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http://mcgs.bcbsfl.com/ Note the timeline on this: 02-40000-10 Original Effective Date: 10/15/99 Reviewed: 04/27/06 Revised: 05/15/06 Next Review: 04/26/07 Subject: Surgery for Clinically Severe Obesity (Bariatric Surgery; Gastric Bypass Surgery) DESCRIPTION: Clinically severe obesity is a result of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. For purposes of this medical coverage guideline, clinically severe obesity is defined as a body mass index (BMI) of 35 kg/m2 or greater. See the height and weight tables for Men and Woman, BMI tables (100-195, 200-295, 300-400, and formula for calculating a BMI. Several surgical (bariatric) procedures are used for the treatment of clinically severe obesity. These procedures can be categorized as follows: <LI class=bulletedList-1>Malabsorptive procedures - alteration of the intestinal absorption limiting nutrients available to the body OR Gastric restrictive procedures - reduction in the capacity of the stomach thereby limiting the amount of food ingested. Gastric surgical procedures for the treatment of clinically severe obesity include: <LI class=bulletedList-1>gastric bypass where approximately 90% of the stomach is bypassed and reattached to the proximal jejunum OR gastric stapling, vertically banded gastric partition, or vertically banded gastroplasty where a proximal pouch of 30-60 ml and a one centimeter outlet are created by a row of vertical staples and a horizontally placed reinforcing band. WHEN SERVICES ARE COVERED: Effective January 1 2005, weight loss surgery is not covered for most contracts. Please refer to the individual member’s contract benefit language. NOTE: The primary care physician must provide a letter with facts supporting medical necessity, for review by the Medical Director. Certain surgical procedures performed for the treatment of clinically severe obesity may be considered medically necessary when ALL of the following conditions are met: The member: <LI class=bulletedList-1>meets the above definition of clinically severe obesity, <LI class=bulletedList-1>has been severely obese for at least five (5) years, <LI class=bulletedList-1>has attempted a physician supervised (by the primary care physician) non-surgical management weight loss program (e.g., diet, exercise, drugs) for six (6) consecutive months <LI class=bulletedList-1>has received psychological or psychiatric evaluation with counseling as needed, prior to surgical intervention; does not have a medically treatable cause for the obesity, (e.g., thyroid or other endocrine disorder). The following procedures may be considered medically necessary when the above criteria has been met: Vertical-Banded Gastroplasty (CPT code 43842) Vertical-banded gastroplasty was formerly one of the most common gastric restrictive procedures performed in this country but has more recently declined in popularity. In this procedure, the stomach is segmented along its vertical axis. To create a durable reinforced and rate-limiting stoma at the distal end of the pouch, a plug of stomach is removed, and a propylene collar is placed through this hole and then stapled to itself. Because the normal flow of food is preserved, metabolic complications are uncommon. Complications include esophageal reflux, dilation, or obstruction of the stoma, with the latter 2 requiring reoperation. Dilation of the stoma is a common reason for weight regain. Vertical-banded gastroplasty may be performed using an open or laparoscopic approach. Roux-en-Y Gastric Bypass (CPT code 43644, 43846) Gastric bypass may be performed with either an open or laparoscopic technique. The original gastric bypass surgeries were based on the observation that post-gastrectomy patients tended to lose weight. The current procedure involves a horizontal or vertical partition of the stomach in association with a Roux-en-Y procedure (i.e., a gastrojejunal anastomosis). Thus, the flow of food bypasses the duodenum and proximal small bowel. The procedure may also be associated with an unpleasant “dumping syndrome,” in which a large osmotic load delivered directly to the jejunum from the stomach produces abdominal pain OR vomiting. The dumping syndrome may further reduce intake, particularly in “sweets eaters”. Operative complications include leakage and marginal ulceration at the anastomotic site. Because the normal flow of food is disrupted, there are more metabolic complications compared to other gastric restrictive procedures. These complications may include iron deficiency anemia, vitamin B-12 deficiency, and hypocalcemia, all of which can be corrected by oral supplementation. Another concern is the ability to evaluate the “blind” bypassed portion of the stomach. Long Limb Gastric Bypass (i.e., more than 100 cm) (CPT code 43847) Recently, variations of gastric bypass procedures have been described, consisting primarily of long limb Roux-en-Y procedures, which vary in the length of the alimentary and common limbs. For example, the stomach may be divided with a long segment of the jejunum (instead of ileum) anastomosed to the proximal gastric stump, creating the alimentary limb. The remaining pancreaticobiliary limb, consisting of stomach remnant, duodenum, and length of proximal jejunum is then anastomosed to the ileum, creating a common limb of variable length in which the ingested food mixes with the pancreaticobiliary juices. While the long alimentary limb permits absorption of most nutrients, the short common limb primarily limits absorption of fats. The stomach may be bypassed in a variety of ways (i.e., either by resection or stapling along the horizontal or vertical axis). Unlike the traditional gastric bypass, which is essentially a gastric restrictive procedure, these very long limb Roux-en-Y gastric bypasses combine gastric restriction with some element of malabsorptive procedure, depending on the location of the anastomoses. NOTE: Coverage of long limb Roux-en-Y procedures is limited to 150 cm. Adjustable gastric banding (i.e., Lap-Band Adjustable Gastric Banding System) (CPT code 43770, 43771, 43772, 43773, 43774) Adjustable gastric banding involves placing a gastric band around the exterior of the