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Pebbles it may seem like the sleeve is new, but it's actually not. There's a category of overweight called the Extreme Morbidly Obese. For those the option that was chosen over gastric bypass was a surgery called the Duodenal Switch. Patients would go through all the hoops and have the sleeve surgery. They would lose a certain amount of weight and then about 10 months to a year later they would go back in for a second surgery, the duodenal switch. Doctors started to note that goal weight was being achieved with just the Gastric Sleeve and the second part of the surgery was canceled. Since the sleeve was considered part of a two-part (two surgeries) it does not have it's own Medicare Code. Many insurance companies sort of follow what the Government considers the norm. Also, since it was not considered a stand-alone surgery it took a little while to get the data back on where the sleeve stands in comparison to Lap Band and Gastric Bypass. There have been so many issues in the past with lap band, and now so many revisions, or people having to get it taken out and problems with adhesions many surgeons are backing away from doing lap band lately because of it. The sleeve has been around for a while now, but the statistics are showing that in the long run it is comparable with Gastric Bypass with less complications from dumping, malnutrition, etc. Of course, it's a surgery so it's not full-proof, some people have issues with it. I only wanted the sleeve, I had no interest in Gastric Bypass, however, with Gastric Bypass there is less issue with GERD or acid reflux, that has given me some pause because I suffer from acid reflux, but then I realized, wow that's because i was eating late at night and eating too much. Since I started the 6 month pre-supervised diet I haven't had any issues with acid reflux in months and I haven't been sleeved yet. Good luck on your decision making and what you are doing is awesome, research research research and start working on adjusting the way you eat now, eat your meats first, vegetables second, lower your carbs, and try practice not drinking with your dinner, try to lower your caffeine in advance because you will have to give up caffeine. Try to monitor what you are eating in advance by joining something like myfitnesspal.com and keep track of your Water, Protein & carb intakes.

The Sleeve wasn't my choice. When i went in for surgery it was for the RNY Bypass. When i woke up my Surgeon told me that due to a large liver and some massive scar tissue in my abdomen from a hernia I had repaired in 2005 he decided to give me the sleeve rather than opening me fully up and performing an open surgery. Now that i have my sleeve. have found this site, and done my research on it, I think it's the best thing he could have done for me.

I chose the sleeve because, for me, it made the most sense. I didn't want to have to return to the doctor over and over again for "fills". I didn't want to be limited on what I can and can't eat. I didn't want major invasive surgery to re route my entire gastric system. Also, my mother and several friends have the band and have had MANY issues with it from slippage to not eating enough to eating too much. I have also heard of the pouch on both the band and the bypass becoming stretched out. With the sleeve the possibility of your stomach ever stretching out THAT much is slim. I also have friends that have had the bypass and have stated that they now wish they could go back and do the sleeve instead because of all the problems they're having. Bottom line is, whichever surgery you chose it's a personal decision. Of course here on the sleeve forum, we're all a bit biased so we'll tell you all the praises about the sleeve and all the downfalls of the other surgeries. My advice to you is this: DO YOUR RESEARCH. Visit web sites, talk to people, learn the good, the bad, and the ugly on every possibility out there. I do have one question, though: you said you're already scheduled for the sleeve in August, but want to know which surgery to go with? Are you having doubts and second thoughts? You should not be forced into any procedure, so be sure you are going with what is right for you! Good luck!

Hello! First of all I'd like to say that even though this is my first post, I've received a lot of advice and encouragement from many of you here so thank you! I had my laparoscopic gastric bypass surgery on December 2nd, 2014 and I'm happy to say I've had an amazing recovery! I started my journey at 5'6 weighing 265lbs at my heaviest, 256lbs on surgery date and 10 days post op am now at 240lbs ????????I stopped taking my pain meds about 4 days after surgery, I can sleep in whatever position I want, I've been trying pureed foods and have never felt nausea, haven't vomited or felt uncomfortably full. I'm feeling great....but Just a couple of hours ago I fell down the steps...only 5 steps, but I hurt my bum and my elbow, and of course I'm concerned about my insides, I just had major surgery a few days ago. I feel ok, my incisions look fine and everything seems normal but I'm still a little nervous. Will be calling my surgeons office tomorrow to see what she says. Did anyone ever go through something like this? Should I be more worried? Help. ????

