Port flips happen in about 2% of Lap-band weight loss surgeries.  Below is a series of emails between Dr. Simpson and a patient from another practice who experienced a port flip.  She wasn’t too happy with her original doctor and wanted Dr. Simpson to perform the additional surgery required to correct the problem.  Dr. Simpson explains that port flips do happen and that she needs to rely on her doctor to be able to fix it.

From: “Allyson xxxx”
To: “Dr. Terry Simpson”

Date: September 27, 2008 07:44:16 PM MST
Subject: RE: Lap Band Port revision surgery

Dear Dr. Simpson, I had Lap Band Surgery with another doctor in the Phoenix Arizona metro area in November 2007.  Since then I have had several “fills” and still have very little restriction and therefore very little weight loss.  After having my first fill under fluoroscopy last Monday, it was discovered that my port is flipped to the extent of making fills impossible.  At one point on Monday, the NP who does the fills thought she had put in several cc’s, but further exploration determined that could not possibly have been the case.  So who knows how many actual fills I have had!  What if all along the saline was going into tissue?!  At least that explains the lack of weight loss.  I’ve been feeling like a complete and utter failure because I can’t lose weight even after WLS!  No wonder the few people who know I had surgery are so skeptical!  Obviously, I now need to have port revision surgery.  However, due to my experiences with the other doctors office, I am understandably questioning their competence.  I am afraid that after being poked unsuccessfully for a cumulative total of HOURS, the tubing may also have been damaged and require replacement.  And then the mind begins to wonder, “What if the Lap-band was never placed correctly in the first place?”  Oh, crap!

To add insult to injury, as of Friday I had not heard from my doctors office.  Basically I was told I needed surgery to fix the problem, then the doctor and NP walked out of the room and that was the last I heard from the office.  I did call on Friday to see what the next step is and to get the ball rolling, but they didn’t have any answers for me.  It’s as if they got my money from the “big production” procedure so I’m not important to them any more.  That brings a whole new meaning to the phrase “Cash Cow”!  Except, they took my cash and left me a cow.

I am beside myself.  I paid for the surgery out-of-pocket because of how important I believed the surgery to be for my overall health.  I felt that it would be a good investment in myself.  Now I have to do surgery again and don’t have any idea how much it is going to cost or when I can have it done.  I feel like my surgery so far has been a huge waste of money and I don’t know how much more money it’s going to take to fix it—or if I can even afford to!

So now my dilemma is this: I’m not sure I want to go back to the other office, but I am also very aware of how deeply doctors detest taking on patient who started treatment elsewhere.  (At least I didn’t go to Mexico!)

Here are my questions for you/your staff:

1. Would you take on a patient from another doctor in this situation?

2. Have you seen any instances when insurance covered a port revision surgery after the patient paid out-of-pocket for the initial surgery?

Thanks for your time and consideration!

Allyson

Dr. Simpson’s response – Advice on dealing with Lap-band port flips

Date: Sat, 27 Sep 2008 21:02:33 -0700
Subject: Re: Lap Band Port revision surgery to answer your questions:

Ports flip about two percent of the time — it is one of the known complications of the operation.  We use a different method of Lap-band fixation –one that we will publish soon and one that has less flips, but we still see them.  It is the way the body heals, and nothing to do with the skill of the surgeon.

It is understanding of the Lap-band how it works, and how the Lap-band does not.  We believe this strongly in our practice, and teach it.  Feeling restriction is something we never teach.  You might listen to our podcasts at www.southwestweightloss.com and learn a bit about how the Lap-band works.

If you paid cash, the chances are the insurance will not pay for a port revision.  It is not expensive to have that operation, but it is something that you must consider when getting surgery — that things can happen that you may need to pay out of pocket.  It is unfortunate but a port revision is easy.

One of the features of our practice is that all my patients have access to me, through a private email.  We think this is a great feature because we want patients to have that access — it is a part of the Total Care package we offer.

So, you have a couple of questions — and it is without a doubt the reason you wish to change to another practice.  I think anyone who has a complication thinks that way.  It is probably natural.

So, first, please listen to my podcasts– they are fairly quick — about eight minutes each.  You can even download them and listen to them on an ipod or a CD.  If nothing else, they will allow you to sleep (ok, that is a joke — please don’t listen and tell me you don’t need sleeping pills anymore).

The Lap-band, the operation is a part of what we do — the important part is teaching people how to use the Lap-band.

Some think it is a cash cow – – but we like it when people say it is the best investment they made — even if it is from another practice.  So, I want you to be a success.

When my NP fills patients, I am in the office (unless I am off traveling somewhere) — and if there is a difficult stick she calls me in.  I always do the first fill.

I know most of the folks who do Lap-bands in town — they are all nice folks — they might have a different way to practice than I do, but they are pretty good surgeons.  I am sure they can replace your port easily — and if they have a good arrangement with the facility where your Lap-band was done they should be able to give you a good price for that service.  We don’t charge our patients for those events (the facility has a fee, but I don’t charge nor does my assistant or the anesthesiologist).

Good luck — I would try your surgeon again.  They have your interest at heart.

But, should you have a friend who wants a Lap-band– we would be happy to see them.

Patient thanks Dr. Simpson for taking the time to answer her questions

From: “Allyson xxxx”
To: “Dr. Terry Simpson”

Date: September 27, 2008 09:57:16 PM MST
Subject: RE: Lap Band Port revision surgery

Dear Dr. Simpson-

Thank you so much for taking the time to answer my questions.  I only wish I had that kind of caring and personal response from my doctor’s office.  That’s probably where the majority of my frustration lies— in the general apathy toward the patient that seems to exist.  You don’t just tell someone, “Sorry, you need another surgery” then walk out and leave it at that.  I have yet for someone from that office to call me and tell me what to expect or when to schedule.

The first and last time I ever met (or heard from) my surgeon in person was just before being rolled into surgery.  Your sense of responsibility to your patients and prompt response to queries (and even to non-patients, as in my case) only underscores the differences between you and your fellow surgeons out there.

Thanks again for sharing your time and expertise with me.

Ally