Hi, im looking to do revision to rny i had back in 2005 and im looking for a specialist in Boston area. Any suggestions?

[Karen Pray]

Hi, I'm looking for a specialist in Boston to do revision to rny i had back in 2005. Any suggestions? I wanted to use Doctor greenbaum in morristown New Jersey but he's not in blue cross and blue shield network of doctors covered by my insurance.

 

[Larra]

Hi, Karen, and welcome.
Revising RNY gastric bypass to the DS is a very complex surgery with significant risks. There are only a handful of DS surgeons who do these challenging revisions, and none in the Boston area.
However, if there is no surgeon doing this operation in your network, you can request authorization to go out of network. It isn't your fault of no one in network does this procedure. The real issue is going to get approved for this operation at all. What you need to do is get your Evidence of Coverage (EOC), a lengthy document, usually more than 100 pages, that provides all the specifics of what is covered and what isn't, and what criteria you need to meet for revision bariatric surgery. These criteria are often different from those for a primary bariatric operation. Never, ever rely on some random employee over the phone who says you are covered. You need to read the specifics yourself. The EOC can be obtained through your HR dept if your insurance is through your employer, though what often happens is that the folks there have no idea what you are talking about and you need to speak with managers, supervisors, etc and persist until you find someone who has a clue. If insurance is through your spouse, you go through spouse's employer.
There is a lot of good info in the "insurance" section in a sticky DianaCox wrote awhile back.

 

[southernlady]

Welcome Karen Pray

 

[Karen Pray]

Hi, Karen, and welcome.
Revising RNY gastric bypass to the DS is a very complex surgery with significant risks. There are only a handful of DS surgeons who do these challenging revisions, and none in the Boston area.
However, if there is no surgeon doing this operation in your network, you can request authorization to go out of network. It isn't your fault of no one in network does this procedure. The real issue is going to get approved for this operation at all. What you need to do is get your Evidence of Coverage (EOC), a lengthy document, usually more than 100 pages, that provides all the specifics of what is covered and what isn't, and what criteria you need to meet for revision bariatric surgery. These criteria are often different from those for a primary bariatric operation. Never, ever rely on some random employee over the phone who says you are covered. You need to read the specifics yourself. The EOC can be obtained through your HR dept if your insurance is through your employer, though what often happens is that the folks there have no idea what you are talking about and you need to speak with managers, supervisors, etc and persist until you find someone who has a clue. If insurance is through your spouse, you go through spouse's employer.
There is a lot of good info in the "insurance" section in a sticky DianaCox wrote awhile back.

Thank you so much I think I'm leaning toward distal revision because it's less evasive.

 

[Karen Pray]

There is a good bariatric center at Emerson Hospital, just off rt 2, in concord ma.

They have 2 surgeons that do DS, I don't know if they do revision from RNY, they do a "revision" from gastric bypass, at least if you got the VSG from them. One is named Lautz

Thank you so much

 

[Karen Pray]

Hi, Karen, and welcome.
Revising RNY gastric bypass to the DS is a very complex surgery with significant risks. There are only a handful of DS surgeons who do these challenging revisions, and none in the Boston area.
However, if there is no surgeon doing this operation in your network, you can request authorization to go out of network. It isn't your fault of no one in network does this procedure. The real issue is going to get approved for this operation at all. What you need to do is get your Evidence of Coverage (EOC), a lengthy document, usually more than 100 pages, that provides all the specifics of what is covered and what isn't, and what criteria you need to meet for revision bariatric surgery. These criteria are often different from those for a primary bariatric operation. Never, ever rely on some random employee over the phone who says you are covered. You need to read the specifics yourself. The EOC can be obtained through your HR dept if your insurance is through your employer, though what often happens is that the folks there have no idea what you are talking about and you need to speak with managers, supervisors, etc and persist until you find someone who has a clue. If insurance is through your spouse, you go through spouse's employer.
There is a lot of good info in the "insurance" section in a sticky DianaCox wrote awhile back.

Thank you

 

[DianaCox]

Distal may be less INvasive, but it’s also much less effective, both for weight loss and resolution of comorbidities, and a much less comfortable lifestyle.

 

[JackieOnLine]

welcome, Karen.

 

[Larra]

The statistics on going from proximal to distal RNY are not good. You keep all the negatives of the RNY (possible dumping, possible hypoglycemia, can't take NSAIDs) and get minimal additional weight loss. I wish it were otherwise.

 

[Karen Pray]

welcome, Karen.

Thank you

 

[Karen Pray]

Thank you so much

Thank you

 

[Karen Pray]

Distal may be less INvasive, but it’s also much less effective, both for weight loss and resolution of comorbidities, and a much less comfortable lifestyle.

So what are people doing for roux en y revision?

 

[Larra]

Most people aren't doing anything. They live with (or are stuck with, depending on point of view) their results, good or poor. A few years ago, the hot thing was endoscopic procedures to tighten the pouch and/or stoma. This was self-pay at 10K, still considered experimental and thus not covered by insurance, and not found to be effective. People lost some weight while following the liquid diet for a few weeks after the procedure, and that was it. I don't see much talk about these procedures lately, though I'm sure there are still docs doing them. Another option, again not considered standard of care, is band over bypass, which also has, at best, mixed results. It makes no sense to me to take the least effective bariatric operation (lap band) and add it to anatomy it wasn't designed for, and I don't know what it costs, but I'm sure some people are having it done.
My personal belief, which I can't prove, is that there are a lot more people, like you, who would very much like to revise to, well, anything that would work, but it's much more difficult to get insurance coverage for revisions of any kind than for a primary bariatric procedure. DS does work, and there are people here who have had RNY to DS revision. Even though the DS is a standard of care bariatric surgery, it's still difficult to get insurance to pay for it as a revision, and as I said earlier it's complex and carries very real risks.
IMHO your best bet is revision to the DS, simply because there's no point in subjecting yourself to any degree of risk for something with minimal, if any, potential benefit. But the risks are real and it's up to you what risks you are willing to take.