Sharowna, you may want to post this in the General Gastric Bypass Surgery Discussion forum because of where it's at now only few people will see it.

He is also a real-life story that we can all relate to. Weight loss wasn’t easy, and he isn’t able to follow his weight loss surgery diet perfectly. Here’s Jamie’s story, complete with triumphs and struggles. You can read more about Jamie’s acting career, plus see headshots and look at his resume, by clicking here to get to his website. He’s also on Facebook and Twitter. And, don’t forget to watch for his upcoming column, “Regain-ing Control,” in BariatricPal Magazine. Familiar Story: Big Kid to Lap-Band Patient For many weight loss surgery patients, Jamie Miles’s story will be familiar. He was a big kid with low self-esteem, and he turned to food for comfort. Later, he tried every diet in the book, from Weight Watchers and South Beach to the grapefruit diet. Jamie found out about the lap-band surgery when he saw an ad in a newspaper that he was reading in his break room at work. He knew his insurance covered bariatric surgery, and he did not like the idea of getting the gastric bypass like some coworkers had. So, he went for the lap-band. Time to Chase a Dream For years, Jamie had dreamed of becoming a commercial model, but his weight was holding him back. Once the pounds began to come off, Jamie began to think seriously about fulfilling a dream of acting. After losing 60 pounds, he landed some “extra” roles. He progressed to some speaking roles in local productions and commercials, and went to acting school. That’s when he lost his day job in marketing and promotion. While the old Jamie might have turned to food, the new Jamie decided to use the chance to pursue acting full-time. Two days later, he signed with a local agent. His career has blossomed to include roles in commercials and local and national films. The lap-band may seem far from acting, but Jamie says the entire experience helps him in emotional roles. He is able to apply the feelings from years of personal pain and being called names, dumped, and treated poorly. What he’s also recognized is the effect of confidence on life. He now realizes that many actors are larger, and the reason he could not dedicate himself fully to acting is that he was not confident in himself. He was afraid others would not see his abilities, and would just judge him based on looks. Relationship with Food: “Complicated” Before the band, Jamie’s social life revolved around food and drink. Plus, he was an emotional eater. Since getting the lap-band, Jamie’s relationship with food can only be described as “complicated.” He started to get a bit depressed when he could no longer tolerate red meat, pork, and chicken breast – the very foods he was supposed to be eating! Now, he tries to focus on what he can eat. He’s able to eat chicken thighs, seafood, and salad when he’s sticking to his diet. Unfortunately, he still loves fast food, and his band allows it. His solution is to avoid trigger foods like Taco Bell and chips. The Challenges Continue A “typical” day for Jamie might begin with some protein and green vegetables. His snacks can consist of almonds, a protein shake, or a 100-calorie Jell-0 pudding. But that’s when he’s being good. Just like so many weight loss surgery patients, Jamie let his guard down a little. When it happened to him, soft drinks, fried foods, and other poor foods crept back into his diet. In fact, he gained back 25 pounds when “life happened.” Jamie still has a lot on his plate, so to speak. He’s pursuing a full-time acting career and working a part-time job in a stressful position. He needs to see his bariatric doctor, and fears his band has a leak, but doesn’t have the cash on hand. And, of course, he wants to lose the extra weight for once and for all. “Re-Gaining Control” on BariatricPal! Jamie has learned a lot along the way. He needs to take care of himself. He needs to love himself. He needs to eat healthy and work out. He wants to help other bariatric surgery patients. He did some public speaking while he was losing weight after surgery, but feels embarrassed to do so with his regain. He can’t wait for this mindset to change once he takes back control. Jamie is planning to get to his goal weight, and he is going to share his journey on BariatricPal! His column will be called “Regain-ing Control,” and it will be a very real and personal journey complete with weigh-ins and photos. As he says, “some days will be good, some bad, and all very real.” He hopes to help readers get back on track, and for readers to inspire him to do the same. Stay tuned for the new column! Jamie’s story begins like so many others, but Jamie has worked hard to make it unique. He is living a dream of his by using his new looks to give him confidence to be an actor. Plus, he will be helping thousands of weight loss surgery patients when he shares his journey toward “Regain-ing Control.”

