fabfatgrl

There's a new study that was just published on the Sleeve that shows weight loss as good as RNY and DS... but complications lower to or similar to a Lap-Band. VSG is definitely better in terms of complications/malabsorption... plus, they remove the portion of the stomach that produces ghrelin... so you aren't hungry at first. As for staples... not all docs use them... some use glue and sutures. (I think Rosenthal at the Cleveland Clinic in Florida is one who doesn't use staples.) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17356932&query_hl=4&itool=pubmed_DocSum "Vertical Gastrectomy for Morbid Obesity in 216 Patients: Report of Two Year Results" Lee, CM, Cirangle PT, Jossart GH From Surg Endosc. 2007 Mar. 14. Epub. ahead of print. Department of Surgery, California Pacific Medical Center, San Francisco, CA, USA, gjossart@lapsf.com. BACKGROUND: The vertical gastrectomy (VG) is the restrictive part of the technically difficult biliopancreatic diversion with duodenal switch operation (DS). The VG was originally conceived of as an independent operation-the first stage of a two-stage DS that would reduce mortality and morbidity in the high-risk superobese because of a shorter operating time and no anastomoses. This article presents two-year data after VG. METHODS: Laparoscopic VG was performed in a nonrandomized fashion in obese patients that met the NIH criteria for bariatric surgery. By using 5-7 firings of 45-60-mm linear 3.5-mm GI staplers along a 32-Fr bougie, a greater-curvature gastrectomy is performed and a 60-80-ml gastric tube is created. VG was compared to adjustable Lap-Band(®) placement, Roux-en-Y gastric bypass (RGB), and DS. RESULTS: Between November 2002 and August 2005, 216 patients underwent VG. The mean age was 44.7 years (range = 16-64) and 173 (80%) were female. The mean preoperative weight and body mass index (BMI) was 302 +/- 77 lbs and 49 +/- 11 kg/m(2), respectively. Of the 216 patients, 5 (2.3%) had a BMI > 80 kg/m(2), 6 (2.8%) had a BMI of 70-80 kg/m(2), and 25 (11.6%) had a BMI of 60-70 kg/m(2). The mean operative time was 66 +/- 11 min (range = 45-180) and the mean length of hospital stay was 1.9 +/- 1.2 days. Complications occurred in 20 (6.3%) patients (vs. 7.1% after Lap-Band). Leaks occurred in 3 (1.4%) VG patients, reoperations were performed in 6 (2.8%), and no conversions to open or deaths occurred. Weight loss on par with the DS and RGB was achieved with just the VG alone. CONCLUSION: The VG operation is able to achieve significant weight loss comparable to the RGB and DS operations but with the low morbidity profile similar to that of Lap-Band placement. PMID: 17356932 [PubMed - as supplied by publisher]

A lot of people like Dory Ferraro. She's in Manhattan once or twice per month and also has a practice out in Long Island. www.doryferraro.com

I'm on my third Bandster pregnancy right now. I've been unfilled for all three. When I got pregnant with my first son, I was 18 months post-op and had lost 95 pounds. I was happy with my weight, but probably had 10-20 pounds to go. During that pregnancy, I gained 50 or so pounds, but I literally lost 30 pounds within two weeks of giving birth. I tried a small fill after that pregnancy (well 7 months after as I was exclusively breast feeding and didn't want a fill during the 1st 6 mos), but had trouble with it. I don't know if it was strange being re-filled or what... so I had it removed. Second pregnancy... I had lost an additional 10 pounds... and remained unfilled. Gained 40 pounds. Once again, majority came off within 2 weeks of giving birth. Tried another small fill after this pregnancy, and had trouble again. No issues with my Band, its placement/slippage, etc. Had fill removed. So.. I went 3 years with no fills and through two pregnancies and maintained 65 or so pounds lost from an alltime high of 95. Not too shabby, as pre-Band I never ever lost more than 5 pounds with a diet... and literally never maintained it for a week. This pregnancy, I'm up 25 pounds and in my third trimester. Not sure if I'll try anymore fills again. I'm leaning towards a VSG should I choose to get WLS again. I wouldn't do anything until my kid is eating enough solids, though... so probably close to 1 year after she's born. VSGers can have trouble getting in enough liquids right after surgery, and I wouldn't want to compromise my breastfeeding. I know many people these days choose not to unfill during pregnancy. I think that is vanity speaking... rather than common sense. Pregnancy is so not about you... and so about your baby. I can't see how anybody could eat enough to grow a baby while filled... at least I never could have. Also, one can vomit during the first trimester... and vomiting is also quite common during labor when one goes through transition. Too risky, IMHO. If one absolutely needed a fill, I'd wait until the 2nd trimester...do a small one... and then unfll before birth.

