It seems like many people on this site have been banded by a Dr. in Mexico. Is this procedure not widely done yet in the US?

Dr. John Feng told me that he taught the VSG to "those guys" at LapSF. I wonder why he isn't on the list as an *expert*? Maybe he couldn't make it.

These conferences end up being a combination of people who are well-known and respected, people who want to come and people who want to promote themselves. So the list isn't absolute IMO.

However, my own definition of a pioneer is not just someone who does something first, but someone who adds to the common knowledge and also brings their own twist to things.

So LapSF has done a lot of publishing of their results and made a lot of refinements to the sleeve surgery. That makes them pioneers, in my book. Elariny, OTOH, who is on that list, doesn't even do the sleeve much any more as he refuses to make the sleeve smaller than a 48f and therefore his patients don't have that much success. So he's on the list, but I wouldn't call him a leading sleeve surgeon. He may have been an early pioneer, but he's dropped out at this point.

OTOH, there is not one Mexican doctor on that list. There were none presenting at the 2nd summit either. This supports my contention that the Mexican surgeons were not the pioneers of this particular surgery and are not ahead of the curve compared to other countries. They were with the band, but not the sleeve.

That doesn't mean there aren't a some MX surgeon with more experience than some US surgeons. But the country as a whole isn't more experienced on average.

Wow Mac, how do you get all the knowledge? It's fantastic. When I first was researching the sleeve, Dr. Feng impressed me by calling me personally from my inquiry via the internet, and he called me after hours, when I got home from work. But, then I thought, maybe he isn't as busy for a reason..He even said he left LapSF, because he *cares* about his patients. And, that made me wonder about a falling out between them. But, he was very honest, and told me I would need 3 weeks off work, not 2, because it is major surgery. And, he was right. I could not have gone back at 2 weeks, in my case. And, after I voiced my concerns that I had, he mentioned that one of his pts would soak potato chips and eat them during the soft food phase. I felt that he almost seemed a little desperate for patients. But, he was very friendly, and told me that at a lower BMI of 39 I could expect to get down to 130 lbs. I felt he was very realistic. But, he has closed his practice Crystal Springs and joined another group in the East Bay. Anyway, I wish him well. And, I think he probably is a very good surgeon, but I haven't found many pts who had him.

Thanks again for your wealth of knowledge, it knocks my socks off, how you know all this!

Edited September 15, 200916 yr by Steph_123

Hi Hope4me-

Being that this is major surgery and irreversible, I think I read about every medical article on VSG published. I did this because I was trying to make an informed decision. I have never run across the name John Feng.

Remember, I mentioned that VSG is the first step of the Duodenal Switch procedure. However, for Duodenal Switch they use a larger caliber bougie.

Dr. Jossart did a fellowship in laparoscopic surgery at Mount Sinai Medical Center in New York under Dr. Michel Gagner. Dr. Gagner is on the list and is highly respected. Dr. Jossart's fellowship was right about the time the first VSGs were done as a first-stage procedure for Duonenal Switch. So I am sure that he learned the Duodenal Switch and the earliest forms of VSG from Dr. Gagner.

Dr. Feng has not published any papers that I have seen. That is a real signpost in this field.

Dr. Jossart has dozens of publications to his name. Drs. Jossart and Cirangle are recognized as being among the pioneers in this field. They have been doing stand-alone VSGs for 7 years. This is as long as anyone has been doing stand-alone VSGs.

Before I decided to have my surgery with Dr. Jossart, I paid for a medical background report. Dr. Jossart has never had a malpractise claim or an arbitration. With all the medical literature I read, including Dr. Jossart's papers, and the medical background report, I was completely convinced that I wanted Dr. Jossart to do my surgery.

My husband told me he was very impressed by Dr. Jossart. I asked him to elaborate. He said he was very intelligent, very experienced, and he really cares that his patients are successful. He is also very accessible to his patients. I am out of state. He gave me his e-mail. I have e-mailed him several times with questions, and he has replied very quickly.

So, my advise is -

1. If you have already had the surgery, tell us who your doctor was and your good and bad experiences with that doctor.

2. If you haven't had the surgery, it is worth it to pay for a medical background report. Do a lot of homework on your doctor before the procedure. It is irreversible. If you have no other way to know how many procedures or how long the doctor has been doing the procedure, ask if you could talk to a few of his patients (with their permission, of course) who had the procedure 5 years ago.

