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My boss had great advice when I told her I was going to have the surgery. She said not to tell anyone at work because even if my small team of a dozen folks or so are supportive, we work in a company with over 1,000 employees. She said that the story will get retold and revised and pretty soon I will be the woman who had a face lift, boob job and tummy tuck while I was at it and that people I don't even know will be checking me out. She has worked at our office for a long time and said she has seen it happen. I am doing what one of the other posters mentioned and that is to take sick leave but tell everyone (except my boss) that I am on vacation. Good luck with managing everyone's crazy expectations. You might try just laughing when they say something stupid like you are sure they must be joking.

I had full RNY bypass in 2005 and lost approximately 80lbs. I was able to keep the weight off consistently for about 10 years until I suddenly lost the “Feeling Full” after meals and the weight started to creep back on. I struggled with almost a constant feeling of being hungry, which I had never had, after the RNY bypass. I returned to my original surgeon to no avail. His feeling was that I must be doing something different and not following the same lifestyle. I was referred to another Bariatric doctor who found a gastric fistula (essentially an opening in the pouch), and via surgery installed a metal clamp (also referred to as a bear paw). While this seemed to help initially, something still was not the same as it had been for the first 10 or so years. After much research and visiting several other Bariatric Specialists over the last few years, all while the weight slowly continued to increase, it was recently discovered that a portion of my pouch had attached and formed a connection to my original stomach, thus allowing food to be processed by both the new RNY pouch/digestive path as well as the original stomach/digestive path. Also the metal clamp previously installed was missing, and probably passed in the normal digestive process. This leads me to where I am today, having been informed that the best solution at this point is for a RNY Bypass revision. They will be going in and separating the pouch from the original stomach again, and suturing/stapling both sections off. I am waiting for the official revision date/insurance approvals etc, but the doctors office does not think it will be an issue at all. Fingers crossed that I will be back on my way to weight loss soon.

Can you give us a bit more info? Revision to what, do you mean? To undo the RNY? To a duodenal switch?

Robin thanks for the reply. Good luck to you with getting civilian approval for the sleeve. I understand about appointments and kids; I have an 11, nearly 3, and 1.5 yr, old believe me nobody wants to see me at an appt with them in tow. That's another reason I want to go to the base, it's 30 minutes closer than the Dr. I'll be 40 too really soon and was hoping for the revision around my birthday. I don't plan on telling anybody about the surgery and was hoping to just let them all jump to their own conclusion about me having a mid-life crisis or something. I really hope things go well for you...I'll be looking for updates.

