*Susan* revision from band to sleeve

[*susan* 1,709]

I had my band placed on in April, 2006. The first year was a breeze and I lost a ton of weight. In month 13 of my journey, I was overfilled and slipped my band. Since then, I seemed to have developed an intolerance for my band. I have slipped it twice, constantly choke on my food, and have been miserable.

On April 2nd, I will be revising from the lapband to the gastric sleeve. Dr. Aceves will be doing the revision in Mexico. I have decided to chronicle my experience here, so others that have band issues and decide to convert can have an idea of what to expect.

I spoke with Nina, the patient coordinator yesterday and we now have everything scheduled. I am excited and nervous all at the same time. I will leave here on April 1st, have my surgery on the 2nd and return home on the 5th. My mother will be accompanying me on the trip.

Nina advised me that Dr. Aceves is concerned about swelling due to the problems I have had with my band. Therefore, I am going this week for a complete unfill. Then, seven days before my surgery, I have to go on a complete liquid diet. This should alleviate any swelling issues and the chances of having to have the band removed and then go back at a later date for the sleeve. It is very important to me that I get this all done at the same time.

I am looking forward to this, and feel like I have been given a new opportunity at life. To those who have helped me to be able to get the sleeve, thank you. Because of you, I now am looking forward to enjoying life again, instead of living in misery.

I will update as I go through this journey.

[WASaBubbleButt 41]

I had my band placed on in April, 2006. The first year was a breeze and I lost a ton of weight. In month 13 of my journey, I was overfilled and slipped my band. Since then, I seemed to have developed an intolerance for my band. I have slipped it twice, constantly choke on my food, and have been miserable.

On April 2nd, I will be revising from the lapband to the gastric sleeve. Dr. Aceves will be doing the revision in Mexico. I have decided to chronicle my experience here, so others that have band issues and decide to convert can have an idea of what to expect.

I spoke with Nina, the patient coordinator yesterday and we now have everything scheduled. I am excited and nervous all at the same time. I will leave here on April 1st, have my surgery on the 2nd and return home on the 5th. My mother will be accompanying me on the trip.

Nina advised me that Dr. Aceves is concerned about swelling due to the problems I have had with my band. Therefore, I am going this week for a complete unfill. Then, seven days before my surgery, I have to go on a complete liquid diet. This should alleviate any swelling issues and the chances of having to have the band removed and then go back at a later date for the sleeve. It is very important to me that I get this all done at the same time.

I am looking forward to this, and feel like I have been given a new opportunity at life. To those who have helped me to be able to get the sleeve, thank you. Because of you, I now am looking forward to enjoying life again, instead of living in misery.

I will update as I go through this journey.

OMG! This is fantastic! I know you are thrilled! I am sincerely happy for you.

When the band does not work it makes life a sheer horror. I know exactly what you are going through and I'm thrilled you decided to go with the sleeve.

Weight loss is faster, it's better, complications are few in number and rare, you'll be able to eat healthy foods again... you get your life back.

Congrats to you, 4/2/09 really will be the first day of the rest of your life. You'll see!

And... Dr. Aceves rocks! I am glad you are going to him. Revisions do carry more risk than working on a virgin stomach. He's done over 500 sleeves and never had a sleeve leak. So you really are in good hands. He's done a bunch of bypass too so he has about a 1000 staple lines. You are giving yourself every opportunity for a safe surgery here, good for you!

[gingerbug 3]

I plan to watch this thread! It is nice to know that this is an option if the band starts to give me problems. So far, it has been great for me but you never know. So docs have no problem changing to the sleeve even if you have lost your weight?

[WASaBubbleButt 41]

I plan to watch this thread! It is nice to know that this is an option if the band starts to give me problems. So far, it has been great for me but you never know. So docs have no problem changing to the sleeve even if you have lost your weight?

I was a 20.8 BMI when I had my revision. The Standard of Care in the US and MX is to do a revision in one surgery. You can't get a straight sleeve under a 30BMI but if you have a history of obesity you can get a revision even if you are at goal.

The thinking is that it is dangerous to remove a band, send you home, wait for you to gain weight, then come back for a 2nd surgery and have you lose again. The more weight you carry the riskier surgery is. Doing it at goal is actually easier for the surgeon as well. Having two surgeries doubles the risk for potential complications such as anesthesia, infection, bleeding, etc. So it's safer to do it in one procedure, remove the band and do a sleeve.

[gingerbug 3]

I was a 20.8 BMI when I had my revision. The Standard of Care in the US and MX is to do a revision in one surgery. You can't get a straight sleeve under a 30BMI but if you have a history of obesity you can get a revision even if you are at goal.

The thinking is that it is dangerous to remove a band, send you home, wait for you to gain weight, then come back for a 2nd surgery and have you lose again. The more weight you carry the riskier surgery is. Doing it at goal is actually easier for the surgeon as well. Having two surgeries doubles the risk for potential complications such as anesthesia, infection, bleeding, etc. So it's safer to do it in one procedure, remove the band and do a sleeve.

