WHICH SURGERY?

So, you are considering WLS.  Which one?

Some of you are going to let your insurance company and whatever surgeon they've contracted with (at a cheap price!), and/or who is close to you, determine which surgery you're going to have.  You may stop reading right now - buh bye - nothing for you to see here.

Others of you already "know" something about bariatric surgery, because you know someone who had it and you want what they had.  You too can just move along.

For the rest of you, who are here with an open mind, these are the following steps you need to take.

First, you need to learn about ALL of your surgical options.  Read everything you can here, on all the surgical forums, and especially on the Regrets, Revisions, Failed Surgery and similar boards (Failed Lap Bands in particular is a group - you have to ask to join).  You CANNOT rely on a surgeon to tell you which surgery to have - this is something YOU decide first.

Second, SCREW your insurance company's policy regarding which surgeries they SAY they cover - so long as they cover bariatric surgery, and you qualify for coverage, you can file an appeal and argue that they MUST cover the procedure that YOU AND YOUR SURGEON decide is best for you if it isn't on their list.  In the vast majority of cases, you will WIN this kind of an appeal.

OK, now HOW do you decide which surgery YOU want?  Here are some things to consider:

1) Which surgery has the best LONG TERM RESULTS, based on statistics?  Most people will lose some weight, and some may even get to goal, with any of the surgeries, at the 18-24 month mark - but so what?  You need to learn to read clinical studies on PubMed, including how to read with a critical eye towards biased reporting, to see what the REAL long term results are.  You should care about how the surgery works at 10 years out, not just during the honeymoon period.

2) Which surgery has the best cure rate for the comorbidities you have, or are likely to get?  And while you consider this, you must also consider the first question, because with most of the surgeries (EXCEPT DS), if you regain weight after a few years, you are also likely to regain (or get for the first time) those comorbidities.

3) Which surgery has issues you are UNWILLING to live with, FOR THE REST OF YOUR LIFE?  With malabsorptive surgeries (RNY and DS), you are going to have to take vitamin and mineral supplements, for the rest of your life, or risk DYING from malnutrition.  With the lapband, VSG and RNY, you are likely to face eating restrictions and/or dieting and/or serious amounts of exercise for the rest of your life, or risk failure or miserable side effects.  With the lapband, you are going to likely face reoperation to remove or replace a failed band within 10 years, probably much less.  With the DS (and with some RNYs), you are going to have to be careful to avoid - and to some extent, you will have to live with/figure out how to best ameliorate the sometimes stinky side effects of malabsorption (which most of us manage quite easily, thankyouverymuch, and only deal with once a day in our own bathrooms).

3) Which surgery has requirements that YOU are most likely going to be able to comply with, FOR THE REST OF YOUR LIFE?  This not only means how much or how little you eat, what kinds of food you will need to eat (vegetarians should not consider the DS, unless they are willing to be willing to eat SOME animal protein - at least dairy and eggs - beans and rice are going to give you awful gas along with your protein), and the quality of what you eat (are you always going to be able to access the protein you need? fresh veggies?).  This also means, are you SURE you are always going to have access (financially, e.g.) to medical care?  To blood tests yearly?  To iron infusions?  To supplements?  Are you going to stick to a supplement regimen, or do you "forget" to take your important meds now?  How old are you?  Are you planning to have kids?  When?  Are you going to have access to revision surgery if you need it?  What if your insurance company puts a one-bariatric-surgery-per-lifetime cap on your access?

There are probably a lot of other primary considerations, but these are the big ones.  I'm sure people will chime in.

OK, now you know which surgery you want.  Now you pick your surgeon.

You need to research who is the BEST at the surgery you have chosen.  If there is some reason access to them is not possible or practical, you need to figure out who is HIGH QUALITY.  They have to have LOTS of experience at the procedure you have selected.  They should be SUPPORTIVE of the surgery you have selected.  Their office should be competent, know how to submit to insurance, not be doc-blockers, etc.  The hospital s/he uses should have a quality bariatric support group (bariatric beds, anesthesiologists who know how to pass gas to the MO without killing them; nurses who don't hate the MO, etc.).

Oh wait - there IS no surgeon that does the procedure you want (or no qualified surgeon) within 50 miles of you - are you willing to travel?  Really?  Not even for access to a surgery that you are going to have to live with FOR THE REST OF YOUR LIFE?

Oh wait - there is no IN-NETWORK surgeon that does the procedure you want - are you willing to pay the out-of-network rate, or self-pay for the surgeons fee?

Oh wait - there is a CLOSE-BY surgeon that does your surgery, but he has a few malpractice claims against him, and some unhappy patients - but he's close by!  And in-network!  And maybe nothing bad will happen to you, right?  SOME of his patients lived, after all!

Ditto, to a lesser extent, the hospital.

Now, you start to figure out how to git 'er done.

(Note: you may end up changing your mind about any of the above after meeting the surgeon, finding out about comorbidities you didn't know you had, insurance issues with specific programs - but you should have a GOOD and pretty FIRM sense of what you want by now.)

This is a great advocacy for doing research and being an adult to make decisions for yourself. Not depending on a doctor just because he/she has  the letters MD after the name.

Very well written.  Great advice.

bump! For a great informative post!

This is a great How to Research WLS 101 post.

*bookmarked for bumping*

 Very well written... LIKE!!!! I will share this with some friends here and others overseas who are contemplating WLS and will certainly benefit from this info.

Very good advice. I see many folks (usually very young) saying I trust my doctors decision to give me XYZ surgery..

WHY would you let another human decide what surgery YOU have to live with? 

Very well written and useful!

Thanks.

Great post, very well-written, and one I'll always recommend.