gingersnap

For those Band to VSG patients out there what did your surgeon's say about the increased risk of a leak due to scar tissue? Did they recommend RNY over VSG?
I met with the surgeon at MUSC yesterday that removed my band and he recommended that I have the RNY over the VSG because of the thickness of scar tissue in the area he would need to cut. With the RNY he can cut around the scar tissue but with the VSG he has to cut right through it posing a higher risk of a leak. He has done 3,500+ WLS's so I trust that he has the expertise. But I think he also doesn't want to see me gain any more weight while waiting around for Tricare to start covering the procedure.
Right now I'm looking into having VSG surgery at Fort Gordon which is 150 miles away. Leaks really scare me as I won't have health coverage right around the corner. I will have to travel to a Military Treatment Facility for any VSG care. With RNY my surgeon is just down the road!!!

Where can we read about it, I'm looking for the information to review.
Thanks!

yes at 3pm 6/27/2012 medicare approved the gastric sleeve.....

I had my band out 4 months ago. I went into revision surgery last Monday, I was pushing for a bypass, but woke up w a sleeve, my doc said because of the scar tissue it made most sense to put in the sleeve. He said my drainage tube would have to stay in three weeks. So I will be out of work for about a month. But I have never had a vacation

Tricare coverage for the VSG will continue to be a hot topic until Tricare approves coverage. I'll share my story again to perhaps make it easier for active and retired military personnel and family members to get a VSG.
I'd like to mention first that current coverage refers to vertical banded/sleeve gastroPLASTY, which is entirely different than vertical (or longitudinal) sleeve gastrECTOMY. The difference is with gastroplasty, they are simply stapling off part of your stomach as opposed to gastrectomy, where the majority of the lower portion of the stomach is removed from your body. Gastroplasty is reversible if necessary. Gastrectomy is not. Once your tummy is gone, it's gone, tossed in the bio-hazard bin and burned. As far as I'm concerned, burn, baby, burn! I love my sleeve.
The reason you can obtain a VSG on base and can't through an outside surgeon is the MTF's Tricare coverage comes from an entirely different pool of funds than the Tricare coverage paid to outside providers. It's a budgeting issue. The MTF's operate on funds granted to the active military hospital system. Insurance coverage through an outside source operates on funds designated solely for insurance coverage via civilian systems. When it comes to reimbursing for services provided, the two systems do not overlap.
OK, so what now?
Step 1.) Get your referral.
It took months to figure out the maze of retired military vs active military insurance, hospitals, referral processes, etc., but once I did, it's not that difficult. The hardest part is getting the doctors to approve the need for bariatric surgery and getting past the pre-surgical psych evaluation. That's step one. So get started on that if you haven't already. Doesn't matter if it's your civilian or military doctor, although I think it's easier to obtain permission from a civilian doctor. Military doctors can be real snooty about weight management through diet and exercise only. Raspberries....
Once you obtain a referral, you will have to get your VSG at a military facility until Tricare approves the procedure. Since it's new, they want to see the long-term statistics compared to other available options now that the VSG is may be on the way to becoming the procedure of choice for both patients and surgeons.
Step 2.) Find an MTF with a surgical bariatric weight-loss program.
Some facilities have had bariatric programs for several years now. Others are just starting to perform bariatric surgery. Ask how many bariatric procedures have been performed at that facility and how many the surgeon doing your surgery has done. Ask about their complication rate and if any fatalities have occured. The only one my surgeon experienced was death by Whopper. One of his patients upon discharge had someone drive her from the hospital straight to Burger King, ordered and ate a Whopper, ripped out her staple line and bled out before getting back to the hospital. Please follow your post-bariatric liquid diet. Be prepared to experience hunger and know you're going to have to tough it out...yes, I'm digressing.
You may have to do a lot of driving at first, but if you play it smart and get them to combine some of your appointments on the same day, you can cut the expense. We combined my EGD with one of my pre-surgical nutrition sessions and my psych eval with my first meeting with the surgeon.
If you are active duty and are traveling outside of your 99 mile treatment zone, you can get reimbursed for travel expenses if your military doctor has approved your surgery. If you are retired military, you're SOL. Start stashing some cash. FYI, obtaining my VSG took 6 or 7 trips to Ft. Gordon.
Step 3.) Contact the Benefits Management office at the base where you want to have your surgery. You will need to send your referral directly to that base's Specialty Services department within the Benefits Management office. The names of the offices will probably be different within the various services. The BM/SS office is the Army version of the on-base Tricare management team. The Specialty Services office has to approve your referral before you can see a surgeon on that base.
Don't bother trying to go through your normal, local Tricare channels once you get your referral. After 5 months and hours of phone calls, talking to people who had no clue as to what I was trying to do, discovering that the different departments within Tricare have no idea what the other departments do, someone finally admitted that Tricare automatically responds with "this MTF is not accepting new patients at this time" if you are trying to get your surgery done at an MTF outside of your 99-mile treatment zone. I spent weeks calling back and forth with the hospital telling me I have no idea why Tricare is saying we're not accepting patients because we are, then calling Tricare and asking them why they're saying the hospital isn't accepting patients. I'm lucky they didn't cause me to stroke out or rip out all my hair.
Another snafu I ran into was my DEERS information was not registered on the Ft. Gordon list of personnel and family members assigned to or being served by the base. I had to contact the I.D. card office and have them register me into the base system. If you are not in that system, the base BM/SS office nor the hospital can access your Tricare eligibility information online. If your information is not accessible on the base internet system, the hospital can't schedule an appointment until they can register you on their online system. This goes for both military and retired personnel and family.
Step 4.) At this time, you can contact the nurse in charge of the MTF's bariatric surgery schedule and make your first appointment. Standard procedure will most likely be attending the next informational seminar at that base. After that, you're off and running.

I had two bands removed and had horrible scar tissue. My band surgeon said he'd never seen anyone build up scar tissue as much and as fast as I did. It took him a couple of hours to remove and replace my first band as opposed to the 45 minutes to put the first band in.
The only thing you'll want to do is make absolutely sure the MTF's surgical team knows you have been warned about your scarring issue. Try and convince them (it should be easy) that you'll need the surgeon with the highest successful number of VSG procedures to perform your surgery because of the scar tissue. I not only had significant internal scarring, I had a deformed upper stomach because of it and still had no problem with sleeve formation.
The only complication I experienced was a small bleeder (they missed or improperly sealed off a small blood vessel when they removed my lower stomach). It's a complication that can be experienced with any form of surgery and not specifically associated with bariatric surgery or my scarring issue. I had a 6-day stay in the hospital and a transfusion, but I was well cared for. They did not release me until they knew the internal bleeding had stopped. Just make sure the facility you choose has a good bariatric program that has been in place for a while.

Also, if you are on facebook, you should look up a group called "Failed Lap-Bands and Realize Bands" - it's a group of folks who either had the band and got the revision, or they currently have the band and are working on getting a revision to another kind of WLS.

I had the band in 2007 - lost about 45lbs in 7 months. Then everything started going downhill. By 2009, I couldn't eat anything without getting stuck - EVERY SINGLE TIME! Soon it was just junk food in order to get something in my tummy. Obviously, I gained it all back. I had the sleeve on 3/22/12, and haven't looked back. The Surgeon said I had a tremendous amount of scar tissue, but he was still able to remove 85% of my stomach - no leaks - and I have never been happier. No more getting stuck, having problems drinking, and back to eating "normal" healthy foods. For me, this was the best thing I've ever done.

