Re Stretched Stoma

[Guest guest]

Hi All,

In a LAP procedure, if Dr G cant do it, probably no one can, but I do wonder

what the options would be in an open procedure...

There is also another ... as you call it ... " dirty little secret in the

bariatric world " ...

It has been documented that banded RNYs, Fobi Pouch type procedures, which are

simply RNYs with A VERTICAL POUCH and a band or ring on the bottom of the pouch

reinforcing the stoma... aids in keeping the stoma from stretching long term.

The dirty little secret is that the Fobi pouch procedures are an INSURANCE

NIGHTMARE IN MANY STATES. They HAVE to be an open procedure, they take about an

hour or two longer...BUT CAN ONLY BE BILLED AND REINBURSED AS AN RNY, THEREFORE

LESS AND LESS SURGEONS ARE WILLING TO LEARN OR PERFORM THEM IN STATES that

control what surgeons can charge their patients OVER WHAT the insurance

charges...

So in other words, in my state..if my insurance pays my surgeon $15,000 for an

RNY, and a FOBI procedure can only be billed as an RNY, my surgeon can not turn

around and bill me another $10,000 for the extra TIME for a Fobi procedure...so

HE PICKS AND CHOOSES HIS FOBIS VERY CAREFULLY, and takes alot less money for

them, and there are less FOBI TYPE procedures done in MA on a regular basis,

not cause of ULCERATION, rather cause of INSURANCE REIBURSEMENT!

..

The incidence of ulceraton or other problems, was, and is being blown way out of

proportion, due to insurance issues. If there are problems with uleration with

the Fobi pouch, there would ALSO be problems with ulceration with the plain VBG

BAND. And there are NOT. The problems with the VBG when there ARE problems...

seem to be more of the long term weight loss and maintenece variety.

:)aDria

Message: 4

Date: Tue, 9 Jul 2002 19:22:13 EDT

From: Subject: Re: Stretched Stoma

Someone on another list had just asked this question, so I copied & pasted my

reply to her...please forgive the cross-post:

I had an open RNY on 8/99, and within 6 months found out I had a staple line

disruption. On 8/00, I went to Dr. Gagner in NYC for a lap transection, who

many of you may know, is Chief of Laparoscopic Surgery at Mt. Sinai. He, as

well as Champion in Atlanta and the California guys (can't think of their

names, but Carnie 's docs) have been doing lap WLS longer than anyone

else in the country. That said, after he fixed my SLD, he told me my stoma

had stretched to the max, but it was just too dangerous to fix, even while I

was already under. Had it been any other doctor, I wouldn't have believed

them, but Gagner is just too good. So, I just live with it. There are some

docs now experimenting with " scarring " the stoma to make it smaller, but to

the best of my knowledge, this is still just experimental.

I would like to add that I still throw up if I eat too much or too fast, but

I can eat constantly throughout the day, if I feel so inclined (hope that

never happens). So, it still works to some extent. Like Dan, I, too,

believe that it's the dirty little secret of the bariatric world. But, at

least I know the surgery is still working, even if it's not in high gear

anymore.

in NJ