Hi @@Phoenix40! So last Thursday I went for my Nutrition/Surgeon/Coordinator appointment. I'll describe each appointment below: First you are weighed in and your height is taken Nutrition: The nutritionist is a very nice lady and she will ask you about what type of diet you have been on (I started following the 1200 calorie diet after orientation). You will have to describe what you usually eat for Breakfast, lunch, dinner, Snacks,etc. She also talks about Vitamins and what type you will need post op (this will depend on if you get the sleeve or bypass) and what to expect as far as diet goes in the first weeks after surgery (i.e. liquids, soft foods, etc) She also informed me about the different types of Protein drinks and answered any questions I had. Surgeon: Dr. Hahn was very patient. He went over my BMI, co morbidities, medications, etc to ensure that I would be a good candidate for surgery. He said it would be my choice whether to go for sleeve or bypass as I would be great candidate for either (I don't have acid reflux). We talked about the differences between sleeve and bypass (right off the bat he discouraged from the lap band so we were in agreement about that). He reiterated that regain was possible with either surgery and so is dumping (so it really comes down to the patient being willing to put in the work to not only lose the weight but keep it off). He went into detail about possible complications withe each procedure (ulcers, reactive hypoglycemia, reflux, etc). He then set a weight loss goal for me. Normally they ask the patients to lose 10% of their body weight but Dr. Hahn only requires a 7-8%, of total body weight, loss. For me 7-8% was 19 pounds (I had already lost 9 pounds since orientation and he credited me so I needed to lose 10 pounds to get a surgery date and 5 pounds to get a psych appointment). The only other requirements Dr. Hahn set out for me, besides weight loss, is attending at least one support group, and an EKG (I already finished my bloodwork). Coordinator: She was very pleasant. She informed of what my next steps to surgery are (support group, psych appointment, etc) and that to be sure I call monthly to update them on my weight and progress. Before the psych appointment each patient must fill out a surgery quiz (located in Chapter 9 of the Bariatric binder) and send it in before the appointment. Overrall it was an interesting yet quick appointment. I was told to expect to be there for 3 hours but for me it was more like 2 hours. Sent from my SM-G925T using the BariatricPal App

Congrats on your surgery date. My revision is on Friday so maybe we'll run into each other. I can't wait! I'm a little nervous, any surgery makes me nervous, but am so ready to get a fill and get on with this.

I ran into the same issue with Aetna. My BMI is 37 and I have no comorbidities. I was worried I wouldn't be able to have the surgery. I decided to look into paying for the surgery out of pocket and bypass insurance. Guess what?! No one cares if you have comorbidities if you pay cash. Very few hoops to jump through. I started the process 6 weeks ago and my surgery is in a week. It would have been sooner if not for Covid. Not sure if you are in a position to pay out of pocket.. it may be less than you think. Just wanted to offer another option if insurance turns you down. Don't give up! Sent from my SM-T500 using BariatricPal mobile app

Well I had my surgery with Dr. Alejandro Lopez....Dr. Ortiz assisted but I think it's a different Ortiz. My coordinators are through Alighterme. I'm happy with my results. Now it's up to me to use this tool in the right way. It's definitely not a quick fix but this is a proces....a continuous process. I think I worry mor about food now than before. But no complains. Btw, when I had my revision surgery in NJ I was treated like crap.at MI Doctor in MX I was treated well and it was very clean

Hi there! I’m 38 years old in Central California. Married to my absolute best friend with the most awesome little dudes (ages 4 and 2). I’ve battled with my weight my entire life. No joke, my mom put me on my first diet in the 3rd grade, which likely set off the years of self hatred and body shaming. About 6 years ago I was diagnosed with a hiatal hernia (via endoscopy), and as of late it’s really gotten significantly worse. I just had another endoscopy on Tuesday and I am awaiting results. Anyhow, since my gastroenterologist suggested I might consider bariatric surgery, as that’s the only way they will repair the hiatal hernia at my current weight (304.6)...it’s all I can think about and am doing as much research as I can. I also signed up for an online seminar at the bariatric office at my local hospital. They do three surgeries at the hospital, lap band, sleeve, and gastric bypass. I’m leaning toward the sleeve, but honestly I just don’t know which is the best option (I don’t want to do lap band, just because I’ve read that it’s not as effective at losing weight). Anyhow, can you tell me a little about your experiences with sleeve or bypass. I only know two people that have had bariatric surgery, and they both have glowing reviews... But I know it’s not all sunshine and lollipops for everyone. Thanks in advance!

