Im back after 10 years...looking at revision with some questions....

Hi. I haven't been on this site since my surgery almost 10 years ago...It was so helpful to me before and hoping for it to be now. I had a very successful RNY in 2010. I lost over 100 lbs and kept it off for 6. I was really enjoying my life, exercising, eating well, etc. Then of course, life happened....I had a few tragedies, family deaths, and overall stopped taking care of myself the RIGHT way and turned back to food....After a few years of getting my head back on straight I realized I am back where I started and have been looking into revision. I found a great doc in South Jersey in Dr. Greenbaum who will do a revision to a DS. Of course after jumping through all the hoops insurance won't pay for it. I was a self pay before and I plan on doing a self pay again. I have an appointment this week.

Question for any of you who went through Virtua with either Dr Greenbaum or anyone else. Did you have to do the 3 month nutritionist visits if you are self pay? I know I will have to meet with the nutritionist and do all the testing, just wasn't sure if I had to do the 3 months or not. anyone have any insight? Of if not with Virtua any other self pay and what you had to wait for? Did you have to wait the 3 months?

thanks for the help

Michele

Just FYI revision from RNY to DS is a very complicated surgery. There are very few surgeons who can do this revision properly. Make sure your surgeon has done this surgery multiple times and ask to speak to some of his revision patients to get an idea of their results.

Many inexperienced surgeons will tell you they are revising you to the DS but in reality are just increasing the biliopancreatic limb length at the expense of the common channel. This is called a Distal RNY.

This surgery can cause all kinds of issues. Diarrhea and protein calorie malnutrition are a big problem with Distal RNY and it also effects the absorption of calcium, and the fat soluble vitamins A and D. I know people who are severely vitamin deficient after Distal RNY, even when 100% compliant with vitamin supplementation.

Do your homework.

Best wishes to you!

hi yes

I have done a great amount of research and am fortunate in that I live so close to Dr. Greenbaum of Virtua who is one of the few in the country that does revisions. I have done a lot of research for my last surgery and for this one. I am very aware of the risks and also excited to have this done. thanks for the feedback.

What was the issue for ins not paying ? Does your plan not cover it etc?

Hi I am a lapband revision to RNY. I have insurance and now they only want you to see a psychologist, dietician, an upper GI, blood work, and H-pylori test..so no exact time frame it used to be 6months then surgery. now its how fast you can get all this stuff done. The only BS that I am dealing with is that they want you to once again have a >35BMi ...which I am like 33BMI so lets just say I had to have a few rocks in my pocket to be able to have the darn surgery because I dont meet their criterial...so they would rather me gain all the wait back..not just most of the weight...ugh!...anyhoot this is not about me... So I think you might be surprised at the little bit they will require for you. Good luck

Dr. Greenbaum is a very good surgeon. I've heard many positive things about his work.

I would post on the DS board for sure; they might have more help for you, and they also might have advice for insurance issues. Good luck!

Excellent idea! Thank you so much!

Michele

Hi Michele - Your story could be mine. I had a VSG 9 years ago and did great for a few years before both of my parents died, I was diagnosed with MS, I had to have a total knee replacement, and stopped being mindful about my eating.

I saw my surgeon a year ago, prior to the knee replacement, got an insurance denial and just put everything on the back burner until I had my knee replacement. I feel as though I have to have a DS/revision and lose weight before having my other knee replaced. The recovery has been horrible, much longer than it should have been and I know a lot of this is due to being so heavy. I was serious about my rehab. I feel I did all I could

So, I'm seeing my surgeon next week and am hoping we can approach the need for another surgery based on orthopedics. I'm very concerned about not having a good outcome from another knee replacement surgery at this weight.

Thoughts anyone?

There is a safer version of the DS out known as SADI or SIPS. It is still considered investigational by insurance and the ASMBS, but seems to be effective for the weight loss without as many of the known side effects of the DS.

There are endoscopists who are also doing a TORe procedure. Transoral outlet reduction (TORe) The TORe procedure, also known as the gastric outlet reduction procedure, is an EBT specifically for people who have had successful gastric bypass surgery but start to regain weight several years later. Gastric outlet reduction reduces the size of the opening between the stomach and small intestine. This reduces the amount of food that can be eaten, promotes early satiety and portion control, and results in weight loss. Mayo Clinic researchers have demonstrated that in some cases, over-dilation of this opening is responsible for weight regain after gastric bypass surgery. This procedure is nonsurgical and is performed in the endoscopy lab.

One of our endoscopists is doing it where I work and has had really good results. She makes the stomal opening smaller than it was when the bypass was done. Less invasive, and some insurances will pay for this. Just a thought.

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