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I was finally able to get some clarification regarding my coverage. Knowing what to expect puts me at ease. Gastric Bypass Surgery (Bariatric Surgery) is covered only if specific medical criteria are met:  Bariatric surgery may be indicated for patients 18 to 60 years of age. Requests for bariatric surgery for patients less than 18 years of age should include documentation that the primary care physician has addressed the risk of surgery on future growth, the patient's maturity level and the patient’s ability to understand the procedure and comply with postoperative instructions, as well as the adequacy of family support. Patients above 60 years of age may be considered if it is documented in the medical record that the patient’s physiologic age and co-morbid condition(s) result in a positive risk/benefit ratio. • The patient has been clinically evaluated by an MD or DO. The physician has documented failure of non-surgical management including a structured, professionally supervised (physician or non-physician) weight loss program for a minimum of six consecutive months within the last four years prior to the recommendation for bariatric surgery. The six consecutive month weight loss program listed above is waived for super morbidly obese individuals who have a BMI ≥50. Documentation should include periodic weights, dietary therapy and physical exercise, as well as behavioral therapy, counseling and pharmacotherapy, as indicated. • Documentation that the PCP and the patient have a good understanding of the risks involved and reasonable expectations that the patient will be compliant with all postsurgical requirements. • A psychological evaluation must be performed as a pre-surgical assessment by a contracted mental health professional in order to establish the patient’s emotional stability, ability to comprehend the risk of surgery and to give informed consent, and ability to cope with expected post-surgical lifestyle changes and limitations. Such psychological consultations may include one unit total of psychological testing for purposes of personality assessment (e.g., the MMPI-2 or adolescent version, the MMPI-A). • The physician needs to be aware and follow-up with individuals who have had gastric surgery for any long-term complications. • In cases where a revision of the original procedure is planned, documentation of all of the following is required: - Date and type of previous procedure - The factor(s) that precipitated failure - Any complications from the previous procedure that mandate (necessitate) the takedown - If the indication for the revision is a failure of the patient to lose a desired amount of 51 weight then the patient must meet all of the initial preoperative criteria. Note: The following surgical procedures are considered experimental/investigational because their safety and/or effectiveness have not been proven: • Loop gastric bypass gastroplasty - also known as mini-gastric bypass • Stomach stapling Endoscopic procedures to treat weight gain after bariatric surgery to remedy large gastric stoma or large gastric pouches are considered experimental/investigational.

I also had the revision for GERD, Gastritis and Esophagitis and I'm very happy that all that has been resolved. But I'm also very happy with the weight loss. As you can see below, I gained almost all my initial weight that I had lost after the sleeve. I felt like a complete failure and a fool for having thrown away my chance at a normal weight. I know this revision is my second chance to do it right and learn from my mistakes. Here are my stats over my 6 year journey. Highest weight May 2012 - 222 lbs. Gastric sleeve surgery weight November 2014 - 212 lbs. Lowest weight post sleeve May 2015 - 151 post op 6 months (61 lbs. lost) Highest weight prior to revision surgery January 2019 - 205 lbs. (54 lbs. gained) Weight day of revision surgery October 2020 - 185 lbs. Current weight March 2021 (5 months post op) - 138 lbs. (47 lbs. lost) I hope that I never have to add a line that says I've gained weight back again!!!! Good luck on your journey!!!!

@Paradigm Star I didn't feel much restriction immediately following RNY either. At least not like I did after VSG. But as time has gone by, it's not really restriction that I feel as much as just feeling full. And yes, I do feel hungry at time. I had a ZOOM meeting with my support group yesterday and the dietician even commented that revision surgery patients don't always feel like the "virgin" RNY patients - maybe because we've "been there, done that", we know what is going on and what to expect and there isn't that huge jump from a normal stomach to 1/4 stomach like we had with the VSG. So we went from 1/4 stomach to 1/8.....not as drastic of a change. But I know I feel great and have a ton of energy at almost 5 months post op. I feel like I'm fully healed inside. I'm glad you had the surgery. It should help, or eliminate, the gastric issues you were dealing with.......and you'll get to lose some weight in the process!!!

Pain after revision was significantly worse than any of my other previous abdominal surgeries (myomectomy, sleeve, hysterectomy, colostomy reversal). I expected it based on the amount of scar tissue I have but it still shocked me upon waking up. Each day it gets easier. This group has really helped me this week. Any suggestions on how to get all my protein in since I’m going home soon?!

I had a Vsg revision to bypass on 03/23 I’m feeling okay there’s more pain this time around. I am able to sip liquids okay but the purée are not sitting to well. They’re waiting on signs that my bowels are active again then I should be discharged.Good luck and speedy recovery to all March Surgeries 😊😊

If you don’t mind me asking, what is the reason for the revision? I am a rny patient. 6 yrs out. I had lost 170 pounds and now have regain 50. This puts me 100 from my goal weight. I am hoping a revision would jumpstart my weight loss again and help me reach my goal weight.

