Lap Band Eroded - Possible Revision To Gastric Sleeve

[JaxBandster 11]

I have had my band since February 2007. Yesterday, I went in for an upper GI to check and make sure my pouch hadn't stretched. I haven't had any pain or discomfort, no vomiting, or acid reflux. My only complaint was that despite having an almost full band, I could at times eat much more than I thought I should be able to. Hence the decision by my doctor to do the upper GI. As reference, I began at 277 before my lapband surgery. I got down as low as 183, bounced back up to 223 and am now sitting at 211 with a BMI of 32. My goal weight is about 165. This is in a period of almost four years.

When I drank the contrast liquid, we watched as the Fluid went down the esophagus, into the pouch, and through the stoma. We also watched as some of the liquid went AROUND my band! The only way that can happen is if a portion of the band is now INSIDE of my stomach. Preliminary diagnosis is band erosion. Next week I will be scheduling an endoscopy to determine the extent of the erosion and see how much damage has been done to my stomach.

In the brief conversation I had with my doctor after the discovery, he stated that the only option for treatment is removal of the band. You could have knocked me over with a feather. I have become dependent on my band and to think of not having restriction is a scary thought for me. Like others, the thought of going back to the weight I was at before is not an option.

My doctor has indicated that once the band has been removed and I have healed from that surgery (after about four months), I can either be re-banded (I don't think so), or I can do a revision to either bypass or gastric sleeve. I am not keen on the idea of bypass. It just seems so extreme and there's no where to go after that surgery. So I am leaning towards the sleeve. From everything I have read, the majority of people who have had this procedure are very happy with it.

Yesterday was spent trying to wrap my head around the prospect of having two surgeries next year. Talking with my family and trying to understand my options. I am fortunate in that my situation is not an emergency. There is no infection and I can eat properly. (The doctor did deflate my band completely). I also have insurance through my company and the enrollment period is coming up in the next couple of weeks so I can make decisions accordingly knowing that I am going to have these surgeries. It is still yet to be determined if my insurance company (BCBS AL) will cover either surgery (scary thought), but I'm willing to fight for it. I was self pay for my band so I don't know if that will impact their decision or not. I know they do cover WLS and have the typical six month waiting period (not sure I would have to do that given the circumstances).

I will be posting here with my progress and experience for the benefit of others who may encounter similar complications and decisions. I would very much like to hear from others who have had band erosion and have done the revision to the sleeve or those who have the sleeve and what their experience has been with that type of surgery.

I can't believe I'm at this point again. Ugh.

[JaxBandster 11]

Spoke with the M.A. at my surgeon's office this afternoon. Asked the following questions and received the following answers. If anyone can suggest other questions I should ask when I meet my surgeon, I would appreciate it very much.

1. From your experience, are removals and revisions generally covered by employer insurance even if the original surgery was either self-pay or covered by another insurer?

A. Removals are usually covered as they are considered a complication and medically necessary. Revisions depend on the coverage.

2. If they do cover the revision, do they typically require the mandatory six month weight loss program requirement?

A. Insurance requirements are rapidly changing - hard to say at this time.

3. Pending the results of the endoscopy, would it be harmful to wait until my new benefits take effect at the beginning of the year before removing the band?

A. Depends on the results of the endoscopy

4. Could the removal and revision be done at the same time?

A. No. You need time to heal from the removal

5. How many removals and revisions has my surgeon done?

A. Quite a few (no numbers provided, will ask surgeon directly)

6. Generally, how long is the recovery for the removal and for the revision to the sleeve?

A. Removal of the band, about the same length of time when having the original surgery. Revision depends on the patient.

7. Is the removal procedure inpatient or outpatient?

A. Usually outpatient

8. Typically, how long is the hospital stay for the revision.

A. Overnight

9. Is there a stomach tube with the revision? How long does it stay in?

A. Sometimes. Depends on the patient.

She informed me that she will contact my PCP in the morning to make sure they have all the information they require in order to make the referral for my endoscopy. They want that done ASAP.

She also suggested that I speak with a rep from BCBS during open enrollment to discuss my specific situation and what actions I need to take to assist in getting approved for the revision.

I know that everyone's situation is unique and everything I asked here may not apply to your situation, but I hope that my experience can help others in similar situations.

[JaxBandster 11]

Went for my upper endoscopy today. Band erosion confirmed. You can clearly see half the band on the inside of my stomach. Will be meeting with my surgeon soon to come up with a plan of action.

Here's hoping my insurance will cover revision to the sleeve.

[Humming Bird 275]

Oh geez .... sorry to hear this happened. I do hear pretty positive things about the sleeve. Keep us posted.

[Matt Z 4,139]

not sure exactly why you are going to be required to wait between removal and sleeving. The process of sleeving removes the left most portion of the stomach, I've seen video where and erosion was removed and sleeved all in 1 surgery. Since they are going to be potentially cutting to remove the eroded band, whats the reason for the wait to cut rest of the stomach off and staple up? Something I would ask your surgeon.

