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Your BMI is about 74...in the practice where I was recently sleeved, you would be a candidate for a Duodenal Switch or a Roux-en-Y bypass, or for a sleeve gastrectomy as a first step, to help you lose some weight prior to a revision to a DS or RNY. This is definitely something that you can only decide in talking with your surgeon, because your co-morbidities will contribute to the decision in a major way. Good luck to you. Exactly! what she ^^^^ said. Spot on advice.

o.k. I am done .. My Bariatric doctor has the pre determination letter done. My own personal letter, my family doctors letter, and my psycholigist's letter is done... I called BCBS and asked them if I could add my own letter to my Dr's pre determination letter and she said the more the merrier.. So all the letters are done.. BUT.. just so I have this right.. I kept saying I wanted the Vertical sleeve. and my Dr said No you are asking for the surgery where we cut your stomach to the size of a banana and dispose of the other part of the stomach.,. I said yes.. He said that it is called the Gastric sleeve , or sleeve gastrectomy.. So is this the surgery you all have had???? Keep me in your prayers.. The Bible tells us ASK AND YOU SHALL RECEIVE... Which means leave DOUBT out of the picture.. Don't pray , ask , and then say Gee I hope God does this for me. Because at that point I put doubt in the picture... SO I am believing that I am getting approved for my revision surgery. And doubt is not even in the picture... Thank you all so much for your support.. This is so mentally draining but to win, to get what we deserve, we have to help each other in support.. Some of cant get it any where but here... God bless you all and please keep in touch with me as I will keep in touch with you all... Rose

I was the perfect sleeve candidate. No GERD and no other comorbities.I went in wanting the bypass. I have been overweight since the age of 5. I thought bypass would be a much better surgery for me. I was on a NUT plan a year before surgery and it took me 6 months to lose 12lbs. Anyways, I let the dr. talk me into sleeve. Almost 3 years later I am in the revision process. I have had some complications that has lead to the RNY path. I wish I had the RNY first.

Here's a lot of information that you can sift through if you'd like. There are patient testimonials, and research articles and links available within this information. It's a lot, but it will help you decide which surgery is right for you, and your lifestyle. I can tell you why I chose VSG over RNY for my revision from the band. 1) No blind stomach left that can't be easily scoped, but can still get cancer and ulcers. 2) The stats on regain with the RNY honestly scared me. 3) Malabsorption of calories/fat only lasts about 2 years, but the malabsorption of Vitamins and micro-nutrients last a lifetime. 4) No medication restrictions with VSG. RNY can not take NSAIDS due to ulcer risks. No food restrictions with VSG. Only 30% of RNY patients dump on sugar and carbs. I didn't want to essentially deprive myself of something occasionally, and suffer consequences. I did that for years dieting, all it did was cause me to binge. 5) Rerouting my intestines really was not an option. 6) I was a volume eater, not a grazer, not a sweet craver, and I simply need portion control and to remove my ravenous hunger. The sleeve gave me both. 7)Pouches and stomas stretch. Our sleeved stomach tissue has minimal stretching capability. Here's those links for research purposes. Diligence-is-always-required Stalls-Happen Update-from-a-2-Year-Post-Op-VSGer 2-year-surgiversary-and-feeling Two-and-one-half-years-post-op TWO-YEARS-YALL Just-Passed-My-2-Year-Surgiversary questions-for-post-ops-2-years-out-or-more 2-years-out-food-amount-info anyone-2-years-out Happy-2-year-anniversary-to-me 2-years-post-op-TODAY 2-5-Years-After-a-VSG Everday-life-at-2-5-years-out 2-1-2-year-update Has-it-really-been-2-years 2-1-2-year-update Two-Year-Surgiversary 2-year-update-portrait-of-a-heavyweight-a-bit-late Two-year-surgiversary 2-and-1-2-years-later 2-years-since-my-surgery-any-advice-on-face-lift 2-year-post-op-pics Two-Years-Before-amp-After-Pic 2-year-update-portrait-of-a-heavyweight-a-bit-late Thought-you-might-enjoy-an-update-with-a-few-pics Busybusymom-is-back-2-years-post-op TWO-YEARS-BABY Any-old-timers-still-lurking-the-boards Long-term Sleeve Experiences - 3 Years on June 8, 2009 10:43 pm Three years out Three and a half years after Vertical Gastrectomy My Story A quick 2 year and 3 year VSG update Third Year Surgiversay Not always easy but always worth it Very Discouraged 3 years out Links for researching the VSG on March 15, 2009 11:18 pm Here are some links I've collected when I was researching the sleeve. ASMBS position paper on sleeve - includes reports of early studies LapSF Educational presentation to FACS - includes some 2 year results LapSF Two Year Study LapSF Five Year Study - abstract only LapSF Five Year Study - presentation (requires Windows to play) Literature review on the sleeve - requires $$ to get the full text unfortunately Sleeve best for over 50 crowd Video of a sleeve with lots of education discussion Video of a sleeve that is more about the operation Ghrelin levels after RnY and sleeve Ghrelin levels after band and sleeve Diabetes resolution in RnY vs. Sleeve Comparison of band to sleeve - literature review