I did gastric bypass + hiatal hernia repair June 6. I have had very few "issues"-- a couple of "one step over the line," one incident of the dreaded foamies, but generally, smooth sailing. I was at around 274 lbs and now am at around 206-7, depending on scale and time of day. That's crazy! I look at the stats for how much folks lose on average and this seems to be beyond the norm. I'm not complaining-- I not only walk, but got into a rigorous exercise regime with a trainer. His focus, for now, is balance, and "whole body"--I do some weights but the "balance" stuff has been a real blessing. I have checked the boxes with the M.D.s- my cardiologist has no problem with testosterone treatment as a means to build muscle mass. I need to get my surgeon to sign off on that, just to be sure. But man, this has been an amazing journey in a very short time. I'm way more mobile, fit into clothes I forgot I had (I used to buy really nice stuff, turned into a slob, and now I'm caring about my appearance again!). I'm closing in on 70 years-- and have not felt this vigorous in a long while. My taste buds have definitely changed. But it's worth the trade-off in health and fitness. And no more GERD!!!

Feeling the same way. Tomorrow morning is VS day Feeling alone and scared. Do not want to leave my 7 year old without a mother Preparing to feel regret and then to get over it in a few weeks Found out today I have a hiatal hernia do they will take care of that too but warned me I may have GERD and offered to do gastric bypass instead Not what you want to hear 12 hours before

I'm reading these replies and other multiple threads with similar themes and I'm experiencing such mixed emotions. I was banded in Sept of '10. Had back and left shoulder gas pains from day one with them coming & going commonly over the past 3+ years. After my second fill I started having more and more problems. After every attempt of a fill I would swell within couple hours and not be able to get liquids down, and end up right back in the office for a deflate. This repeated for a year. During this time I was never able to eat fruit, fresh or cooked vegetables, chicken breasts, or any healthy lean meat without all of those things instantly getting stuck. The only way I could eat those things is if they were covered in a sauce of some type. And yes, I shared this with my doctor. I was told that “in rare cases….some peoples bodies are just more sensitive to having the band and it can be tricky”. After a year of this, I started randomly swelling which would result in no liquids going down and me vomiting the saliva my body would produce because that couldn't get down either. This was happening for no reason and would end up in Dr's office for deflate for no reason. After two years of that, I asked for a revision. My doctor told me no, I was still a success story with a total loss of 75 lbs post op (still considered severely obese) and told I must not be compliant with the plan. Define being compliant? I couldn't eat most the time...how was that ok? When I was able to eat, I ate what I could without fear of it causing problems and getting stuck. Don’t tell me I’m not compliant when I’ve expressed the challenges I’ve had from day one and constantly being told there was nothing wrong. At this point I was averaging 1200 calories a day and hadn't lost a lb in over 3 months. I was again told “in rare cases we see more challenges than others trying to figure out what causes the swelling or problems, but it’s a process”. After gaining 25 lbs from sustaining on liquids and slider foods, I again asked for a revisions and was told I was still a success story and having the risk of putting me under again was greater than the potential benfit of having the revision. I ended up asking for a complete deflate and let the doctor talk me into leaving 2ccs in the band as "something". Another year later, I go to see a new doctor because I relocated. I find out I still have 4ccs in my band and that the dr had only taken out 2cc. No big surprise to me at this point that the other Dr did what they wanted to do. By the time I saw the doctor I had gained another 40 lbs. My own fault, I am not blaming the band or anyone else. I have had a lot big life changes that had me putting exercise and healthy eating on the back burner...and again, it isn't like I was able to eat fresh vegetables and grilled chicken breasts. And frankly, fattening food could go down with no pain. To this day if I want to eat, its chicken with lots of sauce, or foods that easily slide. With that said, the 3 years leading up that didn’t exactly help me develop healthy eating habits and if I didn’t have disordered eating before, it is 100% present now. So here I am today, the last month having random acid reflux that ends up with my esophagus and band super tight and again unable to get anything down for a day or two. Now the past couple of days I have had the esophagus spasms where I can technically drink liquids and eat soft foods but with extreme pain as it goes down and constant back & left shoulder pain/burning. Just sitting here if I burp the pain instantly hits. I have a very high pain tolerance & pain threshold so it isn't that part that is bothering me. What is bothering me is that if all these people on these boards have similar issues over the course of years, and I have shown increasing symptoms for years of the band being a problem for me, why do the doctors immediately assume I'm non compliant? Why don't they move more aggressively? Why am I treated like an annoyance or problem or immediately assumed that I must have caused the tightening or swelling? Now I will go into the office, feeling like a complete failure because I haven't lost any weight since meeting this new doctor (I haven't gained either). In fact, I don’t even want to call to make the appointment because my emotional state just doesn't know if it can take once more being told some how I must have done something to cause it. I want it out. I have asked two different "highly respected" doctors who have talked me into believing it must be me somehow. Now, almost 4 years later, I am 10 lbs lighter from weight on the day of surgery, in a lot of pain, and even more emotionally beaten down than I was 4 years ago. I don't usually post or vent like this, but I am truly at a loss for what to do next. Society says I'm unacceptable because of my weight. Heck, even some posters here treat those of us with these challenges like we are a problem child. Anyone who knows me knows that I believe in taking accountability for my actions. This is one time in my life where I feel that has been used against me and now has negatively impacted my health more than it ever helped. Family tells me to just make the appointment and ask for it out. I can do that. I know I need to do that. Yet after almost 4 years of being told it’s me, I’m the problem, it isn’t as easy as it seems.

