I'm so excited!!

[Larra]

@Stormy the good news is that the silastic will be far easier to deal with than mesh would have been. The bad news is that your surgeon is someone I've never heard of as doing the DS, let alone a revision of VBG to DS, which is far more difficult. So I looked up his website and he (and his associate, Dr. Carlin) offer gastric bypass, sleeve gastrectomy, and lap band. That's it. DS isn't even mentioned. If he's perhaps just starting to do the DS (doubtful, but I'm giving the benefit of the doubt here), your complex revision is not the right way for him to get started.

what I predict is going to happen is you will, at best, end up with a sleeve gastrectomy. You're not going to get a DS from a surgeon who doesn't do the DS. I also predict that your surgery will be open, though this would probably be the case with any surgeon. This is not the surgeon's fault, it's because with the huge incision and lots of operating around the stomach from your last surgery, you probably have significant adhesions (scarring on the inside) that will make laparoscopic surgery unsafe or impossible. Even to go from VBG to sleeve, the surgeon must completely take apart the gastroplasty, THEN restore your stomach to its original anatomy, and THEN make the sleeve.

You started out this thread by saying how excited you are. I get it, and I hate to rain on an excited person's parade. But these are the realities of revision surgery and the realities of going to someone who may be an excellent surgeon, but for an operation he doesn't do. You really, really need to step back and consult with an experienced DS surgeon who is further experienced with revisions to the DS. This is extremely complex surgery that most bariatric surgeons don't do. The realities of revision surgery are not pretty. With the possible exception of revision from lap band, and even these are sometimes challenging, most revisions are far more difficult, far more high risk, often done open, and should only be done by surgeons who are not just experienced bariatric surgeons, but experienced with the specific operation in question.

 

[Clematis]

@Larra She's not asking for a DS but a RNY.

 

[Stormy]

Diana beat me to it. There is no way you had a sleeve 20 years ago. It didn't exist at that time. You had a VBG, or maybe a gastroplasty without the band. But definitely a gastroplasty, which was a forerunner of the gastric bypass and which is so out of date it's no longer considered standard of care. It is NOT your fault that this operation failed. the staple line disruption you have is extremely common with this operation, which is why it has fallen out of favor. With loss of restriction and never had any malabsorption or metabolic alteration, you in effect have no tool whatsoever to help you.
So first of all, stop kicking yourself for failing. You didn't fail, the surgery did, as it did for so many other people that it's not done anymore. Next, consider your options for the future. The DS would far and away be your best choice as it would give you a combination of moderate restriction with significant malabsorption and metabolic changes to not just help you lose weight but help you maintain that weight loss. It would also allow you to continue taking NSAIDs (or take them in the future if you don't need them yet), no dumping, no laundry list of forbidden foods, you can drink liquids with meals, etc.
If you think people can't cheat with gastric bypass, guess again. On average, people with gastric bypass lose maybe 60% of their excess weight, though of course there is a range of results. The failure rate, and rate of regain, are substantial. If someone has told you you can't cheat or you can't regain, they lied. If you think dumping will prevent "cheating" or regain, you are mistaken. Dumping is not a weight loss tool, it is a very nasty side effect that some (not all) people with gastric bypass have. Most responsible RNY surgeons will tell patients that after the first 18 months at most, continued success depends entirely on behavioral changes.

The biggest question will be, what is possible, depending on what damage has been done to your stomach, esp if any mesh was used. Sometimes the scar tissue around the stomach is so bad that it can't be safely revised, and all the surgeon can do is create some malabsorption for you. You really need to have your surgery with a surgeon experienced with difficult revisions. Dr. Kenmeter is a great suggestion.

btw, I have no idea why this post switched to italics , or how to get it to switch back. And I'm not saying all this to discourage you, just to get across that your situation is very complex and just any bariatric surgeon won't do.

My surgeon told me the same thing about the staple line disruption. It wasn't known at the time that this surgery would eventually fail so now it is no longer used. I had Silastic Ring Vertical band Gastroplasty by Jr. John Stoner in Iowa. My surgery was done in 94/95 and really started gaining about 2007. I blamed it on a bad marriage and consoled myself with food since I don't drink. When I realized I could eat a whole meal I started worrying. Sometimes I eat a bite or two and I'm full and other times I can eat more. I still get food stuck and have to expel and that depends on which direction it is going once I swallow. I'm excited about having surgery and curious about the DS. I do remember in class the rep talking about the switch but I will have to review all my folder info today. Thank you for your concern.