Thanks for clearing that up for me, is that the same standard in the US or just Mexico. I would have no problem going to mexico, though, if needed. Are there aftercare issues? It is a relief to know that there are options.

[luluc 6]

*susan* - i'm very happy for you.

while my lone issue has be an isolated port infection - i have NO hesitation in doing anything/everything to never regain... it's work staying under 130, if i want to eat; i have to workout...

again, glad your getting a much needed revision.

lu

[WASaBubbleButt 41]

Thanks for clearing that up for me, is that the same standard in the US or just Mexico. I would have no problem going to mexico, though, if needed. Are there aftercare issues? It is a relief to know that there are options.

MX and the US share the same Standard of Care in this case.

One thing I should clarify, let's say you are at goal and wanting a revision from band to bypass or DS... then it is not possible. You couldn't help but to lose massive amounts of weight with malabsorption. You have a little more control over it with a sleeve. So revision from band to sleeve is doable at goal.

Nope, no aftercare issues. Get surgery and you are done for life. I've seen my surgeon once since my revision 9 months ago and that was when I went with my banded friend to get her band fill. I didn't have the appt, she did. She's jealous of my lack of aftercare and I like that. HAHAHAHA

[MacMadame 81]

Plus aftercare can be done by your PCP. Since my surgeon is local, I see both. But I could just see my PCP, if my surgeon isn't available.

Susan - I want you to know that your complications are one of the reasons I got a sleeve to begin with. I knew that you hadn't caused your own problems from lack of compliance and so it made slippage real to me in a way that some other poster's issues hadn't.

As for standard of care, most insurance companies will pay for a revision no matter what your weight *if* the reason for a revision is a mechanical failure of the first surgery. But they won't pay for it just because you didn't lose enough weight with the first surgery.

That's what their policies say anyway. There are a few cases I've heard of where someone was denied for a revision because they weren't heavy enough, so I think some insurance companies don't follow this standard enough though they should.

[WASaBubbleButt 41]

Plus aftercare can be done by your PCP. Since my surgeon is local, I see both. But I could just see my PCP, if my surgeon isn't available.

Susan - I want you to know that your complications are one of the reasons I got a sleeve to begin with. I knew that you hadn't caused your own problems from lack of compliance and so it made slippage real to me in a way that some other poster's issues hadn't.

As for standard of care, most insurance companies will pay for a revision no matter what your weight *if* the reason for a revision is a mechanical failure of the first surgery. But they won't pay for it just because you didn't lose enough weight with the first surgery.

That's what their policies say anyway. There are a few cases I've heard of where someone was denied for a revision because they weren't heavy enough, so I think some insurance companies don't follow this standard enough though they should.

Actually they do pay for revisions because people did not lose enough. If the person can show effort such as a gym membership, receipts from a personal trainer, WW, OA, etc., that is often times enough for a revision. Usually a two year wait has to be met after the original surgery unless there is a mechanical problem that needs to be repaired.

The problem is that most people in this country do not have WLS benefits. Most believe WLS goes hand in hand with major medical and it does not. It's an extra premium for the employer.

[MacMadame 81]

Aetna doesn't. That's who I had so I looked it up. I looked up UHC too because I could switch to them.

But I believe you that some insurances will. They are all different after all.

The problem is that most people in this country do not have WLS benefits. Most believe WLS goes hand in hand with major medical and it does not.

Yes, I was quite shocked to discover this.

[WASaBubbleButt 41]

Aetna doesn't. That's who I had so I looked it up. I looked up UHC too because I could switch to them.

But I believe you that some insurances will. They are all different after all.

Yes, I was quite shocked to discover this.

Yeah, Aetna does indeed cover revision surgery if weight loss is not adequate. Here it is from their own website:

Obesity Surgery

1. Repeat Bariatric Surgery:
   Aetna considers medically necessary surgery to correct complications from bariatric surgery, such as obstruction or stricture.
   Aetna considers repeat bariatric surgery medically necessary for members whose initial bariatric surgery was medically necessary (i.e., who met medical necessity criteria for their initial bariatric surgery), and who meet either of the following medical necessity criteria:
   
   
   1. 
      
   2. Conversion to a RYGB or BPD/DS may be considered medically necessary for members who have not had adequate success (defined as loss of more than 50 percent of excess body weight) two years following the primary bariatric surgery procedure and the member has been compliant with a prescribed nutrition and exercise program following the procedure; or
      
   3. Revision of a primary bariatric surgery procedure that has failed due to dilation of the gastric pouch is considered medically necessary if the primary procedure was successful in inducing weight loss prior to the pouch dilation, and the member has been compliant with a prescribed nutrition and exercise program following the procedure.
      

