Shellyac

My insurance does cover me if I wanted to have the surgery in Maryland. The only reason I am going to Florida is that I want to have the band with plication and there are very few doctors in the country that do plication. Overall it will work out for me because my parents live about 20 minutes away from the doctor's office so I will spend the first few weeks after surgery with them. Worse case I may have to fly down every few months for follow ups but it's actually feasable to fly down and back in a single day.

I know, I couldn't imagine having it out of country but I'm not as concerned with out of state because I have a support system in Florida in case I ever needed to go back and I feel that since my insurance is covering the surgery in Florida I should have coverage when I get back. I figure that people run into this problem all the time with people having to move to new areas for various reasons.

I also find it easier to drink protein shakes with a straw. I will usually bit down on the straw to make it as flat as possible and start sucking down a slow but steady stream of the shake. I usually end up not tasting much of the drink at all. I think overall the key is to use as small of a straw as possible, the like the ones used for stirring coffee

Generally it is BMI of 35+ with 2 comorbidities or BMI of 40 or higher with no comorbidities that will easily get you approved for the band of the bypass. The sleeve is tricky. Like I said my insurance says your BMI must be 50 or higher. I think that this is probably due to the fact that the sleeve was initially used as the first stage of the Duodenal Switch which was a surgery that was reserved for the super obese. This requirement may soon change since the sleeve is now becoming accepted a primary procedure for lower BMI patients.

The band with plication is similar to the lap band but in addition to implanting the band you stomach is folded in on itself to form a sleeve and the folded stomach is sutured. The results in that you not have a stomach similar to the sleeve but your stomach is intact. Because the stomach isn't removed it is considered safer and reversible (and by reversible I mean that the procedure can be undone...ie the sutures removed, the stomach unfolded, the band taken out...but there may or may not be physical changes to your stomach after the removal). This procedure is still investigational, the plication can be done alone but as of now i haven't seen it covered by insurance, for me and others the band with plication has been covered by insurance. Another advantage of this procedure is that, like the sleeve, you are not making any changes to the digestive system. Also it appears that the plication helps to prevent some of the common complications of the band, such as slippage and erosion. In addition you don't need to go for fills as often and some people never get the band filled at all. Finally unlike the band alone, plication should make it harder to cheat the band because instead of the foods that can easily slip past the band going into a normal sized stomach it will go into one that is greatly reduced. Again, this procedure is new and there aren't that many US doctors that are preforming it. There haven't been very many studies conducted on it but it does show promise and if the early results hold up,it will provide similar weight loss results as the sleeve.

I think that the reason that doctors prefer the bypass for patients with diabetes is that the improvement is seen much sooner. My diabetes control isn't the best which is the primary reason my doctor didn't want me to have the band, because when compared to bypass weight loss with the band is slower and I believe that both the rapid weight loss and the malabsorbiton are what helps improve the diabetes. The sleeve wasn't an option for me so I'm deciding to go with the band with plication. Since this is a new procedure I'm not sure how long it will take to improve my diabetes but initial results show that weight loss so be similar to the sleeve so I'm hoping my diabetes will be resolved or improved by a year out. Make sure that you are also working closely with your endocrinologist (if you have one), they may have you change your medication immediately after surgery, mine is having me cut down to one medication and the amount I take will depend on my sugars in the morning

I'm not sure if it is the same for all insurance companies but I have BCBS and I was told that the sleeve is only approved for patients with a BMI of 50 or higher

Based on a position paper by the ASMBS in their review of studies on patients that have had the sleeve they found that at a little over a year after surgery 66% of the patients had their diabetes resolved and another 27% had their diabetes improved. My original surgeon also tried to get me to have the bypass because of it's track record of resolving diabetes she also mentioned that they are preforming the bypass on non-obese diabetics because of it's ability to help improve diabetes. I think that regardless of which procedure you decide to do you will improve your diabetes because the number one thing that helps it is weight loss, the bypass will help you lose the weight faster but you should get there with the sleeve.

