going from banded plication to DS...sort of...

I had a visit with my surgeon a couple of weeks ago about phase two of my weight loss. Phase one was 1/10/11 lap band over plication. We discussed sugery 2. I'm set on DS but, since I have already had my stomach made smaller with the first surgery, we may possibly leave the band in place along with plication and everything else will be the DS. I still have questions. Not sure I want to keep the band. It is at full capacity and the longer it stays in the more risk of complications such as perforation & slippage. As for the plication there is really not much point undoing that and haveing my stomach cut and made smaller as it is already smaller. I have completed all of my pre surgery testing nd appointments. My biggest obstacle is dealing with the insurance. Once I get my surgery date I will have a pre op visit with my surgeon to discuss our final plan.

I would be amazed if insurance agreed to cover any of those modified hybrid ideas your surgeon has.  There are too many complications becoming way to common for me to even consider leaving that band inside of you.  I really think you should get a second opinion since this is not a typical surgery.  You could wind up a hot mess and nobody else will want to touch you.

Not sure about the insurance issues.....

I can only say what I experienced with the crap band.  Mine erroded into my stomach, I had ulcers at the band site, my port became infected, I had fistulas at the port site oozing.  I was in the hospital for a week after having that thing removed.  I had a severe infection at the port site and along the tubing, which gave me a very high fever.  The area where the port was and the fistulas had to be left open and packed.  Unpacking, cleaning that open wound and repacking it, even with morphine in me, made me cry in pain.  I was on high doses of a very expensive antibiotic (each pill was over $100.00 each) for 28 days.  Luckily, my insurance approved that antibiotic.  The healing time from this ordeal were months, and the ulcers....seemed to take forever to heal up.

If you can, remove it.  It may cause you heartache and pain in the future.

Best wishes to you in whatever you decide.

If this surgeon, or anyone else at the Cleveland Clinic, is doing the DS, it's news to me. And I have never heard of the DS intestines combined with plication OR with band over plication.
     I think band over plication is a particularly bad idea when combined with the DS. With the DS, we need to eat extra protein to compensate for the protein malabsorption. While I have never had the misfortune to live with a lap band, it is my understanding that it can make dense proteins particularly difficult to consume. The advice I've seen (from a lap band surgeon) is to make each bite the size of the eraser on the end of a pencil, and then chew, chew, chew. With the DS, you need to be able to eat protein freely. Of course, you could have the band unfilled, but what is the point of leaving in an unfilled band? Just more potential problems.
      And this is aside from insurance questions, which could be significant since plication with or without band is experimental, let alone in combination with the DS, and aside from the DS generally being a combination of sleeve gastrectomy with the intestinal switch, not plication. No one knows the longterm results of plication, whether and how much it might stretch with time, whether it will stay intact or fall apart. The DS is tried and true. What you have now is experimental.

Larra

You guys have given me more to think about and more questions to add to my list for my next appointment. I am leaning even more toward having the band taken out. I haven't had problems with the band and protein. The bites don't have to be tiny. You just have to chew more. But it's filled to the max & I don't feel there would be much benefit from leaving it in.  My surgeon really listens to my concerns and I'm sure we will come to an agreement on that, He has a very impressive resume & I have total and complete faith in him. He does do the DS and that is the only proceedure that will need to be submitted to the insurance as it is the only new proceedure being done. My biggest obstacle with the insurance is that I have a primary & a secondary. The primary has an exclusion for wls. They denied i & the secondary approved it but now they keep trying to bounce the bill back to the primary. So that mess has got to be fixed before they can submit for this surgery, That's the only thing holding this process up. I have been successful in the first phase of getting my life back. Now I'm ready to move on to the next one.

I second with Larra,  I DID have a band and it caused a HUGE mass, had to remove and found also caused damage,   And yes I did have to have very tiny bites of protein, and had to chew till pulverized !  LOL

As a nurse I could have kicked myself for being that gullable,, LOVE the DS,, have had so much easier of a time, the intestinal part of this will be the art that really helps

Get a second opinion !!!

Deb

Most of my restriction now comes from the plcation. I don't see any benefit in keeping the band. I certainly don't want any of the complications that you've had. Glad you were able to switch.

 If they are submitting for DS and not actually doing the DS, then that surgeon as well as you would be committing fraud.  A DS is a DS, not a plicated stomach with or without a band, and whatever strange things you decide to keep instead of completing a proper DS stomach.  It sounds like you are a big science experiment for them, and they are willing to do whatever it takes to get compensated for this project.

I came over to the DS forum to learn as much as I could about the proceedure from people who have had it done. . I thank those of you who have offered advice and expressed your concerns. It has given me a lot more to think about and a lot more questions to ask before havin the surgery.
I was warned about the DS board. I was told that many of the members here wre judgemental and condesending. I have posted here a few times and I have never felt that way until now.

I don't expect everyone to understand why I have chosen the path I've taken. I know people are leary of anything new. But you must remember that if it were not for those of us willing to have experimental proceedures DS, RNY, Lap Band, VSG or any other wls would not exist. It all starts with research, experimenting and "guinea pigs" who are willing to be part of the research & new proceedures. It all has to start somewhere.

I woild not have had the proceedure done by just any surgeon. My surgeon has done many lap band surgeries and he has performed and researched plication for over 10 years. So combining the two is a proceedure I was willing to try.

The traditional DS  compared to plication and DS is pretty much the same. In both proceedures the stomach is reduced in size. The rest is the exact some. I am not some desparate person who is so desparate to have wls that I am willing to try anything. truth of the matter is the banded plication was a much safer proceedure than the rny for someone of my size at the time. I didn't go into it lightly or uninformed. I asked a million quaestions and did a lot of research reguarding my surgeon and his staff. He has quite an impressive backround and I trust his opinion. His first priority is his patients.

As for the insurance I am not sure how it will be submitted. I know my surgeon and his department are very professional and they would not do anything to compromise their program. So I really don't appreciate myself or my clinic of being accused of insurance fraud in order to have a proceedure done.
I am sure they will follow the proper proceedures just as they did with my first surgery.

 A DS has a sleeve stomach, not a plicated one.  There are distinct differences other than simply restriction.  Back when the DS was considered experimental, one could say in the same context "Oh, it's just like the distal RNY, the stomach is still restricted".  The intestinal bypass without the sleeve isn't even an approved surgery in the US yet.  Diabetic patients have had great success in Europe with it curing diabetes (even if they aren't obese), but it's not approved here yet, so I just can't see how your surgeon will legitimately get around an experimental compilation.  

Just for kicks, give your insurance company a call and ask if they will cover a revised plicated stomach with a distal bypass.  I'm curious of what their answer will be.  Your surgeon is not even on the list of vetted DS surgeons, so he's definitely in a learning phase.  There needs to be someone willing to give them experience, so your faith in him will hopefully take place where experience with the procedure is lacking.  I still am suspiscious of trying to get it past insurance, but I admire your pioneering spirit.