Rdy2Bthin

It has been six months since I had my sleeve and my nissen reversed. There were no complications from the surgery. I had my hernia repaired again as my nissen was protruding into my chest. There were alot of adhesions from the previous surgery that were causing me problems too. My nissen needed reversal regardless of the sleeve procedure. I had few reflux issues during the first three months but as I begin to eat more solid foods the reflux returned. My doctor doubled my anti acid Meds which have helped. Over the past month this has started to help and the fact that I try very hard not to get too full when eating or drinking. As I loose weight the reflux seems to improve also. I have lost a total of 87 lbs and 66 lbs the past six months. My doctor said the sleeve could be convert to RNY if needed due to severe reflux but I do not believe that will be necessary. As far as insurance paying for the nissen reversal, my paid with no problems. If reversal is medically indicated the insurance company will most likely be required to pay. Good luck with your sleeve.

Three days since my surgery on Monday. Stayed in hospital two nights. I am a little sore but doing well. I am just trying to get use to drinking sips instead of gulps. My surgery required a Nissen revision. This plus the fact that my stomach had adhered to my liver contributed to a longer surgery, but thanks to my highly skilled surgeon who was able to peel back layers of adhesions, i will no longer be having chronic pains in my abdominal area. He also repaired my hiatal hernia.

Bariatric Surgery Halts Subclinical Kidney Deterioration

http://www.medscape.com/viewarticle/766296?src=nl_topic

June 25, 2012 (San Diego, California) — Obese individuals who undergo bariatric surgery show improved renal function 1 year later, even if their renal function was within normal range at baseline.

The findings, presented here at the American Society for Metabolic and Bariatric Surgery (ASMBS) 29th Annual Meeting, suggest that addressing obesity early can protect against the first subclinical steps toward chronic kidney disease (CKD), said Wei-Jei Lee, MD, PhD, from Min-Sheng General Hospital and National Taiwan University Hospital.

"With bariatric surgery, we are attacking the 2 main culprits of chronic kidney disease: high blood sugar and high blood pressure," Dr. Lee said in a statement from the meeting. "However, this study suggests the earlier we treat CKD in the disease process with bariatric surgery, the more favorable the impact on the kidney."

The study included 233 obese individuals with a mean age of 33 years and a mean body mass index (BMI) of 39.5 kg/m2. More than 90% of the participants had type 2 diabetes, and nearly half had hypertension.

At baseline, more than half of the cohort (54.8%) had normal kidney function, defined as an estimated glomerular filtration rate (eGFR) of 90 to 125 mL/minute; 26.2% of the patients had hyperfiltration, defined as more than 125 mL/minute; and the remainder had either stage 2 CKD (16.7%) or stage 3 CKD (2.6%), defined as an eGFR of 60 to 90 mL/minute and an eGFR of 30 to 60 mL/minute, respectively.

"The only difference between the groups was age, with the patients with kidney disease being about 6 years older," said Dr. Lee. "There was no difference in sex, blood pressure, glucose, or duration of diabetes. That means obesity itself is a risk factor, and aging is a key factor."

Most of the patients (82%) underwent a gastric bypass procedure, with the remaining undergoing gastric restrictive surgery.

One year after surgery, weight loss (28% - 30%) and BMI (26 - 28 kg/m2) were similar, regardless of baseline kidney function.

Among patients with impaired kidney function at baseline, GFR went from 49.5 to 66.8 mL/minute in the CKD 3 group, from 76.8 to 93.3 mL/minute in the CKD2 group, and from 146 to 133 mL/minute in the hyperfiltration group.

However, "most interesting was the normal GFR group," said Dr. Lee, in which an improvement was seen from 105.7 mL/minute presurgery to 114.2 mL/minute postsurgery. "So even in the normal group, there was already some deterioration."

Blood pressure and serum creatinine improved for all patients, he said.

Among a subgroup of 84 patients for whom pre- and postsurgical urine Protein measurements were available, the percentage of patients with normal levels increased from 34.5% presurgery to 59.5% postsurgery. Similarly, although 39.3% of patients had moderate microalbuminuria (30 - 300 mg/L) before surgery, this dropped to 22.6% after surgery. Finally, although 26.2% of patients had severe microalbuminuria (>300 mg/L) before surgery, only 17.8% had it after.

As a result of the surgery, virtually no patients remained at CKD stage 3, and most patients with CKD stage 2 reverted to normal kidney function, said Dr. Lee.

The study shows that renal dysfunction occurs often with obesity and may be intercepted in its early stages with bariatric surgery, he said.

