GeezerSue

While I don't want to debate, I DO want to provide accurate information: •First, some of the mortality rate of the DS is due to the fact that, in some practices, it is performed ONLY on patients with a BMI of well over 50. ANY surgery performed even PRIMARILY on those with a BMI of over 50 is going to have a higher mortality rate, because those who are super morbidly obese are dying to begin with; •Then, you might want to factor in the band removal/failure rate. When I decided I wanted my band removed, my local "bariatric center of expertise" surgeon was about to do his FIRST band removal. In Europe--where they have had the band being put IN longer--they also have more experience taking it OUT. One surgeon I contacted told me that 20% of his surgical practice was removing LapBands. I suspect that will be the case in here a few years as well, which leads to my next point... What percentage of people who get the LapBand will STILL die from Morbid Obesity, which--as we all know--has a higher mortality rate than ANY of the surgeries? A recent Swiss study says that 66% of band patients experience "success," which they define as 50% of EWL. In my case, losing 50% of my excess weight would leave me with a BMI of over 35, and--given my comorbidities--I'd STILL be a candidate for weight loss surgery. The early deaths of those who have the band and didn't die on the table but died later from not ever losing enough weight cannot be just ignored. Those untallied deaths need to be included in the mortality rate of the band. •Another reason that the band--and the RnY--are performed more extensively is that they are more profitable for the surgeon and cheaper for the insurance company. I know that Dr. Rumbaut can crank out five bands on an average surgery day...and he does that twice a week. The RnY takes a little longer, but the average surgery time is getting shorter every day. The band patient is often a 23-hour stay; the RnY is a day or two. The DS patient's surgery takes two or three hours and his or her stay in hospital STARTS at three days. Like the band and the RnY, the DS requires considerable follow-up. So...(Rachele and) I will need to be more vigilant about post-op labs, but less concerned about over-exposure to radiation. Like many banded people with problems, repeated adjustments have caused me to be exposed to FAR more radiation than I'd like to have been involved with. I know that SOME people have had great success with the band. They have achieved a "normal BMI and are usually very gracious about it because (I suspect) they realize that they are in a fairly small group (and maybe they were just gracious to begin with.) But "success" is subjective. I've had people who were several years post-op tell me that I need to follow THEIR example...and I have been (uncharacteristically) kind enough NOT to mention to them that they are STILL obese and that the whole point of MY having surgery was to NOT BE obese. So, for post-ops who are happy that they have achieved a BMI of 37 or 42...good for them. But, for me, that is FAR from my goal. Anyway, I cannot speak for Rachele. I know that she knows what her risks were going in. She has a baby and a husband and other family that are hoping that she is able to RESOLVE her obesity problem. And I hope that anyone researching the band or having problems post-op will read that--according to that recent Swiss study--one-third of those being banded do not lose even 50% of their excess weight and realize that it is NOT their fault...and not be frightened by partial information and, mostly, I hope that they see that there ARE other options if their first choice does not work for them. Good for Rachele for doing her best to win this battle.

Just as an aside...do NOT sign anything saying that yu will allow a gastric bypass unless you are SURE that is the surgery you want. There are more than just two wls's available and no one should have to chose between just those two. Most of the banded people I've met over the last almost-four years say they would prefer the DS if they cannot have the band. In fact, Rachele from this site is having a band-to-DS revision today and mine is in eleven days. If you didn't want the RnY when you GOT the band...you probably don't want it if/when you UN-get the band. Sue

That's my date, too! I'll be getting revised to a DS on the 28th.

I think two at the same time is the only way. Otherwise, one is always following the other around trying to get a contact high off the fumes. My husband had a heart attack at age 47. So he "quit smoking" right about the time they hooked him up to the oxygen. Three days later, I drove up to the hospital, parked, put out my cigarette, put the rest of the pack down on the bench by the ashtray and went in to get him. Neither of us has had one cigarette since then. (I had a 37-year habit; his was a little shorter because he's a little younger.) My only wisdom on the topic is that I had always previously focused on the stopping. I did just fine once I stopped worrying about how to stop stoking and focused on how to BE a non-smoker. It's been five-and-a-half years and every once in a while, I think, "Boy! If I had one, I'd smoke it." And then I think, "What an idiot THAT would make you." Good luck, Sue

