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WOAH...who knew this much passion was behind the type of surgeries we have had. I stand by my statement, my truth. What sets me apart from any discussion of band vs. sleeve, is I have had BOTH. I was a SUCCESSFUL band patient, loosing 190 lbs. However that did come at a cost...if we really reflect on our lives and living with a band, I do not need to explain more. I was the biggest band promoter, until the complications started. Even with my constant vomiting, and hiding the fact I could not enjoy a meal...I am a master of denial and incognito. I will also say please be mindful of experience. My complications were very real, and very real for many. Look at Australlia studies...we new complications before bringing to the US. Risk vs. reward...and I will tell my story, I will publish in medical journals and I will be meeting with the FDA. IF you have a great band experience, that is great. May you take nuggets from my experience and just tuck them away to be aware if signs happen to you, it may be caught earlier. I also gave you a 5 minute snippet of the last 2 years, my story is much deeper and many providers missed open cues...so again, my point is not to say bands suck...but they are objects placed in our bodies, and at some point they are bound to be attacked upon. As a new sleeve patient, and experiencing both...I am super excited for my future, and last night enjoyed a meal with my fiance never once leaving the table because something was stuck. Beautiful, quality of life

No horror story here, but my heart goes out to those that have had complications from the band. I too was banded in 2010 and didn't have any problems, lost 40 lbs. and feeling 100% better than I had in fifteen years. On to 2013... Then I, because of the lack of caring at the clinic that put in the band, ended up switching doctors and his first response was "when did they fluroscope you last"? My response "day of surgery". Onward to the scope, one week later endoscopy, two weeks later band out. It had slipped. Had I not switched doctors, and the lack of any problems, by the time I probably would have noticed any problem I would have been hospitalized due to an errosion and infection. Did I love my band, you bet. I went into a grieving mode when it came out, lost an additional 7 lbs, but had to accept it was no longer for me. Ended up having RnY as it has a better remission rate for diabetics but I was given a choice of either the sleeve or RnY. The band for me, was a start on a journey to a healthier me and I'll always be grateful.

I think that it sound like you are doing great. The energy levels and meeting Protein and Water goals are very important. Definitely more important then rapid weight loss!! You and I did the surgery at the same time and I can tell you from my personal experience, I would trade 5 pounds of my weight loss right now to be able to get in more water/protein and have more energy. Unfortunately I faced a complication 2 weeks ago which eventually lead to many tests, IV fluids and general lack of energy and malnourishment. I lost 40 pounds in 5 weeks which sounds great but I wouldn't mind trading some of it in for some more energy! Thankfully I am now finally recovering from the complications and eating more but my doctor was alarmed at my weight loss. So be proud of your progress! Especially the non scale related ones! Scale is not everything as I learned from my personal experience Sent from my Nexus 6 using Tapatalk

A word of caution though. Your insurance carrier will have a contracted rate for services that you receive which will help you, but I'm just going to share my experience so at least you have the information. I had my surgery down in Dallas, 2 overnights in the hospital, no complications whatsoever... Just the hospital bill alone sent to Aetna was a bit more than $83,000... that doesn't include the surgeon's bill, anisthesiologist, meds, bloodwork and all kinds of other misc. other things they came up with. The contracted rate with Aetna meant that my ins. company ended up paying I think it was right around $52K or $53K to the hospital bill. I don't recall about the others off hand. I used IN NETWORK hospital and doctors too. Now, if you have a maximum yearly out of pocket which you should, then once you hit that, it doesn't matter whether your surgery costs $1 MILLION dollars, BUT.... you need to sit down and write out a bunch of questions about this and call your insurance company. Document who you talked to, when you talked them, time, etc... I realize you are young, but no time like the present to realize the importance of CYA (cover your @ss). Ask the customer service rep for documentation either to be mailed to you or online links on their site that clearly outlines your responsibilities for payment. Have the CPT code (someone else might know it here) when you call so that you can be as specific as possible. I just hate to see you end up getting bills for several thousand dollars after the fact and then its too late to do anything about it. That would be a crushing experience!

I was banded on 11/12 and expected to go home later that day. I was unable to keep anything down but kept attempting to drink. I went home on 11/15 but ended up back in the hospital less then 24 hours later due to dehydration. Some people are more sensitve and swell more, my esophagus was swollen above the band. When I tried to drink my esophagus would spasm trying to pass the Fluid down to my stomach which in turn caused more swelling, my saliva wasnt even able to pass. I had an MRI and they could see that the band was on fine but I had serious swelling and any fluid hitting it was causing problems. They put a tube down my nose (uncomfortable but at that point I was willing to do ANYTHING) and that kept fluid out of there and allowed the swelling to finally go down. 48 hours later I did a barium swallow and everything passed fine. I too had serious regrets, no one is really prepared for complications. Please hang in there, she is where she needs to be for the best care and will be home soon enough. I finally feel back to normal and pleased with my decision (26 pounds down!) and it wont be long till she does.

