Revision from RNY to Band or DS?? What's Best?? Please Help...

Hi!

     I had the RNY eight years ago, but never lost to goal weight and now am even regaining some weight, as well as have experienced some anemia.  I have Aetna and live in Georgia.  Please help explain the process to get Aetna to hopefully approve, length of time it will probably take from application to surgery date, possible GA doctors you recommend to do this who hopefully take Aetna, and which you would choose (lap band or ds), etc...

Thanks in Advance!
Lisa in Georgia

Directly from Aetna:

1. Repeat Bariatric Surgery:

   Aetna considers medically necessary surgery to correct complications from bariatric surgery, such as obstruction or stricture.

   Aetna considers repeat bariatric surgery medically necessary for members whose initial bariatric surgery was medically necessary (i.e., who met medical necessity criteria for their initial bariatric surgery), and who meet either of the following medical necessity criteria:

   1. Conversion to a RYGB or BPD/DS may be considered medically necessary for members who have not had adequate success (defined as loss of more than 50 percent of excess body weight) two years following the primary bariatric surgery procedure and the member has been compliant with a prescribed nutrition and exercise program following the procedure; or

   2. Revision of a primary bariatric surgery procedure that has failed due to dilation of the gastric pouch is considered medically necessary if the primary procedure was successful in inducing weight loss prior to the pouch dilation, and the member has been compliant with a prescribed nutrition and exercise program following the procedure.

2. Experimental and Investigational Bariatric Surgical Procedures:

   Aetna considers each of the following procedures experimental and investigational because the peer reviewed medical literature shows them to be either unsafe or inadequately studied:

   • Loop gastric bypass
   • Gastroplasty, more commonly known as “stomach stapling" (see below for clarification from vertical band gastroplasty)
   • Sleeve gastrectomy
   • Mini gastric bypass
   • Silastic ring vertical gastric bypass (Fobi pouch)
   • Intragastric balloon
   • VBG, except in limited cir****tances noted above.

   • LASGB, RYGB, and BPD/DS procedures not meeting the medical necessity criteria above.
     
      

Lisa.. I"m in the process of getting my revision approved through Aetna.... Not sure what the outcome will be but this is what I'm doing......  I had RNY in 1993... lost all my weight to goal but have regained almost all of it back now..   I'm trying to get the band approved... 

Repeat Bariatric Surgery:

Aetna considers medically necessary surgery to correct complications from bariatric surgery, such as obstruction or stricture.

Aetna considers repeat bariatric surgery medically necessary for members whose initial bariatric surgery was medically necessary (i.e., who met medical necessity criteria for their initial bariatric surgery), (which you probably did because your BMI was probably over 40) and who meet either of the following medical necessity criteria: Aetna considers bypayss medically necessary w/ BMI over 40 or BMI 35+ w/ comorbities.  Most of us will meet the BMI over 40 from our previous surgery.  Make sure your Dr. knows that no where does it state you have to have a recent/current comorb to have revision surgery.

1. Conversion to a RYGB or BPD/DS may be considered medically necessary for members who have not had adequate success (defined as loss of more than 50 percent of excess body weight) two years following the primary bariatric surgery procedure and the member has been compliant with a prescribed nutrition and exercise program following the procedure; or

2. Revision of a primary bariatric surgery procedure that has failed due to dilation of the gastric pouch is considered medically necessary if the primary procedure was successful in inducing weight loss prior to the pouch dilation,(I was and there is plenty of documentation to prove I lost down to my ideal wieight and the member has been compliant with a prescribed nutrition and exercise program following the procedure. (This is what you probably need to get working on becuase  it does show you need 6 months... Read your policy because there is also something in there about 3 months.  Also as for the pouch dialation.... if your gaining weight... you probably have this and can prove it by having the scope procedure done where they go down your throat and take a pic of your stomach.  Mine was VERY OBVIOUS.
   
   Hope this helps!   I can only share what I myself am doing..    I will keep the board updated as to what happends... My insurance stuff was sent up today.
   
   good luck

Thank you SO VERY MUCH for responding to my post!!  I have a few questions to ask:

1.  Are you located in GA, and if so, which Dr. did you choose on the Aetna Panel?
2.  Why did you choosed the Lap Band instead of the DS?
3.  Do you know how many hours the Lap Band Revision Surgery will take, and how long the recovery will be?  (I am single and my parents helped take care of me during recovery the first time - I feel so bad to ask them to do it again, but I am very blessed to have their support.).
4.  Does the complaince of a nutrition and exercise program start from the date of surgery?  Or can it?  What excatly do I have to submit to prove it?  A diary of what I ate for 6 months and what exercise I did for 6 months?
5.  Is it better to visit with the bariatric doctor first and then let him order the scope, etc...  to look at my pouch OR is it better to go ahead and have the scope before I meet with my bariatric doctor so they can have the test results during our first meeting to know what is going on and to help better decide what to do??
6.  When you have the lap band surgery, do you have to stay overnight in the hospital?

Thanks!
Lisa
p.s.  Best of Luck to you too!!

Lisa,

I'm in Virginia....

2-  I chose the lab band because I did not feel it was as risky as DS or the other procedures out there.   I dont mean to scare you but I do want to be honest.    When I spoke to my Dr. about revision... He said that in order to go back in and do something comparable to my first surgery (RNY)   it would be really dramatic!    He explained that after one has the RNY... the liver lays on/near the stomach and sticks like crazy glue.  They have to chisel the liver away from the stomach.. He said this could take a few or several hours... then there was always the risk of leaks. 
    Dont get me wrong... I know there is risk w/ any procedure... but I just was not willing to go this route.. Even though he did say the death rate was still very low, I was young (in my 30's) and would probably be ok.  I just had a baby 4 months ago and wanted to take less chance w/ the lab band.  Also the recovery time will be a lot less.

