The ABC's of Revision A to Z

Leah,
I am NOT an insurance expert. That said, it would not surprise me if Medicare treated revisions in the same fashion as they treat initial WLS. Neither would it surprise me if they refuse to cover revisions. The best thing to do is to call them for an answer.

Eric Schlesinger, MD, FACS
AZ Weight Loss Solutions

Medicare will cover the scleratherapy and that is done to reduce the size of the stoma I had an endoscopy  today and while he was down my throat he did this procedure to reduce the stoma he said it is less invasive than the stomaphyx and probably less cost to insurance and he said he has had very good luck doing this after the stoma enlarged and he said sometimes it just happens. my pouch was not stretched but the stoma had, letting the food go thru too quickly and therefore I did not stay full long enough and was wanting to eat more often so if I were you I would check this out before I had a stomaphyx done. Now I can also see why they tell us not to drink with our meals and it is hard to do. but that is something now that I will make sure I do not drink with my meals at all.My Dr. today was Dr. Scott from Depaul Heath Center out of Bridgeton Mo. the phone no. is 1-314-344-6800  His associate that did my WLS was a very fine Dr. in fact the two of them together have invented several tools that are used in the WLS around the world and they are two very fine DRs.you could also go on the website of DePaul health Center also they have to be a Center of Excellance to be able to even do the medicare people and to be a center of Excellance you have to meet a lot of certain criteria, and believe me they are the best and they want to keep their patients healthy, and they also have the best staff  they really know their stuff when it comes to the WLS.    And yes medicare does cover this procedure that i had today and I feel fine tonight, only some pain right after the procedure but that did not last too long . If you want you can email me my email is [email protected]

Dear Dr. Schlesinger,  It is so refreshing to have a MD make such a compassionate, informative post to educate the readers of this forum on a topic so important to our health.  Thank you.   I didn't read anything with regard to a revision from a VBG. Would it be possible for you to address this restrictive procedure and the revision issues associated with a failed VBG?  I must admit that I have not followed my eating plan since my VBG in 2000.  I found that it was difficult to eat many "good" foods and became good at "eating around" the band to avoid pain.  Thus I gained all of the 65 lbs I originally lost.   With a current BMI of 33.2 (5'5"~ 200lbs, 50 yrs old) I do not qualify for insurance and was a self-pay to begin with.  I do feel like I am 100% at fault for the weight gain and really wonder if it would be worth me attempting a more malabsorptive procedure.  How do you feel about performing a revision on someone who has gained weight because of eating around the surgery?  Any comments would be appreciated.     Thank You again for your excellent post. Eileen

 

 

Eileen,
The most important question is: "Are you prepared to make a total commitment this time?" If the answer is no, then do NOT have any revision WLS.
We all make mistakes. Have you learned from yours? If you have then all options are open to you. The past is only significant if you have not taken the steps to avoid repeating it.
VBG's fail for a variety of reasons including; staple line disruption, stretched pouch, esophageal dilatation from over eating the restriction, as well as poor dietary choices. If you were having trouble with "good foods" like steak or rice then you never received the counseling that you needed. In a purely restrictive procedure, these types of food should NOT be tolerated. As in the Lap-Band, things that "wad up" or cannot be chewed into small pieces (the size of the red eraser on a yellow pencil) will not pass through your stoma.
I tell all of my patients that we look forward. If you are truly committed to doing the right things and choose a program that will help you sustain this behavior, then I would consider you a good candidate for a revision.
Be honest with yourself. If you are considering a highly malabsorptive procedure and then plan to do as you please; you are asking for a world of trouble.
Follow the program and success will be yours. You will know when you are ready to proceed.

Eric Schlesinger, MD, FACS
AZ Weight Loss Solutions

Thanks so much for your help and support on the boards.  I can print this out and use it as a guide. Thanks again! Barbara Brewer

Hi Dr. Schlesinger, I have a couple of questions for you.  I had rny and lost 95 lbs in the first 6 months and then stopped. I lose and gain the same 5 pounds now and I'm a year out. I have gone to see my surgeon and had an UGI. The surgeons said that my pouch looks okay as far as he can tell but is doing an endoscopy to check my stoma. My question is do you think it is possible for someone who only had surgery a year ago to have a revision? Also I'm still 255 and would like to lose at least another 100 pounds since I'm 5'6 1/2 and I also still have sleep apnea. I know all insurance is different, but should I qualify for a revision? Thanks for any help and advice you can give me. Monique

Monique,         Based on the information that you have provided, I would consider you potentially a good candidate for a revision.          Should your insurance cover a revision? Absolutely! Will they? Quite possibly not. Much depends on the details of your policy. The best way to find out is to call your insurance company and ask. Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Dr. Schlesinger, I thank you for your response before, but I really need help again. I had my UGI and EGD and my surgeon said everything looked fine.  That nothing was stretched more than it should be for a person who is a year out. So what now? What can I do? I'm not okay with being 255 pounds with sleep apnea and lower back pain, and don't know how to get a revision. Am I still a good candidate based on the fact that I'm still 100 pounds over weight. Do you have any advice on what I should do in order to get a revision surgery? I wish I could just get a referral to come and see you, but I have Blueshield of California Calpers HMO and don't know if I could afford the travel. Please help.

Monique, Clearly your surgeon either isn't listening to you or does not perform highly malabsorptive procedures. Regardless, getting BCBS to pay for your revision at this time will be a difficult task. Before doing anything else, talk to a supervisor at BCBS and find out their criteria for revisions. Armed with this information, you can focus your efforts to gain prior authorization. NEVER GIVE UP! Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Dr. S., Thank you truly for being thoughtful and helping us out at a time when we really need assistance.  I would like to ask you two questions.... I had a lap band placed exactly 2 years ago.  I was a good bandster for more than a year, with a total loss of only <30 lbs including the 12 I lost pre-op)  I struggled with the band 1 year out and battled over / under restriction issues, and finally had a total unfill.  I have had a recent upper GI and everything is good. I am scheduled for revision surgery soon.  I am 38 yrs old, I had no lap band complications, but do have some metabolic co-morbidities (PCOS, hypothroidism, pseudo tumor cerebri).  I am genetically an over weight person, but enviornmentally as well.  I have a definate "apple" shape.   Would you normally consider doing a distal RNY on a patient who historically has difficulty losing weight like me.  Also, do you let a patient request a pouch on the right side, instead of left? Thank you again. Kathi