me, I did the removal/revision in one procedure. Mine was smooth sailing in and out in 90 minutes. My doctor has done hundreds of revisions. you want a doctor with experience, because some people end up with adhesions between the band and their organs and you want a doctor who has seen it and and knows how to deal with it. you don't want to be the first. . Yes there are greater risks with a revision depending on how much damage the band has done. the sooner you get it out, the better.

Ok this is just MY opinion! Nothing against anyone that’s getting Bypass. But I just felt that the Sleeve was the less invasive procedure. Just make your stomach smaller...That sounded plain and simple to me. Again, nothing against Bypass! But I just felt bypass was a lot of re-direction / re-creation that I didn’t want my body to have. I have a Degree in Exercise Science, so I had to learn a lot about the human body. So I know a little bit about human body’s. No way am I saying I know as much as a doctor! But I just felt that the Sleeve was the simplest solution to my problem. Go in and make the stomach smaller and get out! Again! To anyone reading this! I’m not saying don’t get Bypass! And I’m not putting Bypass down in any way! I’m just saying this is the best procedure for me! Does any of that make sense? Lol! Sorry I get to rambling some times!

I guess I never looked into the Sleeve vs Bypass for the amount of weight needed to lose. I didn’t know there was much a difference. My weight was at 475 lbs last week when I started my pre-op diet. With the results I got from the “Bod Pod” (Body Composition Assessment). I’d be happy with getting down to 275 lbs.

I have been researching bariatric surgery for over a year & chose the lapband. I'm a 55 yr old nurse & took care of more than my share of gastric bypass patients & felt I just couldn't go that route. My surgery is scheduled for tuesday, the day after my birthday. So, needless to say there will be no cake for me this year. This is my present to myself. My Dr told me in January that I won't live 5 more years with the condition my kidneys are in if I don't lose the weight now.I had to do the 6 mos supervised weight loss which I balked at initially but am now happy I had to do it. I have lost #37 since february on a low carb diet & have really gotten into my new lifestyle. I'm not even sure I will need a fill since even now I never get hungry between meals.What I was wondering is if you never have a fill do you still have stuck episodes,pbing or still have to take the tiny bites & chew,chew,chew?

Medicare is coving the sleeve if you have liver failure or a serious liver problem. Your doctor must call the provider line and get a direct acess to the contractor with your situation only the contractor can approve and process your claim, if you lose you can appeal to a administration law judge, go for it girl. I like it best also hate the lap band and the bypass, well it a trade off for different sickness. I understand also that medicare advantage might cover it now also that is medicare C, check before you change as there are over 200 plans.