Unfortunately a lot of people are in the same boat after a revision. No restriction really stinks and is quite a shock when it is all said and done. We pretty much have a funnel where the food goes straight into the intestines, so the food just slides right on through is my understanding. What are you eating and how often ? I find I get more of a fullness feeling when I eat solid protein like steak or salmon. It really comes down to making the best choices you can in what you are eating and eating every 3 to 4 hours and make sure you dont drink until 30 min after a meal or you are just washing it out.

So here is my story and already I know your being able to help me is a long shot. I had my stomach stapled in 1999. I lost 100 pounds but the metal ring that was placed at the bottom of my stomach eroded through. Later I learned this is why they do not do this procedure anymore. I then had a conversion surgery to a gastric bypass in 2012. This was following the death of my daughter. I lost 30 pounds but that was from no appetite due to depression. I never had restriction from the surgery. I had a revision in 2020 (October)) again I have no restriction and am not losing weight. I have done everything I was told and it did not work again. Have you ever heard of this? My pouch is an appropriate size, but I can still eat? Why doesn’t it work for me? Why can I still eat? Do I need a ring or device to truly have restriction? I need some help and answers.

So, I am almost 2 weeks out. My sleeve never healed correctly, and my surgeon reccomended revision to rny. I was like you. Sleeve, no problem, I can still eat, just less, but rny terrified me because of dumping. Recovery has been harder for me with this, but, weigh in last Friday, I was told to move ahead to purees, because I've lost so much already. It's getting easier everyday. I know I will be thankful I did this. I'm right ahead of you, so message me if you need any support. You've got this!

Greetings to everyone, On May 2, 2016, I received my VSG from my Bariatric Surgeon. Fast forward to February 2019, I start getting experiencing abdominal pain, nausea and vomiting that my general GI specialist couldn’t figure out what was wrong with me. Diagnostic testing revealed a raw sore in my esophagus, a hiatal hernia, and the medical professionals couldn’t diagnose why I was experiencing abdominal pain in my gut. As time moved on, my aforementioned symptoms got worse and worse where I couldn’t keep down my food and medications. Now jump to March 10, 2021, I have my first surgical consultation with the Bariatric Surgeon that had put in my VSG in 2016. My Bariatric Surgeon recommended a revision from the VSG to RYGB to fix my hiatal hernia and the rest of my digestive symptoms. Dr. Chen has fast tracked my RYGB surgery to Monday, March 22, 2021. I have to admit to everyone that in 2016 when I the VSG, I was fine with it. However, now with the RYGB surgery within 48 hours of this posting in the BariatricPal forum, I’m getting nervous to having this surgery. One of the main reasons why I’m nervous is about having the RYGB surgery is the possibility of complications and after having surgery, and the dumping syndrome that seems to be common with a lot of individuals who get the RYGB surgery. Fortunately for me, while I was recovering from the VSG, I was not subjected to dumping syndrome. Can anybody share with me about your own experiences with getting the RYGB surgery? How was your recovery period? How was it going from a clear liquid diet to a full liquid diet to purée foods, etc. Share your thoughts and feedback. I would greatly appreciate that very much.

Revision is such an interesting topic! I'm hoping I can get the rest of my weight off on my own, but my Surgeon and Endo are talking about some sort of revision that might help my reactive hypoglycemia. I hope everyone does well with their revision and appointments! I would also love to hear how everyone is doing after!

I had the sleeve in 2017, and revised to bypass in December 2020 due to GERD and weight regain. Since the bypass in December I have lost 25kg (55 lbs). - current weight 187 lb. Weight loss for me now seems to be slower then the first time around, however I am ok with that. Since my revision I also have had NO more symptoms of GERD. Am so happy I was able to ge this revision, weight is steadily coming off. Hope this helps a bit

This is helpful. I was sleeved in 2018 and never had adequate weight loss no matter what I did. My insurance approved my revision after having 6 nutrition visits and my Dr stating it was medically necessary. My revision is scheduled for this upcoming Monday

I was sleeved before my revision. It took a little bit, but I enjoyed everything you listed. It's why I wanted bypass in the beginning because I needed something to really help me with that. I'm not typical. Wasn't a big eater before sleeve or after. A regular day for me was 700 calories, but I drank my calories, lol. Mostly in coffee. I could drink coffee all day & be fine, then maybe a little bit of steak w/ veggies for dinner. But if we were on vacation, forget it, I would eat ALL the things. I could still eat everything I did pre sleeve, after the sleeve. It was just that waiting period waiting for my sleeve to heal. I LOVE sparkling water, and I keep picking up a can and staring at it, lol. My sleeve recovery was super easy. You'll do great!