My plan is Aetna and they prefer at Center of Excellence but will pay at a greatly reduced rate for a non center of excellence per my plan(it varies so check your plan specifically). So basically, I'd pay more out of pocket for less assurance (in theory) that my surgeon is capable, culpable, and able to meet my needs. That's how I look at it. I chose a center of excellence because I want to know that I'm getting the best for my money and hopefully can avoid un wanted complications from a less experienced surgeon.

I cannot even imagine losing 70 lbs and keeping it off! Im a bit concerned about adverse and long term effects. Glad to see 3 years out you are doing well. Did you have any post surg complications? Nausuea? Were you on birth control pills around sugery time? I am on them just to regulate period . Due to clotting concerns they want to take me off before and after. Hoping losing weight helps regulate me!

To me it means your golden year is your best time frame for weight loss. Weight loss surgery restriction is fantastic in your first months. Your surgery restriction will become less over time and weight loss slows down. “Taking advantage” means don’t waste this time frame. Follow your surgeons’ plan/instructions. Log your food, hit your calories and macro goals for the day, hydrate, exercise/activity and make behavior changes for the long term. We cannot control the “luck factor” Sex, age, medical issues, medications, complications, hormones and body physiology. What you can control is “working your plan” Decide how lax or strict you want to work this. Decide what you want out of your first year.

I had an ablation after our third kid e cause I have a large fibroid in my uterus. We did the ablation to not only stop my cycle but to see if the fibroid would die off or stop growing. I have had it since I was preg for my first child.....11 years ago. So after our third because the surgery to remove it was too dangerous with my knowledge of how complicated my preg were and breaking everything in that area due to an accident several years ago. The ablation was the best thing we did, but the fibroid did not change so no dr would touch the removal of the fibroid due to size and where it's pushing inside due to the fact I did not so well after three kids each one did something else to my lower body section and I couldn't loose any of the weight due to the pain the fibroid caused, thus 11 yrs is enough and I just had the bypass last Wed and once I am down some weight they will be able to remove the fibroid. Can't wait. Sorry for the end, just wanted to tell you the ablation was one of the best things I have done for myself medically and if you are done with children and have a medical need. I highly recommend it! Best of luck with yours.

Just don't go to salinas ca I have complications

Hello everyone I am 18 month post op and if many of you have heard my stories will understand that I been through a lot since I had Surgury. Unfortunately I have had many complications and recently I was put on TPN which is iv nutrition for the second time. The reason I had gastric bypass was because I had severe erosion in my esophagus and had esophagitis and my surgeon told me that I could develop esophagus cancer. I was also overweight for my height. I am 4"11 and I was 189 pounds before Surgury. I would aspirate in my sleep and had the worse reflux ever. Now I have been very depress and feel so much regret since I lost so much weight. The surgeon is trying to figure out why is it that I keep losing and can't gain weight on my own. Last week I was 90 pounds and since on TPN I have gained 6 pounds. I am 96 pounds now. I was advice to see someone for Theapy but I want to be able to move on normally. Has anyone experience depression or regrets? Also I have had so many Surgury and never was able to fully workout and now I see sagging skin on my legs, arms and belly and feel more depress. I don't want to have more Surgury but I am trying to deal with all these emotions. Any suggestions will be appreciated. I am very Down and feel hopeless of life. I get teary and guilt is to much to handle. Thanks for reading my post and looking forward to hearing what you all think or advice.

You can't speak on bypass complications if you don't have a bypass.I had a bypass and I have no complications.

You can't control IF a complication is going to happen. Follow your plan provided by your doc. That's what you CAN control. You've made it thru the past week with no complications - consider that a success! Focus on your fluids and Protein intake and taking care of your body. Rest when you need to. Walk when you can. You're going to be fine - worrying about things is not going to get you anywhere.

Well said Lifeliver. It's clear there are risks/complications with any WLS. Some can be mitigated but some cannot. We cannot "blame the victim" in every case. I'm glad you're having success now and while I don't want to bash any WLS, I do think that public awareness and education about these eventualities is a must.

Wow girl you look GREAT!! Im 5 days post op!!! I haven't had any complications. I go Tuesday for my week follow up. Have you been exerizing any? What have done if so?