stomach. The band is attached to a reservoir that is implanted subcutaneously in the rectus sheath. Injecting the reservoir with saline will alter the diameter of the gastric band; therefore, the rate- limiting stoma in the stomach can be progressively narrowed to induce greater weight loss, or expanded if complications develop. Because the stomach is not entered, the surgery and any revisions, if necessary, are relatively simple. Complications include slippage of the external band or band erosion through the gastric wall. Adjustable gastric banding has been widely used in Europe. Currently, the U.S. Food and Drug Administration (FDA) has approved one such device for marketing in the United States, Lap-Band (BioEnterics, Carpentiera, CA). The labeled indications for this device are as follows: "The Lap-Band system is indicated for use in weight reduction for severely obese patients with a body mass index (BMI) of at least 40 or a BMI of at least 35 with one or more severe comorbid conditions, or those who are 100 lbs or more over their estimated ideal weight according to the 1983 Metropolitan Life Insurance Tables (use the midpoint for medium frame). It is indicated for use only in severely obese adult patients who have failed more conservative weight-reduction alternatives, such as supervised diet, exercise and behavior modification programs. Patients who elect to have this surgery must make the commitment to accept significant changes in their eating habits for the rest of their lives." Biliopancreatic Bypass with Duodenal Switch (43845) The duodenal switch procedure is essentially a variant of the biliopancreatic bypass. However, instead of performing a distal gastrectomy, a “sleeve” gastrectomy is performed along the vertical axis of the stomach, preserving the pylorus and initial segment of the duodenum, which is then anastomosed to a segment of the ileum, similar to the above procedure, to create the alimentary limb. Preservation of the pyloric sphincter is designed to be more physiologic. The sleeve gastrectomy decreases the volume of the stomach and also decreases the parietal cell mass, with the intent of decreasing the incidence of ulcers at the duodenoileal anastomosis. However, the basic principle of the procedure is similar to that of the biliopancreatic bypass (i.e., producing selective malabsorption by limiting the food digestion and absorption to a short common ileal segment). WHEN SERVICES ARE NOT COVERED: Surgery for clinically severe obesity is not covered when these services are excluded from the member’s contract benefits. Studies are needed to determine the long-term health outcomes of the following procedures, therefore the procedures listed below are considered investigational when performed for the treatment of clinically severe obesity: Biliopancreatic Bypass Procedure (i.e., the Scopinaro procedure) (CPT code 43847) Biliopancreatic bypass (BPB) procedure, developed and used extensively in Italy, was designed to address some of the drawbacks of the original intestinal bypass procedures that have been abandoned due to unacceptable metabolic complications. Many of the complications were thought to be related to bacterial overgrowth and toxin production in the blind, bypassed segment. In contrast, BPB consists of a subtotal gastrectomy and diversion of the biliopancreatic juices into the distal ileum by a long Roux-en-Y procedure. This procedure consists of the following components: <LI class=bulletedList-1>A distal gastrectomy functions to induce a temporary early satiety OR the dumping syndrome in the early postoperative period, both of which limit food intake <LI class=bulletedList-1>A 200-cm long “alimentary tract” consists of 200 cm of ileum connecting the stomach to a common distal segment <LI class=bulletedList-1>A 300- to 400-cm “biliary tract,” which connects the duodenum, jejunum, and remaining ileum to the common distal segment <LI class=bulletedList-1>A 50- to 100-cm “common tract,” where food from the alimentary tract mixes with biliopancreatic juices from the biliary tract. Food digestion and absorption, particularly of fats and starches, are therefore limited to this small segment of bowel (i.e., creating a selective malabsorption). The length of the common segment will influence the degree of malabsorption Because of the high incidence of cholelithiasis associated with the procedure, patients typically undergo an associated cholecystectomy. Many potential metabolic complications are related to biliopancreatic bypass, including most prominently iron deficiency anemia, protein malnutrition, hypocalcemia, and bone demineralization. Protein malnutrition may require treatment with total parenteral nutrition (TPN). In addition, there have been several case reports of liver failure resulting in death or liver transplant. Mini-Gastric Bypass (no specific CPT code) Recently, a variant of the gastric bypass, called the “mini-gastric bypass” has been popularized. Using a laparoscopic approach, the stomach is segmented, similar to a traditional gastric bypass, but instead of creating a Roux-en-Y anastomosis, the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. This unique aspect of this procedure is not based on its laparoscopic approach, but rather the type of anastomosis used. NOTE: CPT code 43846 does not accurately describe the mini-gastric bypass, since this CPT code explicitly describes a Roux-en-Y gastroenterostomy, which is not used in the mini-gastric bypass. The following procedures reported as gastric bypass or gastroplasty are also considered investigational due to the lack of clinical studies to support effects on health outcomes: <LI class=bulletedList-1>jejunoileal bypass <LI class=bulletedList-1>gastric wrapping Garren-Edwards gastric bubble. BILLING/CODING INFORMATION: CPT Coding: 43644 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (Roux limb 150 cm or less) 43645 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption (investigational) 43770 Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components) 43771 Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric band component only 43772 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only 43773 