I'm in Houston and the price I was quoted was $17500 but I'm having revision surgery....and the price includes insurance against any complications that may occur

No evidence of erosion or slippage via ER CT....worried about being able to qualify for revision!Ingo Horizon Health NJ BCBS

I had a revision 2 weeks ago at MI Doctor, they gave me my band back. Jana, sleeved 1/31/13

Congrats on your quick approval. My reasons for choosing VSG over RNY for my revision: 1) Malabsorption with RNY only last 18-24 months for calories/fats/sugars, but you get a lifetime of vitamin/mineral malabsorption for life. That isn't a fair trade off in my opinion. 2) I had a pouch/stoma with the band, RNY offers the same thing, and my body hated the pouch. 3) I wanted to keep my pyloric valve for normal digestive functions. No bypassing no dumping 4) No blind stomach left behind that can still get ulcers/cancer yet it's very difficult to scope. 5) Pouches stretch. Regain stats with RNY are just scary. 6) Long term complications with malabsorption, and other various issues with RNY just weren't worth the immediate payoff of quick weight loss. 7) stats on VSG vs. RNY for weight loss were neck and neck, and I knew I didn't need malabsorption to get to my goal weight. That's the short list. Best decision I ever made ! ! !

I want to know how you revise a bypass to a sleeve! I've been dying to know this ever since the topic first came up on another board.

I would not recommend trying to do the clearances yet, as most of them have to be done within a certain time period before surgery. You never know if you're going to have a fight with insurance, like I did. I had to go back and forth with appeals for 3.5 months before I was approved for my revision, so if I'd tried to do my clearances early, I would have just had to do them all over again, since they all had to be done within 30 days prior to having surgery. Now, once you get your date, I would try to get them done ASAP, because there might be follow-up things that you have to do that may require some waiting (a sleep study, in my case). I only had 3 weeks notice, and I wasn't going to be able to get in to see my PCP for a week and a half, so I had to go to a new doctor for my lab tests. Luckily, I was able to get everything done in about 1.5-2 weeks (delayed a few days because my pulmonologist required me to go for the sleep study before she would clear me), so now I'm just waiting for everything to be forwarded to my surgeon's office on Monday.

I am so glad you are NOT going with the lapband. Some tough talk here, you are pretty high BMI and the band is completely unsuited for that situation in my opinion based on my personal experience of being the not so proud owner of one of them for a decade.... I was a BMI of about 52 when I revised from the band to sleeve. The first surgeon thought I was too high of BMI/failed history for the sleeve and I should go with RNY. I chose a different surgeon who did think I was a good candidate for the sleeve and i have done very well (I revised to sleeve in Dec 2011) If I was higher BMI, I would seriously consider the RNY or the DS procedures. I don't know much about it, but there is a new DS technique that seems to have less side effects and for people with alot to lose, the DS is by far the most effective. It is also the procedure with the most "issues" including defieciencies so it is about tradeoffs... Anyway, do your research because failing and revising to another procedure is really tough, physically, emotionally etc. Really learn about the options and chose the one that has good research to back it up being successful for your goals, amount of weight loss desired etc. Good luck!!!

The first two issues should be easy to resolve. It's not up to a clerk to decide if something is medically necessary. Fed BC/BS most certainly does pay for sleeve. The BMI...that one they may just get you on. If their requirements are that you be a certain BMI they have every right to deny you. :laugh0:( Not right and not fair, but they get to make the rules. I would explain that the Standard of Care is such that you should do a revision at the same time as the band removal when possible. Now, if you have a slip it may not be possible to do a revision at the same time as band removal. If your stomach is swollen it is not wise to do a sleeve until it heals. The problem is, then you really will be in a pinch because it will no longer be considered a revision to get a sleeve but it will be treated as your original surgery. WLS for an obese person and you *will* have to meet all the requirements.

