else, give me a call or shoot me an email.

Mark Pleatman MD

Member ASMBS

Member SAGES, serving on Bariatric Liaison Committee, Ethics Committee, Go-Global Committee, Technology Committee

Mark Pleatman MD Weight Loss Surgery Website

248-334-5444

Email info@drpleatman.com

Yes, it's true that I have had a couple of leaks after VSG. I am honest about admitting them. Whether or not that makes my leak rate higher than that of other surgeons who deny ever having had a leak is questionable. Certain people on this site push their own surgeon. I suppose that is up to them. Certain people on this site badmouth me based on rumors and misinformation. Certain people on this site give out a lot of medical information in spite of the fact that they are not physicians. This is unfortunate. All I can do is give the facts.

My patients can stay in the hospital as long as they need to. The hospital has agreed to a certain price, and this price is not changed if patients stay longer. My scrub tech inflates the stomach with air and I check it to make sure the staples fired correctly. If there is any question, I will inflate the "real" stomach in the patient or even do an endoscopy. If there is a question of a leak after the surgery, I will get an upper GI series (using gastrograffin, a Water soluble contrast). Though gastrograffin is more expensive, we use it because it will be absorbed if it leaks out. The bad thing about gastrograffin is that it is very harmful to the lungs if aspirated; in addition, it gives lousy pictures. Barium is safer in the lungs and gives much better pictures; we avoid it if there is suspicion of a leak. So you see it's not just about the money.

The only reason my price is low is that there are 3 hospitals bidding for my business. My complication rate is low and my patients do well. They like having me there.

Finally, if you have a question about me or anything else, give me a call or shoot me an email.

Mark Pleatman MD

Member ASMBS

Member SAGES, serving on Bariatric Liaison Committee, Ethics Committee, Go-Global Committee, Technology Committee

Mark Pleatman MD Weight Loss Surgery Website

248-334-5444

Email info@drpleatman.com

I think everyone pushes their own surgeon if they had a positive experience. It's the nature of the beast.

You have to admit, between bypass and sleeves you have had more than the average doctor for leaks. There are no rumors or misinformation, you are the one that provided the info. As I told you when you asked me to call you I explained that a friend of mine wanted to stay in the US for surgery and she was researching doctors. She asked you for your stats and while I fully respect your honesty, your leaks stats did come directly from you. I do not know if I still have a copy of that email or if I deleted it but going by memory I thought you wrote that you have 3 sleeve leaks and 7 bypass leaks? Less than 500 staple lines? I will see if I still have that email. If I do not I will get it from the person who emailed you.

This is a site for patients to post and share experiences and tips, that's what we do. No medical instruction is given here unless it is, "Call your doctor." We exchange information, tips and tricks to weight loss and dieting, personal experiences, research data, etc. That's what message boards are designed to do. So I beg to differ with you, it is not unfortunate in the least. It's a form of support and sharing information and what is unfortunate is that you have a problem with this.

I'm sure there are three hospitals bidding for your business. You told me on the phone that you only do about 100 WLS cases a year. Hospitals are hungry right now and they are doing everything they can to get business.

Finally, I did call you as you requested and you suggested that I exercise instead of post. While it was quite rude of you to say that I'll have you know I do exercise, probably more than you do. I am also a normal BMI and doing quite well. You went on to say that I have no business telling people about the fact that you don't do routine leak tests. You said I had to be a surgeon before I could discuss that. I would remind you again that this is a message board where people do research, we exchange information on just about everything. I'm sorry you have a problem with that but it does not take a physician to write the words, "No routine leak tests."

I thought I would post a recently published abstract from the Journal "Obesity Surgery," one of the leading Bariatric Surgery Journals. The reason I do this is to point out the difference between real research and the anecdotal "research" reported by some people, consisting of reading of posts on forums such as this and others. This series reports 6 staple line leaks in 200 patients, for a rate of 3%. This is a fairly typical leak rate reported in the literature; my leak rate is slightly lower, but in the same range.

If your surgeon says he has done 600 VSGs and never had a leak, he is either a god or a liar. You decide.

Mark Pleatman MD

www.drpleatman.com

G. Casella1, E. Soricelli1, M. Rizzello1, P. Trentino1, F. Fiocca1, A. Fantini1, F. M. Salvatori2 and N. Basso1

(1) Department of Medical and Surgical Digestive Diseases, Policlinico ?Umberto I?, University ?La Sapienza?, Viale del Policlinico, 00161 Rome, Italy (2) Department of Radiological Sciences, Interventional Radiology, Policlinico ?Umberto I?, University ?La Sapienza?, Rome, Italy Received: 22 January 2009 Accepted: 1 April 2009 Published online: 21 April 2009

Abstract Background Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as a ?per se? bariatric procedure due to its effectiveness on weight loss and comorbidity resolution. The most feared and life-threatening complication after LSG is the staple line leak and its management is still a debated issue. Aim of this paper is to analyze the incidence of leak and the treatment solutions adopted in a consecutive series of 200 LSG.

Methods From October 2002 to November 2008, 200 patients underwent LSG. Nineteen patients (9.5%) had a body mass index (BMI) of >60 kg/m2. A 48-Fr bougie is used to obtain an 80?120-ml gastric pouch. An oversewing running suture to reinforce the staple line was performed in the last 100 cases. The technique adopted to reinforce the staple line is a running suture taken through and through the complete stomach wall.

Results Staple line leaks occurred in six patients (mean BMI 52.5; mean age 41.6 years). Leak presentation was early in three cases (first, second, and third postoperative (PO) day), late in the remaining three cases (11th, 22nd, and 30th PO day). The most common leak location was at the esophagogastric junction (five cases). Mortality was nihil. Nonoperative management (total parenteral nutrition, proton pump inhibitor, and antibiotics) was adopted in all cases. Percutaneous abdominal drainage was placed in five patients. In one case, a small fistula was successfully treated by endoscopic injection of fibrin glue only. Self-expandable covered stent was used in three cases. Complete healing of leaks was obtained in all patients (mean healing time 71 days).