3-  My family/friends that's had the lab band said they were ok after 3-4 days and most of them said they could/did return to work within a week.  I think the procedure itself is less then 3 hours for revision patients.

4- You need to talk to your dr's office.. they will be able to lead you in the right direction as to how they want to handle your diet program.   I went to a center that had a Dr., nutritionist, and personal trainer.  The hospital I'm using was very familiar w/ them and they knew exactly what notes to provide and what most of the insurance companies are requiring. 

5-  I would recommend you visit your gastric bypass Dr that you want to do the procedure and let him do the scope procedure to prove the pouch dilation.  The procedure only takes a few minutes.  Mine was over in like 2 minutes.

Good luck

I hope you decide against getting the lapband. They are very unpredictable and doomed to failure, and you will not reach goal more than likely. Check out the DS forum here on OH. Come aboard and ask questions all you want. There is also DSFACTS.COM AND DUODENALSWITCH.COM. I would suggest you visit those two sites and read all you can about the DS. It is a more forgiving weight loss surgery and you are more apt to reach your goal with it. Then DO NOT GO SEE A RNY SURGEON. At least, see a surgeon who does all the surgeries, and there may not be one inGeorgia who does revisions. Dr. Husted in Sommerset, Ky, is one of the best in the DS and in revisions from the GB to the DS.  By only seeing a RnY surgeon, you are set up to not get the surgery you really need. A RNY surgeon is very biased and will put down the DS just so you retain him to redo your RnY. Why do a surgery that already failed you once? Check out the "revision" forum too and see who is looking to redo it again, not those who got a DS.

"Doomed to failure"

Not quite...

You should check out ALL your options including the labband.  Go talk to the folks at the band forum here.  No failures, there.  MANY MANY MANY people are at goal and many others have lost 100-120 lbs in the first year.  That's not quite failure.  The band requires a lot more out of the patient.  We have to "work our band".  We mus****ch portions and exercise daily but the proof is in the puddin' as they say.  It's worth it!  The risks of the lapband surgery are so incredibly minimal.  Many of us simply aren't willing to risk so much in order to lose weight. 

Good luck on whatever you choose.  I truly believe that WLS is a very personal decision and you must find the right option FOR YOU.  One surgery is not better than the other, no matter what people say.  There have been success stories and failures, with EVERY WLS.  In the end, our success is up to US...not the procedure we have done.  WLS is a tool...not a magic wand!

Lindsey :)

~~Go talk to the folks at the band forum here.  No failures, there.~~

???  What the heck are you talking about?  There are quite a few people 3 years out that have lost 30#, 50#, or 70# and they are nowhere near goal.

According to Dr. Husted the band has a 25% failure rate.  According to Dr. Pleatman (okay, I know... not a great source but he can certainly repeat what he was told) a rep from a company that partners with Allergan - the Lap Band is predicted to be obsolete in the near future.  Studies show re-ops at 30-50% in the first five years.  Inamed says at 5 years people have lost and maintained around 55% of their excess weight.  Those are not great stats.

The band about killed me, I didn't fail the band I lost weight in spite of the band.  So I'm a band failure and I post there.

I'm all for cheering on your surgery type but please, no band failures on the band board?  There are quite a few.  It's important to give accurate info.  Then there are all the people that had bands and revised to something else.  They are posting on other forums such as sleeve, bypass, DS, revisions and here, failed WLS.

As for the OP, it's important to know why she failed bypass. Mechanical problem?  Food issues?  If she's eating high fat foods and lots of them the band is not going to help her, that would be DS.  If she just needs restriction alone then the band would be a better option.  If the surgery was not done correctly then a revision to correct a lack of malabsorption, etc.

Hi there,

I guess it depends on what you consider failure.  I don't consider a 30, 50 or 70 lb. loss failure.  I haven't seen any posters on the band forum say that the band failed them...none.

And you're a band failure, really?  Your signature says otherwise.

The band about killed me, and I mean that literally.  Funny, I really don't get how that would be a success.  My weight loss was done with my band unfilled or underfilled about 95% of the time.  If my band had been a success don't you think I'd still have it?  I didn't have it removed because life was peachy having one.  There is more than weight loss, there is HEALTH.

If someone has 150-200# to lose and they lose 30 after three years, I don't consider that a success, not even a little.  Remember, not everyone has a sweet spot.  People are revising left and right.  It's dangerous to revise to another procedure.  The only thing that is left after a band is something involving a staple line and leak risks increase three fold after having been banded.  It's dangerous to revise but if someone wants to actually GET to goal instead of being thrilled with a 15-30% piece of their goal, so be it.  I don't think you'll find many people that are happy with that.  Spending thousands of dollars and putting your body through major surgery to lose 30# is not great and to call that a success is not fair considering the person is still MO after having all the weight loss the band will provide.

If you only lose 15% of your excess weight, will you be thrilled with that?  I bet you wouldn't.  I will bet you that YOU want to get to goal.  So do others.  I'll bet you have visions of wearing small cute clothes again, going to the beach, looking good, getting your health back if you have any weight related complications.  So do others.

You were quite clear when you said there are no band failures on the band board.  That's just flat out not true.  There are people that have lost nothing.  There are people that openly write they wish they had RNY, Sleeve, DS.  There are people that flat out write on the band board that they would not get another band.

Have you read the revision board?

www.obesityhelp.com/forums/Revision/a,messageboard/board_id, 5360/

I totally get being optimistic but reality has to play a part too and to suggest there are NO band failures on the band board is simply not true.