It was probably my post. And while it is not my intention to diminish the results of any person here--or the Dallas banded folks in general--the study looked at several hundred people who were FOUR YEARS OUT from surgery. (I'm a little over three years out, and I was 55 at the time with a BMI of about 48.) I'm emphasizing the time, because many of the problems with banding occur a couple of years down the line. Impact of age, sex and body mass index on outcomes at four years after gastric banding. Branson R, Potoczna N, Brunotte R, Piec G, Ricklin T, Steffen R, Horber FF. Departement of Surgery, Hirslanden Clinics, Bern, Switzerland. BACKGROUND: Adjustable gastric banding for weight reduction in severely obese persons allows reversible individualized restriction during postoperative follow-up. It is unknown whether preoperative age, sex and BMI might modulate treatment outcome. METHODS: 404 severely obese patients (79% women; age 42 +/- 0.5 years [mean +/- SEM]; BMI 42.1 +/- 0.2 kg/m2) completed 4-year follow-up after banding. Weight loss, complications, and Bariatric Analysis and Reporting Outcome System (BAROS) scores were recorded prospectively. RESULTS: 4 years after banding, younger (<50 years) women lost more weight than older (50 years) men (28.2 +/- 0.7% vs 19.4+/- 1.6%; P=0.001); older women and younger men lost similar weight. Patients with preoperative BMI >50 lost more weight than patients with BMI <35 (30.5 +/- 2.3% vs 22.8 +/- 2.6%; P=0.03). 22.3% of patients (n=90) had band system-related complications. Compared to women, men had more band leaks (7.0% vs 1.9%; P=0.007), and older men had more band slippages than younger men (8.4% vs 0.0%; P=0.035). Patients with preoperative BMI >50 were less likely than patients with BMI 35-40 or 40-50 to experience gastric complications (10.6%, 18.8%, 23.0%, respectively), but more likely to experience port/tube complications (15.8%, 2.4%, 7.9%, respectively; P<0.055). BAROS scores were different between men and women (P=0.05), and between younger and older people (P=0.001). Women and younger people were more likely than men and older people to score "very good" (P=0.03, P=0.001, respectively). CONCLUSIONS: Adjustable gastric banding is an effective intermediate-term treatment for severe obesity. Preoperative age, sex, and BMI are important modulators of outcome and should be considered during preoperative evaluation. PMID: 15999426 [PubMed - indexed for MEDLINE] Also, I may be reading this wrong, but in this group, although people were much happier after banding, it looks like the percentage of excess weight lost by the most successful group was 28%.

I want to comment on a couple of things...First, it's great that your daughter is doing so well. Then, even though it's not a surgery I would choose, I have to say that gastric bypass does NOT have "a higher mortality rate than most surgeries." It has a higher mortality rate than the LapBand and a lower mortality rate than the DS. (And to compare it to an angioplasty, it has a lower mortality rate than angioplasties done on the oldest patients by the least experienced surgeons and a higher mortality rate than angioplasties done on younger patients by very experienced surgeons. Which kinda means nothing, but I thought I'd throw that in there.) Also, I suspect that at "almost 59," I'm a little older than your daughter. I'm scheduled for the DS which is a more extensive surgery than the bypass, and I really hope I survive. I've been through a lot but have a rather resilient physiology, so I'm playing the odds. Finally, about age and wls. Actually, patients over 55 years of age are now considered rather poor candidates for a successful LapBand journey. Some of the problem is of the old-dogs-new-tricks variety, but esophageal dysmotility and other problems are often a function of age. To add in the band may expedite those problems in those who were going to have them or cause those problems in those who were not going to have them. So, actually, the LapBand is a less dangerous surgery, per se, for older patients, but it has rather limited success and more complications for those patients, as well.

...just a lot of roads to the same (intended, at least) destination.

Yes, Melissa, the old Jejunoileal bypass (JI) was horrid. I'm sorry that your mother had to go through that. A surgeon I know told me to find out what was different about the JI and the newer DS before I did anything, because he spent his early years as a sugeon doing take-downs of that surgery on a regular basis. The DS is a different surgery. But just to make sure we're on the same page on the "RnY vs Ds thing," the BPD/DS surgery permanently removes the gall bladder and the appendix. The stomach is made smaller than normal (but it is about six times bigger than the RnY "pouch"), and the stomach (in both cases) eventually stretches out. I don't know that we can say that the band always leaves the anatomy intact. It didn't leave MINE intact, as the esophagus is compromised. And I don''t think it left Donali's intact as it eroded through the stomach (although I haven't visited with her lately and HOPE that is all repaired/repairing.) But, most importantly, with the DS, the pyloric valve remains intact and the "switch" part of the surgery can--if the need arises--be "unswitched."

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

Most of what they are looking for--positioning (a slip) and how fast the barium move through the band--they can find with the barium swallow at the adjustment. They can also see if the esophagus is widening (dilatation.) Then, it can get tricky. Esophageal dysmotility is not necessarily an easily found problem. Sometimes my food went through. Sometimes it didn't. You have to be lucky and run a test at a time it's acting up. At an Upper GI, they saw it, but didn't document it well. This time, as I got unfilled, they could see the barium just sitting there, so THAT'S how they were able to diagnose the dysmotility. Ersosion is best diagnosed with endoscopy, where they look at the inside of the stomach with a little camera and can see if the band has worn through. (I HOPE I don't have that one!) So, yes and no. some swtuff they will notice at an adjustment. Some, not.