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only 43774 Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band and subcutaneous port components 43842 Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty 43843 Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty (investigational) 43845 Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) 43846 Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy (may be done laparoscopically) 43847 Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption (may be done laparoscopically) There is no specific CPT or HCPCS code to report mini gastric bypass. A laparoscopic approach is used with the mini-gastric bypass. The stomach is segmented similar to a traditional gastric bypass; the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. The mini gastric bypass is not based on its laparoscopic approach, but rather the type of anastomosis used. HCPCS Coding S2083 Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline ICD-9 Diagnoses Codes That Support Medical Necessity: 278.01 Morbid obesity REIMBURSEMENT INFORMATION: Bariatric surgical procedures are limited to individuals 18 years and older and are reimbursed based on the procedure performed and not the surgical technique used (e.g., microsurgical, laser, laparoscopic). PROGRAM EXCEPTIONS: Federal Employee Program (FEP): Follow FEP guidelines. State Account Organization (SAO): Follow SAO guidelines. DEFINITIONS: Biliopancreatic bypass: gastric restriction rerouting bile and pancreatic juice to the distal ileum. Garren-Edwards gastric bubble: a free-floating intragastric device made of elastomeric plastic is placed in the stomach via a gastroscope, used for reducing stomach capacity. Gastric wrapping: the stomach is folded over on itself and a full stomach wrap, i.e. polypropylene mesh, is applied to limit gastric volume. Gastric banding: a synthetic band rather than staples is used to divide the stomach into a small upper pouch and a lower portion). Gastric bubble: see definition of Garren-Edwards gastric bubble. Jejunoileal bypass: shunts food from the jejunum into the ileum, bypassing the small intestine. Morbid obesity: defined as a body mass index (BMI) of 40 kg/m2 or greater. Satiety: the quality or state of being fed or gratified to or beyond capacity. RELATED GUIDELINES: Gastric Bypass Revision, 02-40000-11 OTHER: Other index terms for gastric surgery: Adjustable gastric banding Bariatric surgery Gastric bypass surgery Lap-Band System Mini gastric bypass Billroth II Long limb gastric bypass Roux-en-Y Scopinaro Vertical banding REFERENCES: <LI value=1>All-plan survey (Blue Cross Blue Shield plans) <LI value=2>American Academy of Medicine CPT Coding (current edition) <LI value=3>Blue Cross Blue Shield Association TEC Evaluation (12/88), 2003 <LI value=4>Blue Cross Blue Shield Association TEC Special Report: The relationship between weight loss and changes in morbidity following bariatric surgery for morbid obesity. BCBSA TEC Assessment Program, 2003; 18:1-25 <LI value=5>Blue Cross Blue Shield Association-Surgery for Morbid Obesity (7.01.47), 12/14/05 <LI value=6>DeMaria, E J, Sugerman, H J, Meador, J G, et al. High Failure Rate After Laparoscopic Adjustable Silicone Gastric Banding for Treatment of Morbid Obesity. Annals of Surgery 2001:233:809-818 <LI value=7>First Coast Service Options (FCSO) Medical Policy - surgical Management of Morbid Obesity, LCD #L14600 (01/01/06) <LI value=8>Guidance for Treatment of Adult Obesity, American Obesity Assoc., 1998 <LI value=9>Hayes Medical Technology Directory - Laproscopic Bariatric Surgery - us.lapa0008.2005 (11/03; Update report 12/05) <LI value=10>Hayes Medical Technology Directory - Obesity Management, Surgical Approaches OBES0802.03 (10/99; updated 07/27/02; updated 04/04/03) <LI value=11>InterQual Care Planning Criteria: General Surgery; Weight Loss Surgery GS-23 (2003) <LI value=12>National Institutes of Health Consensus Development Conference on Gastrointestinal Surgery for Severe Obesity Statement (March 25-27, 1991) <LI value=13>Rutledge MD, Robert. “The Mini-Gastric Bypass: Experience with the First 1,274 Cases”; Obesity Surgery 2001; 11:276-280 <LI value=14>St. Anthony’s ICD-9-CM code book (current edition) U.S. Food and Administration (FDA) Talk Paper, FDA Approves Implanted Stomach Band To Treat Severe Obesity, T01-26, 06/05/01 COMMITTEE APPROVAL: This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 04/27/06. GUIDELINE UPDATE INFORMATION: 10/15/99 Medical Coverage Guideline developed. 09/15/01 Various revisions. 01/01/02 Coding changes. 10/15/02 Annual review. Added Roux-enY anastomosis or vertical-banded as covered services. Added biliopancreatic bypass with duodenal switch and very long limb gastric bypass procedure (e.g., greater than 100 cm) as non-covered services. 05/15/03 Revised to clarify coding of the various procedures; criteria revised and is consistent with Inter-Qual criteria. 09/15/03 Coverage criteria for psychological testing/counseling revised. 10/15/03 Reversed investigational status for CPT code 43847 and provided coverage criteria for long-limb Roux-en-Y procedures up to 150 cm. 01/01/04 Annual HCPCS coding update. 04/01/04 2nd Quarter HCPCS coding update; added S2082 and S2083. 07/15/04 Scheduled review; no changes. 01/01/05 HCPCS coding update. Added 43644, 43645, 43845, S2082, and S2083. Revised descriptor for 43846, and deleted S2085. 05/15/05 Unscheduled review of the non-covered statement for laparoscopic adjustable gastric banding (Lap-Band); coverage statement unchanged. 01/01/06 Annual HCPCS coding update (added 43770-43774; deleted S2082). 04/15/06 Scheduled review; removed investigational statement for laparoscopic adjustable gastric banding and biliopancreatic diversion with duodenal switch; updated coding, index terms, and references. 05/15/06 Scheduled review; removed investigational statement for laparoscopic adjustable gastric banding and biliopancreatic diversion with duodenal switch; updated coding, index terms, and references; added age limitation of 18 years and older. Private Property of Blue Cross and Blue Shield of Florida. This medical coverage guideline is Copyright 2006, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association.