Although people who have revised post here, I would check out the both the sleeve and bypass boards because revisers tend to be more active on their new procedure boards. Also you may want to consider revision to the band with plication This is a relatively new procedure which combines the band with the sleeve except the sleeve is formed by suturing the stomach instead of removing it. Another advantage is that the band with plication tends to be covered by insurance whereas the plication alone isn't. Good luck with your journey Michelle

By definition a procedure is considered successful in the patient achieves 50% EWL. But If you want to consider 61% a failure then the sleeve should also be considered a failure based on this information from www.sleeveguide.com A multicenter study of 163 patients that Dr. Michel Gagner participated in showed the average patient lost 48.97% of their excess weight in 6 months; 59.45% at 1 year (120 patients); 62.02% at 18 months, and 61.52% at 2 years (98 patients). Other studies have shown similar weight loss, with most patients losing the bulk of their weight within the first 6 months--and keeping off roughly 60% of the weight long-term. This is corrorborated by the 5 year results of the Magenstrasse & Mill operation. In addition 5-9 year follow-up studies have found EWL rates of between 53% and 68% for the sleeves. The article that you cited also reported that there were no major complications, no weight regain seen in the patients two years out, and that plication had the lowest rate of early complication of all WLS. I am choosing to undergo this procedure because initial results show that this will be an effective procedure, Also there was a time when preforming the sleeve as a primary procedure was considered experimental, if it weren't for patients like me willing to take a risk the sleeve would still be limited to patients who eventually needed to have the Duodenal Switch. And finally, I am fortunate in that the banded plication is covered by my insurance unlike the sleeve because of my BMI being under 50. I don't think the banded plication is the right procedure for everyone but I think that it shows promise and I would encourage people to consider it as one of their options. If it weren't for banded plication I would either be having the band alone (and based on the reaction of my original surgeon and from what I have read on these boards I would have maybe a 50/50 shot of being successful) or no surgery at all (I did not want to have the bypass, I was not 100% comfortable with the sleeve and when I found out it was not covered it was definitely out)

Hi, Good luck with your surgery. I'm scheduled to have the banded plication in January and I'm really excited about the potential results. I would recommend that you also visit the lap band board as there are several people there who either already have the banded plication or will be getting it soon. I think that it would be great for you to talk about your experiences there so others can continue to hear about this new procedure and hopefully it can become a more popular procdure Michelle

I will have to disagree with this. While overall the US does have a high standard for healthcare, there is an unfortunate segment of "healthcare" providers that are allowed to operate with little to no regulation. Look at the recent case of patients dying as a result of having lap band surgery in out patient surgery centers that were associated with 1-800-Get-Thin. Regardless of what you think of the outcome, the lapband is considered the one of the safest surgeries you can get. Can you imagine what the death toll would be if these clinics tried to preform bypasses and sleeves? Do not fool yourself into thinking that just because your surgery is done in the US you will get the best care possible. We all need to make sure that do as much research as we can about the procedure we choose, the doctor who will preform the surgery, and the facility where it will be preformed. I have to disagree with your statement that plication has a high failure rate, if you can point me to the research that supports this statement I would like to read it. In the research that I have done, I did find a study where two methods of plication were studied and one method produced much better results. Since at this stage it is considered an investigational procedure I don't think it is fair for anyone especially doctors who are not involved in the research to make blanket statements about the procedure. The American Society for Metabolic and Bariatric Surgery recently released a statement about both plication and the band with plication calling for continued research under controlled conditions, informing patients of it's investigational status, encouraging doctors to report their results. It's also interesting to note that the ASMBS only just recommended the sleeve as a primary procedure in October of this year when they updated their position from 2007 and 2009 based on updated research. I will hopefully be undergoing the band with plication next month. Based on the limited results I have has seen I think that this surgery will be a viable option for people who are unwilling (like me) or unable (due to insurance or other financial reasons) to have the sleeve. The reason that I'm on this board also is I think that I might have similar experiences as sleeve patients. I am not here to convince anyone to not have the sleeve but I will try to provide as much unbiased information as I can about the procedure to those that are still exploring their options. Michelle

