Second opinions on gastric sleeve surgery: when and how

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Second opinions on gastric sleeve surgery: when and how

A second opinion is reasonable at two points: before a sleeve, when you want to be sure it is the right operation for you, and after one, when a problem is not improving or you have been told you need more surgery. A sleeve cannot be reversed, so checking the plan first is sensible. Bring your records, and tell both surgeons what you are doing.

Before surgery: when another view helps

Many people go ahead with a sleeve without a second opinion. It may be worth the extra visit when:

You already have heartburn or a hiatal hernia. In the SLEEVEPASS randomized trial, 10 years after surgery, 31 percent of sleeve patients had esophagitis (inflammation of the esophagus) compared with 7 percent of bypass patients (Salminen and colleagues, JAMA Surgery, 2022). Surgeons weigh existing reflux differently, and it is fair to hear more than one view.
You were offered only one operation. A surgeon should be able to explain why a sleeve suits you better than a bypass or a non-surgical route, not only how the sleeve works. Gastric bypass versus gastric sleeve sets out the differences.
You were told you do not qualify. The 2022 ASMBS/IFSO guidelines recommend surgery at a BMI of 35 or more regardless of other conditions and say it should be considered at 30 to 34.9 with metabolic disease. Some programs and insurers still use older, stricter criteria.
Your situation is less typical. Examples are a very high BMI, age over 60, earlier stomach surgery, or type 2 diabetes that is the main reason for surgery. The guide has pages on a sleeve with a BMI over 50 and on the sleeve and type 2 diabetes.
You felt hurried, or left with questions the visit did not answer.

After surgery: when another view helps

You have been advised to have a revision or a conversion to a bypass, and want to confirm the reason and the choice of operation
Reflux, vomiting or trouble swallowing has continued despite treatment, and no clear cause has been found
Tests disagree, for example an X-ray and an endoscopy that point in different directions
Weight has returned and you have been given no explanation or plan
Your surgeon has retired or moved, or you had surgery far from home and have no one following you

For that last situation, the page for transfer patients may be a better starting point, because the goal is ongoing care and not a one-time opinion.

When not to wait for a second opinion

A second opinion is for planned decisions. Call your surgeon's office the same day for worsening nausea, trouble getting fluids in, or new pain in the weeks after a sleeve. Go to an emergency room or call 911 if you cannot keep liquids down, vomit blood, have black stools, have severe chest or abdominal pain, have a fever with a fast heart rate or shortness of breath, or have pain or swelling in one calf.

Records to gather

A second surgeon can only be as useful as the information in front of them.

Before surgery: the first surgeon's consultation note, recent blood tests, any endoscopy, upper GI X-ray or sleep study reports, and your medication list
After surgery: the operative report, the discharge summary, the pathology report, endoscopy and imaging reports (with the images on a disc if possible), recent vitamin and blood test results, and a record of your weight over time
Either way: any insurance denial or approval letters

Under the federal HIPAA privacy rule (45 CFR 164.524), a health care provider must act on your request for your records no later than 30 days after receiving it, with one extension of up to 30 days allowed if it explains the delay in writing. If you ask in writing, sign the request and name where to send it, the provider must send the copy directly to another person you choose, such as the second surgeon. Ask early.

How insurance treats second opinions

Rules differ by plan. Medicare.gov states that Part B covers a second opinion before medically necessary, non-emergency surgery, and a third opinion if the first two differ. HMO plans often require a referral or an authorization first, and may ask you to stay within the network. PPO plans often let you see another in-network surgeon without a referral. Ask your plan two questions: whether a second surgical opinion is covered, and whether you need a referral first.

The practice works with PPO and HMO plans that allow care with Dr. Davtyan. Ask us whether we can see patients on your plan. For general information on Medi-Cal managed care, see IEHP, Medi-Cal and bariatric surgery.

Checking a surgeon and a hospital

Two public tools help, whichever surgeon you are checking:

The Medical Board of California's license search. You can look up a physician by name or license number. The profile shows information about the licensee, and the Board's license alert app notifies you when administrative actions or enforcement documents are added to a doctor's profile.
The American College of Surgeons' MBSAQIP program. It accredits bariatric surgery centers in the United States and Canada, says nearly 1,000 sites have undergone its peer evaluations, and has a "Find an Accredited Center" search. Accreditation applies to the hospital or center, not to an individual surgeon.

Our list of questions to ask a gastric sleeve surgeon works for a second-opinion visit as well as a first one.

Frequently asked questions

Will my surgeon be offended if I ask for a second opinion?

It should not cause offense. Second opinions are a normal part of surgical decisions, and Medicare Part B covers them before medically necessary, non-emergency operations. Telling your surgeon also makes it easier to get your records sent. If a surgeon discourages you from asking another doctor about an operation that cannot be reversed, that reaction is useful information in itself.

What if the two surgeons disagree about my sleeve?

Ask each one to explain the reasoning, not only the conclusion: which findings they rely on, and what they expect to happen with each option. Disagreement often comes from different weight given to reflux, to your BMI or to your other conditions. Medicare covers a third opinion when the first two differ; other plans may too.

Do I have to repeat my tests for a second opinion?

Often not, if you bring the reports and images. A second surgeon may ask to repeat a study when the first is old, incomplete or unclear, or when your symptoms have changed since it was done. Bringing a disc of the actual images, and not just the written report, reduces the chance of a repeat.

Can a second opinion delay my surgery or my insurance approval?

It can add time, mostly waiting for records and an appointment. An authorization is usually issued for a named surgeon and facility and for a limited period, so check both before you change plans. If you decide to switch surgeons, ask your insurer whether a new request is needed.

Talk with Dr. Davtyan in Rancho Cucamonga

Dr. David G. Davtyan, MD, FACS, FICS, FASMBS, is a bariatric surgeon. If you want a second opinion on sleeve surgery, call Davtyan Medical Weight Loss & Wellness at 909-355-2525 or use the contact page and ask whether a visit is available for your situation, whether the complimentary first consultation applies, and which records to send. The office is at 8330 Red Oak Street, Suite 201, Rancho Cucamonga, CA 91730. More topics are in the Rancho Cucamonga gastric sleeve guide.

Second opinions on gastric sleeve surgery: when and how

Second opinions on gastric sleeve surgery: when and how

Before surgery: when another view helps

After surgery: when another view helps

When not to wait for a second opinion

Records to gather

How insurance treats second opinions

Checking a surgeon and a hospital

Frequently asked questions

Will my surgeon be offended if I ask for a second opinion?

What if the two surgeons disagree about my sleeve?

Do I have to repeat my tests for a second opinion?

Can a second opinion delay my surgery or my insurance approval?

Talk with Dr. Davtyan in Rancho Cucamonga

Sources

More in the Gastric Sleeve in Rancho Cucamonga guide

Understanding the sleeve

Weighing your options

Getting care in Rancho Cucamonga

Adult BMI Calculator

Beverly Hills

Glendale

Rancho Cucamonga

South Coast Lap-Band

Marina Del Rey Hospital

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