<p>yeah, i've been doing terrible.</p> <p> </p> <p>i haven't worked out in 2 weeks (1st week had a sick child, last week..no excuses). i haven't been logging my food. i get my first fill tomorrow.</p> <p> </p> <p>i'm revising my goal of items to do before December 27 (approx 2 months post op):</p> <p>1. go 3 whole days without any sugar or simple carbs</p> <p>2. work out 15 times at Curves</p> <p>3. log my food 25 out of 30 days.</p> <p>4. go on one family/friend outing that does not involve food. </p> <p>5. read a book (i used to love to read, but i'm not a big fan of fiction, and some of the non-fiction stuff is really dry, maybe i will find a self-help book for head hunger..lol)</p>

Thank you for your posts. I am having surgery with him on June 12th And its good to hear of others experiences. He did my band 10 years ago and is now doing my revision. I am also an RN so I loved hearing your point of view. I do speak Spanish though so I will be asking for those guantes!! LoL please keep us posted on your progress.

I have to admit, this is a situation I would have enjoyed. I would have taken great pleasure in giving her a bit of attitude (okay, a LOT of attitude) and a bit of education. I would have gotten right back in her face and explained how it all works and I would have explained that I did not want the path she clearly has chosen. I would never dream of being insulted by her behavior, I would have enjoyed the pleasure of watching her back down. ;o) But, that's me. Again, I wouldn't have thought twice about telling her the price. Plant the seed, you know? All of us have issues to work through, including nurses. The only people that have ever been that way to me are obese people who have had WLS and are not overly successful with it. THOSE people are brutal. When I was so sick with a band and needed a revision before I was so ill I would no longer be a good surgical risk I had a few that insisted that if I didn't have the band removed, gain all my weight back and THEN have a revision then that meant I was anorexic. It was weird, 100% of the time the only people who were on my tail about getting a revision without waiting to regain everything back were WLS failures, people who were not able to do it with surgery. Those that were doing well or at goal they were 100% supportive. I have a hunch that nurse was going through her own stuff. I'm not sure I'd write a letter to the hospital, but I would contact her and let her know how she made you feel and take it from there. See what her response is. THEN go to the hospital if you are still not happy. We all have our demons, that's why we needed surgery.