They will assume the corrections are necessary because weight loss was not adequate. In reality sometimes one person needs more intestine bypassed vs. another person. Some folks can get away with 100cm of intestine bypassed, others need 200cm bypassed. Each person is unqiue and their needs are unique.

[MacMadame 81]

Guess I misremembered. Thanks for posting that. :confused:

[WASaBubbleButt 41]

Guess I misremembered. Thanks for posting that. :confused:

There is a HUGE amount of info to remember. No one person can remember it all. That is why I have links. ;o)

Without links my brain is on overload.

There is info I depend on you for, I couldn't possibly remember it all but you do. That's how it all works.

[MacMadame 81]

I also think that I allowed some discussions on OH to influence me. I do know people whose insurance wouldn't approve a revision because they didn't weigh enough, but some insurance companies are real pills about everything related to WLS.

[*susan* 1,709]

I just don't understand why insurance companies don't make wls a standard covered procedure. It seems like, in the long run, it could literally save them thousands upon thousands of dollars based on all the potential health problems it will help prevent.

Things are moving along well for me. I get more excited every day. I am nervous, but I have a great deal of confidence in Dr. Aceves and his abilities.

Last night, I received the email containg the "My-Emmi" video information. I watched the video and it was fairly interesting, although a great deal of it I already knew from my own research. It discussed exactly what the sleeve is and how they perform the surgery. It also covered what to expect pre-op, during the hospital stay and post-op. It went over all the risks and benefits, as well as other surgery options that are available.

Nina also sent me an email with some post-op diet suggestions. She recommends I purchase all this before I have my surgery so it is ready and waiting for me upon my return. For anyone interested, I am just going to copy and paste her suggestions from the email into this post:

Some ideas are:

broth, chicken, Beef, Vegetable, or they have new products out (new to me) that are Chinese Soup broths in a carton that you simply heat. It would give you a bit of variety.

Popsicles that are Water based, sugar free, and a variety of flavors.

Ramen Noodles. While the noodles are not acceptable during the clear phase of the post op diet there is a packet of dry broth mix that many seem to like, it has a bit more kick than regular broth, I am told.

Propel Water, you can purchase this as bottled water or you can purchase individual packets of this product and put it in water and mix. The reason this product is good is because many are used to a high carbohydrate diet and when your body is used to many carbs, especially white carbs such as flour, Pasta, rice, potatoes, sugar; your pancreas tends to put out a bit too much insulin because of the carb load. When you remove carbs from your diet it can potentially be a drastic change and your pancreas is still putting out a bit too much insulin during the post op diet. This can cause low blood sugar, your stomach might feel nauseated, you might begin to perspire, feel like you are trembling. This does not happen to everyone but it does seem to happen more to older folks or those used to very high white carb diets. Propel water has a very small amount of sugar in it. Just enough to bring your blood sugar up but not enough to cause large blood sugar spikes.

Power Aid Zero, it is a new product that is low carb but it has some electrolytes that are beneficial during the post op stage.

Water, you need to get about 64oz of fluids in daily. Your broth and Popsicles count toward your 64oz of fluids daily. The key is to sip, sip, sip all day long. The first few days you may find that you cannot get your full 64oz of fluids in, try as hard as you can. You do not want to become dehydrated. If you enjoy tap water that is fine, if you don't then perhaps try bottled water and see if that goes down.

Crystal Lite, sugar free Hawaiian Punch, pretty much any sugar free water flavorings are fine during the post op diet.

Protein products, during days 1-5 you'll need a clear Protein product such as Isopure clear bottled protein liquid or powders?utm_source=BariatricPal&utm_medium=Affiliate&utm_campaign=CommentLink" target="_ad" data-id="1" >unjury. You can find Isopure at General Nutrition Stores or a variety of Health food stores. Unjury must be ordered on line in advance of your surgery, www.unjury.com. They have an unflavored product that is nice because when you are done with clears it is versatile and you can add it to Jello, cooking, smoothies, etc. Please note, this is a whey protein product. All whey protein products have one issue in common and that is that they don't heat easily. If you add any whey protein product to a hot liquid it will clump. The key is to add it to a cold liquid and heat slowly, then it will not turn into lumps.

A good source of protein products after the clear liquid phase (you can use these with water instead of milk starting day #5, and with milk starting day #11) can be purchased reasonably at:

www.netrition.com

Some excellent products are:

Matrix 5.0 by Syntrax http://www25.netrition.com/syntrax_matrix_page.html

The more popular flavors are chocolate and Cookies & Cream.

You can spice up the chocolate with Da Vinci Sugar Free Syrups:

http://www25.netrition.com/cgi/prices.cgi?manu_id=121

Another very popular protein product if you like Chocolate and Peanut Butter is Whey Gourmet, Choco/Peanut butter:

http://www25.netrition.com/pvl_whey_gourmet.html

I suggest the above because you'll need to consume about 60-80gms of protein after surgery. During the post op diet this can be difficult to do. Adding protein supplements can make this much easier.