Hi Gingersnap, I agree with you 100%. I might even have gone with a higher number and say that 99% of all people with a lap band will eventually have to have it removed or replaced. It is a foreign body, and the body's natural inclination is to isolate it from the rest of the body by building scar tissue around it. This and all the other things that can happen -- such as erosion, hiatal hernias, ulcers, slips, etc. -- make it a temporary solution or tool at best.
Congrats are in order to you, however, for losing 140 pounds with the band. You certainly did not fail. I think the questions of failure that I was referring to were being directed at another poster or the original starter of this thread (Sarah). That is actually whom I was talking to in the second part of my post. Sorry for the confusion. I would never say that someone failed with the lap band; I would say instead that the lap band failed that person.
I'm sure you will do what is best for you.

CamarilloCA
Thanks for those encouraging words. I believe the band failed me I didn't fail the band. There is a huge increase in the number of band problems out there. I guess it's just not meant to last forever. I predict that (my opinion) at least 90% of people that have the band will at some point in their lifetime need to have it replaced or removed due to a complications.
I think the VSG is a great surgery and so is the RNY. I feel fortunate to have both of them available to me. As I go into the vetting process I want to gather as much information as possible form all sources and make the right decision for me.

Gingersnap, my surgeon did a revision surgery on me from band to sleeve. My surgical report said I had extensive adhesions between the left lobe of the liver and the anterior gastric wall. Those had to be removed to even access the band. I also had an obstructing scar ring circumferentially obstructing the upper gastric cardia of the stomach. Both the port and the lap band were surrounded by scar tissue and causing problems for me after four years in my body. I'm glad you got rid of yours.
I think you will be successful with the sleeve. There is a risk of a leak, I think, but I think that is fairly rare. In the hospital, they do a leak test before you are released.
Sarah, I think you will be successful also, and I'm not sure why there are some posts asking you to closely examine your failure with the lap band when there are so many other people on this forum who have gone through exactly the same failure with the band and revision to sleeve (including me). The sleeve is so much different than the band. The sleeve is a much more reasonable tool with less complications. Don't let anyone discourage you from doing this for yourself. Yes, it is always a good idea to do self-examination and figure out if you are an emotional eater, but that doesn't mean that you shouldn't have the sleeve and learn how to deal with that issue at the same time. I think probably all of us are emotional eaters of some sort or another. I also think that just because the band wasn't working for you doesn't mean that the sleeve won't either. The band never worked for me, but I've had the sleeve now for a month, and I've lost 20 pounds -- something I couldn't do with the band.

I also had the band in 2008 and had revision surgery a month ago. I hated the band. I threw up blocked food at nearly every meal, and I was hungry all the time with the band. I chose food that would stay down, which was usually unhealthy food that I wouldn't have normally chosen just so I wouldn't be hungry anymore. There were so many things that I couldn't eat with the band -- healthy foods, high Fiber foods. I looked at my band as surgically induced bulimia. I did lose some weight with it but just about 10% of the weight that I needed to lose, and it eventually came back.
I know that there are some people that have been successful with the band, especially people who normally eat large portions, but I wasn't one of them.
Like others have said, I am only sorry that I didn't do the revision surgery sooner.
Edited to add: I have the sleeve now, and I have not thrown up once since the surgery. I can eat healthy foods now, and the weight is coming off.

My VSG went very well. I have had no complications with leaks or anything else. I did get dehydrated one time but that was my fault, not the VSG. I would choose this again in a heart beat. I also have lost my weight as quickly as a friend of mine who had RNY. I have/had less complications that she has. Love my sleeve.

It's a tough call and you can't compare yourself to others. 2 people will have the same procedure and end up with vastly different amounts of scarring. I'm assuming your surgeon has done some sort of imaging study if he's convinced your scarring is particularly bad? If so, I'd go with his recommendations.
One thing I've learned on my 3-week bariatric surgery rotation is that the leaks with RNY are, for some not yet known reason, easier to fix than with the sleeve.

I love reading all these conversations because it inspires me and gives me hope again. Right before my LapBand slipped and was removed my BMI hit NORMAL! The feeling of being considered normal and not obese gave me an overwhelming feeling of pride. But what it didn't do is make me like myself. Just because I lost the weight didn't mean that I had dealt with all the issues that caused me to gain weight in the fist place. When I lost my tool I immediately started to put the weight back on. So this time around I'm working on getting my head straight so I'm ready not only to have a normal BMI but to truly feel valuable inside and out. Even after the VSG if we don't deal with our head our body may not follow us in the long term.

