Hi everyone,

So I'm still in insurance appeal hell and trying to decide whether to just skip the months of fighting and go directly to self-pay with Dr. Aceves. (Skip to the last paragraph if you already know my story :-)). I need my lap band out and want to revise to a VSG but my insurance company is fighting me (I lost weight with the band and am under a 35 BMI). Odds are that I'll get the band removal covered but it won't save me much unless I can find a surgeon who'll do the revision as a single procedure and just charges me the difference. Dr. Cirangle said he would when I had my consult with him but darned if I can get anyone at his business office to return my calls.

At any rate, aside from the cost that only thing that holds me back from booking my surgery with Dr. Aceves now is the risk of any future complications happening that my insurance company would also refuse to cover. All things being equal, if I had no hope of insurance coverage or unlimited funds, Dr. Aceves would actually be my first choice. All I've heard is great feedback and he's one of the most experienced surgeons there is. Not to mention I really like the idea of a 3 day hospital stay.

So I'm hoping to finally make a decision (hang out in the hope of winning the appeal or just book my trip to Mexicali) this week. And I have a question on oversewing. I understand that Dr. Aceves uses a 34f boughie and then also oversews the staple line. Given that old VBS and stomach staplings had lots of problems with failed staple lines years later, it seems very wise to me to use this techique. The double-staples they now use for the VSG plus the oversew.

Does anyone in the U.S. do the oversew? Am I correct in my assumption that this adds a extra level of protection against leaks?

Thanks!

Britt

You need WASa to come in here and answer that. She seems to know the procedure very well.

There are docs in the US who oversew. However, there are also docs who think it's a bad idea and can actually lead to more leaks.

So it's an area that surgeons don't agree on.

Staple line disruption happens only when the stomach is still attached, such as with the old VBG and the old technique of the RNY bypass. In the RNY they now cut and detach the stomach and in the VSG (sleeve) the stomach is detached and removed, thus staple disruption cannot occur.

It depends on who you talk to whether or not over sewing the staple line is a good thing or not. Many surgeons believe over sewing leads to a higher risk of leaks. Most surgeons in the U.S. do not over sew.

Sandy Johnston

Patient Care Coordinator

MexicoWeightLossSurgery.com

800-935-6710

Dr. Aceves does oversew and to this date has not had any leaks and he has performed over 600 sleeves.

According to his website, Dr Guillermo Alvarez also oversews.

Hi everyone,

So I'm still in insurance appeal hell and trying to decide whether to just skip the months of fighting and go directly to self-pay with Dr. Aceves. (Skip to the last paragraph if you already know my story :-)). I need my lap band out and want to revise to a VSG but my insurance company is fighting me (I lost weight with the band and am under a 35 BMI). Odds are that I'll get the band removal covered but it won't save me much unless I can find a surgeon who'll do the revision as a single procedure and just charges me the difference. Dr. Cirangle said he would when I had my consult with him but darned if I can get anyone at his business office to return my calls.

At any rate, aside from the cost that only thing that holds me back from booking my surgery with Dr. Aceves now is the risk of any future complications happening that my insurance company would also refuse to cover. All things being equal, if I had no hope of insurance coverage or unlimited funds, Dr. Aceves would actually be my first choice. All I've heard is great feedback and he's one of the most experienced surgeons there is. Not to mention I really like the idea of a 3 day hospital stay.

So I'm hoping to finally make a decision (hang out in the hope of winning the appeal or just book my trip to Mexicali) this week. And I have a question on oversewing. I understand that Dr. Aceves uses a 34f boughie and then also oversews the staple line. Given that old VBS and stomach staplings had lots of problems with failed staple lines years later, it seems very wise to me to use this techique. The double-staples they now use for the VSG plus the oversew.

Does anyone in the U.S. do the oversew? Am I correct in my assumption that this adds a extra level of protection against leaks?

Thanks!

Britt

I was just told by my surgeon a week ago at my consult that oversewing is NOT a good thing. He said he did his fellowship with a bariatric surgeon. It is his practice not to oversew do to the fact that the new stomach can become swollen and infected and come open at the staple line. My surgeon uses glue along with the staples. This is just what I was told and this is a center of excellence at www.coloradobariatric.com Dr. Matthew Metz . Sorry to put a twist on your thoughts but I'm trusting of this doctor.

Dr. Myers uses three rows of staples and we are on a stricter diet post surgery than most to prevent leaks early on.

Dr. Myers uses three rows of staples and we are on a stricter diet post surgery than most to prevent leaks early on.

WOW, I can't imagine stricter than Dr. Aceves -- what is your post-op diet?

Rebekah:

I am just curious: How can oversewing cause infection?

Also, there is always swelling after cutting out a portion of the stomach, whether oversewing is done or not. Does your surgeon think there is MORE swelling after an oversew than if the staple line is just glued?

Have not had my VSG yet, but am wanting to learn everything I can about this before hand so I ask good questions when I get to the point of talking to a surgeon. Have not seen any literature looking at this issue...if you know of any I'd like to read it.

Thanks.

I seriously doubt that there documented published proof that oversewing causes infection - I doubt that Dr. Aceves and so many other surgeons would oversew if there was documented evidence to this effect.

I have read on blogs that this is controversial but am yet to see ANYTHING discussing the issue in the professional literature that I have reviewed.

The theory is that over sewing causes the tiniest of pin holes which can cause contamination of stomach contents in the abdominal cavity. Some surgeons don't believe this and some do. It depends on who you talk to. It is true that most of the U.S. Centers of excellence do NOT over sew, but glue over the staples instead. That technique is the latest and becoming popular. My surgeon does not over sew, but some in Mexico do.

Sandy Johnston

Patient Care Coordinator

aLighterMe.com

MexicoWeightLossSurgery.com

877-765-THIN (8446)

www.MexicoWeightLossSurgery.com

The number one surgeon in the LV area for sleeves also oversews his staple lines ... he never made any mention of glue, so it's not only "mexican" surgeons who oversew the staple line. Again, I believe it is a matter of personal preference on the part of the surgeon and not something that is standard protocol.

ZSFlower:

The "pinhole" theory makes sense...but I would suppose they had more leaks before they started doing the oversewing, so it has continued as a practice (for some). If the stats that come out of using glue for a couple of years turn out to be better, I guess they will eventually all switch to glue. It's all about getting better and better at a relatively new procedure.

Thanks for the info.

Doctors are only human and they are all different.

I have followed people who had VSG with 6 incisions (I had 5), post op drainage tubes ( I didn't have one), staples to close their incisions (I had sutures that dissolved), oversewn staple lines (mine wasn't) and pain med pumps on their IV's (I didn't have or need one).

It's the results that count.