Randy had the Fobi Pouch done... basically an RNY with a silastic ring. I believe Roseanne had that procedure as well, as well as Andrae and Sandra Crouch, Jennifer Holiday, Etta James, etc. I heard some people say that Star had a DS,.. others said just a very distal RNY. I do think she looked great as a big girl... she always dressed and looked lovely. But, I'm very proud of her accomplishments in losing weight... and she seems to be doing a great job keeping it off. Let's see... celebrities who've acknowledged that they have Lap-Bands: Ann Wilson (removed); Khaliah Ali; Brian Dennehy; Anne Diamond; Joe Gannascoli (Sopranos), Sharon Osborne (removed), etc. RNY: Carnie Wilson, Al Roker, Jackie Guerra, Anne Rice, Ron Lester, DJ AM (Adam Goldstein), Patti Austen. And I'm sure there are countless others. :mad:

OK, for the past three years, my Band has pretty much been unfilled due to pregnancies. I had a small fill in March... but it bothered me, so had it removed. Everything did look fine under fluoroscopy, though So... fast forward to today. I'm pregnant... and for those of you who have never been preggers and Banded (unfilled or filled)... it's kind of like having your period in that your hormone fluctuations can cause your Band to become tight. Anyways... today, for a snack, I had 1/2 of a beef hotdog. Didn't chew well enough (not something I've had to deal with in a long time, so out of habit)... and things got stuck. No biggie... went to the bathroom... and PBed. Then went again. And again. I think the hotdog was all gone by then, but I still had to stop my car on the way home to vomit some stomach snot and saliva. Being stupid, I did not stick to liquids for dinner... and had a few bites when I started vomiting again. I've been PBing all night now... can't keep even Water down. I just had some real true vomiting about 10 minutes ago... y'know... gut renching type... so I'm hoping that's the end. But I'm worried. I'm assuming if I can't keep liquids down tomorrow, I'll have to go get things checked out as dehydration and pregnancy don't mix. Thing is... I'm preggers... so... x-rays/fluoroscopy is out (only 10 weeks)... not sure if they could diagnose slippage with ultrasound... and being pregnant, what if I need Band removal?? Just freaking a bit... so send some good wishes my way. Thanks

Really late update... but it resolved in about 24 hours. I basically sipped Propel for about 24 hours... and then went liquid/mushies once I could get Water down. Scared the bejeebies out of me, as I've never had that happen before with my Band... especially the "real" vomiting. As for diet after an unfill, I was told I could eat whatever I wanted. It is totally freaky... you go in eating Bandster-like, and two-seconds later, it's like you've never been Banded. Good and Bad. Although, I do remember a two week honeymoon (maybe divorce)-like celebration when I was eating all of the foods that gave my Band trouble. Then things normalized.

It's going to depend on how large you are to start with... BUT... in general, most Bandsters lose in the 1-2 pounds/week range... with occasional stalls. I think that the 50-60% figure rings true as far as I am concerned. It's amazing though what a gigantic difference that made in my life... health, appearance, happiness, etc. I probably could have gone further had I not gotten preggers... but I was actually very happy where I was even if I never lost another pound. One thing I want to point out is that some people stop losing because they can't handle more restriction... either it's just too tight or they're having reflux problems. That's why I really think you need to do all you can to make each fill work... and work with each fill. I really recommend people doing Weight Watchers or NutriSystem or something with their Band... rather than relying completely on fills. Seems to get you further, and you also have a built-in support system long-term.

I will have been Banded 6 years this June. I've been unfilled for 4 of them due to pregnancies. The amazing thing is that up until this last pregnancy, I was maintaining most of my loss without any fill!! I've never ever ever lost weight before the Band... ever. Like, maybe 5 pounds and that's it. The Band allowed me to lose 95 pounds (from 297) and keep most it off through 2 pregnancies. That rocks, as far as I'm concerned. The one thing I got sick of was the fill game, though. Paying for fills... paying for unfills. Seems like I'm still paying for my Band. Went through times when I decided I was just too tight, and wanted to eat more. Also, got tired of PBing... or having to worry about PBing in public. Always knew where all of the bathrooms were... kept baggies in my car/purse... etc. Even without a fill, I can still sometimes get stuck which is strange. Happens maybe 2-3 times per year. I'm going to try and refill my Band after this pregnancy and see if I can lose the weight I've gained. When I tried to refill it in-between pregnancies, it was just really hard to go back to the feeling of restriction. I think the post-surgery diet is a blessing, in that it gets you into that mindset. It's much harder 2-3-4 years down the road. If not, I think I will look at the Vertical Sleeve Gastrectomy. No slippage... no GERD.... no erosion... though Port still works fine/looks fine. No nutritional issues/osteoporosis/etc. In general, I stopped hanging on boards at around 2 years post-op... unless I needed to find a fill doctor, or was just curious if any old friends were around. I think that's pretty standard for most Bandsters.