First, it it no longer band vs. bypass. There is another surgery, the DS. http://www.duodenalswitch.com/ Cornell just published a study showing that the DS worked better than the RnY. And, if all your surgeon does is those two surgeries, it's best to find another surgeon to get a consult on that third option. I VERY lucky in that I'm getting a second chance at this...but I relate to having only one chance. Then, there is no guarantee that you can keep getting adjustments with the band. I think that about 20% of us can't even tolerate ANY saline in the band without causing problems. That, of course means that 80% of the banded patients can tolerate adjustments...but that's four out of five. Finally, while there ARE people who lose tremendous amounts of weight with the band (and we all want to be in that group), when you look at the large numbers, people with higher BMI's just don't do well enough for BC of Calif to keep paying for it. The study they use is one that shows that the percentage of weight lost--about 50-60%--is not enough to move heavier people out of Morbid Obesity. According to the charts, I needed to lose about the same amount of weight as you. If I had lost 50-60% of my excess weight and kept it off, I'd have been within a couple of pounds of STILL being MO. Good luck on choosing, but consider ALL the options, and listen to those who have done well and those who have done so-so and those who are having it all yanked out. Good luck on your choosing. Sue

To do band RESEARCH, you also have to hit the medical journals and the Inamed site. A number of people here have had complications, but may not notice the post or maybe they have gone on to other methods. But, in partial answer, "Am I sorry I got the band?" No. "Knowing what I now know, would I recommend that my fictional identical twin sister get the band today?" No.

When you look at the big picture (not those individuals who did well or did poorly), two to three years out, band and bypass people have the same general %of EWL. I do not want a bypass because, other than bypass patients, there ARE no animals whose mouths are bigger than than their stomachs. It's 20 cc's--four teaspoons--two saltine crackers. It's just, for me, an incredibly bizarre way to live...especially when the band will take you to essentially the same place. Cornell University just published (small group, but the DS is a more complicated surgery and there aren't that many surgeons or patients) complaring their Rny stats with their DS stats. The DS produced the highest percentage of long term weight loss.

A better guide to how people do overall is in the medical journals. I'm one who has regianed all of my weight, due to having all the saline in my band removed, due to damage to my esophagus and its functioning. I don't think the band is a BAD chooice, it just was not the right choice for me. I'm having the DS surgery. (BilioPancreatice Diversion with Duodenal Switch.) As you research, don't fail to check that surgery as well. Good luck with your choice! Sue

Hi, again. Rachele! How about you looked into DS because of me, but have decided to go with it on your own? Otherwise, I'd have to stalk you all the time because I'd feel totally responsible. Anne, generally, an unfill improves the dilatation. I think my dilatation is due to the dysmotility. Physics. (If it isn't in the stomach and doesn't come back up, it has to be somewhere.) I *THINK* the food will actually have a bigger place to land with the smaller stomach than it does with the band's "upper" stomach, but I'm not sure if that will cure the problem. Desertmom, the "success thing" is touchy. For ME, losing about a third of my excess weight was a good thing, but it didn't stay lost without causing me complications. For others, losing half of their excess weight is fine. (I have an age factor involved here, too...if not now, WHEN?) But, you are right in that--more and more--the literature refers to a sustained loss of 50% of excess weight as a success for bariatric surgery...and I want more help than that. But re smelling the roses...Blue Cross of California is no longer authorizing the band for patients with BMI's of =/+50. That's based on the math that a 50% excess weight loss for higher BMI people will leave them MO...and the comorbidities that exist DUE TO MO will continue to exist..which, to their bean counters, means that banding for BMI's of 50 or above is not enough bang for the buck. Desertmom, I'm hearing that you feel that the band was a WRONG step for you, in that you are taking the "blame." STOP!! It was the FIRST step. It was a conservative effort to rid yourself of excess weight without slicing and dicing your innards. It works (regardless of who is defining that word) for a good number of people and there is no reason to be blaming anyone--including yourself--for that choice. (My DS surgeon says that so many come to him for revisions and are blaming themselves for "failing" their first surgery, whatever it was. That garbage gets in the way.) Think of a troubleshooting flow chart. I use a Mac computer. If it gets hung up, I try to stop the procedure in progress (the diets, gyms, pills, shrinks, etc.). If that doesn't work, it's time to "force quit" the program (Band). If that ever fails, it's time to force a quit and restart of the computer (bypass or DS). Am I an idiot for not trying to quit the program (bypass or DS) at the first sign of trouble? I don't think so. I think it makes all the sense in the world to take baby steps. Again, thanks to all for the support. Sue

