Kurian or Aceves for Revision? Self-Pay

[ctsleeve 20]

Hi revisioners!

I am paying for revisional band to sleeve surgery. I have seen both Marina Kurian at NYU and researched/talked with patients and coordinator of Alberto Aceves in Mexicali.

I got my band in Jan 2010, lost 60 pounds, had ongoing problems with maintaining a reasonable restriction, gained 30 back, etc.

Basically I'm trying to decide between the general surgical excellence and proximity of Kurian and NYU and the (as far as I have heard) vast experience and excellence of Aceves but significant distance if I have a problem/complication.

I need to decide by Monday morning. If you have any thoughts and can weigh in, I would so appreciate any input. Assume money is not the most important factor here.

Biggest questions: Does experience with 200 vs 20 conversions make a big difference when both surgeons have extensive experience with bands and sleeves?

How critical is in-person follow-up care with sleeve?

Is there a big difference in weight lost between Kurian's and Aceves' patients?

Is there anything else I should be considering in this decision?

Here's my pro/con list:

MARINA KURIAN/NYU

Pros:

* 40 minutes from home.

* Experienced, well-respected US surgeon. A known entity.

* Will perform this surgery herself

* Has done thousands of bands, close to 150 sleeves, but so far just 20 band to sleeve conversions

* Follow up will be easier/

* Two nights in hospital

* Kurian does two leak tests before discharge - one in OR, one with esophagram day after surgery.

Cons:

* Less experience with conversions

* Fewer outcomes to compare

* Cost is three times same procedure in Mexico with one less night in hospital and no guarantees that costs won't be higher

* Lots of hoops to jump through ahead of time.

ALBERTO ACEVES/MEXICO

Pros:

* Well-regarded surgeon, member of ACS and ASMBS

* Tons of experience with this surgery - almost 200 band to sleeve revisions, 1800 sleeves and 2500 lap bands.

* Performs all surgeries himself.

* Everything included in price; if I need an extra night in the hospital, no problem, no extra charge

* Three leak tests before discharge

* Kurian says she doesn't know Aceves but knows some of the Mexican surgeons are excellent and she can certainly understand why someone would go there since NYU is being so crazy with pricing. She noted the problems with follow-up care.

* Every person I've spoken with has nothing but good things to say about Aceves, the hospital, the staff, the care they received.

* Price is 1/3 that of NYU

Cons:

* Follow-up care - would have to go back to Mexico for serious problem; otherwise, dedicated follow-up staff member to answer questions and advise

* Cross-country flight home three days after surgery

* Hospital is not accredited by US standards and while it seems clean, no idea about infection rates, surgical complications etc.

[chinamama 104]

FWIW since the money factor is not a factor I would go with local with a conversion. You don't know what they are going to find once they get in there ( my stomach was adhered to my liver). There is NO way I could have flown home 3days later. Heck, I was in the hospital for 4 days! I have not had any real complications since being home, but it did take 4 weeks to feel back to normal.

As for number of conversions my dr has done, I didn't ask. We did have a conversation over why she leaned towards bypass for me over sleeve, and if this was in her comfort zone, or should I go elsewhere. I also know she interned with one of the best bariatric surgeons in the country. It turns out her dislike if you can call it that, of the sleeve is the leak chance. She says leaks don't happen often, but when they do its catastrophic, and not overcome quickly or easily. Before my surgery she had me do some research to know I knew what I was getting into.

Anyhow, that's my 2cents. Good luck with your decision.

[ctsleeve 20]

Thanks so much for your input, Chinamama. Your point of view is enormously helpful! I'm glad you're feeling better now.

Best of luck on your journey, I hope the hard part and medical issues are long behind you now.

[relax#3 7]

I had a band to sleeve revision in March with Dr.Aceves. My liver was also adhered to my stomach. I chose Dr.Aceves because of his experience in revisions. I would not have gone to anyone who had so few previous revisions.

Can you speak to the surgeon near you and see if they would help if you had any issues?

My doctor here does my follow up (bloodwork). If I had other complications I would have had to go back to Mexicali, and it is not a quick trip for me (about a day of travel. A few flights, hours and hours of driving). I just felt more confident going to someone who had more experience since a revision is riskier.

Good luck

[ctsleeve 20]

Thanks so much for your input. I really appreciate it!