Than you for posting that. I am planning a revision and was turning more to rny then started questioning my thoughts.

I was asking for a guys perspective. I've been with her through many diets, revision surgery and her constant 2 AM anxiety attacks. Gotten enough advice from her girlfriends. Thanks anyway.

My Doc said the same thing. In fact she said she almost cringes when some opt for the band because she has done so many revisions.

Had my Surgery 6-4-15, best decision ever, don't regret it at all. I had the lapband in 2010 and revised to RNY in 2015. I only lost 30lbs with Lapband and over the years had issues with the band, I'm so glad I revised to RNY I've lost 58lbs so far and still slowly dropping SW 230 CW 172 GW 150 or whatever looks good to me

The mantra about protein first is less about cutting carbs, and more about making sure that your limited intake ability is stacked towards the protein you are going to need for the mass revisions and healing that your body is about to go through. You, in fact, need little in the way of complex carbs. The repair of surgery, the destruction of fat, the conversion of some of you fast twitch muscles to slow twitch, etc., is going to leave you with a need for protein. Lots and lots of it. I'm no expert, but my understanding is that there is an element of stacking the right combinations when it comes to heart disease. When you eat a protein rich diet, you are less likely to have problems when you have less carbs. I have heard it said that bread is like sandpaper in your vascular system, scraping along and allowing plaques to adhere. Meatless proteins can be had. My favorite is nutritional yeast. It makes salad taste like bread. It's got some nice iron and B vitamins, too. Also, low fat meat proteins are easily obtained as well. Not all calories are creates equal in the body. Healthy carbs... I hate that term. The evidence seems so very strong out there that grains of all stripes would be best if left OUT of the human diet. Fruits are better. Nuts are better. Eggs are better. All are better when we go against the grain.

Feb. 26th revision VSG to RNY.

Hi Lynn, I see that you've been banded back in February. So was I, on the 18th. I am just curious as to why you have not yet had your fill? I had a port revision surgery this May 5th, and I've had two fills since then, one during the revision surgery, and one this past Thursday.

Not sure if you have Kroger by you but they have this CARBMASTER MILK! Chocolate, Plain and Vanilla, 8 onz has 11 grams of Protein and 60 Calories. I know you need more but you could maybe mix protein powder with it. A Christmas I used it with Egg Beaters to make Eggnog. I told a friend of mine who's daughter has medical issues she was talking how her girl needed more protein but wouldn't drink ensure etc. I told her and she loves it. Tastes like regular chocolate milk. I mentioned it to my Dr he said it was find but as space is at a premium perhaps mix some additional unflavored protein powder with it. I currently have a band and am having a sleeve revision in May.