The port site was the most tender to me as well, but in two weeks time I had no pain at all so hang in there and take your drugs if you feel like you need to. The first time around I was religious about taking my pain meds the first four days and I honestly did not hurt nearly as bad as when I had my port revision surgery and decided to 'go it alone'. They give you the meds for a reason so use them if you feel you need to. Soon you will be in a lot less pain just hang in there!

Don't have the Gastric Bypass unless you have a lot of health issues for now. Gastric Bypass is out dated for the time we are living in. Gastric Bypass is not as safe as Sleeve surgery plus it causes ulcers, bleeding, dumping, no Nsaid for pain,& I just read an article that VSG patients outlive Gastric Bypass patients 5 times longer. People have been waiting since 2009 for Medicare to pay for VSG Surgery and when I had my surgery Dec. 15, 2010 Medicare still is not covering VSG Surgery.

@@Roo101769 I just want to say thank you for writing this post and being sooo honest and open about your struggle. I'm still pre op and have been looking for ppl that could share the "real" deal about surgery. I was trying to decide which surgery to get and the biggest fear I had about vsg was what you are describing in your post. I have decided to go with bypass because like you, I know having no consequences after a while may leave me stuck. Just know you are not alone in your struggle. I'm sure there are a lot, who's had either surgery, in the same predicament as you. It's probably a little hard right now but I'm sure you'll get over the hump and kick it in gear soon...you've come so far, let that and your baby girl be the motivation to keep going...good luck!

I work in the health industry, and this article came across my desk today... it's an opportunity for you, the patient, speak up regarding their proposal to NOT cover surgery for patients whose BMI's are under 35 who are dealing with diabetes. Their argument is that it won't make a dramatic difference in a person's health. CMS Proposes Covering Bariatric Surgery to Treat Diabetes Written by Stephanie Wasek Monday, 17 November 2008 After an extensive evidence review, CMS has announced a proposal to revise its existing coverage policy for bariatric surgery to include type 2 diabetes as one of the co-morbidities CMS would consider in determining whether bariatric surgery would be covered for a Medicare beneficiary who is morbidly obese (an individual with a BMI of at least 35 is considered morbidly obese). CMS is also proposing to not cover bariatric surgery when it is used to treat type 2 diabetes in a beneficiary with a BMI below 35. In 2006, CMS expanded coverage of bariatric surgery for Medicare beneficiaries who receive one of four procedures — gastric bypass, open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch — in bariatric centers of excellence, as certified by the American College of Surgeons or the American Society for Bariatric Surgery, and as reported on the Medicare coverage Web site. To be considered for coverage, Medicare beneficiaries must have a BMI of 35 or higher and must have exhibited a serious health condition in addition to morbid obesity, such as hypertension, coronary artery disease, or osteoarthritis. Type 2 Diabetes would join the list of serious health conditions. However, after "a careful review of the medical evidence available on bariatric surgery," CMS is also proposing to not cover bariatric surgery for patients who do not meet the definition of morbid obesity, even if they do have type 2 diabetes. "While recent medical reports claimed that bariatric surgery may be helpful for these patients, CMS did not find convincing medical evidence that bariatric surgery improved health outcomes for non-morbidly obese individuals," says the agency. CMS is seeking comments from the public about this evidence and its implications for coverage, and about which groups of patients should be covered for this surgery. Public comments may be submitted directly to CMS's Coverage Web site for 30 days from the Nov. 17 posting of the proposed decision memorandum. CMS will issue a final decision memorandum within 90 days of the proposed decision. Read the proposed decision memorandum and submit comments at the CMS Coverage Web site.