My decision was based on largely irrational fear of the bypass. I suffered mightly with the band and I dreaded something permanent that would make me vomit alot and often without predictability. Tighter in the morning, certain foods especially Proteins, fiberous veggies and rice often triggered vomiting. I had watched a reality show about a very big (800#?) man who was bitter about the bypass and vomited ALOT. What I recognize now is that he was not over his food addiction and ate too fast/too much. So I choose the sleeve 4 years ago and am quite pleased! I am half my former size and maintaining a normal weight/size. I would do it again in a heartbeat (so far no complications!), and a lucky member of the majority that don't have reflux. However, I would advise a smart person to be open and research both. Like, read research abstracts. Ask opinions of people who are years post op. Ask your surgeon for his reasons behind whatever he recommended. Go to support groups, heavily biased toward newer post op, but another perspective. BTW, they have their biases too. First surgeon I went to recommended bypass for me since I failed with the band and was high BMI. I didn't question him but was not comfortable with the bypass. I went to one of the support groups, and all the patients were bypass. I realized that this surgeon strongly advocated bypass, so I wound up switching surgeons/clinics. There were other reasons (hated his NUT) and it truly worked out for the best.

If you have say "please don't scream" then you know exactly what you are doing wrong. So fix it. It's that simple. Follow your diet and let your yes mean yes and no mean no when it comes to food. Don't make it complicated. Sent from my SM-G935V using BariatricPal mobile app

what caused me to look into this elective insurance option is I noticed that Dr. Kelley in Tijuana offers the cover for $250 but I later found out it only covers complications during surgery or while you are recovering in Mexico. It does not cover complications when you return to the U.S. I'm signed up with Corvala at Hospital Angeles. They said that they have looked hard for insurance to cover post op complications but haven't been able to identify any policies that would make sense for patients. That caused me to look at my own health insurance policy fine print. I am fortunate to be covered by two health plans but neither covers bariatric surgery. The first plan is silent as to whether it would cover post bariatric surgery complications. The second plan does cover post surgery complications for elective surgery but I had to dig through the fine print to find it and the insurance company rep I spoke to orignally gave me the wrong answer over the phone and I had to correct her leading to her eventually agreeing with me. If you are going to have elective bariatric surgery and are under a health plan you may want to check to see if your plan will cover post op complications(i.e. leaks or strictures) from elective surgery. If it doesn't cover post op complications and you are one of the unlucky ones that develops complications it could obviously lead to very large out of pocket medica bills.

Here is another company with the type of insurance policy I'm referring to and there are several other companies that offer this coverage. What put me onto this is that Dr. Kelley who is a bariatric surgeon in Tijuana does VSG surgery sometimes at Hospital Angeles and other places in the TJ area offers Medical Tourism insurance as part of his package for an extra 250 dollars. It seems to me that it would be money well spent to have this coverage in case I get back to the u.s. and develop vsg related complications. I have a feeling my primary and secondary health insurance companies in the u.s currectly covering me would give me a hard time about paying for any complications related to an elective vsg. i would have better piece of mind having surgery in tijuana if I had a policy like this to cover large unforseen medical bills due to vsg complications when i get back to the u.s. https://www2.sevencorners.com/medical-tourism-insurance/ MEDICAL TOURISM INSURANCE Why Buy Medical Tourism Insurance? Whatever the reason you decide to pursue Medical Tourism, complications are always a possibility. When a medical procedure is performed abroad, there is normally no insurance coverage to protect you if you have complications. Bordercross WorldwideSM medical tourism insurance is the first plan to help with the needs of a medical tourist. Our plan protects you for medical complications and provides travel assistance services. Maximum Trip Length: 60 days Bordercross Worldwide Key Highlights: Medical Complications Up to $50,000 Trip Cancellation Up to $40,000 for you and your traveling companion for travel accommodations, including non-refundable expenses paid to the medical facility scheduled to perform the procedure, in the event you need to cancel your trip prior to your scheduled departure date Medical Coverage Up to $50,000 for acute illness and injuries for you and your traveling companion, which may arise on your medical tour Medical Evacuation Up to $100,000 Coverage Available for medical procedures performed outside the United States Travel Assistance Services Included- Available 24/7/365 Underwritten by Certain Underwriters at Lloyd’s of London. Virtual ID cards available immediately after purchase. View the Bordercross WorldwideSM Brochure for details, restrictions and the schedule of benefits. View the Bordercross WorldwideSM Program Summary for full details and restrictions.

