The "wrong" way to perform VSG?

[steve 0]

Hello folks,

Brand new member here, and I'm doing my insane research on VSG. I've read through countless experiences and links on this site and the other site; one comment has stuck in my mind:

I've read elsewhere that Dr. Cirangle says that there is definitely the "right' way to do VSG surgery, and a "wrong" way. (Obviously implying that Dr. Cirangle knows the "right" way to do it)

I kind of ignored that comment at first, but I recently read an article highlighting Dr. Higa out of Fresno Heart holding a conference for VSG surgeons.

http://www.medwatchtoday.com/2789.htm

and this quote from the article caught my attention:

"“However, this procedure is an easy one to perform incorrectly and has its own set of unique complications."

So does anyone know the technical details about what these experts are talking about in terms of why and how it's easy to perform incorrectly? (the "wrong" way)

[Tiffykins 673]

They can leave too much fundus behind making the capacity larger after the sleeve matures. They can dissect too far or too close to the pyloric valve which can effect gastric emptying time/transit time. There's been several cases of surgeons dissecting too much of the "middle" of the stomach, and leaving a balloon or "pouch" type pocket at the top or bottom the stomach. Not all sleeves are created equally, there is NOT a standardized procedure because every patient's anatomy is different, and every surgeon has a different technique. Certain complications can be contributed to technique such as strictures, and leaks (the obvious ones), but then there are other complications/long term issues such as bigger sleeves which indicates higher regain stats at 2+ years out, and/or transit time for food which can lead to more hunger/less restriction because the food leaves the stomach faster.

[steve 0]

Wow, thanks for the quick reply. I'm adding these to my list of questions when I eventually get to interview some surgeons. Thanks!

[chilo1 62]

My husband is an experienced surgeon (although not in WLS) and said when we were researching and even after he assisted my surgery that "technically" it is quite a simple surgery. Apart from what Tiffykins stated, I think the "wrong" way of performingy this surgery doesn't only apply to the anantomical or technical procedure, but to the patient, his background, general health, mental/emotional state etc. It's good that you're doing your research thoroughly and you could write down questions you want to ask your surgeon before deciding on surgery, it's a life changing desicion, which I am so glad I have decided to go for¬!" Good luck

[wishes 125]

Wow, that is a good question with some quite good responses. I think I will save this post and add some questions to my list for my surgeon.

[christina420 3]

Well I'll that I know for sure is that dr Cirengle is world renowned and one of the very best vsg surgeons in the world. He is also very confident and somewhat abrupt. He actually invented a certain way to do part of the sleeving ( I forget the name of it) so if he says there is a certain way to do it right. There probably is.

[ybnormal 21]

I personally would have my doubts that he is "world renowned". According tho whom? Also, I looked him up and I'm not sure I would use him, especially if he makes you sign something saying you will never sue him.

http://www.yelp.com/biz/dr-paul-t-cirangle-san-francisco

[Tiffykins 673]

I personally would have my doubts that he is "world renowned". According tho whom? Also, I looked him up and I'm not sure I would use him, especially if he makes you sign something saying you will never sue him.

http://www.yelp.com/...e-san-francisco

He really is one of the pioneers of VSG as a stand along procedure. Him, Dr. Jossart and Dr. Gagner are 3 tops in the U.S. He does have some differing opinions and reviews from patients. From what I've read across the boards for a few years, he has his followers and he has his naysayers. But, when it comes down to technique, long term results, and surgical stats, he is definitely up there in the Top 3-5 surgeons in the nation.

[steve 0]

I didn't want to start a debate about Dr. Cirangle. It wasn't my intention. Personally I believe that Dr. Cirangle is extremely experienced and has outstanding results. I believe the source of doubt that arises is because Dr. Cirangle's practice is a pure private practice, or a private business. As a private business, there is a necessity for marketing. Don't get me wrong, I have nothing against private business or marketing. I'm just saying that it's a necessary part of business, and some people may be turned off by marketing in general, especially since his practice charges a $5750 'program fee' that is not insurance billable.

But in terms of Dr. Cirangle's technical skill, results, etc. I completely agree with Tiffykins. For those interested in the "who's who" in terms of those who are really promoting and teaching the VSG technique, I'd look at this conference brochure as an example:

http://www.obesityed...cssg/agenda.htm

http://www.obesityed...ssg/faculty.htm

In addition, my research in the medical literature shows Gagner, Jossart and Cirangle are everywhere. It should be noted that Gagner is credited with pioneering the VSG technique. Jossart did his laparoscopy fellowship with Gagner at Mt. Sinai Hospital in NYC, and it appears that Gagner and Jossart still collaborate academically extensively. Another lesser known surgeon (at least on the internet forums) is Dr. John Feng who also did his laparoscopy fellowship with Gagner. There are probably others throughout the US and the world with similar credentials, but since I'm researching mainly for myself, I'm looking mostly in N. California.

Dr. Higa is also a world renowned bariatric surgeon out of Fresno Heart and a former president of ASBMS. But It looks like he may just be coming around to the VSG now that the short-medium term medical evidence is very compelling. So his numbers of VSG procedures may not be up there like other surgeons. But the fact that Gagner would come to Higa's VSG conference attests to Dr. Higa's excellent reputation. With all these excellent surgeons out here in california, I have a nice list of surgeons to interview, and probably will have to make a decision based on factors other than technical skill/ability/statistics.