He added that increased intraabdominal pressure and renal sinus fat most likely contribute to impaired renal function.

Carel le Roux, MB ChB, head of the clinical obesity program at Imperial Weight Center, Imperial College, London, United Kingdom, has recently published a study showing that bariatric surgery improves renal function in obese patients with preexisting renal impairment. The study also showed a reduction in renal and systemic inflammation.

Reached for comment by Medscape Medical News, Dr. le Roux noted that "clinicians should be very cautious to interpret the reduction in creatinine (and any calculations based on creatinine such as eGFR) as improvement in renal function, because after bariatric surgery, lean body mass reduces. It is the reduction in lean body mass that is responsible for the changes in creatinine and eGFR, and not renal function improvements per se."

He added, "better markers should be used, such as Cystatin C or even chromium EDTA clearance tests, before a patient is wrongly told their renal function has improved. Moreover, changes in the urine albumin/creatinine ratio [are] also very prone to misinterpretation. Two samples should be analyzed prior to surgery, as well as after surgery, to compensate for the variation that may naturally occur."

"Having said that, the pleiotropic effects of bariatric surgery with improved glycemia, blood pressure, and inflammation may well be responsible for improved renal function, but we should remain cautious until better evidence becomes available," Dr. le Roux cautioned.

Dr. Lee disclosed financial arrangements with Covidien, J&J, and Allergan. Dr. le Roux has disclosed no relevant financial relationships.

American Society for Metabolic and Bariatric Surgery (ASMBS) 29th Annual Meeting: Abstract PL 108. Presented June 20, 2012.

Getting sleeves today. Currently waiting on the pre op crew to gets ready.

Waiting for registration and pre op procedure. Surgery scheduled for 10:00 am. My doctor will reverse my nissen fudiplication before he can proceed with the sleeve. Good luck to everyone today.

Medscape Medical News from the:

American Society for Metabolic and Bariatric Surgery (ASMBS) 29th Annual Meeting

June 17 - 22, 2012; San Diego, California

http://www.medscape.com/viewarticle/766243?src=nl_topic

http://www.medscape.com/viewcollection/32520

Sleeve Gastrectomy Gets Boost in Push for Insurance Coverage

Kate Johnson

June 22, 2012 (San Diego, California) — With a final decision expected within days from the Centers for Medicare and Medicaid Services, there is now ample evidence supporting the agency's full coverage of laparoscopic sleeve gastrectomy (LSG), researchers asserted here at the American Society for Metabolic and Bariatric Surgery (ASMBS) 29th Annual Meeting.

Reporting the largest series to date, John Morton, MD, from Stanford University in California, said "laparoscopic sleeve gastrectomy is positioned between the band and the bypass for both safety and efficacy."

In a separate, unrelated study, Abraham Fridman, DO, from the Cleveland Clinic Florida in Weston, reported that sleeve gastrectomy showed the lowest morbidity of the 3 procedures.

In March, the Centers for Medicare and Medicaid Services revised its blanket policy of no coverage for LSG by allowing limited coverage of the procedure in randomized controlled trials.

In its so-called "coverage-with-evidence-development proposal," the agency is considering comparative evidence for LSG against other obesity surgeries, with its final decision due on June 27.

"There's considerable amount of evidence now for coverage of the sleeve. It's actually overwhelming, the amount of evidence," said Dr. Morton, who presented a national comparison of LSG vs laparoscopic Roux-en-Y gastric bypass (LRNYGB) and laparoscopic gastric banding (LGB) from the Bariatric Outcomes Longitudinal Database (BOLD) from 2007 to 2010.

The analysis included data on 271,726 patients from 540 hospitals and 1200 surgeons.

Comparing mortality, morbidity, and efficacy outcomes for 117,365 LGBs, 138,222 LRNYGBs, and 16,139 LSGs, the data clearly show that LSG is safe and effective, concluded Dr. Morton.

At 1-year postsurgery, the absolute body mass index [bMI] reduction was 16.6 kg/m2 for bypass patients, 13.4 kg/m2 for sleeve patients, and 7.6 kg/m2 for band patients.

Length of hospital stay was a mean of 2.3 days after bypass, 1.9 days after sleeve, and 0.7 after banding.

Improvement of baseline comorbidities of hypertension, type 2 diabetes, and dyslipidemia was seen after all surgeries, but was most significant in the bypass group, said Dr. Morton.

The bypass group also had the highest 30-day mortality and serious complication rate (0.14% and 1.25%), followed by sleeve gastrectomy (0.08% and 0.96%), and then gastric banding (0.03% and 0.25%).