I had mine done with Dr. R on June 16th2006 and had to have theband removed as it slipped on June 22 2007. When the complications started i was told it was all in my head, as long as i stressed I would have issues and pretty much that was it. i never had a fill and lost 69lbs total. I also could not tolerate solids for the last 3 months of this whole deal. I too thought he was great until i asked for help. The first time I had to be hospitalized for dehydration we all agreed for me to get care here then i would see him after they stabalized me. i was ok with that. Then when I went he did a fluro and said I was fine, just swollen leading to more restriction. He told me to stay on fluids another 2 weeks. I did and upon returning to solids I started vomitting again and called. He said he thought I had a slip and could remove it for 3000. I was so upset as I was not even a year out. My husband called and they had words- he stated he wouldnt charge for his services, but the hosiptal fee was 3000 for the night. GIVE ME A BREAK- do I look dumb- I know that hosiptal does not cost 3000 for one night. Upon finding a Dr here who would take me Dr. St. Laurent stated I had too tight of a band and it has slipped. he stated i needed a bigger band all along which would have solved all of this. We brought this up to Dr. R numerous times and he stated he knew what he was doing and I had the right size. I now agree with this Dr. If it had just slipped why hadnt Dr. R tried to reposition this. Why hadnbt he given me any drugs for the inflamation? I am still just mad and every time I see my payment taken out I am sad. If he knew I had vomiting all along why didnt he offer a different apporach to help me keep even liquids down. Let me tell you that upon thinking I had a slip- not even other MX Drs wanted anything to do with this case or to help me. Sad huh. I admit fault in not being persistant, but I wished he would have offered me more options. i think what made me the saddest was I did like him and he never even checked up on me- it was all one way communication when problems arouse. Just think about making a choice that would benefit you if an emergency did arise- what is your back up plan!!! I wish I had a better back up plan. Cover all your bases!:cry