3. Celebrate - we're all getting healthier and skinnier!!! :drool5:

Best wishes to all,

My signature shows my VSG surgery date and pratice. Dr. Cirangle performed it, assisted by Dr. Jossart. Dr. John Feng was w/LapSF since 2002, until he opened his own in 2007, Crystal Springs, which he just recently closed. I got a letter in the mail last week from him. You can research Dr. John Feng on OH and find out that information for yourself. There is not one bad word written about him. Most testimonials are glowing. I was debating between LapSF and Dr. Feng, strickly because I was not comfortable traveling a long distance for major surgery. I was willing to pay the extra to be driving distance from home and for a top notch surgeon. I did research, I was just trying to share information regarding the surgeons that I personally spoke to or met inperson. There has been one death at LapSF, it is in their own literature I rec'd prior to surgery from their practice. You got the same literature and forms that I did. It was a pt 10 days out. But, you have to look at the whole picture. If a surgeon has perfomred 5,000 bariatric surgeries and has 1 death, that is much lower compared to a surgeon that has done 1000 surgeries and 1 death. And, you have to know the circumstances regarding that death. Was the patient compliant to the surgeon's post-op instructions? Before I had my surgery, I had to fill out a 25 pg questionnaire regarding my surgery and explain in my own words how I interpreted it, using at in least 10 words or more. There isn't much room wiggle room for a lawsuit. And, you sign a document that you will settle through arbitration only. Of course, if you want to go to court and sue, you still can, but it might not hold up with that massive legal document you signed. Believe me, they are not stupid.

As for my surgeon, he will kick my butt if I don't lose wt! That is very motivating, he doesn't just hand you kudos without really deserving them and working your butt off. This isn't a "magic bullet" and you still have to comply to the program and exercise to lose weight. If you don't comply to the diet in the first couple weeks, eating regular food could put you back in the hosp and maybe even cost you your life. I don't blame him for being tuff about it. His reputation is on the line.

I really like my RD and counselor. Since I didn't have any complications whatsoever, I didn't need to email or call my surgeon once. But, if I did, they are avail 24/7 on a pager. and, I could have easily traveled to their office in SF if necessary. They care about their patients, because that is what they do for a living and they have a good reputation to maintain.

I am sure that I would have been fine going to Mx w/Dr. Aceves, but I know traveling back would have been miserable for me. Everybody has their comfort zone.

Edited September 16, 200916 yr by Steph_123

Dr. Feng is a very nice man and an excellent surgeon.

I didn't go with him because his office person wouldn't answer any questions in my email and wanted me to go to their seminar instead. I had already been to another seminar where I wasted 2 hours of my life and found out info that, if I'd known it beforehand, I never even would have gone. So I was not willing to do that. Plus, she kind of made fun of my questionnaire, which pissed me off. I figured that it wouldn't be a good fit between us because I like to ask a LOT of questions and need a practice that is okay with that.

Nicole at LapSF answered *every single one of my questions* in my 3 page questionnaire. I figured that was a good sign and I was happy with most of the answers so I went to the seminar and knew almost immediately that Dr. C was the surgeon for me. If I hadn't felt that way, I would have continued to look and would have reconsidered Dr. Feng because he really has a great reputation.

Since then I've met him and I like him, and think he knows his stuff, but I think Dr. C is a much better fit for me. Dr. Feng is the sort that will tell you it's okay that you've regained or haven't got a normal BMI. Some people like that, but I wanted someone who was willing to be a straight-shooter and have high standards rather than make me feel good.

Anyway, Dr. Feng is going to be the head of the bariatric department at Palo Alto Medical Foundation, which is the medical group I use. I think they are lucky to have him and that it's a good fit for him. I don't think he has the personality to be a sole practitioner -- it requires a lot of salesmanship and not everyone is good at that. Plus, now PAMF will do more than RnY -- so I won't be my PCP's only sleeve patient -- and I will have another place to go to for help and support and maybe even their protocols will match LapSF's better.

So I'm happy about it. :biggrin:

Hope, I would really like to read your posts but I seriously can not see them. Your font is so tiny I would need a magnifying glass to read them. I don't mean to be rude, but

I have never seen a font so tiny anywhere else.

There has been one death at LapSF, it is in their own literature I rec'd prior to surgery from their practice.

That patient had a blood clot and did not return to LapSF for treatment. Anyone can get a blood clot at any time (I had one in the Fall of '80), but having surgery really ups your chances and you need to be vigilant about the symptoms.

Plus, it's not unusual for the ER to dismiss your concerns. The symptoms can be nebulous and similar to other, less serious, problems.

For example, there was a gal on OH who had a blood clot and went to the ER and they just hooked her up to an IV because she was dehydrated and sent her home. She was worse the next day, so her husband drove her back to the ER but she died on the way there.