The readmission and reoperation rates were also highest for bypass patients (4.62% and 2.73%), followed by sleeve patients (3.61% and 1.7%), and then banding patients (1.38% and 0.65%).

Although 30-day follow-up data were "great," Dr. Morton noted that the limitations of the study included poor follow-up beyond this time and lack of information about patients who might have been admitted to other hospitals.

However, he said, the data are convincing for the safety and efficacy of sleeve gastrectomy.

The second study, which included 2433 bariatric procedures, was performed at the Cleveland Clinic Florida between 2005 and 2011, with a mean follow-up of 17 months.

Similar to the BOLD study, this study also showed that BMI loss after the sleeve procedure (11.2 kg/m2) fell between that of bypass (14.8 kg/m2) and banding (5.6 kg/m2).

A total of 1327 bypass, 619 sleeve, and 233 band procedures were included in the analysis, reported Dr. Fridman.

However, looking at readmission and reoperation rates, this study showed that sleeve gastrectomy was superior to both bypass and banding.

Specifically, the average number of readmissions in the sleeve gastrectomy group was the lowest (1.49), followed by the band (1.54), and then the bypass (1.96). Similarly, the rate of reoperations for complications was lowest in the sleeve group (1.8%), followed by bypass (6.6%), and then banding (14.6%).

Asked to comment on the evidence for sleeve gastrectomy, Michel Gagner, MD, told Medscape Medical News, "I think it should be covered [by insurers]."

Dr. Gagner, a Canadian bariatric surgeon, practiced in the United States for 15 years at 3 different centers before returning to his native Montreal at the Hôpital du Sacré-Coeur.

He said he now performs sleeve gastrectomy in 90% of his patients, and "I think the evolution I went through we will see in a lot of practices in the United States," he said.

"Outside the US, sleeve gastrectomy is growing very fast, and there are several countries where it is number one," he said. "In Chile and Japan, it is very popular; in India, it's the number one procedure; and there are many countries in Europe where the number of sleeve gastrectomies has surpassed the number of bandings. This is seen in France and in Belgium, for example."

The BOLD data place sleeve gastrectomy between gastric banding and bypass in terms of morbidity and mortality, he noted. "When surgeons are looking at abandonment of banding, they are looking for a procedure with similar risk ratio, and actually I think that the weight loss and comorbidity resolution with sleeve was better than banding, while the mortality and morbidity rate was slightly higher. So I think it's still an excellent risk–benefit ratio."

In fact, Dr. Gagner said, the BOLD data for sleeve gastrectomy is likely to improve, as the current figures still include a steep learning curve for the new procedure.

"We know it's in the first 100 cases that we get the highest rate of leaks, highest rate of bleeding, and strictures and mortality. Once they go beyond, we're going to see a drop by 2-fold in the leak and major complication rate. So what we're going to see in the database in the future of sleeve gastrectomy is that it's going to be very close to banding, so it's going to be very convincing for surgeons who've been using banding that they could adopt a procedure that has almost the same morbidity and mortality as banding, but yet an increased benefit."

Dr. Morton noted that he is a consultant for Vibrynt and Ethicon. Dr. Fridman has disclosed no relevant financial relationships. Dr. Gagner is a speaker for Covidien, Ethicon and Gore.

American Society for Metabolic and Bariatric Surgery (ASMBS) 29th Annual Meeting: Abstracts PL104, presented June 20, 2012 and PL133, presented June 21, 2012.

Three days to go before surgery. I have lost 15 lbs during Pre-op diet. I am feeling a little anxious and apprehensive. I am ready to get this new journey started.

My doctor told me that the sleeve could be converted to an RNY if needed.

What about diabetics? Is the sleeve just as good? I know a lot of people say RNY is better for diabetics. My sister and I are both having surgery and she has chosen RNY because of this. I do not want to try to undo influence her for a sleeve as she might feel unsupported for her RNY. Should I say something? I think the sleeve would be better for her too.

Have you started your preop yet? I start tomorrow, but quit soft drinks over a month ago and have just been drinking Water, Water with Mio, a glass of sweet tea ever few days. I have had no caffine except what is in the occasional sweet tea. I have already started a couple of shakes a day and eating at supper time. Trying to make my transition as painless as possible. I cannot imagine doing this with a caffine withdrawal headache! There is so much info out here.....even more than my surgeon gave me. Not knowing what to ask, I have read so many posts, I now have questions for him! I've researched and researched for months now and I am ready to be sleeved!!! Preop tomorrow and surgery on the 29th!