The American Society for Metabolic and Bariatric Surgery (ASMBS) emails each new edition of “connect,” their official news magazine to its members upon publication. In it, they provide a synopsis of recent articles of interest related to WLS. One noted article this week is titled, “What Matters: What’s the magic behind successful bariatric patients?” and is written by Dr. Jon O. Ebbert, an internist at Mayo Clinic. In the article, Dr. Ebbert states, “I was left wondering how I can best help my patients using this information.” Let’s help him help his patients! I’ll share the short article, give my editorial (what I didn’t share with Dr. Ebbert) and then write the response I did share with him. Finally, I’ll provide the link where you, too, can share feedback directly about the article, or send it to me and I will be happy to forward it! The article: “MARCH 3, 2016 A fair number of my patients have had or are undergoing bariatric surgery. Disconcertingly, a not insignificant number of them are regaining the weight after surgery. Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss. When this occurs, not only do we have a patient with an altered gut putting them at risk for nutritional deficiencies if we are not fastidious in our follow-up, but they are discouraged and overweight again. Add this to the concern that bariatric surgery has been associated with an increase in suicides (2.33-3.63 per 1000 patient-years), and we may have some cause for alarm. So, what predicts success – and can we facilitate it? Several factors have been shown to predict successful weight loss after bariatric surgery. An “active coping style” (that is, planning vs. denial) and adherence to follow-up after bariatric surgery have both been shown to be associated with a higher percentage of excess weight loss. Interestingly, psychological burden and motivation have not been associated with weight loss. In a recent article, Lori Liebl, Ph.D., and her colleagues conducted a qualitative study of the experiences of adults who successfully maintained weight loss after bariatric surgery (J Clin Nurs. 2016 Feb 23. doi: 10.1111/jocn.13129). Success was defined as 50% or more of the excessive weight loss 24 months after bariatric surgery. The voice of the successful bariatric patient is an interesting and important one. Several themes were identified: 1) taking life back (“I did it for myself”); 2) a new lease on life (“There are things I can do now that I am not exhausted”); 3) the importance of social support; 4) avoiding the negative (terminating unhealthy relationships in which “food is love”); 5) the void (food addiction and sense of loss); 6) fighting food demons; 7) finding the happy weight; and 8) a ripple effect (that is, if you don’t eat it, the rest of family doesn’t, either). I was left wondering how I can best help my patients using this information. First, I think the themes can mature our empathy for the struggles that these patients face, and perhaps help us combat bias. Second, I think this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure, such as social support. Finally, I think the themes can be universalized and help us counsel patients who may be struggling with weight, but who are otherwise not candidates for bariatric surgery.” My Editorial I’m grateful that an internist is addressing the topic of WLS. I love that he is thinking about ways to use the information gleaned from the research he notes related to the behaviors of those who have “successful weight maintenance” following weight loss surgery. Pardon my sarcasm, but, WOW! Getting information about the behaviors that led to weight loss from patients who have 50% or more of excessive weight loss 24 months after bariatric surgery? Does that really tell us anything? I’d venture to say that the majority of professionals in the field would note the surgery itself as being primarily responsible for the “success” of the weight loss at 24 months out. I’m NOT saying that many patients fail to put forth a great deal of effort at that point, because I know many do work very hard during those first 24 months. But come on… let’s talk to successful weight maintainers at 5 years after surgery to get a better indication of what they are doing to manage a healthy weight. I’d also be curious to know at what point in time after surgery the statistic was obtained noting “Weight regain will occur in 20% of patients undergoing bariatric surgery after initial weight loss.” How much weight regain? After how much time? If you look closely at research in many fields, you can find numbers that vary widely on a particular topic. Dr. Ebbert states, “Psychological burden and motivation have not been associated with weight loss.” I wasn’t at all sure what this meant. Questioning my comprehension skills, I asked some other people how they interpreted that statement, and they couldn’t tell, either. If the implication is that psychological issues have no impact on weight loss or lack thereof, I have to disagree. But then, I have no research to back up my hypothesis. I do have 11 years working in this field and the anecdotal evidence of hundreds of patients that says otherwise. I’d say depression interferes with the desire/ability to follow through with certain behaviors that require significant energy. I’d say that intense shame interferes with the perceived efficacy to follow through for the long haul with behaviors necessary to sustain weight loss – well past two years of having WLS. I don’t know… I believe poor self-esteem, a history of “failing” with “diets,” unresolved grief, loss, and abuse issues sometimes affect a person’s perceived ability to succeed. I also believe treating these psychological issues in conjunction with treating one’s physiology and teaching important skills such as healthy coping mechanisms, positive self-talk, and efficacy-enhancing skills is a recipe for better outcomes. My Response to Dr. Ebbert (in an attempt to be brief): “Dr. Ebbert - With all due respect, the medical field is, in my opinion, missing several very large pieces of the puzzle with the surgical weight loss population in terms of treating them. I am a licensed clinical psychologist. I work in a surgical weight loss clinic and have spoken with literally thousands of patients who have had weight loss surgery. Obesity is a complicated disease that is more than just physiological. I treat the underlying and associated psychological co-morbidities, which the medical community largely ignores, except under the broad category of "Behavior Modification." I assure you that there is a lot more than changing behaviors that needs to be addressed with this population. A vast majority of this population suffers with deep shame and low self-esteem, both rendering them inefficient at maintaining motivation to follow through on a long-term basis with "behavior modification." I am working tirelessly to try to address the elephants in the OR, but surgeons don't really want to listen to myself - or the patients - who are clamoring for additional mental health care (MORE than behavior modification) following WLS when their "issues" interfere with healthy behaviors - just like before surgery. More suicides? Maybe because in a sense, we take away the patients’ coping skill (food) and throw them to the wolves. I've created a video series that I require all of my patients to watch before surgery to help them understand the deeper issues they may face and to urge them to seek counseling. I could use help in the medical community. You in?” I do believe, and I thank Dr. Ebbert for noting, “this knowledge can inform early discussions around what sorts of things need to be lined up for after the procedure.” Let’s all pitch in and share with Dr. Ebbert and other interested physicians what you need to be successful, on and off the scale, for years and years following WLS. Please share your comments at: http://www.clinicalendocrinologynews.com/comments/what-matters-whats-the-magic-behind-successful-bariatric-patients/016f71fe2abdc0198ac42d75d039d712.html?comments_link=1 Or, post your comments here or contact me via my web page: www.conniestapletonphd.com Let’s pitch in and help! Connie Stapleton, Ph.D.