Hi Kerri, Welcome to the board. You may want to look into having the iBand also referred to as banded plication. There is a doctor that preforms it in Austin and it might be worth the drive out there to have it done. This procedure is relatively new but there are a few members on this board who either have had it done or a planning to (I'm scheduled to have it done in January). This method combines the lap band with plication (a procedure where your stomach is folded in on itself and sutured to form a sleeve). The advantages are that there isn't the removal of 85% of your stomach, it is should be reversible, and the results to be similar to that of the vertical gastric sleeve. Also when done with the band you are less likely to experience some of the common band complications like erosion and slippage, you should require fill less often (some people have even gone without a fill) and it is harder to cheat the band because food goes into the smaller plicated stomach instead of a normal sized one. Good Luck with your journey. It will be nice hearing from you Michelle

Congrats. Things always work out in their own time. Good Luck with the surgery. I should also be having my surgery in January

I would go back to the med spa and see if they they would be willing to fill out some information after the fact. I think if they at least have your weight at each visit, you might be ok. I have a template that a surgeon's office gave to me to give to my doctor after the 6 months and I think it was good enough. I would be happy to send you a copy if you provide an email address. Also if they can't provide per visit info, see if they would be willing to provide a letter detailing what you did with them for the 6 months You could also try to file an appeal, I think if you at least have some proof like payment records to the spa that will probably help. Worse case if you might have to go through the 6 months again, I know that it seems like a long time to wait but if that is all that stands between you and the surgery then it will be well worth the time.

Hi. I haven't been banded yet so I don't have direct experience but based on some of the comments I've seen in you post you may need to up the amount of protein that you consume, especially if you are still losing your hair. Also are you feeling restriction? Unless you were able to eat the portion sizes you were able to eat before surgery, you shouldn't need to cut down the amount you need to eat if you are in the green zone. I wouldn't be that hard on yourself, it is not your fault if you weren't give the right information after your surgery. You have lost an amazing amount of weight for being only a few months out. I would look into finding out what other people who have good restriction eat and if eating that amount still leaves you hungry then you probably need a fill.

I did watch the video and I have some concerns about it The doctor does not site any research in regards to his claims. You should not trust a medical professional who cannot refer you to research that supports their claims. And you should not trust a medical professional that wants to preform something on you that does not have some scientific evidence to support that it will work. The doctor that made the statement offers both the lap band and the plication to his patients. If he honestly felt that they were dangerous for his patients wouldn't he be ethically obligated to not offer them or is he willing to put his objections aside in favor of getting paid by the people who still want those procedures over his objections or does he plan to change their mind once they come in, which for most will be the day they come in for surgery and probably don't have the time to research the consequences of changing their mind. The ASMBS has published a statement about plication. In essence they say, it is a new procedure. There is insufficient published research to make a decision this time but they support continued research. The ASMBS has also published a statement about the sleeve "The ASMBS therefore recognizes SG as an acceptable option as a primary bariatric procedure and as a first stage procedure in high risk patients as part of a planned staged approach." But you may be surprised to know that that statement was only published in October 2011 This recommendation came after 2 other reports that I assume did not recommend the sleeve as a primary procedure. (I cannot access the articles but anyone with access to Surgery for Obesity and Related Diseases can, they are the first two citations in the sleeve statement). I believe like the plication it was because there was not enough research at the time of the first statement (2007) not an indication that the sleeve was unsafe or ineffective. I am fully aware that the band with plication is investigational at this time and I am excited to be one of the pioneers. If it weren't for patients like me, the sleeve might not have been available as a choice for you. Imagine what would have happened if doctor didn't a patient who wasn't obese enough for the Duodenal Switch (the second phase of the traditional sleeve surgery) the chance to have the sleeve alone.