Hi WASA, What's funny is that they didn't deny the VSG for the BMI reason, the denial letter states only that it's investigational. It's the removal of the lap band that they denied because of the BMI. Isn't that funny? Like no matter how much you're suffering you have to regain the weight AND vomit and not be able to eat to get the danged thing out. Or be lucky enought to have a slip before you lost much weight :-). Even if they brought out the BMI argument for the VSG I'd still fight them - I had a gastric restrictive procedure and it needs to be fixed so that I have gastric restriction again. My original surgery was covered and I met all the requirements so it seems like a continuation to me, not something new. If I went and asked for breast implants I'd be denied. But if I had breast cancer and a mastectomy and a year later asked for breast implants I'd be covered. They wouldn't deny me because I no longer had cancer. ahchancey, Would you be willing to share the doctor and/or state in which you had the revision? Part of my argument includes a list of all the doctors I've found with Fed BCBS patients who were approved for VSG. I've been calling the local plan admins in those states and confirming the coverage. So far, everyone says no problem. Of course my state admin said no problem too. They actually have two separate local BCBS companies doing the admin here and I think that's part of the problem. The group that does the customer service told me it was fine but the company that handles the pre-certs says it wasnt' and the other company was wrong. Sigh... Almost every day I think just screw it and I'll go see Aceves and pay for it myself. But now I've almost got the letter done, just need a blurb or two on why VSG is safe and mainstream and I'll send it off. Then I'm done and I'll either get it or book my trip to Mexicali. If I won the lotter I'd just book my trip and get goin' :-). Britt

I thought about it, but sleeves do stretch out once they're a couple of years out. Also it has to be difficult to revise from plication to sleeve although I am aware of one person on verticalsleevetalk that has successfully revised. I know the chances of a leak in a band to VSG revision quadruple (virgin leak risk is 1%). Some sleeve surgeons unband their patients, send them home to heal and then sleeve them in a separate surgery. I'm holding off at the mo and trying not to stress too much.

These are my before and after tummy tuck photos. As you can see that pre-op there was a lot of excess skin and the port can be seen. Post-op pictures are two weeks out and as you can see the port is no longer visible. My starting weight was 329 lbs. and my day of surgery weight was 129 lbs. Please feel free to ask me any questions and I hope that this post helps you with your decision.

It's funny cuz since being banded for almost 4 yrs prior to my revision 5 1/2 weeks ago, my stop signal was always "I got tired of eating". was never really "full", just couldn't eat anymore cuz I didn't want to. Now, I feel like I've swallowed a plum that sitting right at the top of my stomach. It doesn't hurt, but feels like if I take one more bite I might vomit. So I stop. Haven't vomited yet with the slveev (unlike my frequent vomiting with my band). Since first getting the band in 2009, I have yet to feel that "Thanksgiving full" I used to feel. It's more like ucomfortableness.

Amen to every reply to your post. It's your body and you have made the choice to be healthy. Good for you!! It was because of the comments I received after getting the lap band and then when it failed, that I chose not to tell anyone about my revision to the sleeve. Only my husband and daughter know. I just say Dr. has me on high protein and low carb diet. Which is sorta true...... I am 63 and love my sleeve! Good luck dear! Jeri

First step is to get a denial letter starting the reasons for the denial. So, your surgeon would still have to submit the paperwork for approval and then get a denial response letter from the insurance company. Also, getting a letter of support from your primary doctor, and any other doctors you may see for related co-morbidities. Also, documented attempted and failed weight loss attempts such as diets/exercising, and why you need surgery that will get you to healthy weight, and a surgery that will help you maintain your weightloss. I'm with you on the RNY being scary. I was having no part of that one considering how many RNY patients seek a revision in 5-8 years or so because of regain. Then you can appeal the decision. Here is a list of sample appeal letters with recent research and published studies discussing that VSG is a successful procedure as a stand-alone surgery. This is a lot of information, but you have to get the denial letter before you can appeal the decision. One of the factors to consider with RNY or lapband is that you can not take NSAIDS (alleve or ibuprofen) with either of those surgeries. But, you can take them with the sleeve. So, if you need to take NSAIDS make sure to have that included in your letter. This is a lot of info, but all the published studies, and ASMBS statement that the sleeve is a successful stand-alone procedure. http://www.obesityhelp.com/morbidobesity/information/wlsjourney/insurance+trouble.php http://verticalsleevetalk.com/insurance-financing/1496-my-appeal-draft-w-references.html#post14133 http://vsgappeal.blogspot.com/2009/06/appeal-letter.html http://verticalsleevetalk.com/pre-operation-vertical-sleeve-surgery-vsg-questions-answers/1751-unapproved-sleeve-ready-cry-2.html#post17480 http://thediaryofafatwoman.blogspot.com/2008/11/deny-deny-deny.html

I had revision surgery on March 16 as well, i feel you're pain. I keep seeing everything happy at the dinner table while I am left to the side hungry with a bowl of cream of wheat.