Don't trust them with your life! The waiting room of the Beverly Hills surgery clinic was teeming with customers on a recent Saturday, with many of the patients there for the weight-loss operation hawked on freeway billboards, bus placards, and TV and radio commercials across Southern California: 1-800-GET-THIN. But few, if any, were probably aware of the troubled history of the medical suite where they might be waiting to undergo major surgery. Suite 106 at 9001 Wilshire Blvd., currently known as the Beverly Hills Surgery Center, has for years been a business address of TopSurgeons, the sponsors of the ubiquitous marketing campaign for the lap-band® -- a surgical implant designed to suppress the appetite of obese patients and normally prescribed for those who are at least 75 to 100 pounds overweight. As I wrote last month, the people behind TopSurgeons are the Omidi brothers -- Julian, whose medical license was revoked in 2009, and Michael, who was placed on three years’ probation for gross negligence in 2008,according to the Medical Board of California. TopSurgeons attracts customers in part by pitching the lap-band® to people who, according to conventional medical guidelines, shouldn't need major surgery to shed weight. The Omidis formerly operated the Wilshire Boulevard facility as the Almont Ambulatory Surgery Center. Almont lost an important federal certification last summer after inspectors determined that conditions there posed "immediate jeopardy to the health and safety" of patients. The government's cancellation of the clinic's certification, which was effective July 20, meant it could no longer receive payments from Medicare and Medicaid for treating the programs' members. Separately, the American Assn. for Accreditation of Ambulatory Surgery Facilities had already revoked the clinic's accreditation. The California Department of Public Health was well aware of health and safety issues at the clinic -- its own staff had performed the inspection for the federal government. The Medical Board of California was aware of the history of TopSurgeons' owners because it was the agency that had revoked Julian Omidi's license and placed his brother Michael on probation. Yet state regulators' ability to respond to the actions by the federal government and the accreditation body was limited. Under state law, no agency has clear jurisdiction over such free-standing ambulatory surgical centers. Free-standing surgical centers owned by a physician are exempt from licensing by the Department of Public Health. For its part, the California Medical Board has no legal oversight over a surgical facility because its legal authority extends only to disciplining individual doctors. The federal government's authority is limited to determining whether a clinic can participate in Medicare and Medicaid (in this state, Medi-Cal). Once it does that, its regulatory bolt is shot. Robert Silverman, an attorney representing the Omidis, points out that his clients "have no involvement in the performance of weight loss surgeries themselves." So why should you care about them? For one thing, the business model of free-standing surgery clinics unaffiliated with hospitals is spreading. These places perform major surgery under general anesthesia, which can be life-threatening. If there are any holes in the regulatory safety net applicable to such facilities, they need to be closed, but quick. Then there are the particulars of that June inspection report of Almont Ambulatory Surgery Center, which runs for 22 pages. Here are some highlights: * The inspectors found unsanitary conditions in the surgical areas. Medications and supplies to treat complications from anesthesia were expired or missing, though 23 patients were waiting for surgery. * Surgical instruments weren't being properly disinfected. Medical supplies that were supposed to have been tossed after use on a single patient were being reused. Two employees had positive tests for tuberculosis, but there was no record that they got required follow-up chest X-rays. * The crash cart, which carries equipment and supplies for cardiac emergencies, contained opened and expired drugs and supplies, including some more than 4 years old. Other drugs and supplies, including emergency drugs, were months or years past expiration. Filled and inadequately labeled syringes were found in the operating room. Most of the scrub sinks weren't working. * Patient records, which contain such confidential information as psychological exams, were left where unauthorized people could read them. That inspection wasn't the only one to turn up problems. The American Assn. for Accreditation of Ambulatory Surgery Facilities, a voluntary association that inspects such facilities to make sure they're safe and properly run, had revoked the facility's accreditation April 4. The association's executive director, Jeff Pearcy, told me that it had suspended Almont's credentials a few weeks earlier, after receiving a serious complaint that he wouldn't specify. During an unannounced visit April 4, its inspectors discovered that surgery was being performed on the premises despite the suspension. Pearcy said his organization promptly informed federal Medicare authorities and the state medical board of its action. Silverman blames those violations on unidentified Almont managers who he said were placed in charge by the Omidis. He said Almont went out of business soon after the revocation of its certification and accreditation. The clinic's quarters, he maintains, were then taken over by Beverly Hills Surgery Center. Under that name the facility received accreditation as an ambulatory care center in January from a different medical accreditation agency, the Joint Commission. Silverman maintains that Beverly Hills Surgery Center is "a completely separate entity" from Almont. But he also acknowledged that Julian and Michael Omidi helped launch Almont, and records show both have connections to Beverly Hills Surgery Center. The Department of Public Health still lists Michael Omidi as 100% owner of the surgery center at Suite 106 at 9001 Wilshire Blvd. and Almont as its corporate name, department spokesman Ralph Montano said Wednesday. He said the information was filed with the agency in May 2009 and that the center's owners have not updated the filing since. Julian Omidi, who is identified in Los Angeles County records as president of Almont, is also listed as president of TopSurgeons Inc., which, as mentioned earlier, also listsits address in state and county business filings as 9001 Wilshire Blvd., Suite 106. Beverly Hills Surgery Center was registered with the county by Thomas C. Cloud on Oct. 15, 2009, also at 9001 Wilshire Blvd., Suite 106. Cloud is a business associate of Julian Omidi's, according to legal papers Cloud filed in several lawsuits in Los Angeles Superior Court seeking payments from patients who allegedly did not pay their bills. Cloud is a former doctor whose license was revoked by the medical board -- for the second time -- in 2001, based on a string of felony convictions, including a 1993 conviction for Medi-Cal fraud that garnered him a sentence of 16 months in state prison. Silverman says Cloud isn't an employee of TopSurgeons, just "an independent contractor." Through Silverman, the Omidis refused my request for interviews. Silverman told me this week that TopSurgeons Inc. no longer conducts any business. There's a TopSurgeons LLC, he says, but it doesn't operate at 9001 Wilshire Blvd. As of Wednesday, however, the California secretary of state's website listed that address as the entity's official address, and the TopSurgeons website listed the location as one of the offices to which it refers patients. Silverman refused to identify the ownership and management of TopSurgeons LLC but said it's different from TopSurgeons Inc. Should we take that on faith? I'll just note that when TopSurgeons LLC registered its business name with the county last April it listed the same Wilshire Boulevard surgical suite as its address and named as its registration agent Cindy Omidi, which is the name of Julian and Michael Omidi's mother. When TopSurgeons LLC filed its business registration with the California secretary of state in 2008, its agent was Thomas Cloud and its address of record was 9001 Wilshire Blvd., Suite 106. Silverman said there was no "wrongdoing, illegal conduct, or even inappropriate conduct" involved here. But the public record shows that one or both Omidi brothers have been doing business out of the same location under various corporate names since at least 2005 -- and it's a location that has drawn some not entirely positive attention from health and medical inspectors. If I were even remotely inclined to answer one of those "GET THIN" ads, I'd like to know if my regulators were still keeping their eyes on the place. Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at michael.hiltzik@latimes.com, read previous columns at Michael Hiltzik - latimes.com, and follow @latimeshiltzik on Twitter.