Question, especially for those of you who have had a TT, then gained and lost again. I am still hoping to have kids someday and wanted to know if would be better to try to hold off on having a TT until I know that there isn't a chance of any(more?) kids or would it be ok to have it as soon as I'm ready. I guess it's something that I would want to go through one but i want to make sure I get the best bang for my buck. I think I remember reading on one of these boards and I know I heard it from a friend who had the bypass that insurance will pay for some skin removal after weight loss surgery. I think that you will have to have your doctor document that the excess skin is causing physical problems like rashes in the folds or things like that. You may be able to find out what is covered by looking at your insurance's EOB. I think that you might to refer to it in a special king of way to make sure they cover it. Also I think it was also mentioned that you could "upgrade" what insurance will cover and just pay the difference

BTW I am a member of all three boards. I guess the reason why I am fanatical about wanting people to stop trying to push their procedure by bashing the other is that I feel that the banded plication will give me something in common with all three and I would like to be able to share and learn without judgement

I am sold on the band with plication but I still feel that I can both learn about what to expect after surgery on this board as well as the lap band board. I did seriously consider the band earlier this year. From the time I decided I was interested in weight loss surgery I always thought it would be the band, I think at some point 4 or 5 years later (the main reason for the delay was working for a small business that was excluded from having to cover bariatric surgery) I had finally finished all of my pre-op requirement and scheduled my surgery when my surgeon for I believe the 4th time wanted me to reconsider and have the bypass. And for the first time the office coordinator also tried to get me to consider bypass they even told me that the bypass was reversible! Needless to say when I left the office, after finally nailing down the date I was going to change my life and having two of the people who should be supporting me the most doubting that I will be successful , i was nearly in tears. I took their doubt seriously and began to research both the bypass and the sleeve because I was determined to be successful with whichever surgery I ended up doing. I had decided that I would have the sleeve. My cousin had it done in June of this year and I knew that she would be a good gauge of how I would be able to cope because as I'm sure nearly all can sympathize with, I come from a family of eaters. I was also interested in the sleeve because if I was going to do something where I couldn't "un-ring the bell" I wanted to go with the procedure that would at least leave me with the most normal system. That is when I joined this forum. It was hear that I also learned about plication as a option and for me it was that light bulb moment. From what I read about plication, it would give me the restriction and digestive system of sleeve with the permanent removal that gave me anxiety about have the sleeve. Even then there were some obstacles, my original surgeon did not preform plication and even if I wanted to go ahead with the sleeve my insurance would not cover me because my BMI is under 50. Also it seemed that stand alone plication was only starting the process of clinical trials so I would have to wait until it was approved. Finally I stumbled across Hollywood Bariatric's website and everything fell into place. The offered the band with plication, my insurance would pay for it 100%, and they are located about 15 minutes away from my parents home so I could travel to have the surgery and have a place to recover for free until I am able to return home. I know that this a new procedure and that I am stepping into the unknown but there was a point not too long ago when the first sleevers were doing the same thing. I have high hopes for this procedure not as a replacement of the sleeve but as a was to bring in the people like me who didn't want to consider an irreversible procedure, or those who don't qualify for the sleeve, and hopefully also make the band surgery a safer procedure overall. I'm not surprised that you haven't heard of the band with plication, if it weren't for the pressure to reconsider the band I wouldn't have found out about it either. The reason I posted those quotes wasn't because I didn't know the correct answer (which is of course the one you gave) but because that I felt that they illustrated what I see as the biggest problem on these boards, I would be willing to bet that these same conflicting statements could be found within a some thread on the lap band board on why the band is better. That problem is that people are so caught up in justifying their decision and trying to convince others to make the same one that they don't realize that they are misinformed themselves. Another question I have for those of you who have revised from the band to the sleeve, especially those of you who were in the green zone, does the feeling of restriction differ with the sleeve than with the band or even with that stuffed feeling with overeating with a normal stomach? It would be helpful to know which feeling restriction I will be similar to once I'm finally on the other side. Michelle

I am planning on having this done in January. While it is a new procedure, my insurance is covering it because at it's core it is a lap band procedure, it's like the doctor is throwing in the plication for free. I would encourage you to consider the procedure if possible. It looks like the banded plication will help to reduce the risk of band slippage and erosion. Also you'll need fill less often and possibly not at all. The other advantage is that you will not be able to eat around the band. With the plication, if you eat slider foods they will go into a reduced stomach and you will have to stop eating. With the regular band you could eat as much of the slider food as you could before the surgery. If this is something you decide you want, you should see if your doctor will accept the insurance's payment for the band as full payment for the banded plication, and if not ask them what the price difference is and see if it is affordable. I have a feeling that doctors are more concerned about finding patients willing to do the procedure than getting extra money for doing it. Michelle