[LilMissDiva Irene 3,282]

Hi Jax, I do believe I remember you!

I had my band removed last year and revised to the vertical sleeve. It was not due to erosion, it was due to poor results on weight loss. I absolutely love my sleeve. I'm now working on reaching my third goal post op, which is to fit into size 0... I never imagined that would be me!!!

I wish you well in your journey. It IS best to heal first in cases of erosion before getting your sleeve. Leak factors rise for band to sleeve revisions, and its in your own best interest to do this as healthy as possible.

Blessings!!

[LilMissDiva Irene 3,282]

I'd also like to invite you to join in on the Vertical Sleeve Talk website. There is an entire section dedicated to band to sleeve revisions.

http://www.verticalsleevetalk.com/

[JaxBandster 11]

It has been a while since I have written, but it's been because I've been in a holding pattern waiting for my new insurance coverage to kick in. Fortunately, my band hasn't given me any issues besides some minor pulling feelings and twinges. I have had no sign of infection thus far thankfully.

While I was waiting for the updated insurance, I gave a great deal of thought about who I wanted to do my surgeries. The doctor I had been going to for my band maintenance is a capable surgeon and a nice enough person, but I wasn't comfortable with his level of expertise in doing band to sleeve revisions. I did some research and found another surgeon here locally who has been doing sleeves for more than four years and has been doing band to sleeve revisions about once a month and is doing them on an increasingly frequent basis. In his words, a band to sleeve revision is not bariatric 101 surgery. It is more complicated due to scar tissues and adhesions from the band. I like his forthright attitude and his confidence, so I am waiting for a call next week to schedule the first surgery to remove the band. We will then wait three to six months and do the revision to the sleeve.

He indicated that he will probably keep me overnight in the hospital for the band removal as he uses a stomach tube for drainage and that will need to be removed and he also wants to make sure there are no leaks. However, he also said that in all likelihood I can have the surgery on Friday and be back to work the following Monday as long as I have a sedentary job which I do.

I am ready to get this process started. Let's do this thing!

[Cocoabean 430]

Wow, Jax..that's quite the ordeal. Very sorry it happened to you. I wish you all the best with the sleeve!

[JaxBandster 11]

Thanks Denise,

It is what it is. In hindsight, I wish I had done things differently (gotten the sleeve in the first place) but hopefully this will all work out in the end and I can get back on track!

[Cocoabean 430]

I'd also like to invite you to join in on the Vertical Sleeve Talk website. There is an entire section dedicated to band to sleeve revisions.

http://www.verticalsleevetalk.com/

And all I can say to YOU Miss Diva is WOW!!! I remember when you were struggling with your band and so frustrated. You look amazing!

Well done, Woman! :-) I am so happy it's worked so wonderfully for you. Keep up the good work.

[Cocoabean 430]

Thanks Denise,

It is what it is. In hindsight, I wish I had done things differently (gotten the sleeve in the first place) but hopefully this will all work out in the end and I can get back on track!

Was the sleeve around back then (I know they could do it as the first step of an RNY and not do the bypass part)? I was banded in Feb. 2008 and I don't recall it as even being experimental then, but my memory sucks. The good news is you were successful with your band, so you pretty much know you'll be successful with your sleeve.

The possibility of long-term complications is something we must all deal with. It stinks, but it is the reality of any implanted medical device. Knee, hip, heart valve, yada yada.

But, here's to a speedy recovery, and an even quicker journey to goal!

[JaxBandster 11]

Well after many months and many ups and downs I finally have a date to have my eroded lap band removed. March 29th is the big day!!!!!!!!!!! I will have my surgery VERY early in the morning and will stay overnight to make sure there is no leaking from the repaired area of my stomach. Hopefully, if all goes well, in two months I will revise to either the sleeve or banded plication. There is much to consider with both of these procedures and the positives and negatives are pretty well balanced. I have read good and bad things about both procedures.

Right now though, I'm just going to focus on getting the band removed and see what kind of damage it's done. So far I have felt no effects other than an occasional pull or tug or momentary pain in the area just below my sternum. I still have some minimal restriction due to there being a plastic ring in the middle of my stomach but I can pretty much eat anything I want and have been. I figure that eventually I will have the tool necessary for me to succeed so I might as well enjoy myself while I can even though the weight gain is making me feel miserable physically. I can't wait to be thin again. Weird how the mind justifies things. If I couldn't eat another cheeseburger tomorrow it wouldn't bother me, but since I can I do! Ugh.

I'm definitely ready to get back on track. Let's get this party started!

[Cocoabean 430]

Thanks for the update! Is your insurance covering the procedures?

Best wishes in your decisions!

[JaxBandster 11]

Thanks for the update! Is your insurance covering the procedures?

Best wishes in your decisions!

So far it is covering the removal of the band and it supposedly will cover revision due to erosion. Time will tell!