I started my Pre op diet on Monday. I also tried to ease into it the week before by drinking shakes and avoiding caffeine. My surgery is on the 25th. Good luck to you all. Stay in touch.

i dont like premier its so dang heavy and i think it gave me gallstones. hee hee hee

Who could argue with a new grandmother? Congrats!

Just noticed that the website http://www.premiernutrition.com/protein-shake.html

states that Meijer carries Premier Protein shakes too as well as online ordering.

Are you used to drinking caffeine? Sounds like caffeine withdrawal. I quit caffeine about a week before my pre-op diet because I didn't want both misery together.

Sounds like good advise to me. I wished I had found this site sooner as there is a lot of Pre op information here to digest. Just glad to have the resource for the future.

Well at 298 lbs., I am finally in Twoterville or Twoderland. Both sound great to me. Uncle Joe votes for Twoterville but just go ask Alice about Twoderland. Was it the blue pill or the red pill? I think it is the Pre-Op Diet. My surgery is scheduled for June 25th. Hope I do not need the Shady Rest Hotel.

Well at 298, I am finally in Twoterville or Twoderland. Both sound great to me. Uncle Joe votes for Twoterville but just go ask Alice about Twoderland. Was it the blue pill or the red pill? I think it is the Pre-Op Diet.

Your Welcome, I will be in your position on the 25th as that is my surgery date. Seems everyone I spoke to had difficulty their first week getting enough Water and Proteins.< /p>

Let me know if it works for you.

Premier shakes from costco are tasty' date=' low sugar, not bad on the calories and high in Protein. They are pre mixed, however.[/quote']

The Premier Protein Shakes are tasty and are available from Sam's too. For more info here is their website:

shake.html" rel="external nofollow">http://www.premiernutrition.com/protein-shake.html

30g Protein

160 Calories

1g Sugar

I was sleeved last Tuesday' date=' the 5th. It was a rough first few days but I'm feeling better and better each day. I've had no real significant issues with gas and absolutely no issues with reflux or Constipation. It feels like a full-time job, but I'm doing great getting my fluids in. Protein, however, is another story. If that were my job, I'd have been fired by now. :-)[/quote']

Have you tried putting the Liquid Protein in your Water and getting both that way? Seems water and protein are the first big hurdles for most first week sleeves. Walmart carries the liquid Proteins, but I was told that the one that tasted best was New Whey Liquid Protein. It can also be mixed with sugar free Jello which you can make yourself.

Pre-made jello proteins are expensive at 3 to 4 dollars or more. I am told that the other liquid proteins taste less than desirable too. Here is a link to its web site:

http://www.newwhey.com/

There are several flavors.

Also, the sleeve can be converted to a RNY if needed. If this was the case, most insurers would be obligated to pay for the RNY too. If you are self pay then this could be an additional expense and this might make the RNY your first choice.

My biggest concern is that the Nissen reversal might require conversion to an open procedure.

Any comments from someone with experience with a Nissen reversal would be appreciated.

I had my pre op appointment at the hospital today' date=' it seems to be getting more real by the day. I keep having the nagging second thoughts of, "if I can loose this weight this way, should I do the surgery". has anyone else had this thought.

With that all said, I am still excited and scared, its like getting on the best roller coaster you could ever ride.[/quote']

I have had that thought but remind myself that I also need to keep it off. One episode of binge eating can put back on a lot of pounds. With me it is also about maintaining pounds lost. The Pre op diet does give me confidence that I can loose weight, but it is only for a short period. Maintaining an 800 to 1000 calorie daily intake would not be possible for me long term without the aid of a gastric sleeve.

I also am having a reversal of my Nissen. The only issue with the sleeve would be stapling over scar tissue from the Nissen. My doctor stated that he had performed several and did not forsee any problems. He stated that only a one or two day stay in the hospital would be required.

Thanks for the reply

I had the acid reflux but not really bad. I also had a large hiatal hernia repaired at the same time and I really think that is why he wanted to do the fundo. I told him at that time I was wanting to have the VSG in the future and he said that would not be a problem at all. It is just happening alot sooner that I thought is was going to. Dr. Almanza said it will not be a problem to take it down. It is a little more complicated and I will have to stay an extra night at the hospital. I feel ok about it but I just want to hear from someone else that has had it done.

I am in the same situation. My doctor says he will reverse the Nissen first and perform the sleeve. He said there might be some issues with stapling over the scar tissue from the Nissen but he did not anticipate and any problems?

My surgery is scheduled for June 25th. I just started my two week pre op diet which consists of combination of meal replacement shakes, Soups, and Protein Bars totaling 800 calories per day. I hope to loose 20 lbs. before surgery. My doctor tells me that this is possible.