So all you pre-ops and recent post-ops: do your walking immediately after surgery like they tell you, stay hydrated, and, if you aren't getting better every day, make your surgeon/PCP/the ER take your symptoms seriously!!

That is horrible mac! I don't even know what the symptoms of a blood clot are!

Yes, it was upseting for those of us who knew her.

The symptoms are pain at the site of the clot and it often feels hot (if it's in a leg). When I had mine, it was in my lung and I felt like someone was scraping it with sandpaper when I moved.

Wow, that's so disturbing, how trained professionals could miss something so serious. But, the patient has to take some responsibility if they never return for follow-ups with their surgeon. That kind of behavior can cost you your life. When I worked at SNMH in Grass Valley, if anybody came in with a suspected DVT, they were immediately put into a w/chair...no more walking! An US was done of LE immediately. If there wasn't a tech on hand (small rural community) they would call on in. If there was a clot, they were admitted for IV anticoagulants. But, that was in 1997. The biggest fear they had was that the clot might travel to the lungs, then it is called a pulmonary embolism, which can kill you. I remember working with a gal who went in to have her first baby, at age 30, and died because of a pulmonary embolism. That was the saddest day ever. I can't believe that I doctor could confuse a clot w/dehydration. But, I guess incompentence can happen anywhere. Yes, it pays to speak up for yourself. My PCP was so ignorant of what a VG even is. I took the illustration and literature from LapSF to show him, and he still confused it with intestinal bypass. He was so against it and told me I would probably gain the weight back later and then be stuck with malabsorbtion. I tried explaining to him, this would never happen with the VG. I am looking to find a new PCP within my network. A doctor with an open mind would be a good start.

I think the problem is that she came in complaining of "not feeling right" and she was dehydrated and had symptoms of that so they didn't look further.

When I didn't feel right, I demanded they check for a blood clot even though I had vague symptoms. (I was passing a kidney stone.) But I went to an ER at a hospital that had a bariatric department.

As a scientist I have read the published papers of those bariatric surgeons who pioneered VSG. About 5 years ago there were only about 15 surgeons who did VSG. Let me pass on some of the history of this operation.

Around 2000, some surgeons who were performing the Duodenal Switch Operation began to do VSG as a first-stage for poor-risk patients. They intended to do the rest of the Duodenal Switch Operation about one year later. The thinking was that a two-stage operation would lower mortality and complication rates for the Duodenal Switch procedure.

Of the patients operated on in 2000, when the year was up, many of the patients had lost sufficient weight so that the second state was unnecessary. Thus, the first VSGs were performed in 2000.

By 2002, a handful of physicians worldwide began to do VSG as a stand-alone

procedure. Between 2002 and 2007 surgeons performing this operation gradually revised the VSG procedure to what it is today, publishing their findings as they learned how to improve the operation.

In 2007, The First International Consensus Summit for Sleeve Gastrectomy as held in New York City. The first day consisted of live surgery by experts performing VSG for the 250 attendees wishing to learn the procedure. Afterwards, presentations were given by the experts. The presenters (experts) at this conference were:

Gagner of New York, NY

Dakin of Cornell, NY

Parikh of New York Pomp of New York

Jossart of San Francisco

Crookes of Los Angeles

Elariny of Virginia

Schauer of the Cleveland Clinic Florida

Rosenthal of the Cleveland Clinic Florida

Assalia of Israel

Langer of Austria

Himpens of Belgium

Kotidis of Greece

Melissas of Greece

Basso of Italy

Baltasar of Spain

Lacy of Spain

Mognol of France

Krawczykowski of France

Weiner of Germany

Won Woo Kim of Korea

Boza of Chile

De Paula of Brazil

So, here is your list of those considered "experts" in this field by their peers as of 2007. So, I think the discussion of who has a lot of experience and who does not has already been established by the medical community itself. The list is above.

The procedings of the conference were published in Obesity Surgery 18:487-496 2008. See for yourself.

Best wishes,

I'm really pleased to see one of my choices in this post... Dr Baltasar in Spain... I've got one appt next week with another and am going to call and book an appointment with Dr B as well. He is at the moment slightly in front for me on information and experience, but time will tell.

me too, i had to pay my own surgery, plus it's a lot cheaper, and Dr. Aceves is very professional and reliable.....if you need more info on the cost you can contact Nina, she's Dr. Aceves patient coordinator and she'll answer all your questions. you should give it a try!! Goodluck!!

Nina Eguia

Patient Coordinator, Dr Aceves

888 344 3916 toll free

nina_eguia@yahoo.com