I had my surgery 10/21 and returned to work 11/16. I had sleeve to RNY revision with hernia repair. I couldn't have gone back in two weeks like some people do. I was still in so much discomfort. I have a desk job. I went back last week still in some discomfort but more than that I was exhausted in bed the first day back to work by 7 pm. I get up at 4:15am. I am just now starting to feel like my normal self and I am 5 weeks post op today.

Just using this thread as a running list of my medical/dietary commentary and questions. lol. Called the doc to move up my appointment since I can't eat and he did an emergency endoscopy today. He said everything he can see looks fine. He said he made my pouch twice the normal size and bypassed more intestine than he normally does "in case" I ever need a revision so he has extra stomach to work with. That kind of annoys me. He said it puts me at a higher risk of ulcers, which I developed. I don't really understand why he doubled the size of my pouch. I still get stuffed off 3oz though. He is removing my gallbladder on the 22nd. Pre-op I had a lot of gallstones, polyps, and calcification, so he hopes removing it will get rid of the nausea. It's bizarre though because everything makes me sick. I never, ever have high fat food. Even 0 fat stuff makes me sick. I hope it helps. GI Swallow on the 7th to see if there's a small bowel stricture he couldn't see in the endoscopy, but he doubts it. In the meantime, I guess I just feel sick for 3 more weeks and hope removing the gallbladder helps? I really don't want more surgery... [emoji53] I hope I can make it 3 weeks. He said if I can't bear it anymore to go to the ER and they will do emergency removal. Sent from my SM-G930R4 using BariatricPal mobile app

Update: November 8th, 2012 - this morning weighed in at 204, down 17 since I posted on 9/7 - I may need to revise my goal! I absolutely need to move more - that is a big goal for 2013 for me and my famly. Keep going strong gang - even if we stall those losses pick back up again if we stay the course

@@Embrace Hi! Thank you so much for checking in on me. Your note before my surgery gave me great peace and comfort. I have told NO ONE but my husband, so having you and others checking on me in INVALUABLE! I have had a tough 1st week of recovery, but am beginning to feel better. My 1 week check up is tomorrow. Because I was converting a "plication" to a sleeve, my procedure lasted 5.5 hours. I think this may be the reason the Anesthesia was particularly difficult to rid from my system. Not sure if this is the cause of my blurry vision for the last 6 days, but reading online, I have found that this can be a result of anesthesia and will improve in 9-10 days. (I have been unable to read the newspaper, emails, or any of the 3 new books I bought to enjoy during my recovery phase.) Additionally, I have had severe headaches that I cannot treat with my regular migraine meds, due to the complicated revision-----my doc's fear that the strong meds (even crushed) would cause damage to my new sleeve. ENOUGH COMPLAINING THOUGH!!! I'm grateful for my supportive husband who paid the 17,500. fee to have this done and my steady improvement. I actually feel myself getting stronger each day. Remembering what you said about walking the anesthesia off, I made sure to walk a little each day but honestly I only made it to my mailbox and back, walked from one end of my house to the other.....etc. (I was quite wimpy this week) I tried to balance what you said about walking and resting my body. I have a goal of walking 30 minutes (all at one time) by Saturday of this week. I hope I am able. Your 3rd piece of invaluable advice was very helpful and something I HAD NOT considered. As soon as I can get out, I'm going to purchase tiny bowls and small plates. Thank you so much for this tip!! Something I had not expected was the weight gain in the hospital from fluids. ( I probably should have done better research and made myself aware of this bc it SHOCKED me!) I gained 11 lbs and after 6 days that was finally gone. I hope I begin steady "losing" from this point on. I practiced "going out to dinner" last night with my husband. This is a little scary at first! We went to a Tai restaurant where I was able to order a bowl of simple broth. It was divine. (After eating broth from a box all week.) Since today is 1 week out, I'm going to weigh, take measurements, etc. I'm hoping I'm on the right path and will continue to improve. Enough about me! Are you doing o.k.? Still losing? Adding new foods to your diet? Feeling good? I think your surgery was this summer so we are just a few months apart. Your wisdom and compassion came through so clearly in your message to me and I want you to know how very much I appreciate the time it took to send it. Please continue to send your valuable tips and please let me know how you are progressing.

