Which type is best?

Hi everyone,

I had the gastic bypass in July 2003 ... started out around 400 lbs ... dropped down to 270 lbs ... now, almost 7 yrs later, back up to 350 lbs ... med problems came back and its time for a revision...

Started the process of researching about a month ago. It is frustrating ...

1. Have to find Dr. that will do revisional    AND
2. Has to be IN NETWORK (AETNA Choice POS)   AND
3. Has to be somewhat local (old car, limited travelling funds, etc)   AND
4. Doesn't require an upfront cash fee (still trying to figure out when/who my deductible is to be paid to)

Fortunetly, I have found a doctor that seems to meet all of the criteria. I have an appt. with him in 2 days! But now, I am getting bogged down with info regarding procedures. I was initially thinking of lapband over bypass ... then I am reading about a "sleeve" and "ROSE."   I am wondering which of all these seems too be the most successful??? As anxious as I am to have this revision, I want to do it RIGHT and am getting discouraged with reading about failed procedures... 

My company is also revising our health plan as of 4/1/10. I have no way of knowing if WLS will be EXCLUDED this year until the beginning of April... I don't want to jump at anything with any doctor but feel like the clock is ticking, ticking, ticking ...

Any advice from anyone that has had revisional surgery is gratefully appreciated!

Thank you!
Michele

Hi Michelle
I am going to revise myself from Lap Band.  My insurance covers revisions but I only have 2 choices - RYGB or BPD/DS.   I am currently doing my research about revision, and I am strongly leaning towards the DS surgery.  I wanted to comment on the Aetna POS, which is the insurance I have.  You will have to contact them and check what surgeries they will cover.  Unless you decide with a surgery you will pay yourself, then you can start researching the surgeries that Aetna will cove.  Notice item 7 - there are several surgeries they will NOT cover.  If I choose DS, I will have to fight for out of network surgeon, as my state does not have any experienced revisional surgeons.  Hope this is helpful and a starting point...

Aetna's guidelines:

1. Repeat Bariatric Surgery:
2. Aetna considers medically necessary surgery to correct complications from bariatric surgery, such as obstruction or stricture.
3. 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:
4. 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

5. 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.

6. Experimental and Investigational Bariatric Surgical Procedures:

7. 1. 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

   • The StomaphyX device/procedure.

Cholecystectomy:

As a high incidence of gallbladder disease (28%) has been documented after surgery for morbid obesity, Aetna considers routine cholecystectomy medically necessary when performed in concert with elective bariatric procedures.

Hi,

Thanks so much for this info ...

Ok ... I printed the AETNA Clinical Policy Bulletin: Obesity Surgery  booklet a few days ago ... it didn't quite look like a piece of enjoyable weekend reading so put it aside ... As soon as I saw your post I kinda figured it was in there ... yep ... pages 4 - 5 ...

So more restrictions I guess ... hopefully the dr. does one of these "approved " procedures ...

If not, back to the drawing board and countless phone calls (during lunch on my cell with office door closed) ... I forgot how this is like a part time job. I guess nothing worthwhile comes easily.

I see you are in CT. Would you be able to make it to NYC? I found a few in this area In Network.

Best of luck to you with this uphill battle!

Thanks again,
Michele

Yes Michelle, its the beginning, but don't be discouraged...I've learned THIS TIME AROUND TO READ READ READ AND BE INFORMED.  I did not do that with the lap band decision, but it was my decision and I will carry the burden of 2 lost years...

So, once you narrow down what surgeries are approved by your insurance, then do the homework on them.  Just some additonal information, if one of those choices is the DS, please post as many questions as you have with the DS forum, and find an experienced DS surgeon, I understand there is a very good one in NJ. 

Yes, I can travel to NY and NJ, and this is where I am now.  I just had a meeting with my lap band surgeon to discuss my dissapointment with lap band, and to ask for their full support in the revision, and I got it.  However...when I mentions my interest in the DS surgery, I did not get the support, however, I am continuing my quest to get the weight off.  I've received lots of great support, suggestions on this forum, and now I am in the process of reading journals to be informed of this surgery.

thanks and I wish you the best and same also!!!
Janine

Hi Janine,

Did you happen to catch the name of the DS surgeon in NJ?

