Lap Band to VSG

Question
QUESTION: I had a lap band placed in April of 2007.  I have had the band slip 3 times due to having the stomach flu.  With 2 small children and my husband and I both working we are likely to have the stomach flu at our house at least once a year.  

My question is whether it is common to have the lap band slip every time I get sick?  I currently have a slipped band and am looking towards more surgery to have it repaired, have it removed or revised to another type of surgery.  I am scared to death of having bypass so I am thinking VSG might be my best option.  Can you tell me if VSG patients have issues if they get sick?  Are there medical issues I should be concerned with having a VSG?  

I chose lap band as it was the least invasive, but it has not been a good fit for me.  I have lost 55 pounds and kept it off even without the use of my band (when fluid was all removed due to slippage 3 times), but I seem to slip more easily than other band patients.

Thank you for your help in this decision.

Donna

ANSWER: Donna,
I'm sorry to learn about your troubles.  I think you may have captured the essence of your Band situation when you said "it has not been a good fit for me."  Since you have had 3 slips, it seems very unlikely to me that your Band is going to stay in the right place for the long haul.

It is not usually the case that a Band will slip every time someone has stomach flu, but perhaps your first episode took place at a time when the Band had not fully healed into place and the flu pushed your Band toward a slip.  If a Band has slipped once, it is more likely to slip again, etc.

I have had several patients for whom we've needed to remove the Band for one reason or another.  About half have chosen conversion to a sleeve, and about half to a gastric bypass.  Both groups of patients are very happy after conversion.  If you find it difficult to get your "brain wrapped around" a gastric bypass then I think your odds of success with a VSG are still quite good.

Best of luck!

Dr JP

---------- FOLLOW-UP ----------

QUESTION: Thank you for your help!  Can you tell me if your patients have been able to have VSG covered by insurance?  My insurance has covered the Lap Band procedures and will cover Bypass, but there is question on the VSG.  I am sure my surgeon will contact my insurance for me and "fight" to have it approved, but I am wondering how big of a fight we face and how long approval might take.

Thank you again!  It is good to hear that others have had problems and that I am not alone.  

Donna

Answer
Donna,
Coverage for sleeve surgery is uncommon in our area as well.  For my Band patients who are changing to a sleeve, I have used general surgery codes (not bariatric surgery codes) to describe the operation to the insurance company.  This is a bit of a fudge, and it is something your surgeon may or may not be comfortable with.  So that you will be able to have an educated conversation with him/her:

Actual procedure:
Band Slip -->  Band removal + VSG

Rephrased for insurance processing:
Gastric obstruction due to foreign body --> laparoscopic exploration with removal of foreign body and segmental gastric resection

Good luck,
Dr JP

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