I wouldn't do the lapband at all, and I'm surprised your surgeon still does them. Few surgeons do those anymore and lots of people have had theirs removed because of complications. if you have GERD, just know that it gets worse for about 30% of sleeve patients. You may be OK with that amount of risk - I was not, so I went with bypass. Bypass usually (but not always) improves if not outright cures GERD. Having GERD won't prohibit you from getting the sleeve, though - but just know your risk if you do have it and you decide to proceed with the sleeve. Sometimes it can be medically managed, but we do see a fair amount of revisions to bypass on here if the GERD gets really severe (and again, that doesn't happen to most people - but it does happen to some..) P.S. Malabsorption issues aren't common with bypass AS LONG AS people are consistent about taking their vitamins. There are some people who can't absorb iron very well from oral supplements, so they need to go in for occasional infusions, but most of us absorb iron from pills just fine. As far as other nutrients, again, as long as you keep on top of your vitamin regimen, problems are rare.

My story started in 2012 my moms doctor told me if I lost weight we could work on me being her living donor. So I went to my doctor said I need this to save her life help me. We got me set up for the sleeve. At almost 300 pounds I would have done anything to help her. I had the sleeve done March 2014 and after getting to 190 her doctor told me I couldn't be her donor she wouldn't survive the surgery. So fast forward to 2019 I have major heart burn so bad even water gives me heart burn. By 2020 i was over the heart burn and the miserable life I met with my new doctor he informed me due to my sleeve it will be constant and just get worse so we did a revision and basically went to the bypass. Its been a very long and exhausting road. I wouldn't change it for anything but I would reconsider the original surgery.

those must be your particular surgeon's requirements, because I don't think that's universal - except maybe in the early weeks or months. I have a virgin RNY (not a revision), but I didn't have any restrictions at all once I get a ways out. I don't drink a lot (maybe three or four times a year), but I eat tacos every time we go to a Mexican restaurant. There's literally nothing I can't eat (although I watch my portion size)

A couple of comments to fill things in here. It's not really a matter of steroids vs. non-steroids, but rather what a drug or class of drugs does to the stomach as a side effect, NSAIDs are merely the most common that are sited as being problematic for bypass patients. The issue is that the part of the intestine where where the stomach pouch is connected is not resistant to the stomach acid, so that anastomosis there is quite vulnerable to ulcers, so any med that can cause some stomach distress is generally to be avoided. Some of the osteoporosis drugs are avoided for this reason, too. This presumably applies to the MGB as well, as it uses a similar connection. The duodenum, the part of intestine immediately downstream of the stomach and is resistant to the acid, is bypassed along with the remnant stomach. These various meds can sometimes be used in limited times under certain circumstances under medical supervision, but it's a risk/reward trade off between doctor and patient. The sleeve based procedures are generally more tolerant as they don't have that marginal ulcer issue, but many docs still restrict them owing to their bypass experience, (and the sleeve is probably less tolerant than a normal person, while being more tolerant than a bypasser.) Your bypass can be reversed, (that is sometimes one of its "selling points" but it's not commonly done as it's a pretty complex job; not all surgeons will do it. It is usually reserved for times when there is no other option in treating some problem, rather than just buyers remorse. I have seen it done a couple of times in cases of intransigent ulcers, where no other treatment worked. It can also be revised to a duodenal switch, but that's even more complex than a reversal (they have to reverse it first, then sleeve it, and redo the intestinal rerouting. It is usually done when weight loss was inadequate or with excessive regain, or for other RNY complications such as the intransigent ulcers or bile reflux. You weren't offered the MGB as it doesn't fit the "standard of care" for WLS in the US - insurance doesn't normally cover it and the ASMBS hasn't approved it, though it has been further developed and used more commonly elsewhere. The next procedure that's likely to gain approval here is the SIPS/SADI/Loop DS

Hi! I am in the same boat as you! I had surgery in August 2014, got to goal (8 pounds below at 142) and maintained 150-160 for 5 years. Then a neck injury, cancer diagnosis, and the year 2020 hit and I’m up to 188 at this point. It’s so damn depressing having to buy new clothes because nothing fits anymore. My doctor has put me on a BED medication called Vyvanse for the time being, and it’s really helped suppress my appetite. I’m back to exercising at least 3 days a week, and tracking what I eat. Trying to keep it protein and fiber rich foods. We will see. I feel like I’m back on the diet roller coaster/fat brain thinking from before. Seriously thinking about a revision to bypass since I have reflux anyway, but have been through so much medical crap, I don’t know if I want to deal with another surgery again. You’re not alone, friend!

