Re-Sleeve or Sleeve to Bypass / DS

[miss_smiles 192]

I had my surgery March 2016, and after 1.5 years I gained back the 50 pounds I lost and am now at my weight before surgery (230, 5 ft 4 around 40 BMI). My lowest was only 185 from 240. I believe the first surgery pouch wasn't small enough and I do have gastric re-flux occasionally. I started gaining after 6 months - a year. I will admit after 6 months, I was not exercising as much (went from cardio every day for an hour, to only 3x a week), and I was more lenient with food adding in some carbs whereas I was only eating Protein and veggies ~1,000 calories daily to ~1,200-1,500. I have an appointment with a new doctor in a few weeks to go over my options, but I just want to know if anyone has been resleeved, or changed to a bypass or DS and if yes, did insurance cover the second procedure? (note: please do not comment about changing diet, a pouch reset and/or about habits and how a 2nd surgery won't help, only comment if you have knowledge of a resleeve or additional surgery, thanks).

[Syd147 1]

I am so glad to have came across you post!! I am in the same boat. Had sleeve done in 11/2013. Started at 290 and I am 5’5. I got down to 208.. then started going up. Almost 4 years later I am at 27 and 246lbs now.

I met with a surgeon about 2 months ago, she mentioned possibly doing a revision to bypass but that’s not what I wanted... I had an upper GI done, and she pulled he OP report from my previous surgeon and it showed that they didn’t take enough out. She said she is optimistic that she can revise the current sleeve and take what should have been taken from day 1. So I was sent for approval yesterday 10/24.

I have Aetna POS II. They do not require a 3 or 6 month diet like the first time. So everything was sent...

I will say that my surgeon told me she has never done a revision before. She said that if I won’t let her do the bypass then she will go in there, she if/what she can take out of my stomach, and if she can’t she will close me up and tell me I’m SOL. Kind of frustrating but I feel like she wouldn’t have sent me into surgery unless she WAS going to take more of my stomach.

Sigh... lol I guess I will keep you posted!

[miss_smiles 192]

THANK YOU so much for responding! Especially knowing it may not require the 3-6 month diet like the first time around. I definitely DO want a bypass now, especially since the sleeve failed. I would hate to have a re-sleeve just to have it happen again. I really hope it is indeed the surgeon who messed up and that my occasional bad habits isn't the culprit. Please keep me posted, and good luck to you!

[RickM 1,747]

If your insurance doesn't have any restrictions on the number of WLS per lifetime (some limit to one WLS per lifetime) then the usual insurance rules generally apply - BMI of 40 and above, or 35 with comorbidities. So, that's the good news - if you were covered before and have regained to that point, then you should be covered again.

The bad news that you probably don't want to hear is that it won't likely do you much good in the long term, unless there was something seriously defective with your first procedure that needs to be corrected. Changing to a bypass may get you back on track again for a while, but ultimately you will be in the same position as the two procedures are very similar in overall strength or outcome. Think of your WLS as more of a "do-over" than a metabolic reset - it gives you the chance to get things in order to live sustainably and maintain your weight, but it doesn't do it for you.

While I don't agree with everything this doc says, he is one of the few that acknowledges that our meal capacity will increase over time (to around half of our pre-op capacity), and has a viable prescription for living with that fact. His numbers are consistent with my experience over the years. Also, that sleeve/pouch size has little to do with long term capacity or success - my wife has a huge sleeve on VSG terms (from her DS, which typically uses a sleeve of about twice the size of a stand alone VSG sleeve,) and our meal sizes are pretty much the same several years out. It is very much a matter of food choices and habits rather than absolute restriction minimizing how much we eat.

A good part of the game here is matching the right procedure with the patient - think in terms of the WLS procedures having somewhat different personalities, and you have to find the right "fit", just as you do with friends and associates. The RNY isn't any mover powerful overall than the VSG, but may be a better fit for you. Or it may not - research and talk to as many people with the bypass as you can to see if it is right for you, as one of its' drawbacks is that it is very difficult to revise to something else if it doesn't fit. With either procedure, it would not be uncommon for women of average and below height to maintain in the 1000-1200 calorie range long term. If you are having problems at 12-1500 calories now, a bypass or resleeve isn't going to help much if you can't find a way to maintain at whatever level your metabolism dictates.

The DS does offer a better metabolic kick long term and may be your best option if you can't make the long term diet/lifestyle adjustments to make the VSG work; its' caloric malabsorption is long term vs the bypass which sees its caloric malabsorption dissipate after a year or two.. But it requires more serious commitment to supplementing and follow up lab work for life (that's part of its' "personality" that you have to live with. But I have seen many be successful over 10-20 years with it, often eating a less than "ideal" diet.

[miss_smiles 192]

Thank you for the post, Rick! I also was thinking about the DS as a first choice, but don't know if I would be eligible without speaking with the new surgeon. I will keep all this in mind!

[Rocky4521 0]

Hi I am to going to have a sleeve to bypass revision due to serve GERD and hiatal hernia. I also have AETNA. Did you say you did not have to do the 3 or 6 month program again? I'm really hoping I don't have too. I do have a bmi of 40. I did have some weight gain back from the sleeve. Look forward to hearing from you 😊

[Mhy12784 423]

On 10/25/2017 at 4:54 PM, miss_smiles said:

Thank you for the post, Rick! I also was thinking about the DS as a first choice, but don't know if I would be eligible without speaking with the new surgeon. I will keep all this in mind!

The DS is rarely performed. I think statistically it accounts for 0.5% of weight loss surgeries, meaning it might not be the most appropriate option. Getting a re-sleeve less than 2 years after an original sleeve is absolutely ridiculous and I have no idea why any insurance would cover it or surgeon would perform it.

Having a sleeve to a bypass is a reasonable option. Especially if you think reflux is a factor.

I just noticed this post is almost 2 months old though, so im gonna stop here.

[miss_smiles 192]

I am actually back to the Drs. and he thinks the switch to a bypass would be my best option. Ill keep this thread updated with my progress. Hopefully Ill be in surgery by March/April.

[miss_smiles 192]

UPDATE: Just got a second opinion and the first surgeon did it WRONG the first time. He did not remove enough of my stomach and essentially set me up for failure. For all of those who don't feel restriction or lose restriction after 6 months, get an upper GI series done and have someone other then your own surgeon look at your sleeve. I refused to blame myself anymore for my unsuccessful weight loss and eventual weight regain PLUS 20 MORE pounds, and getting this second opinion changed my life. They are fast tracking my case through insurance, I will not need the whole 6 months pre-op like 1st time around, and I FINALLY have a good Dr. in my corner. For all of you who have felt/feel the same GET A CHECK UP. I wasted nearly 2 years with an improper sleeve due to blaming myself thinking it was MY fault for not losing enough weight, and for being too embarrassed of being a failure. 260 Pounds and sleeve #2 next year to hopefully change my life the way it should have changed years ago.