Here is a prefect example of why it is so damn difficult to talk to people who choose a procedure different than the one you have chosen: Which one of you are correct? If anything I think that this illustrates that most of us aren't as informed as we think about the other procedures. We hear about these procedures and then there is the one that you know is right for you and then you start researching. For some you're just looking for all of the positives of what you want to do and reject anything negative. For others you see and hear what can go wrong and realize that you want to go with something with less "risk" and never look back. And for others you keep an open mind and acknowledge that you choice as both benefits and risks and work to come to peace with your decision. I find it funny that I have not once questioned a person decision to get the sleeve yet nearly every post since mine and been to tell me why my choice is the wrong one. To me it seems like a classic case of cognitive dissonance in the sense that those with the sleeve have made a choice that cannot be reversed or fixed so there is nothing so in order to be at peace with your choice you have to believe that all other options are inferior. I AM NOT SAYING THAT SLEEVERS REGRET THEIR CHOICE. For those of you who think I am making the wrong choice do you think that I should just not have surgery because I cannot afford to pay for the sleeve on my own, and my insurance will not cover the sleeve. If I should just get the bypass then why didn't you get it instead of the sleeve? Or should I just stay obese because I can't get the surgery that you have? For those of you who have an issue with having a foreign object inside your body, are you planning on telling your doctor no if she says that you need a pacemaker to help your heart or you need an artificial knee to help you walk? Oh and I thought those staples that were used to form your new stomach were permanent. I already have my back up plan in place. I am having the band with plication. I will not be able eat around the band because of the plication, and initial studies have shown that this procedure results in a lower risk of band slippage, band erosion, and there are fewer fills needed and they don't need to start until much later than with a regular band patient or may not be needed at all. Also I have yet to hear of any banded plication patients that have needed to be revised, the closest I have seen was one person who said that banded plication was a planned first step in her weight journey. I have honestly learned alot of great info from people on this board. I think that we have several things in common and can share our experiences. We will have the name nutritional needs since we don't have to deal with malabsorption. We should loose weight at similar rates (that is if we all follow our post surgery diets correctly, especially the banders) I think it is important to those of you who needed to revise to go the lapband board and give advice to those that are having problems and frankly there are some people who are on there who you can tell from jump are making the wrong choice but unless they go to the revision forum they won't have anyone to show them the error of their ways. I would be interested in hearing why you chose the band the first time? Was the sleeve not available? Did the reality of getting the fills or how you had to eat and what you could eat differ from what you expected how so? Looking back is there anything in the pre-op process that was a warning you ignored that could have saved you the grief of two procedures? Is there anything post-surgery that could have helped you not need to revise? I always feel like the people who post that their band it tight and think it is a good thing because they need to lose weight are going to be the ones that get in trouble down the line because they'll end up eating around the too tight band or their band will start to erode or slip. I'm sorry if I tend to ramble but I'd like to hope that we can turn these boards into a place we help get the people who come here for advice to be best for them. I think it is a disservice to discourage someone with a lower BMI who's insurance is never going to approve them for the sleeve from having the band, bypass, or plication. I would rather have someone have a procedure that will help them as long as they put the right amount of work in and do it fully informed than decide to not have one at all or going into a another procedure expecting to eventually fail.

I totally agree. If you are referring to my post as one of those comments, I'm sorry but intention wasn't to say that doctors is other counties aren't as good as the ones here but rather to to say that we need to be aware that these issues could easily happen here. It is dangerous for us to think that we are immune from bad doctors just because we are in the US. There are bad doctors everywhere and we're probably more at risk because our healthcare system allows so many people to fall through the cracks that some people are willing to take more risks in order to get the care they need.

I know I'm a bit late to this party but one of the first things my surgeon said to me is that obviously I can tell you to eat a tiny meal three times a day and if you did that you will lose weight but then eventually you are going to get hungry and gain the weight back. What surgery is about is to make me comfortable in that when I now eat those small meals, I will not have the desire nor the ability to eat anything more and I will not feel deprived