• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Revision of sleeve to bypass: an effective procedure worth the fight

Aaron R Bolduc, MD, Matthew D Spann, MD, D Brandon Williams, MD, Wayne J English, MD, Chetan V Aher, MD. Vanderbilt University Medical Center

Introduction: Gastroesophageal Reflux Disease (GERD) is a known risk following laparoscopic sleeve gastrectomy (LSG), with up to 50% of patients affected by the disease postoperatively.  Of these patients, an unknown number progress to medically refractory GERD.  Due to their postsurgical anatomy, these patients have limited options for intervention.  While endoluminal therapies are available, surgical revision to Roux-en-Y gastric bypass (LRYGB) has become an accepted revisional treatment. Despite this therapeutic option, many payors deny coverage for this treatment.  In this study, we report outcomes of revision of LSG to LRYGB and difficulties in obtaining insurance approval for the operation.
 
Methods: We conducted a retrospective review of all patients who underwent a revisional bariatric operation at a single institution between January 2015 and August 2017.  We analyzed all patients who underwent conversion of LSG to LRYGB. We collected data on 30-day mortality and morbidities, pre- and postoperative antacid use, and the insurance approval process.
 
Results: Within the study period, we identified 164 patients undergoing revisional bariatric surgery.  Seventeen patients had undergone conversion of LSG to LRYGB.  All of these patients underwent revision due GERD refractory to maximal medical therapy.  The average body mass index was 37 kg/m2, and our average operative time was 184 minutes.  One patient required laparoscopic cholecystectomy within 30 days due to acute cholecystitis, and another patient required reoperation for control of staple line bleeding. There were otherwise no 30-day morbidities or readmissions.
 
Fifty nine percent stopped all antacid medication by six months, and 65% stopped by 24 months.  Of the 35% percent of patient still on proton pump inhibitor therapy, none of those patients complained of reflux symptoms.
 
Of non-Medicare patients, 69% were initially denied insurance coverage for revision.  Only one plan accounted for all initial approvals.  Twenty five percent of denied patients eventually paid out of pocket, and the remaining 75% ultimately secured coverage after an appeal process.
 
Conclusion: Our results indicate that conversion of LSB to LRYGB for intractable GERD is a safe and effective surgical intervention.  Despite promising results, insurance coverage for this treatment remains a challenge.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87380

Program Number: P601

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

335

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons