VBG Staple line disruption

9 yrs ago I had a Vertical Banded Gastroplasty. I chose it because I was afarid to have my insides moved around. I initially lost 100 lbs and over the last 9 yrs have gained and lost and gained again.
I went to a meeting about the Lap band and found out that a revsion is possible for people who have failed WLS. I was informed by the doctor that Lap band isn't the best choice as a revision but that an RNY or DS was the norm.
So I had the upper GI and it showed that I have a rupture in my staple line. I'm not certain when this happened or even how serious it is. But I have done some reasearch and found that 22% of VBG's have this complication. So now my insurance company is telling my doctor that there is no prevision for a revision and they denied the RNY.
How dangerous is a Rupture? Do I need to be scared?
The insurance specialist  and my doctor says that the surgery is medically necessary.  What do I need to do to appeal? 
My surgery was scheduled for next Monday but the last thing I hear from my doctors office is that my insurance company wanted to speak to my surgeon.  As of Tuesday that had not happened. I am so frustrstraed.

Elizabeth:

As hard as it is, be patient, but be persistant....The squeeky wheel gets the oil so to speak. Call them daily and find out where this lies. Always be sweet and nice but never, never give up. And never miss a day calling. I believe they start to feel bad after a while and then begin to push for you.

I understand your frustration, I'm trying for Insurance Approval myself and no stranger to being turned down.

It's a tough road, but it should happen for you...I had a VBG and a Staple line Disruption as well and my original surgeons changed me to RNY because they said the scar tissue and internal bleeding can cause severe anemia. The staple line disruption does heal on the inside but it takes a while.

J Rolfson

Thanks for your reply. I was thinking that yestereday was Tuesday. I am so angry and furstrated my days are running together. Last Tuesday I got a letter from my insurance company requesting more information from my doctors office. I faxed a copy to the doctors office even though it said a copy had been sent to them. I just dont trust the insurnace companies. I didn hear from them so I called on Wedensday to be sure that they got it. When I spoke to  Patty the insurance specialist she told me that my insurance had denied coverage ( this was before I got the denile letter from my insurance company yesterday). She told me that she expained to them that the revision was medicallly necessary because of the rupture and in her words "they kind of caved". This gave me some hope. At that point Independance BCBS told her that their Medical director wanted to speak to the doctor and when I called she thought that it was the doctor calling her back because he had been in surgery all day.  So I gave it a few days and didnt call bac****il Friday. That day she told me that the doctor had not returned her call so nothing had been done about it yet. I told he how scared I was and that I needed to be kept in the loop about what was going on even if it ment that she had no new information and she said ok. I called three times yesterday leaving 2 messages for her and she hasn't returned my call. The other time I called I spoke with one of the nurses and she told me that she didn't want me to think that she was just trying to blow me off but that she could not help me and that I needed to talk to Patty. I called again and left another message today. I have been very nice never getting angery. I just want to be kept informed even if there is no new information just know that they are working on it would make me feel better.

I am going through the same denial with UHC-State of Arizona and we are appealing it.  I have hired a lawyer and after 31 days they were finally able to get the denial letter out of them.  We have submitted my appeal and now we are waiting again.  Don't give up, the insurance companies want you to do that.  Document every call with the insurance company, name, time and everything else.  They need to fight based on medical necessity.  They may deny you because of not meeting criteria like they say I wasn't qualified because of bmi not at 40 which it is now and no 6 month diet (which I am currently doing just in case).  Hang in there.

Thanks Deanne, It is good to know that I am not alone. I asked Patty if I could do anything to help ie write a letter of have my PCP write a letter. She told me no just to let the doctor talk to them for now. I have considered calling my insurance company just to see if they have spoke to the doctor because I haven't heard back from Patty. I hate waiting. Like I said even if there is no new news I still want to hear from them. I am not going to let this go past the weekend with out either calling and speaking to someone in my doctors office or the insurance company. Getting the denial was not hard they sent that right away but what I am worried about is that this rupture could be a potential theat to my health. I want to lose weight but it is more important to me to be heathy.  I have searched the internet looking for information on what the health risks are for a staple line disruption because my doctors office keeps saying that the insurance company should appove because it is medically necessary.  I still have not a straight answer from anyone including my doctors office about how dangerous the rupture could be to my health. I dont want to end up with peritonits and possible die.
I will hire a lawyer if I must but I am not even sure how to do that. Will I have to pay for one up front or is it possible to get on on contingency.

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Gee most people I know with staple line disruptions have no health issues from it except the staples become separated and we regain the weight.  My staples disrupted two years after my VBG though by dieting I still managed to keep the weight down to 113 lbs. for several more years.

I had the VBG back in /87, and my understanding that up to 80% of experienced staple line disruption through no fault of our own due to the way they used to staple the stomachs.

I had a revision to the Lap Band in /06 and have lost more than 100% of my excess weight.   It has been great 28 months out and so much easier to work with.

Best wishes on your upcoming RNY hope it works out.

I had VBG back in 92.  I kept the weight off about 5 years until the surgical ring passage got blocked with scar tissue and a fistula (staple disruption****urred.  I only found this out recently by a endoscopy and upper GI done while seeking a revision.  My concern for you is from the research I have done for myself that since you have already had a pouch surgery that failed due to staple failure, you may be prone for it again with the RnY.  This is why I have chose the DS for a more normal stomach anatomy along with the malabsorption to lose and maintain the weight for once and for all.  I am done having pain, acid reflux and eating foods to reduce vomitting . Continue to do research especially being a revision, you want to do the best thing you can do for your health that will effect the rest of your life.  VBG's are a surgery of the past and most doctors will never do them again.......I feel that any "pouch surgery" is wrong in my research.  But to all who has managed this type of WLS more than 5 years, consider yourself lucky....and I hope you all the best.
Terri

Howdy, I'm stll researhing for my surgery, I had the VBG back in the 90's, too.  The doctor I talked to is plannig a gastric bypass.  What is the DS in real words, I have read all about it,but I don't really understand it.