Good Advice -I am trying to do that too🐾💕-I also have been immobile on a scooter due to leg issues - had to have revision of a prior tendon repair - I was not going to do this surgery but my Dr said I had a hiatal hernia and bad esophageal scarring and as long as that had to be repaired I should consider it and so while I was out with my leg I had the additional testing done- once we knew I did not have esophageal cancer I thought - I should do this and get myself back. I was in a very bad relationship with a man who tricked me into putting him on the deed of my coop. When I sold it he drained our shared account- as this happened- I needed hope and to do something for me. The feeling of betrayal was so horrifying- he nearly ruined me financially, physically and mentally. So when we say look forward I am so right there ready to not look back!!!

I had 4 with my band surgery, and they used all of those plus one other one. I had sutures with band surgery over the port incision which my revision surgeon used the same incision to remove the excised portion of the stomach. With my revision incision, all they used was a type of skin glue, no sutures, no staples, and it took almost 3 weeks for the skin glue to finally flake off in the shower. It wasn't the blue/dermabond type of skin glue. It was pretty cool because I had zero sutures or staples. Because of my complications, I did end up with more incisions. I have a total of 10 or 11 scars on my abdomen, but all of them are shrinking and fading pretty good. I did buy some Mederma, but I'm not good applying it on a regular basis. I caught it on sale for $20 from skinwest.com I heard that prefer-on stuff works to help fade scars just as good as the Mederma.

Wow, first let me say I can completely understand your frustration! I have not yet had my surgery but I will be a band to sleeve revision, and just getting up to this point has been extremely frustrating. I decided to take extreme measures almost 4 years ago when I was first banded,and here I am now, still overweight, feeling like a failure, and having to go through all of these emotions all over again. But enough of the negative! Congratulations on your success so far. I have read hundreds of posts on here, and one thing is guaranteed -- we will all plateau. Some may only last 3 days, some up to two weeks. And although you already said you don't want to hear it, many people have said the way they have jump started their weight loss again, is by doing something different. One girl mentioned adding a tsp. of fat (olive oil) - maybe you're actually eating too little? I don't know what the answer is, but even if you do absolutely nothing different, the weight loss will continue if you stick with the plan. As for the hair loss, it is a HUGE concern of mine also. Also just like you said, my hair is "my thing". I may be overweight, may not have porcelain skin complexion, but I have always gotten compliments on my hair. That is another thing people say gets better over time, but for your daughter's wedding, if it will make you feel better go and get yourself a hair piece! But you will look absolutely beautiful regardless of whether you have thick hair, thin hair, or no hair! You are just dealing with an awful lot right now, and I bet it is quite overwhelming. When you start feeling like this, go for a walk or start a journal, or if you still have any - go try on a pair of your largest size pants and I bet you will start to feel even just a tiny bit better. Best of luck to you, and keep up the great work!!

Has anyone had surgery with Humana as their insurance? If so, is the approval process through them easy? Original insurance was Cigna with the lapband 5 years. Now, I'm trying to have revision surgery to the sleeve with my company's new insurer. Any helpful information would be greatly appreciated. Thanks

The requirement was removed July of 2014. My surgery was November of 2014 and there was no 6 month requirement for me. They only revise the procedure annually so it won't change again (if at all) till July of 2015. Here is the link to the official medical procedure guidelines on the BCBS NC website. You will see it was reviewed May 2014 and next review is May 2015. All that being said, if your insurance is through an employer, they may have their own requirements that can differ from the BCBS requirements. http://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/surgery_for_morbid_obesity.pdf

Hi all! I am getting revision surgery early tomorrow morning! I am excited, stressed, and so ready to do this! I started with the band in 2008 and lost around 30 pounds, had to have gall bladder surgery, and gained back 15. I had a too tight band and developed a hiatal hernia and erosive gastritis. Getting stuck was the norm! So, with my sleep apnea and needing to lose 90 pounds to hopefully regain my health, I am doing it. I have been on a liquid 800 cal diet since last Wednesday. I am 10 pounds down this morning. Wish me luck sleeping tonight here in Raleigh, NC!!