sleep apnea (i.e., patient meets the criteria for treatment of obstructive sleep apnea set forth in Aetna CPB 004 - Obstructive Sleep Apnea); or 4. Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite optimal medical management); and 2. Member has completed growth (18 years of age or documentation of completion of bone growth); and 3. Member has attempted weight loss in the past without successful long-term weight reduction; and 4. Member must meet either criterion 1 (physician-supervised nutrition and exercise program) or criterion 2 (multidisciplinary surgical preparatory regimen): 1. Physician-supervised nutrition and exercise program: Member has participated in physician-supervised nutrition and exercise program (including dietician consultation, low calorie diet, increased physical activity, and behavioral modification), documented in the medical record at each visit. This physician-supervised nutrition and exercise program must meet all of the following criteria: 1. Nutrition and exercise program must be supervised and monitored by a physician working in cooperation with dieticians and/or nutritionists; and 2. Nutrition and exercise program(s) must be for a cumulative total of 6 months or longer in duration and occur within 2 years prior to surgery, with participation in one program of at least three consecutive months. (Precertification may be made prior to completion of nutrition and exercise program as long as a cumulative of six months participation in nutrition and exercise program(s) will be completed prior to the date of surgery.); and 3. Member's participation in a physician-supervised nutrition and exercise program must be documented in the medical record by an attending physician who supervised the member's participation. The nutrition and exercise program may be administered as part of the surgical preparative regimen, and participation in the nutrition and exercise program may be supervised by the surgeon who will perform the surgery or by some other physician. Note: A physician's summary letter is not sufficient documentation. Documentation should include medical records of physician's contemporaneous assessment of patient's progress throughout the course of the nutrition and exercise program. For members who participate in a physician-administered nutrition and exercise program (e.g., MediFast, OptiFast), program records documenting the member's participation and progress may substitute for physician medical records; or 2. Multidisciplinary surgical preparatory regimen: Proximate to the time of surgery, member must participate in organized multidisciplinary surgical preparatory regimen of at least three months duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member's ability to comply with post-operative medical care and dietary restrictions: 1. Consultation with a dietician or nutritionist; and 2. Reduced-calorie diet program supervised by dietician or nutritionist; and 3. Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and 4. Behavior modification program supervised by qualified professional; and 5. Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen at each visit. (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multidisciplinary surgical preparatory regimen.) and 5. For members who have a history of severe psychiatric disturbance (schizophrenia, borderline personality disorder, suicidal ideation, severe depression) or who are currently under the care of a psychologist/psychiatrist or who are on psychotropic medications, pre-operative psychological clearance is necessary in order to exclude members who are unable to provide informed consent or who are unable to comply with the pre- and postoperative regimen. Note: The presence of depression due to obesity is not normally considered a contraindication to obesity surgery. 2. Vertical Banded Gastroplasty (VBG): Aetna considers open or laparoscopic vertical banded gastroplasty (VBG) medically necessary for members who meet the selection criteria for obesity surgery and who are at increased risk of adverse consequences of a RYGB due to the presence of any of the following comorbid medical conditions: 1. Hepatic cirrhosis with elevated liver function tests; or 2. Inflammatory bowel disease (Crohn's disease or ulcerative colitis); or 3. Radiation enteritis; or 4. Demonstrated complications from extensive adhesions involving the intestines from prior major abdominal surgery, multiple minor surgeries, or major trauma; or 5. Poorly controlled systemic disease (American Society of Anesthesiology (ASA) Class IV) (see Appendix). Aetna considers VBG experimental and investigational when medical necessity criteria are not met. 3. 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. 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 2. 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. 4. Experimental and Investigational Bariatric Surgical Procedures: Aetna considers each of the following procedures experimental and investigational because the peer reviewed medical literature shows them to be either unsafe or inadequately studied: * Loop gastric bypass * Gastroplasty, more commonly known as ?stomach stapling? (see below for clarification from vertical band gastroplasty) * Sleeve gastrectomy * Mini gastric bypass * Silastic ring vertical gastric bypass (Fobi pouch) * Intragastric balloon * VBG, except in limited circumstances noted above. * LASGB, RYGB, and BPD/DS procedures not meeting the medical necessity criteria above. Cholecystectomy: As a high incidence of gallbladder disease (28%) has been documented after surgery for morbid obesity, Aetna considers routine cholecystectomy medically necessary when performed in concert with elective bariatric procedures. Notes: Calculation of BMI: *BMI is calculated by dividing the patient's weight (in kilograms) by height (in meters) squared: BMI = weight (kg) * [height (m)]2 Note: To convert pounds to kilograms, multiply pounds by 0.45. To convert inches to meters, multiply inches by 0.0254. or For a simple and rapid calculation of BMI, please click below and it will take you to the Obesity Education Initiative. *BMI = weight (kg) * [height (m)]2 See also CPB 039 - Weight Reduction Medications and Programs.

I had mine on Monday. Been pretty good thus far. Post op care is good and that is helpful in recovery. Some swelling but walking well. I have a revision from lapband to rny. So happy with this New Journey.