revision from band to sleeve ?'s

Hi everyone,

I had originally posted this in the VSG forum but someone there suggested I post here.  I had missed this forum before somehow.  I apologize if this is the second time you are reading it, please bear with me...  My consult is on friday morning and I am trying to prepare as best I can.  I am going to bring in a LOT of notes with me so i remember everything I need to say.

I was banded in 2008. Since the initial surgery took place, my hunger never subsided and I have never felt satiated. I have had MANY tests but nothing like obstruction or stricture has ever been found. I experience occasional chest pain and reflux, port site pain and I throw up nearly everyday. And very odd, but since I was banded, i get pneumonia once or twice a year (strange). I have had almost everything taken out of my band too, so it is nearly empty. From 2008-2011 I only lost 25lbs and have struggled a lot. In 2011, I discovered Medifast and at that point, was able to lose 80lbs. It got too expensive and after stopping last year, I have gained it all back again. My BMI is back at 40.3.

I am not sure what to do. I am thinking about getting a revision to the sleeve. Not sure how I can have these issues but nothing has ever shown up in testing? My insurance will only cover revision/removal if they deem it "medically necessary". As nothing concrete has ever been detected, not sure if I am stuck forever. I feel a little hopeless at this point.  I do have an initial consult on Friday for sleeve revision but honestly don't want to say the wrong thing.  So far, previous doctors haven't diagnosed any band problems so not sure if the revision will be covered by insurance or not.  I just want to be able to lose weight!!

My insurance coverage reads like the below...  Anyone have any thoughts/suggestions?

Cigna covers revision of a previous bariatric surgical procedure or conversion to another medically necessary procedure due to inadequate weight loss as medically necessary when ALL of the following are met: • Coverage for bar iatric surgery is available under the individual’s current health benefit plan. • There is evidence of full compliance with the previously prescribed postoperative dietary and exercise program. • Due to a technical failure of the original bariatric surgical pr ocedure (e.g., pouch dilatation) documented on either upper gastrointestinal (UGI) series or esophagogastroduodenoscopy (EGD), the individual has failed to achieve adequate weight loss, which is defined as failure to lose at least 50% of excess body weight or failure to achieve body weight to within 30% of ideal body weight at least two years following the original surgery. • The requested procedure is a regularly covered bariatric surgery (see above for specific procedures). NOTE: Inadequate weight loss due to individual noncompliance with postoperative nutrition and exercise recommendations is not a medically necessary indication for revision or conversion surgery and is not covered by Cigna.  

I am hoping they won't just view me as a failure.  I have tried and tried to stay on path but still get so hungry.  I am told the sleeve removes the hunger hormone which is why it is appealing.   Anyway, any feedback is appreciated!!! Thanks all!!

I have Cigna also.  I was banded in 2003 and did well for the first 5 years or so and then the problems started.  I have scar tissue around my port you can feel it with no problems.  This is causing pain and I am no longer able to get fills.  Also, the heartburn is like a 10 fold for the last year and I have nothing in my band.  With just those two things Cigna did approve to have my band out.  I am now waiting for them to approve me for the bypass. 

Good Luck

can't speak to your revision. Needs but I can tell you that the pneumonia you have gotten once or twice a year since you were banded,is likely" aspiration pneumonia", where you are sucking reflux/gastric juices into your lungs,probably while you sleep and it is causing the pneumonia. 

That may help as a medical necessity to get your revision.

GL