 

[DianaCox]

<Shrugs> If you go to a Ford dealership, they are NOT going to tell you how much better for you a Mercedes is than a Ford - they are going to sell you a Ford, no matter what is in your best interests.

You are unlikely to be getting a DS at all from these people, and sure as **** not getting it done by a skilled DS revision surgeon when we have never even heard of this group doing a VIRGIN DS. And if you settle for an RNY because that's all they know how to do (nevermind your insurance issues - they can be overcome - we help people do it all the time), that will be a damned shame.

It's your life - you happen to have stumbled upon the most knowledgeable and experienced group of DS patients (many of us with advanced science and medical degrees) - but if you choose to ignore the vital information we are giving you, the result will be on you.

 

[Stormy]

@Stormy the good news is that the silastic will be far easier to deal with than mesh would have been. The bad news is that your surgeon is someone I've never heard of as doing the DS, let alone a revision of VBG to DS, which is far more difficult. So I looked up his website and he (and his associate, Dr. Carlin) offer gastric bypass, sleeve gastrectomy, and lap band. That's it. DS isn't even mentioned. If he's perhaps just starting to do the DS (doubtful, but I'm giving the benefit of the doubt here), your complex revision is not the right way for him to get started.

what I predict is going to happen is you will, at best, end up with a sleeve gastrectomy. You're not going to get a DS from a surgeon who doesn't do the DS. I also predict that your surgery will be open, though this would probably be the case with any surgeon. This is not the surgeon's fault, it's because with the huge incision and lots of operating around the stomach from your last surgery, you probably have significant adhesions (scarring on the inside) that will make laparoscopic surgery unsafe or impossible. Even to go from VBG to sleeve, the surgeon must completely take apart the gastroplasty, THEN restore your stomach to its original anatomy, and THEN make the sleeve.

You started out this thread by saying how excited you are. I get it, and I hate to rain on an excited person's parade. But these are the realities of revision surgery and the realities of going to someone who may be an excellent surgeon, but for an operation he doesn't do. You really, really need to step back and consult with an experienced DS surgeon who is further experienced with revisions to the DS. This is extremely complex surgery that most bariatric surgeons don't do. The realities of revision surgery are not pretty. With the possible exception of revision from lap band, and even these are sometimes challenging, most revisions are far more difficult, far more high risk, often done open, and should only be done by surgeons who are not just experienced bariatric surgeons, but experienced with the specific operation in question.

I have HAP insurance and this is the ONLY place I can go for bariatric surgery. they no longer do lap surgery because of the failure rate. Now I'm nervous.

 

[Clematis]

We are not trying to give you a hard time @Stormy we are merely afraid for you.

Think twice, cut once. Well I guess you already cut once but that was so long ago you now get one more chance.

There are ways around difficult insurance companies. Not only are their physicians here, but also attorneys -- who have had the DS themselves.

Please do more research -- research that you get from somewhere other than this surgeons office. (The Ford vs Mercedes sales principle)

 

[DSRIGGS]

I have HAP insurance and this is the ONLY place I can go for bariatric surgery. they no longer do lap surgery because of the failure rate. Now I'm nervous.

Stormy what we are trying to tell you is that the RnY has a very high failure rate and the DS does not. If you go ahead with an RnY your results have a strong probability of being like you have now and you have a high probability of getting dumping syndrome which makes people miserable.

Many people self pay and these two ladies you are talking to, @DianaCox and @Larra are more knowledgeable than you will ever know and they have helped countless people who believed their insurance wouldn't cover/approve the DS.

 

[Stormy]

<Shrugs> If you go to a Ford dealership, they are NOT going to tell you how much better for you a Mercedes is than a Ford - they are going to sell you a Ford, no matter what is in your best interests.

You are unlikely to be getting a DS at all from these people, and sure as **** not getting it done by a skilled DS revision surgeon when we have never even heard of this group doing a VIRGIN DS. And if you settle for an RNY because that's all they know how to do (nevermind your insurance issues - they can be overcome - we help people do it all the time), that will be a damned shame.

It's your life - you happen to have stumbled upon the most knowledgeable and experienced group of DS patients (many of us with advanced science and medical degrees) - but if you choose to ignore the vital information we are giving you, the result will be on you.

I'm not ignoring this information as it is all new to me just within hours of posting my first time. I am now worried and starting a list of questions to ask. I thank you for your concern and letting me know there is another option that I will review with my team. I'm almost sick about this now.