For those of you sleeved, then revised to by-pass, did you feel depressed at all? Like with the sleeve, I could eat or drink what I wanted. I'm only a week post op, but the thought of not having hot spiced wine or a mojito ever again is depressing. I'm DREAMING of a taco. With the sleeve, I couldn't eat a whole one, but a tortilla with guac, beef, pico, and cheese!! The fear of never being able to eat or drink normally again just keeps flooding my mind. Tell me I'm not alone please, lol

Hello, Just wanted someone’s input on my situation. I was banded back in 2014. I lost about 85 lbs and was doing great. Until all of a sudden it caused me grief. A lot of pain, throwing up and reflux. After6+ years I’ve since gained about 40lbs and with all the problems I’ve incurred over the years my doc and I decided on a revision to the sleeve. Well, my insurance company, BCBSIL approved removal only. So, my doc is submitting a request for the revision to the sleeve. Has anyone had this happened to them? What are the odds of them not approving the sleeve? My worry is that I do not meet the BMI requirements to get the sleeve. If anyone can shed some light on this, it will be greatly appreciated. Thanks!

Well I have been on both sides of this fence. In 2009 when I had the lapband placed at 232lbs (5'2") I told my (now) x husband (we were married 26 years), my two sons, daughter in law and a couple of co workers that i thought i could trust. Well my x went and told a few friends after they made comments that "chris's looking good". He said and i quote.... Well she's only losing weight because she had SX.....then, of course, others started to ask and I would say from diet and exercise... Which was true. But when i found out what he said and turns out the co works were saying the same things..... I had a person say.... Well i heard you had WLS.... So after that i was open about it. I found some support and a lot of judgment. Grant you it was back with WLS wasn't as well accepted as it is now. Awful comments from my x, x-friends, x-co workers.... and people in general...... Too skinny, i looked sick, i was lazy for having WLS, i thought i was better than them cuz i was skinny now, how people died from WLS, that i would lose all my hair....i could go on and on. So in 2017 my band slipped and was removed. I went on FB and told everyone. Six months later I moved out of state to where no one knew me except my husband and four of his co workers. When i moved here i was 143lbs.... over the next 2.5 years i put on 30lbs. So i decided to do a revision.......It was not covered by insurance. I was going to crossfit 4 days a week and trying to lose for pending wedding in Sept, 2019. So i laid the groundwork....... Told my co workers i had a hernia (true, Hiatal) and it needed to be fixed (still truth). The weight loss started and they just thought it was from dieting for the wedding (still true). I went in on Wednesday and was back at work on Monday. Still, the only person that knows is my husband. Didn't tell sons, family, friends (not even best), or co workers....... THIS IS 100% BETTER. No comments, no snarky looks, no having to explain anything. Now i'm 120lbs and you know NOT ONE PERSON has said.... You look sick, you are too thin, you are lazy, .... etc. Not one person said i would die from hernia sx..... I'm 100% team.... keep your mouth shut....... Even if you tell just one "friend".... it will get out, especially if its a girl. Us bi*ches like to gossip.

I had the stomach stapling in 1984. It was the Vertically Banded Gastroplasty. On the 15th of February I had it revised to a Gastric Bypass and I am doing splendidly. I never had any symptoms like you describe but I did gain my weight back after the 1984 proceedure. The good thing about the Bypass is it is harder to gain weight back. My surgeon was Dr. Stephen Boyce in Knoxville TN. He was the only surgeon in the state I could find who would tackle my revision. No one else wanted to touch me. I highly recommend him. I'm sure you could fine someone to do a revision for you but for some reason the old surgeries seem to cause most surgeons to shy away. Good luck.

I had lower body lift and both arms done last Aug 25. It was tough for the first few days, The arms were painful but the lower part not so much...I had a nerve block for that. I only used one dose of narcotic once I got home. The combo of gabapentin and robaxin on a round the clock schedule is being used more and more post op for pain control and has been effective for me after my RNY, my hip replacement and now plastic surgery. I was in surgery for 12 hrs for all 3 procedures and spent 2 nights in the hospital. I recovered at home alone except for my brother would come over every day at lunch time and bring me food and change my arm dressings. The first 2 weeks I didn't do much except sit in my recliner with my arms elevated. After that, recovery became much easier. I had 4 drains for my LBL and I managed them myself and even was able to wrap my own arms and then get into my compression garments once I got them. My brother drove me to my first post op appointment but after that I drove myself to my weekly appointments. I have now scheduled my next surgery, breast lift and back lift and scar revision on left arm, for Aug 2. I'd love to do it sooner but that's when I could get enough time off from work. My third surgery will be a thigh lift and scar revision on right arm, hopefully in January (depends on work schedule). I wouldn't change anything other than wishing I had done it all sooner! My arms are 10 inches smaller and my hips are 33 inches! I wear a size 2P and will probably be a size 0P after I get my thighs done. I never dreamed I'd have this kind of success when I was at my highest weight a few years ago! Good luck with whatever decision you make and you can do it alone with a lot of planning and determination!

The pain and all that comes with this revision will pass and you are going to feel great ! It just takes awhile.