Don't trust them with your life! The waiting room of the Beverly Hills surgery clinic was teeming with customers on a recent Saturday, with many of the patients there for the weight-loss operation hawked on freeway billboards, bus placards, and TV and radio commercials across Southern California: 1-800-GET-THIN. But few, if any, were probably aware of the troubled history of the medical suite where they might be waiting to undergo major surgery. Suite 106 at 9001 Wilshire Blvd., currently known as the Beverly Hills Surgery Center, has for years been a business address of TopSurgeons, the sponsors of the ubiquitous marketing campaign for the lap-band® -- a surgical implant designed to suppress the appetite of obese patients and normally prescribed for those who are at least 75 to 100 pounds overweight. As I wrote last month, the people behind TopSurgeons are the Omidi brothers -- Julian, whose medical license was revoked in 2009, and Michael, who was placed on three years’ probation for gross negligence in 2008,according to the Medical Board of California. TopSurgeons attracts customers in part by pitching the lap-band® to people who, according to conventional medical guidelines, shouldn't need major surgery to shed weight. The Omidis formerly operated the Wilshire Boulevard facility as the Almont Ambulatory Surgery Center. Almont lost an important federal certification last summer after inspectors determined that conditions there posed "immediate jeopardy to the health and safety" of patients. The government's cancellation of the clinic's certification, which was effective July 20, meant it could no longer receive payments from Medicare and Medicaid for treating the programs' members. Separately, the American Assn. for Accreditation of Ambulatory Surgery Facilities had already revoked the clinic's accreditation. The California Department of Public Health was well aware of health and safety issues at the clinic -- its own staff had performed the inspection for the federal government. The Medical Board of California was aware of the history of TopSurgeons' owners because it was the agency that had revoked Julian Omidi's license and placed his brother Michael on probation. Yet state regulators' ability to respond to the actions by the federal government and the accreditation body was limited. Under state law, no agency has clear jurisdiction over such free-standing ambulatory surgical centers. Free-standing surgical centers owned by a physician are exempt from licensing by the Department of Public Health. For its part, the California Medical Board has no legal oversight over a surgical facility because its legal authority extends only to disciplining individual doctors. The federal government's authority is limited to determining whether a clinic can participate in Medicare and Medicaid (in this state, Medi-Cal). Once it does that, its regulatory bolt is shot. Robert Silverman, an attorney representing the Omidis, points out that his clients "have no involvement in the performance of weight loss surgeries themselves." So why should you care about them? For one thing, the business model of free-standing surgery clinics unaffiliated with hospitals is spreading. These places perform major surgery under general anesthesia, which can be life-threatening. If there are any holes in the regulatory safety net applicable to such facilities, they need to be closed, but quick. Then there are the particulars of that June inspection report of Almont Ambulatory Surgery Center, which runs for 22 pages. Here are some highlights: * The inspectors found unsanitary conditions in the surgical areas. Medications and supplies to treat complications from anesthesia were expired or missing, though 23 patients were waiting for surgery. * Surgical instruments weren't being properly disinfected. Medical supplies that were supposed to have been tossed after use on a single patient were being reused. Two employees had positive tests for tuberculosis, but there was no record that they got required follow-up chest X-rays. * The crash cart, which carries equipment and supplies for cardiac emergencies, contained opened and expired drugs and supplies, including some more than 4 years old. Other drugs and supplies, including emergency drugs, were months or years past expiration. Filled and inadequately labeled syringes were found in the operating room. Most of the scrub sinks weren't working. * Patient records, which contain such confidential information as psychological exams, were left where unauthorized people could read them. That inspection wasn't the only one to turn up problems. The American Assn. for Accreditation of Ambulatory Surgery Facilities, a voluntary association that inspects such facilities to make sure they're safe and properly run, had revoked the facility's accreditation April 4. The association's executive