MCG has no affiliation with the Fort Gordon Military Treatment Facility and their WLS program because they both have their own program. MCG does accommodate when births because they don't have a maternity ward. I will try to ask around and see if anybody has heard anything about their program.

I had my sleeve April 26, 2011. I am very excited for this process. My highest weight was 271.8. I was placed on a two week Liquid Protein diet for two weeks before my surgery. I lost 10 pounds in that 2 weeks. Should have been more but after the first few days, I ate a salad once a day. I spent two nights in the hospital. First night was pretty bad. Surgery went great but I was vomiting all night long. Felt better the next day. Up and walking with no problems. Now I just hope that I don't mess up my new stomach. I'm scared. I'm glad I found this website so I can see what others are going through and what to expect. My surgery was at Fort Gordon, Ga. Eisenhower hospital. Dr. Choi. He and his surgical team were awsome.

Thanks! I haven't actually met with the surgeon I chose yet. I have my initial consultation set up for 4/28 if all my financing goes through (which I'll hopefully know about today or tomorrow). I've just been looking at things online and reading a lot to find out more about the diets and everything before I go in to the doctor so I can have a list of questions ready & everything. That's why I wanted to ask here too.

Hi! I am totally new to this!! I am going in for my seminar tomorrow and am not really sure what to expect. I have a BMI of 35 and nervous that they will kick me out. LOL! The nurse said to wear boots. hehe......so at a MTF, what should I expect? I am going to EAMC at Fort Gordon. Anyone else go there? Any info/advice would be GREAT! Thanks!

I'm a GA sleever! I was all done up at Ft. Gordon, Augusta, GA. March 16... Summerjade I live in Evans. Hope your surgery went well!

Tricare says the MTF needs mor info before they can approve me for the VSG at the MTF. Any ideas of what I can give them that will help get this done? Tricare said Fort Gordon wants 6 months documented attempts of excercise, diets and meds. Doc has meds list so thats not a problem. Are they looking for food journal and excercise logs? I have a weight watchers thing with my wegh-ins on it from 2009, will that help? Any info would be helpful, just trying to get this done before my husband is unavailable due to military stuff at the end of this year. Thanks so much everyone!!!!!

Exactly one month ago today I was sleeved....I feel great! I am 21 lbs down as of this morning....I was hoping for more but have had a few stalls along the way My first stall was about 2 weeks after surgery but that was due to my period I think....I am trying not to step on a scale everyday, but find this to be more difficult than I thought. I guess its due to the excitement of seeing the scale actually move after years of it not budging. Just wanted to share my anniversay and small but huge to me success! Wishing everyone out there luck in their journey!!!!!! Have a wonderful day and God bless!

O.k. I have Tricare Prime and see a civilian pcm. She is on board with me getting a vsg. She submitted a referral to tricare for me to have a vsg done at an mtf. Tricare denied the first one so she has submitted another a different way. Still waiting to hear. Can anyone please tell me how to get this done.... My mtf (Ft. Benning, Ga.) doesn't do the surgery so I am trying to go to Fort Gordon, Ga about 4hrs away. Does anyone know how to get this done. Tricare tells me they don't have anything to do with an MTF and the MTF tells me that the referral has to go thru Tricare. I am so frustrated and upset as this is going on 3 weeks of going in circles to get no where. My husband deploys in December and I really wanted this done by then. Please help me I am not sure where to go from here. I make a bunch of calls and just get transfered from person to person. Has anyone transfered MTF"s with a civilian pcm to get this done?

I needed to hear this to help with my own personal fears. If all else fails can I live without a stomach? YES. And they have been doing this for a really, really, long time in different forms and people have lived.
Good Post!