Revision Surgery Needed

Hi, I went for my followup a few months ago, and my doctor had me do a EGD test, and my pouch is find from my gastric bypass but my stoma is dilated.  I went for a consultation with the revision surgeon, and all seemed well. I have 1 more nutrition appointment and  and pych evaluation coming up.  I was wondering is it really hard to get this kinda stuff approved, i'm steadily gaining weight ,but i work out 5 times a week. obviously i've been taking care of myself because the pouch is of normal size, it just anatomy changes within the stoma.  Any experiences of advice is great.

Not sure what type of revision you are looking for.

There are some procedures that are suppose to make the stoma smaller, but i have not seen one pooter really telling us that it worked for them. I may work for a few months, as they are losing a few lbs...but i have not seen any long term good results. 

Revision to VSG, or DS...that may work...

Good luck.  

I am in the middle of the insurance battle right now. I have been disproved 3 times now and my surgeons office put in one more after the peer to peer conference 6 weeks ago. I had been seeing a different surgeon than I have now, for the last 6 years for weight gain. I up to 100 lbs regain. I work with a nutritionist, exercise and eat on a normal day-

Breakfast is usually a protein drink and a few dry mini wheats to wa**** down because I cannot stand the after taste of the protein shake. 
Lunch is 2/3 slices of lunch meat with a few cheddar cheese cubes and wheat thins, 
Dinner is what ever I am preparing but I don't eat much of it.
Sometimes I will have a protein bar for a snack to take with my afternoon vitamins but that is about it. 

The only thing I suggest is to get as much paperwork with medical proof of your reasons your regain has negatively affectively you. Proof of what you have tried and a great surgeon and surgical office to fight this for you. The big thing I think is needed is PROOF that you need to lose the weight, PROOF of what you have already done and are currently doing on your own to lose and any other paperwork you can come up with to support your request. I see a neurologist for the increase intensity and frequency for migraines, debilitating enough now that I cannot work. An orthopedic surgeon for a replaced knee and the other one is, if I don't lose, will have to be as well. I have either hiatial hernia or ulcer again (surgeon thinks ulcer, I tend to agree, but on the other hand I have already had to have one hernia fixed surgically). A spinal specialist ,for neck bones are degenerating at a much faster pace that they should and aback pain, and I see a psychologist bi weekly to address any stress / food choices I am making that might be the issue. He is the psych that sees patients for the initial screening so he knows what he is talking about and even he thinks I am a great candidate for revision. So I am using everything in my arsenal to fight. If I still get disapproved after this most recent request, I am planning on getting letters from all my dr.s explaining their position and reasons why they feel I need a revision. And then also a personal letter from me with a picture of me after the original surgery and now so whom ever the head administrator of my insurance is, he / she can actually SEE ME.. not just a name on a paper. I am going to ask him why them why they feel they know what is best for my health better than all my doctors and even my surgeon think is best for me.  Then after that I will have the dr. office do another appeal in a few weeks so I sure that this person, sitting behind a desk, in some unknown place, has at least seen I am a human being, not a name and can add that info to his / her decision to deny me or approve me. I don't know if I will have to go get a lawyer or not next, if they still disapprove it, but I will if I need to. I am to the point I cannot work due to migraines, my knee, shoulders & back. The migraines and the knee are definitely my driving factors given that I cannot stand the migraines anymore.... and the idea of another knee replacement is something I will do anything to prevent!

I am in the middle of the insurance battle right now. I have been disproved 3 times now and my surgeons office put in one more after the peer to peer conference 6 weeks ago. I had been seeing a different surgeon than I have now, for the last 6 years for weight gain. I up to 100 lbs regain. I work with a nutritionist, exercise and eat on a normal day-

Breakfast is usually a protein drink and a few dry mini wheats to wa**** down because I cannot stand the after taste of the protein shake. 
Lunch is 2/3 slices of lunch meat with a few cheddar cheese cubes and wheat thins, 
Dinner is what ever I am preparing but I don't eat much of it.
Sometimes I will have a protein bar for a snack to take with my afternoon vitamins but that is about it. 

The only thing I suggest is to get as much paperwork with medical proof of your reasons your regain has negatively affectively you. Proof of what you have tried and a great surgeon and surgical office to fight this for you. The big thing I think is needed is PROOF that you need to lose the weight, PROOF of what you have already done and are currently doing on your own to lose and any other paperwork you can come up with to support your request. I see a neurologist for the increase intensity and frequency for migraines, debilitating enough now that I cannot work. An orthopedic surgeon for a replaced knee and the other one is, if I don't lose, will have to be as well. I have either hiatial hernia or ulcer again (surgeon thinks ulcer, I tend to agree, but on the other hand I have already had to have one hernia fixed surgically). A spinal specialist ,for neck bones are degenerating at a much faster pace that they should and aback pain, and I see a psychologist bi weekly to address any stress / food choices I am making that might be the issue. He is the psych that sees patients for the initial screening so he knows what he is talking about and even he thinks I am a great candidate for revision. So I am using everything in my arsenal to fight. If I still get disapproved after this most recent request, I am planning on getting letters from all my dr.s explaining their position and reasons why they feel I need a revision. And then also a personal letter from me with a picture of me after the original surgery and now so whom ever the head administrator of my insurance is, he / she can actually SEE ME.. not just a name on a paper. I am going to ask him why them why they feel they know what is best for my health better than all my doctors and even my surgeon think is best for me.  Then after that I will have the dr. office do another appeal in a few weeks so I sure that this person, sitting behind a desk, in some unknown place, has at least seen I am a human being, not a name and can add that info to his / her decision to deny me or approve me. I don't know if I will have to go get a lawyer or not next, if they still disapprove it, but I will if I need to. I am to the point I cannot work due to migraines, my knee, shoulders & back. The migraines and the knee are definitely my driving factors given that I cannot stand the migraines anymore.... and the idea of another knee replacement is something I will do anything to prevent!