director, Jeff Pearcy, told me that it had suspended Almont's credentials a few weeks earlier, after receiving a serious complaint that he wouldn't specify. During an unannounced visit April 4, its inspectors discovered that surgery was being performed on the premises despite the suspension. Pearcy said his organization promptly informed federal Medicare authorities and the state medical board of its action. Silverman blames those violations on unidentified Almont managers who he said were placed in charge by the Omidis. He said Almont went out of business soon after the revocation of its certification and accreditation. The clinic's quarters, he maintains, were then taken over by Beverly Hills Surgery Center. Under that name the facility received accreditation as an ambulatory care center in January from a different medical accreditation agency, the Joint Commission. Silverman maintains that Beverly Hills Surgery Center is "a completely separate entity" from Almont. But he also acknowledged that Julian and Michael Omidi helped launch Almont, and records show both have connections to Beverly Hills Surgery Center. The Department of Public Health still lists Michael Omidi as 100% owner of the surgery center at Suite 106 at 9001 Wilshire Blvd. and Almont as its corporate name, department spokesman Ralph Montano said Wednesday. He said the information was filed with the agency in May 2009 and that the center's owners have not updated the filing since. Julian Omidi, who is identified in Los Angeles County records as president of Almont, is also listed as president of TopSurgeons Inc., which, as mentioned earlier, also listsits address in state and county business filings as 9001 Wilshire Blvd., Suite 106. Beverly Hills Surgery Center was registered with the county by Thomas C. Cloud on Oct. 15, 2009, also at 9001 Wilshire Blvd., Suite 106. Cloud is a business associate of Julian Omidi's, according to legal papers Cloud filed in several lawsuits in Los Angeles Superior Court seeking payments from patients who allegedly did not pay their bills. Cloud is a former doctor whose license was revoked by the medical board -- for the second time -- in 2001, based on a string of felony convictions, including a 1993 conviction for Medi-Cal fraud that garnered him a sentence of 16 months in state prison. Silverman says Cloud isn't an employee of TopSurgeons, just "an independent contractor." Through Silverman, the Omidis refused my request for interviews. Silverman told me this week that TopSurgeons Inc. no longer conducts any business. There's a TopSurgeons LLC, he says, but it doesn't operate at 9001 Wilshire Blvd. As of Wednesday, however, the California secretary of state's website listed that address as the entity's official address, and the TopSurgeons website listed the location as one of the offices to which it refers patients. Silverman refused to identify the ownership and management of TopSurgeons LLC but said it's different from TopSurgeons Inc. Should we take that on faith? I'll just note that when TopSurgeons LLC registered its business name with the county last April it listed the same Wilshire Boulevard surgical suite as its address and named as its registration agent Cindy Omidi, which is the name of Julian and Michael Omidi's mother. When TopSurgeons LLC filed its business registration with the California secretary of state in 2008, its agent was Thomas Cloud and its address of record was 9001 Wilshire Blvd., Suite 106. Silverman said there was no "wrongdoing, illegal conduct, or even inappropriate conduct" involved here. But the public record shows that one or both Omidi brothers have been doing business out of the same location under various corporate names since at least 2005 -- and it's a location that has drawn some not entirely positive attention from health and medical inspectors. If I were even remotely inclined to answer one of those "GET THIN" ads, I'd like to know if my regulators were still keeping their eyes on the place. Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at michael.hiltzik@latimes.com, read previous columns at Michael Hiltzik - latimes.com, and follow @latimeshiltzik on Twitter.

I'm telling you he is wonderful!! I have talked to numerous patients in the waiting room that have told me he saved their life bc another surgeon messed up the surgery. I love him and believe its bc of his good work that I have almost zero complications. Nice to meet you too!

I was supposed to be over night, but ended up in for two. My heart rate and blood pressure wouldn't come back up after surgery and I was very nausious (sp?). Since I live 45 mins from the hospital, the surgeon felt I should stay another night...glad I did...I would have been fine, but it gave me peace of mind to know I was in the right place if a complication arose. Got home last night and feel pretty darn good today!