There's a new ruling as of today for surgery for the morbidly obese. It states that if it is nationally accepted and medically necessary, it will be covered by tricare. Here's the link to the Federal Register Document on the Department of Defense Final Ruling. I think this could mean the sleeve will be covered as of march, but read it and see. There's a contact person and phone number in the document, so that might help with insurance issues. Here's the Link. DOD Ruling DEPARTMENT OF DEFENSE Office of the Secretary 32 CFR Part 199 [DOD–2008–HA–0057] RIN 0720–AB24 TRICARE Program; Surgery for Morbid Obesity AGENCY: Office of the Secretary, DoD. ACTION: Final rule. SUMMARY: This final rule adds a definition of Bariatric Surgery, amends the definition of Morbid Obesity, and revises the language relating to the treatment of morbid obesity to allow benefit consideration for newer bariatric surgical procedures that are considered appropriate medical care. The final rule removes language that specifically limits the types of surgical procedures to treat co-morbid conditions associated with morbid obesity and retains the TRICARE Program exclusion of nonsurgical interventions related to morbid obesity, obesity and/or weight reduction. This final rule is necessary to allow coverage for other surgical procedures that reduce or resolve comorbid conditions associated with morbid obesity and the use of the Body Mass Index (BMI), which is the more accurate measure for excess weight to estimate relative risk of disease. As new technologies or procedures evolve from investigational into generally accepted norms for medical practice, the statutes and regulations governing the TRICARE Program allow the Department to offer beneficiaries these new benefits. These changes are required in order to allow the Department to provide these newer technologies and procedures for the treatment of morbid obesity as they evolve. DATES: Effective Date: This rule is effective March 16, 2011. ADDRESSES: TRICARE Management Activity, Medical Benefits and Reimbursement Branch, 16401 East Centretech Parkway, Aurora, CO 80011– 9066. FOR FURTHER INFORMATION CONTACT: Gail L. Jones, Medical Benefits and Reimbursement Branch, TRICARE Management Activity, telephone (303) 676–3401. VerDate Mar<15>2010 14:08 Feb 11, 2011 Jkt 223001 PO 00000 Frm 00030 Fmt 4700 Sfmt 4700 E:\FR\FM\14FER1.SGM 14FER1 WReier-Aviles on DSKGBLS3C1PROD with RULES Federal Register /Vol. 76, No. 30 /Monday, February 14, 2011 /Rules and Regulations 8295 SUPPLEMENTARY INFORMATION: I. Background On December 27, 1982, the Department of Defense (DoD) published a final rule in the Federal Register (47 FR 57491–57493) that restricted surgical intervention for morbid obesity to gastric bypass, gastric stapling, or gastroplasty method (excluding all other types) when the primary purpose of surgery is to treat a severe related medical illness or medical condition. The severe medical conditions or illness associated with morbid obesity included diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian Syndrome (and other severe respiratory disease), hypothalamic disorders, and severe arthritis of the weight-bearing joints. The DoD also limited program payments to two categories of patients: (1) Those who weighed 100 pounds over their ideal weight with a specific severe medical condition; and (2) those who were 200 percent or more over their ideal weight with no medical complications required. Program payment was made available as well in cases in which a patient, who originally met the criteria, received an intestinal bypass, or other surgery for obesity and, because of complications, required a second surgery. Payment was allowed even though the patient’s condition may not have technically met the definition of morbid obesity because of the weight that was already lost following the initial surgery. All other surgeries including non-surgical treatment related to morbid obesity, obesity, and/or weight reduction were excluded. The DoD used the definition of morbid obesity, which was based on the Metropolitan Life Table and used then by other major health care plans, as well as reflected the 1982 general opinion regarding which cases justify surgical intervention. The DoD decided, at the time, that it was necessary to be very specific in benefit parameters due to fiscal responsibility and to ensure that Program beneficiaries were not being exposed to less than fully developed medical technology or procedures. At the time the current regulation was written in 1982, gastric bypass, gastric stapling, and gastroplasty methods were the recognized surgeries for morbid obesity. However, in recent years, other bariatric surgical procedures have evolved and some have a substantial body of literature to support their safety and efficacy. Unlike the original rule that listed the specific surgical procedures and the clinical conditions for which coverage may be extended; this final rule authorizes benefit consideration for those bariatric surgical procedures that have moved from the unproven status to the position of nationally accepted medical practice, as determined by the Program standard of reliable evidence. Also in 1982 during development of the current regulation for morbid obesity, overweight and obesity were typically measured with height-weight tables (such as the Metropolitan Life Table). The 1982 regulation restricted eligibility for bariatric surgery to individuals who exceed their ideal weight for height by 100 pounds with an associated severe medical condition, or 200 percent or more over their ideal body weight with no associated medical condition required. This final rule changes the Program definition of morbid obesity to reflect the current nationally accepted medical use of the BMI, rather than the typical assessed height-weight table (i.e., the Metropolitan Life Table), to determine an individual’s eligibility for bariatric surgical treatment. The BMI is the more accurate measure for excess weight to estimate relative risk of disease. Since there now are more than 30 major diseases associated with obesity, the final rule requires the Director, TMA, to issue specific criteria for co-morbid conditions exacerbated or caused by (morbid) obesity, as determined by the Program standard of reliable evidence. This final rule does not expand the TRICARE benefit for morbid obesity surgery. However, it does make the specific procedures that are covered, as well as the clinical conditions for which coverage may be extended, a matter of policy. In other words, new bariatric surgery procedures may be added to the TRICARE benefit structure as such procedures are proven safe and effective and are established as nationally accepted medical practice as determined by the Program standard of reliable evidence.

Surgery was successful🤗 Band to bypass revision & A hernia repair on Oct 16, 2018. stayed 2 nights at the hospital. Terrible shoulder pain since I been home. They say it's gas.. I'm walking & applying a heating pad on it, but the pain LAWD it hurts!!! I got a JP drain which is uncomfortable & painful but controlled by medication. I'm getting it removed Wednesday & I can't wait .. Overall, I'm doing good😊

I didn't feel shame but I think it's only because I had gotten to the point in my life that I was desperate for any type of real help. That was back in 2009. I got the lap band, and that helped tremendously for many years despite it being finicky. After that surgery, it gave me the hope and willpower I needed as far as weight was concern. Within 6 months, that feeling of hopelessness and hitting my rock bottom disappeared. When I was told that I should have a revision to sleeve, I saw it as an extension of that help that I know I will continually need to be successful to stay healthy.

sunflowerw...., Sorry you had such a traumatic experience with your band. When I had mine removed I was too afraid to attempt a revision because I was afraid that it wouldn't work and that I could just try to lose on my own. At first I was able to lose but it turned around within a month. My stomach had shrunk before so I ate little but soon was back to my old self and now working on my RNY approval. I don't have to eat a lot to gain anymore because my metabolism is so screwed up from so many years of dieting and then the lap band. I feel I have no choice but to take another risk again! Good luck to you though, Nancy.:w00t:

Much of my depression was based on a pervasive sense of self-hatred for being so fat. (I was an obese low-carber.) Even after trying everything, including a Lap-band, I was getting fatter every year. My blood pressure was creeping up. Fasting blood glucose readings were creeping up, too. My ankles were swelling. My liver enzymes were not so great, and my kidney function was affected by stone formation. My left knee was going, and my hips were constantly sore. I was clumsy, and was always getting bruises. I needed physical therapy for my left shoulder. Felt 85, not 55. Insurance covered my revision, but based on results over the last 5 months, I would self-pay with no hesitation. The sleeve gave me my life and sanity back. Even if doctors found out that the sleeve resulted in growing a second nose on the side of the face, I would buy extra Kleenex and move on with my life. I weigh less than I have weighed since I was 18, and I feel 20 years younger. Come what may, I made the right decision for me.

It also sheds some light on the often poor results in regards to weight loss after revision surgery (exception seems to be band to bypass; these patients often seem to have good results).

Thanks for sharing, I agree about the weight maintenance. I have always been able to lose weight, it is keeping it off that is the challenge. I am a band to sleeve revision. I did good w the Lap Band for the first year, then I started having problems with it. I just got revised to the sleeve, and I feel that I made the right choice. I think I will have much better results this time around. Your story gives me hope!!

After two dialtions of the esophagus due to band slipping and a replacement of the port due to my body encapsulating the port with scar tissue and not being able to make adjustments my band was removed yesterday, July 5, 2012. Hopefully my insurance will approve a revision to bypass. I had lost around 87 lbs when all this started and was very please with the band. I still need to lose another 100 lbs though so wish me luck. I guess the admins should delete my account not that I no longer have the band. Good luck to you all and if you do what your doctor tells you, you will lose the weight!

That is odd that you're able to eat more now that you have a sleeve. Most people get the sleeve after the band for 2 reasons: Because the band was causing complications, or because the band wasn't working as much as they expected. A lot of people get the revision because the sleeve has a higher/quicker weight loss rate than the band. Have you talked to your doctor about this? I was going to ask if maybe what you're feeling is cravings instead of hunger pangs. But I see where you said that you're feeling nauseous by trying not to eat more than you should be, which makes me think that you're actually feeling hunger pangs. If I were you, I'd call my doctor and discuss this with them. My first assumption would be that they didn't remove as much stomach as most doctors do. I actually know of a woman whose doctor only removed 65% of her stomach, (while most doctors removed 85-90%) and she still felt hunger pangs.

I have spoken with the PA regarding my hunger pangs and was prescribed Zofran for the nausea. It's definitely not "head hunger" as I can feel my stomach churning when I do not eat enough to satisfy. I'm stumped, honestly. I am depressed and feel like such a failure. They tell me to "reset" and start the post surgery diet again, but I'm hungry to the point of nausea and headaches. Just wondering if any one else has experienced this. I have found some articles that mention a band after sleeve, and was curious if anyone had in fact received this revision.

January 12th! Revision to sleeve from lapband. Had lapband removed oct 2016. So I’m basically starting the lifestyle all over again that I had done so great with for 5 years!! I am nervous!!

I'm the 24th, going for revision as well.

To be fair, you're mostly asking people who've already had it done, so they probably didn't think it was too soon. The first Duodenal (which I'm assuming would have included the first VSG) switch was performed in 1988. Prior to that - gastrectomies had been in use for a very long time, just not for weightloss. The first gastrectomy for cancer was done in 1881 (Billroth - and not a "sleeve" per se, but still gastrectomy). Removal of the greater curvature of the stomach for reasons other than weightloss really aren't new at all. It's just the "as a bariatric procedure" that's new (well, if you count having been performed for > 20 years as new). I think this is majority true, but certainly has exceptions (your use of "typically" is well noted). For those not familiar with these or the difference, Billroth I connects to the duodenum, Billroth II connects to the jejunum - which is performed depends on how much/exactly what has to be removed. When I was first researching the sleeve (with the help of a friend who is a very good surgeon and an even better researcher), removal of the fundus and greater curvature of the stomach was done for gastric cancer (retaining the pylorus and pyloric valve, removing the fundus and some amount of the greater curvature) around 1950. I think cancers of the gastric fundus are generally treated through a sleeve procedure, unless the cardia is also affected (but by no means am I sure). I'm a band revision, and honestly - I never believed it would be with me forever. I was banded earlier than most, and even then I knew that chances were it would come out at one point. I hoped it might, but never trusted. Even 6 or 7 years ago it was very carefully stated that it was intended to be a permanent implant, but... And the band isn't causing a high rate of physical complications (things like erosion are still fairly low stats), it's just mechanically failing a lot. It's also one of the only procedures out there that can mechanically fail. With what's available right now, my firm opinion is that the VSG is the way to go IF you are a personality that can be responsible for a restrictive procedure. Maybe it's too soon, I guess more time can always tell something new. But I think it has been used long enough to be a calculated, well-researched risk. A much better risk than sitting around waiting for the next greatest thing, which probably will be brand new, so then you'd be waiting another 10 - 20 years to start seeingthe mid-long term research coming out...