Hi Gigi, I made the revision from lap band to gastric sleeve recently. My doctor required a three month wait between band removal and sleeve surgery. He said a lot of the callous tissue that builds around the band will subside if given a waiting period. It made sense to me, and asking around in my area at seminars pre-decision to do this, all the doctors (under my medical coverage) in my local area were of the same opinion. They said simply, waiting was safer. The band removal was quick. I was in surgery and out same morning. The port site, removal, was the most painful area for a few days. The sleeve pain levels were less than the band removal, however new eating rules and such of course have been a much bigger event after the sleeve. Best wishes to your husband, and you. It's great to see your support already in this, as My husband has been terrific supporting me.

Yes thanks catwoman7 it is due to my severe GERD. Was giving the advice from my surgeon to have it done back in 2017 and I decided to wait keep doing meds and big lifestyle changes and unfortunately no relief if anything only worse. Definitely know the food choices and calorie intake are important. Also was told the weight loss is very low after the revision but not from personal experience.

I had the sleeve and loved it.....until I didn't. I lost 116 pounds in 10 months. I was working out 5 days per week. I was doing weight training, core and strength training, and cardio. THEN I started having major GERD symptoms. They were insane. I was put on 80mg of Nexium daily and still had break through GERD. Also has gastritis and esophagitis. 4 endoscopies and 1 colonoscopy later (and upwards of 30 polyps removed) I was scheduled for my revision from sleeve to bypass. I just had it done on the 28th. And while the recovery SUCKS majorly, I know once I'm past this, I'll have my life back. Oh, and I never had any reflux or GERD before, which is why I chose the sleeve to begin with.

Honestly, at this point, I'm beginning to wonder why I did this. I mean, I'm thrilled with the weight loss so far...80lbs in 11 months. But, with all of the problems I've been having and the thought of possible erosion being in the back of my mind at all times, I'm just not sure. I never really thought up front about what I'd do financially if the band had to be removed and now that's a very real possibility. I am still paying off the original surgery because my insurance only paid half. There's no way I can afford to have this thing taken out, much less have revision surgery too. My insurance changed 3 months after I was banded and the new insurance considers everything band-related to be pre-existing so refuse to pay anything. So I'm seriously stuck. I've been having these pains in my stomach around the band area for a while now and have no idea what it could be and I couldn't get an appointment to see my doctor until September. Once I see him and have tests done (no telling how much those will cost me!) I'll know what I'm facing. Meanwhile, all I can do is try not to think the worst and that's pretty much impossible. :cursing:

i used to be a lapband patient that had an unknown slipped band. i was losing so much weight that i looked sick but i was obsessed with losing weight. i vomitted multiple times a day but i thought i was bulimic. i weighed a skeletal 116 pounds before i decided to get my band checked. when they found the slip they took all the fluid out and told me to EAT. and eat i did! i gained 30 pounds in 2 months before deciding to revise to the sleeve. i basically feel like i have the same restriction with the sleeve as i did with the band BUT i no longer throw up. i know now i'm not bulimic, just a person with a slipped band. i'm so much happier now being able to eat and not worry how close i am to a bathroom!

My new surgeon to be, did my endoscopy yesterday and said my sleeve is dilated and has a bulge, he said it's not my fault, the sleeve was too big to begin with..causing weight loss failure. He advised that it could be revised with no issues. Now I have to wait and find out if my insurance will approve, since I have no bariatric benefits. I am so frustrated...

Hey everyone. I'm soon to be revised from lapband to sleeve and I'm in PG county. Surgery being done by Dr. Salameh at Virginia Hospital Center. Would love to interact with some other weight loss surgery peeps for support in the DMV area. You can contact me here or directly poohressa@gmail.com

Hi Cathy, First off congrats on your smooth recovery from your sleeve surgery. I've heard lots if revision patients say that it's such an easy transition that they almost feel nothing had been done. But the feeling of blah can get us all in the first month. Oh and I moved this thread to the "band to sleeve revision" section so it can be seen and answered by fellow former lap-banders

DG, you may not know this but reading your post has brought me peace being a former lapbander soon to be revised. Knowing ahead of time about the blahs will help me when that stage comes around. Congrats on your sucess too.