Wow! What wonderful support. •The band, as you know, is restrictive only. It can limit the amount of solid food you can eat at one time. •The RnY, (and I'm biased, so ignore me if you're wise) is both restrictive (the stomach is reduced to 20 cc's--4 teaspoons) and temporarily malabsorptive (after about two years the remaining intestine "learns" to absorb much of what the missing intestine used to absorb. That's when the weight regain begins. To me, it works like a kind of non-reversible band. •The DS is also a little restrictive (the stomach is reduced to 4-6 ounces) but it remains malabsorptive forever. So, the DS has the highest percentage of long-term excess weight loss...and the highest number of risks, including long-term metabolic stuff we don't even know about. OTOH...my 60-year-old cardiologist and I were discussing that the promise of long-term ANYTHING, when you are 60-ish and morbidly obese, is not necessarily a bad thing. Here's a link to a site started by a DS patient: http://www.duodenalswitch.com/index.html And here's a mention of some research at Cornell: http://global.med.cornell.edu/news/wcmc/wcmc_2005/10_14_05.shtml If anything I read made an impact, it was a post by Melanie M (the woman who started the DS board.) Scroll down to read her take about the DS as a tool. http://www.duodenalswitch.com/openbb/read.php?TID=3932 I know I will have to make some changes with the DS. But those will mostly--my friends tell me--be learning not to eat stuff that doesn't agree with my new plumbing. I'm glad that this wasn't received as a the-band-is-bad post. You guys are cool.

As someone whose band is about to be removed...and who has posted there recently...let me tell you what happens to some banded vets. The VAST OVERWHELMING number of OH band posters are newbies. They are people who have just decided to get the band or who just got the band or who have had the band for a few months. They are extrememly defensive about their choice. If anyone says anything negative about their own banding experience, that person is suspected of being a troll, attacked on the board and receives hate email. At the same time, those people take great delight in mentioning how invasive and life threatening other surgeries are and even post links to problems that people with other surgeries have had, as though they take delight in those problems. It is sad that so many of the people who participate in that board are so very uninformed. I mean REALLY uninformed. And the format of the board promotes the "pop-in, post, disapear" format that you see. The band has is benefits. But it is not without problems. And only those boards which have long-time banded people who hang around for years, share both the plusses and minuses with the readers, as those members go through life with the band. Just like in the stats, some have NO problems...and others have REAL problems. To me, if you are in the categories of people who seem to have the best success with the band, it makes sense to go that route. If you are in the categories that do the worst with the band, you can still try that approach, but be prepared to go another direction is success (as YOU define it) eludes you. Good luck with YOUR choice!

Okay...at the risk of setting you off again...you may not have lost an ounce. But don't panic. See...people get very dehydrated and, wanting to believe that they have already lost a bunch of weight, insist they have lost a bunch of weight, and then get all cranky when it "stops" or when they "regain." You got dehydrated from surgery. You MAY rehydrate and "gain" (on that stupid scale) every ounce...BUT it's all PRETEND. REALLY. The scale is bouncing around. It's fluctuating Water weight. There is no other way--short of amputation or childbirth--to achieve a 14 pound loss on a scale in less than a week. So...as you rehydrate...the scale may move upward. If that happens, REPEAT AFTER ME: THIS IS MEANINGLESS. You just need to back away from the scale and have a responsible adult take care of it for a while. (NO. I cannot do that. But it's still a good idea.)

thin AND sin? I'll be nght there Hey, Donali. Hey, Lisa!

If this doesn't work for you, let me know. http://thinforlife.med.nyu.edu/assets/LapBand-in-the-USA.pdf When you open the pdf file, search on "african" The AA patients had the lowest weight loss in the study, but there were only five African-American patients in the study. Sue

Yeah...in the original band research...the FDA trials...AA's had a lower success rate than other ethnic groups. I remember it. I'll go look for it.

You know what else...food is merely the mechanism OF THE MOMENT by which we demonstrate that we are nuts. Plenty of people have wls and start drinking or gambling or complusive shopping or discover an out-of-control libido. It's always a good idea to remain vigilant against the NEXT manifestation.

I sure haven't. But I'm certifiably weird.

Far be it from me to be argumentative (that's a joke), but right now, it's an "experimental/investigational" denial. And that can be overturned, because it's hogwash.

I think yo should appeal the denial they gave you. You MIGHT slip in between policy changes! Sue :::currently preparing to battle BC re approval for DS:::