I’m 2008 I had a lapband installed. I have had many problems from that over the few years. they can revise that to a different surgery, to Gastric bypass or sleeve. I choose gastric bypass. they were unable to do that at this time and just removed my lapband. hope that helps..

I stayed two because I was a revision patient. A friend of mine with the same doctor had the sleeve also and was a first time weight loss surgery patient spent one. It depends on your doctor and how you feel the next day after surgery. Good luck with your upcoming surgery.

I was banded in 2010. I did really great on the diet and lost around 30 lbs. I was going to the gym at least 3x per week until my knees started Killing me! I couldn't take my prescription anti-inflammatories because of the band. Once they were out of my system (I stopped them just prior to my band placement - I didn't realize how much knee pain they were conceling), I could hardly walk up & down stairs. It was awful. Of course I couldn't exercise so I started gaining some of the weight back. I went to an Ortopedic surgeon who tried shots in the knees to no avail. This surgeon did not want to do replacement surgery & told me I'd needed to lose weight! I'm in my 50's, so not being able to even do my housework tasks helped me gain the weight back. About a month ago I got something stuck in my band (it was something I'd been able to eat before) and violently vomited. It was a Sunday so I couldn't go to my Bariatric Surgeon's office. I suffered all night long to the point of pucking up my own saliva. The stuck food was NOT moving. I went in the next day and had a doc remove all the fluid. I found out on a later visit with my Surgeon that my band has slipped.I'm so done with the band! I'm having it taken out & am considering the sleeve (my surgeon encouraged me to switch; he answered all my questions) - I just want to make the right decision. I feel like I've failed at every "diet" possible to man & now I've failed at the LapBand...am worried I'll fail yet again on the sleeve. No matter how much you tell yourself you have to change your diet and exercise, those old temptations come back. I could eat the "bad" things with the band, but not always the "good" things I wanted, like scrambled eggs. I could eat a wafle, but not scrambled eggs??? Ridiculous! Sometimes I could eat granola, sometimes I couldn't! It drove me crazy! I feel that having the band was a big mistake for me. Now I'm just hoping my insurance will pay to remove the band; it has to come out, & approve a switch to the sleeve. I just am not certain about having that revision????

I have had a gastric bypass and am considering a revision. I was not sure what the option are or if it was even possible. I have had a concern ever since my surgery with a section of my bypass that is where the stomach was connected to the intestine. It has always caused me pain and I am concerned that it is not correct.

I was banded today! And I had a BMI of 55 when I started my consult a BMI of 53 when I started pre op and up until today I've lost about 20lbs (not sure what BMI that gives me no less than 51 though. I was banded this morning & my only complication was my nausea to the anesthesia. Not even 24hrs later I feel much better! And I think like everyone said you know yourself and what your true needs are. If you know you're commited to the lifestyle changes the band requires go for it! Its a lot easier to revise from the band than it is to go from the other WLSs to the band. Most doctors like many ppl look at ppl with higher BMIs as those who have extremely bad habits & lack of self control/comittment to make the band work so ofcourse they'll recommend faster somewhat easier options but you shouldn't let that opinion sway you. As long as ur healthy enough to go be approved for surgery get what you really want & are comfortable with!

Dr. Watkins is amazing !! I was banded there in 07 and there is no one else I would ever trust to do my revision except for him.

I will add that with the bypass you can always get a band over a bypass down the road as an option, though I dont know if I would classify that as a revision or not. But i probably see more band over bypasses done than I do lap bands for people who have never had surgery before.

right.... that's the whole point! the sleeve constantly needs to be revised because it either causes unbearable GERD, or did not provide enough weight loss. so they are revised to - guess what - RNY. RNY is virtually never revised or reversed because it works so well in the first place and doesn't need to be. i don't understand why this is so hard to understand. best weight loss, best diabetes outcomes, no GERD. and if you aren't an idiot and have the ability to follow basic instructions (take a vitamin every day... oh god, the HORROR), the chances of you experiencing "complications" is extremely low. RSM - the only real alternative to RNY is the mini-gastric bypass. but most dr's still don't provide it - it's still considered "experimental" for some reason. and it has a higher rate of reflux than the RNY. not nearly as high as the sleeve, but higher.