Expert: Karla K. - 11/19/2011

Question
i had gastric bypass in 2005 i weighed 220 at the time lost to 149 now i weigh 270 and have sleep apnea with cpap nightly and also have just been sent to diabetic clinic nutrional staff cause my encronologist says i am pre diabeties i am 41 years old 5 foot 5 inches do you think i coulod have lap band down over gastric pouch i have medicare and medicaid i did not have insurance before but i do now please help with answers and steps i have appointment with center of excellence doctor in jan. cause my old surgeon says no

Answer
Hi Amy:

I'm sorry that you're facing a revision.  I'm not 100% sure if Medicare/Medicaid covers the Lap-Band over the pouch revision because they might view it as experimental.  Also, I'm not sure that it's really the solution you need.  

Here's one study on the results.  Granted it's a small study, but most of these are (which is why I think it might be considered experimental): http://www.ncbi.nlm.nih.gov/pubmed/19914147

Here's another: http://www.ncbi.nlm.nih.gov/pubmed/18996754

Bands have their own issues--and currently have one of the highest failure rates of all of the bariatric surgeries currently performed--so I really have a hard time recommending them as a fix.  I fear that you'd be facing another surgery in a year or two... and the more surgeries, the more risk of complications.  

However, only you know why you're facing a revision.  Is it truly one of food volume? Is it both one of food volume as well as dumping lessening as happens to many people? Etc.  I really think that the RNY is a great short-term operation for many--but doesn't seem to hold long term.  I see way too many people looking for revisions at the 3-5 year mark.  So, it just might have not been the right surgery for you.  The DS allows many people to eat a relatively normal diet, normal volumes--yet still achieve very good weight loss.  However, one does need to be attentive to protein and vitamins--which is not unlike any surgery.  That reminds me! Be sure to have your blood levels for various vitamins and minerals checked prior to your revision, so you can take care of any deficiencies prior to your revision. :)  I know that sometimes when people have gained, the last place they want to go is to their surgeon to have their annual blood work done!

I really think your best bet is to look at a duodenal switch for your revision operation, as it has better results and is more likely to be covered.  If you go to dsfacts.com, you can find a list of DS surgeons.  The key is, though, you want a surgeon who is experienced in doing revisions from RNYs to DSs.  You can also ask on the ObesityHelp Revision or Duodenal Switch boards.  A DS is not the same as having your RNY made more distal--and I really would steer you more to a regular DS than extending your RNY.  

If you still decide to go ahead with the Lap-Band over your pouch, then please just make sure that you're using an experienced revision surgeon--not just somebody whose done Lap-Bands and has done RNYs...so feels he can do them both.  Revision surgeries are always trickier--and you really want somebody who has experience in them.  You can also talk to your surgeon on whether or not doing your revision in a one step or two step procedure makes sense, etc.

I hope this helps!

Good luck,
Karla