I am in the middle of the insurance battle right now. I have been disproved 3 times now and my surgeons office put in one more after the peer to peer conference 6 weeks ago. I had been seeing a different surgeon than I have now, for the last 6 years for weight gain. I up to 100 lbs regain. I work with a nutritionist, exercise and eat on a normal day-

Breakfast is usually a protein drink and a few dry mini wheats to wa**** down because I cannot stand the after taste of the protein shake. 
Lunch is 2/3 slices of lunch meat with a few cheddar cheese cubes and wheat thins, 
Dinner is what ever I am preparing but I don't eat much of it.
Sometimes I will have a protein bar for a snack to take with my afternoon vitamins but that is about it. 

The only thing I suggest is to get as much paperwork with medical proof of your reasons your regain has negatively affectively you. Proof of what you have tried and a great surgeon and surgical office to fight this for you. The big thing I think is needed is PROOF that you need to lose the weight, PROOF of what you have already done and are currently doing on your own to lose and any other paperwork you can come up with to support your request. I see a neurologist for the increase intensity and frequency for migraines, debilitating enough now that I cannot work. An orthopedic surgeon for a replaced knee and the other one is, if I don't lose, will have to be as well. I have either hiatial hernia or ulcer again (surgeon thinks ulcer, I tend to agree, but on the other hand I have already had to have one hernia fixed surgically). A spinal specialist ,for neck bones are degenerating at a much faster pace that they should and aback pain, and I see a psychologist bi weekly to address any stress / food choices I am making that might be the issue. He is the psych that sees patients for the initial screening so he knows what he is talking about and even he thinks I am a great candidate for revision. So I am using everything in my arsenal to fight. If I still get disapproved after this most recent request, I am planning on getting letters from all my dr.s explaining their position and reasons why they feel I need a revision. And then also a personal letter from me with a picture of me after the original surgery and now so whom ever the head administrator of my insurance is, he / she can actually SEE ME.. not just a name on a paper. I am going to ask him why them why they feel they know what is best for my health better than all my doctors and even my surgeon think is best for me.  Then after that I will have the dr. office do another appeal in a few weeks so I sure that this person, sitting behind a desk, in some unknown place, has at least seen I am a human being, not a name and can add that info to his / her decision to deny me or approve me. I don't know if I will have to go get a lawyer or not next, if they still disapprove it, but I will if I need to. I am to the point I cannot work due to migraines, my knee, shoulders & back. The migraines and the knee are definitely my driving factors given that I cannot stand the migraines anymore.... and the idea of another knee replacement is something I will do anything to prevent!

I am 7 1/2 years post op.  I have gained back 60 of my 175 lb weight loss.  I found out that my stoma was dilated too.  Apparently, that is not an uncommon problem with the Gastric Bypass (RNY).  I had no idea of that problem before I had the surgery.  I am dealing with the insurance now.  My surgeon wants to do the Band Over Bypass surgery in which he places the lap band over the stoma area to close it up.  He said the only other option is to switch me to the Vertical Sleeve (which takes away my malabsorption).  I want the DS (Duodenal Switch) but he said my BMI is not high enough to do it... it isn't over 50.  Insurance doesn't cover the Band over Bypass as it is "investigational and experimental".  My Surgeon is doing the Peer to Peer with the insurances' Medical Director to fight the denial.  I don't know what plan B is.  If we don't get this approved... I don't want just the Vertical Sleeve and I don't think he will do the DS.  I see the Surgeon again tomorrow to figure out the plan.  Good luck to you!!  I would work with your PCP and get documentation of you working on your diet and exercise (insurance will want at least 90 days or so showing you are still following diet and exercise).  Even if the gym writes something to say you are there working out 5 days a week.  Collect any documentation you can of your diet and exercise.  (we aren't all perfect, but we are still trying to work with the tools).  All of that may not matter if you are already doing your nutrition appointments.   Good Luck and just take one day at a time.... try not to stress about when it is out of your hands.

wow ,i 've just been approved for the apollo procedure, have you guys heard anything good about it

NO!  These stoma tightening surgeries work while you are on the liquid diet.  Once you begin to eat again, the weight jumps back on.

Good Luck

No, I've never heard of anyone having long term success with apollo, or rose, or stomaphyx, or any of them. The stoma is really a major downfall of the RNY and Erny. Stomas stretch too often, and are a cause of weight regain, dumping, stomal ulcers and reactive hypoglycemia.

You might want to see a revision surgeon that can revise you to a VSG or DS, but there are very few surgeons that ACTUALLY are capable of revising the RNY to one of these. Good luck. 

You may want to see if they can actually make the 50 BMI nonsense stick for revision to the DS or sleeve. It's been challenged (and successfully) many, many times. The requirements are the same for all three surgeries (I don't count the band, as it has such dismal statistics it shouldn't even be considered). RNY, VSG (sleeve) and DS all require a BMI over 40 or over 35 with co-morbs. 

There are only a few surgeons that are actually capable of doing the RNY to DS surgery, and otherwise they will throw out a lot of BS reasons why you should settle for something else, even if there is no data to show any success. Who's your surgeon? Dr Kesheshian in CA is one of the best known (and best) at doing this complicated revision, but there are a few others too.