Conclusion Nonoperative treatment (percutaneous drainage, endoscopy, stent) is feasible, safe, and effective for staple line leaks in patients undergoing LSG; furthermore, it may avoid more mutilating procedures such as total gastrectomy.

Keywords Morbid obesity - Bariatric surgery - Sleeve gastrectomy - Complication - Leak

Sorry, but I am going with he is very good.

I'm NOT sorry and I am going with he is absolutely AWESOME and NOT a liar! Some surgeons are totally honest and GREAT at the same time.

I also feel as though you have a guilty conscience and are trying to push YOURSELF onto those in this forum.

Research and studies have shown that the best form of advertising is referral and word of mouth -- everyone on here has had a positive experience with Dr. Aceves and for you to call him a liar is just downright low ... so i guess given your other option, we would have to call him a God. However, I don't believe he is a God, I believe he is an absolutely outstanding superb Surgeon. I have worked med mal for over 7 years and seen the worst of the worst and deal with doctors on a daily bases ... I find most to be extremely arrogant and think themselves God ... Dr. Aceves is not like any other surgeon I have ever met. He is a very humble person ... who is above-average at the surgeries he performs.

So if you are here to push yourself on others and speak negatively of another's choice of surgeon ... IMO -- JUST GO AWAY!

Edited July 6, 200917 yr by VegasAngel
TYPO

I thought I would post a recently published abstract from the Journal "Obesity Surgery," one of the leading Bariatric Surgery Journals. The reason I do this is to point out the difference between real research and the anecdotal "research" reported by some people, consisting of reading of posts on forums such as this and others. This series reports 6 staple line leaks in 200 patients, for a rate of 3%. This is a fairly typical leak rate reported in the literature; my leak rate is slightly lower, but in the same range.

If your surgeon says he has done 600 VSGs and never had a leak, he is either a god or a liar. You decide.

Mark Pleatman MD

He is neither. Before you start calling your peers "liars" I am going to ask you to prove your claims.

Also, to find a study that shows the worst case outcomes and claim your stats are better... well, do you see where I am going with this?

My surgeon's published leak stats in their pre-op materials are 0.7% over a six year period. However, they have haven't had a leak in over a year so those stats are old and the new stats are lower. (They've been doing the sleeve for about eight years now.)

In this abstract of their published results for the first two years, they had 216 patients and 3 had leaks for a rate of 1.38%.

Vertical gastrectomy for morbid obesity in 216 pat...[surg Endosc. 2007] - PubMed Result

This presentation of 5 year results includes their leak stats for the first 5 years:

http://www.ssat.com/video/2008/SSAT%2049th%20Annual%20Meeting(3)-Cirangle.htm

It's under 1%.

These results will be published in a peer reviewed journal soon, probably in the Fall.

If your surgeon says he has done 600 VSGs and never had a leak, he is either a god or a liar. You decide.

My surgeon's published leak stats in their pre-op materials are 0.7% over a six year period. However, they have haven't had a leak in over a year so those stats are old and the new stats are lower. (They've been doing the sleeve for about eight years now.)

In this abstract of their published results for the first two years, they had 216 patients and 3 had leaks for a rate of 1.38%.

Vertical gastrectomy for morbid obesity in 216 pat...[surg Endosc. 2007] - PubMed Result

This presentation of 5 year results includes their leak stats for the first 5 years:

http://www.ssat.com/video/2008/SSAT%2049th%20Annual%20Meeting(3)-Cirangle.htm

It's under 1%.

These results will be published in a peer reviewed journal soon, probably in the Fall.

Thanks, Mac.

Dr. Pleatman? I don't believe a surgeon needs to be a God or a liar, some surgeons are just plain better than others and there is little value in getting pissy about it and begin calling people names.

My doc told me that leak stats under 1% are acceptable, more than that is not acceptable.

I wasn't calling anybody names or singling out a particular surgeon. The article I posted was not preselected. It was from the latest edition of the Obesity Surgery Journal.

I agree that Dr. Cirangle is excellent; he taught me bariatric surgery. Even his leak rate is not zero.

One needs to be careful about making judgments about small series; your statement that under 1% is OK and above 1% is not makes no sense, as it would be the same as saying that 2 leaks in 210 patients is acceptable, but 3 is not. The fact is that there is no statistically significant difference between 2 and 3 leaks in a series this size.

And then, there are other issues to consider. At the recent VSG Summit Conference it was shown that leak rates are higher when narrow bougies are used, as the pressure in the sleeve is higher (though weight loss is better). I use a very narrow bougie (32 Fr), so one would predict that my leak rate would be higher than if I used a large bougie. You also need to consider how many revisional procedures are being done, as well as the risk factors and comorbidities of the patients. You have to make sure you are comparing apples to apples.

Finally, I didn't start this fight. I was responding to the inappropriate comment by Wasabubblebut that I am "kinda cheap for a reason," as well as the downright false statement that my patients are only allowed one night in the hospital. In addition, your administrators are claiming that one needs to have done 250 VSGs before they can be trusted. Please supply data to support this claim. I'm not here to "push myself on anyone in this forum; only to defend myself against false and misleading accusations.

Respectfully,

Mark Pleatman MD

Mark Pleatman MD Weight Loss Surgery Website

I can only wonder why you are not so busy that you don't have the time to cruise the message boards.

I am sure you are a very nice doctor and have been kind enough on other boards to answer people's questions. However, it would seem that a busy doctor in high demand would have a busy life and not have time to look at message boards.