 

[DSRIGGS]

I'm not ignoring this information as it is all new to me just within hours of posting my first time. I am now worried and starting a list of questions to ask. I thank you for your concern and letting me know there is another option that I will review with my team. I'm almost sick about this now.

Don't be sick hon, be thankful you found this site before you made a final decision. You have very good options. It may take a little longer than you intended but you are doing the right thing and can have a great outcome. Help is available.

 

[Stormy]

Stormy what we are trying to tell you is that the RnY has a very high failure rate and the DS does not. If you go ahead with an RnY your results have a strong probability of being like you have now and you have a high probability of getting dumping syndrome which makes people miserable.

Many people self pay and these two ladies you are talking to, @DianaCox and @Larra are more knowledgeable than you will ever know and they have helped countless people who believed their insurance wouldn't cover/approve the DS.

There is no way ever I could afford this surgery on my own. I wish I had those choices! As of now I have to have $2000 paid before surgery in a couple of weeks. This will give me time to explore other options because right now I have 2, the RnY or the sleeve.

 

[Stormy]

We are not trying to give you a hard time @Stormy we are merely afraid for you.

Think twice, cut once. Well I guess you already cut once but that was so long ago you now get one more chance.

There are ways around difficult insurance companies. Not only are their physicians here, but also attorneys -- who have had the DS themselves.

Please do more research -- research that you get from somewhere other than this surgeons office. (The Ford vs Mercedes sales principle)

What is the approximate cost if I were to pay on my own? I do know other ladies with the RnY that have gained back their weight. One gal is 14 years out and she has gained about 80 pounds so she wants to start over with me since she already has the tool.

 

[Larra]

@Stormy, there is a lot of confusion on this thread and I apologize for my contribution to the confusion. You just added slightly to the confusion by saying they no longer do "lap surgery", when I think you mean they no longer do lap band surgery, which is just as well as it does indeed have a high failure rate. But "lap surgery" to most people means ANY operation done laparoscopically, not lap band surgery.

Now, to try to clear up my own confusion, I now understand you are having revision to gastric bypass (aka RNY) because your insurance only covers this one center that only offers RNY and sleeve. At least, I think that's why you made this decision, that and because you didn't know anything about the DS. So your next step is to get your hands on your EOC (evidence of coverage) to see EXACTLY what is covered by your insurance. For example, let's say the DS is covered, but going to any surgery group other than this one in Detroit is NOT covered. Well, it's not YOUR fault they don't do the DS, and if there is no one in network who does it, you can get them to pay for it to be done out of network. We see this issue all the time.
Your EOC will also tell you your appeals rights, if any. This is not your little summary of benefits, you need the whole EOC, which is a lengthy document, usually at least 60 - 100 pages, to see what your coverage is for bariatric surgery and your appeals rights.

I get that you would rather be excited than worried, but you owe it to yourself to learn as much as possible about ALL your options, not just the very limited option of exactly one center that your insurance is trying to push you into for financial reasons. Get that EOC and we will go from there. I also realize you may decide to stick with the plan you have and hope for the best, and we will all be wishing you the best if that is your choice. But make an informed choice, and understand the pros and cons and limitations of that choice.

 

[DianaCox]

The DS is a standard of care option. If your facility can't provide a surgery that you have a letter of medical necessity from a qualified surgeon saying that you NEED (which you may have to get via an outside second opinion consult, self-pay if necessary but they aren't that expensive), then almost certainly your insurance is REQUIRED to pay for you to get that surgery out of network at in-network rates. You need to obtain a copy of your insurance contract, called the Evidence of Coverage or something like that, and it should be the FULL CONTRACT not just a summary of benefits - we will read it and let you know how to (1) request an out of network consult for a revision to a DS; (2) obtain the OON consult and LOMN, even if they refuse to pay for it; and (3) how to appeal, where it is highly likely you will win.

Many people here have traveled far and wide to get a proper DS, and have even self-paid rather than settling for an inferior surgery. How much is your life worth?

 

[DSRIGGS]

@Stormy

Self pay is expensive but as these two great ladies are stating they can help you do everything you can to get your insurance to cover a ds revision, if you get the information they are asking for... No guarantees but they will give you the best chance of making that happen so hopefully self pay doesn't come in to play

 

[newanatomy]

I'm not ignoring this information as it is all new to me just within hours of posting my first time. I am now worried and starting a list of questions to ask. I thank you for your concern and letting me know there is another option that I will review with my team. I'm almost sick about this now.

You are doing the right thing by taking this slow and asking questions. Do not rush into anything, especially another surgery.