I am trying to figure out if the Lapband is one of the accepted revisional surgeries. It looks like the Dr. I am going to does the lapband, but there is no mention of BPD/ DS and since I had the gastric bypass that would rule out RYGB. Plus, I went down that invasive road already and like the idea of the same day surgery.

Of course AETNA is closed today, so I am trying to decipher this myself. I don't want any surprises when I go to my appt. on Monday. I also don't want to waste sick time or an office co-pay if this won't be covered.

So, you are looking to go from lapband to DS, and I'm trying to get to lapband?

This site is great! I really was thinking I was the only person in the world trying to get the only bariatric revision ever done...

Its a bit comforting to know I am not alone!

A "quest" is a good way to describe it. My best friend just called. He reminded me of how lining up the initial gastric bypass was difficult.

I'm trying to keep the faith knowing this will change my life for the better (and yours too!)...

I'm going to jump in, since I know who the surgeon in NJ is.

David Greenbaum, MD, FACS
Email: [email protected]

Surgical Specialists of New Jersey, LLC
Rancocas Division
1000 Salem Rd., Suite A
Willingboro, NJ 08046
Phone: 609-877-1737
Email: [email protected]

VERY�respected surgeon, and also capable of the tough cases and revisions. You can find a list of all the top DS surgeons at DSfacts.com

ETA - I should have read further, as I see many mentioned Dr G as being in NJ. That said, I would have been THRILLED to have such a great surgeon within several hours driving distance of me! I ended up flying 30 hours EACH WAY to see a surgon outside the US. A 2 hour drive is spitting distance.

Based on your location, and who I like in that area, I'd send you to Dr. David Greenbaum. Heart + skill. Can't beat it.

www.southjerseybariatrics.com

None of the procedures you mentioned would I recommend if wt loss is the goal.

Thanks ... but have to stay close to home ...

Hi Michelle,

The DS doctor in NJ below.  Yes you are not alone, and everyday is getting easier for me.  The Lap Band is a restrictive surgery only.  I realize my body needs restriction and a surgery that will alter my metabolism.  Yes, the DS surgery will be a very invasive surgery compared to the lapband (I have to say that I was home the next day by 2:00 pm, and my only discomfort was the breathing excercises.)  I went to work the following week.  With the DS, the revision can be lapostropic depending on wether  or not there is tissue or other damage from LapBAnd.  Again, I only have 2 choices to pick from, and I am really receiving lots of information, feedback from many sources, I want to succeed with the revision.   If you want to really be informed about DS surgery, go to dsfacts.com, you'll find loads of information there.  Also, Michelle, don't let anyone scare you, not even your doctors or surgeons about the DS.  When I first started to even explore a revision, my heart was beating a million miles an hour just thinking of first having to explain to everyone else the revision, having to justify it to my lap band doctor (then I realized she knew...she saw me every follow up and saw the scale wasnt budging..it took ME telling her the lap band failed me). 
Wish you the best!

David Greenbaum, MD, FACS
Email: [email protected]

Surgical Specialists of New Jersey, LLC
Rancocas Division
1000 Salem Rd., Suite A
Willingboro, NJ 08046
Phone:  609-877-1737  609-877-1737
Email: [email protected]

Hi Janine,

I'd say about 2 years after surgery I stopped losing weight. I struggled with the whole "oh I can lose it on my own" thing ... which didn't work out.  Finally I got past the whole "I am a loser because this surgery didn't get me to where I thought I'd go" attitude and googled revisional surgery. I came to realize I am not the only one. I also became part of the whole BBW world, going to all of the events and dating men from them.

I had a sort of realization about a month ago. I feel like I am not living the life I deserve, and I feel my weight is playing a big part of it. While I know life will not be perfect, I really think it will get me closer to the things I desire, such as a better paying job and a man that will not take me for granted or feel like he is doing me a favor because he is with me because of my size... I feel like I have to "take what I can get" and it must end.

People who are normal sized don't really get it... They mean well, but to just "go on a diet" isn't as easy as they think it is.   I am not ashamed of having surgery. If it all works out I'm sure every woman I work with will want to know how I lost weight so quickly, and I will be proud to tell them.

So onwards we go ... I am going to keep telling myself that somewhere out there is the right doctor and the right procedure for me ... I guess I am not patient enough