Rumbaut used pars flaccida on me. You bring up another really important point regarding expectations with this surgery. EWL is 53-65% at 3 years, on average. Not 100%, as most people expect/want. You need to ask yourself, will I be happy if I lose only about 1/2 of the excess weight I need to lose?? Is that enough for me?? For me, it was...and it made a huge difference in my quality of life. BUT, I know a lot of people who get very upset when weight loss does stop around 50-60%.

I really think you need to consider a different surgery. I've met very very few people with that high of a BMI who have lost 200 pounds with a Band. If you're not comfortable with a malabsorptive procedure, look into the Vertical Sleeve Gastrectomy. It's a restrictive-only operation, that was originally done as the first step of a DS procedure on very high BMIs like yourself (low op risk). Docs found out that many patients lost enough weight that they never needed the second part of the operation (the intestinal rearrangement). I know quite a few people who have lost over 150 pounds with that op. ObesityHelp has a VSG forum... and check out the www.lapsf.com website. Costs are similar to a Band. Self-pays in the States can be as low as $11,500... although $18,000 is the average. Mexico is about $10-12,000.

I definitely think you really need to take an honest look at your eating habits as well as your comfort levels regarding both surgeries. All WLS is a tool... and a tool which does a lot of the work at first, but requires more work for you long-term. That's why you read about people needing revisions LT. I know people who've had VSGs (look into that surgery as well... try ObesityHelp), RNYs, and DSs after their Lap-Band. I know quite a few RNYs who've had Lap-Bands added to their pouches due to pouch dilation. You will probably lose slower with the Lap-Band vs. an RNY--but you will still lose. Most studies show that weight loss equalizes between the two procedures (assuming you get fills and such) 18-24 months post-op. The big difference is the adjustability of the Band. This is good and bad. The pros are that you can adjust your Band's tightness depending on your needs/health. Great in case you get pregnant. The cons are that you will need to have regular follow-ups with your surgeon or fill person in order for your Band to work. For 95% of people (perhaps 99%), the Band is pretty much useless unless you get fills. Most Bandsters that I know have problems with certain foods as things get tighter... bread, Pasta, meat, salad... can all cause problems. BUT, if you decide that you can't handle life without them, you can always have some fill removed. RNYs face dumping, which Bandsters do not. Some view this as an advantage, others a disadvantage. Among RNY folks I know, the dumping effect does tend to lessen over time... so if it is something you rely on to keep you from high sugar foods, you may have to go at it alone at some time. Lap-Band is an easier procedure, with less operative risk... mainly because the intestines are left alone... as is the stomach (no cutting). You don't hear about the hernias, adhesions, and such that some RNYers face. One disadvantage with the Band can be longevity of the operation. I've been Banded for almost 6 years now, and I have to say... I know very few Bandsters who were Banded at the same time and still have their Bands. GERD, Band slippage/erosion, frustration with never-ending fills, slow weight loss, pouch dilation... have all caused them to choose other operations. BUT, most do not regret being Banded at first. In many ways, it's a good introduction to WLS with little risk (other than financial). With the other operations, if you decide you just can't live off of such small amounts... or hate dumping... or whatever... there's not a lot open to you other than an expensive and complicated reversal. For Bandsters, one can always have all fill removed... or chose to have the Band removed. One other advantage is regarding Vitamin issues/etc. One doesn't hear about them nearly as often with Bandsters... as well as osteoporosis and such. Those tend to be much much more common in malabsorption ops like RNY and DS.

I'm on my third Band pregnancies--and have been unfilled for all of them. You definitely need to consider an unfill during your first trimester due to morning sickness concerns. If you're vomiting a lot... you could cause your Band to slip... meaning you could need emergency Band surgery while pregnant. Not a good thing. See how things go during the first trimester, and then talk with your OB and your surgeon about a re-fill during your 2nd and 3rd trimester. If you've gained a lot during the 1st trimester, it may be something to consider. IF not, then probably it's best to wait until after the Baby is born. Your Band can be tightened after your pregnancy... and you won't have to worry about how your WLS is affecting your Baby. If you do keep your fill, you may also want to talk with your OB and surgeon about having it removed at 38 weeks or so... as when you go into labor... during a period called Transition (around 5 cms dilation) many people experience vomiting. (Real vomiting, NOT PBing). Once again, this is a risk for slippage.

If you're breastfeeding. you may want to wait until 6 weeks or so to get filled so that you can establish a good milk supply. Also... please please don't forget to do you're follow-up Glucose Tolerance Test now that you're not pregnant. 3 months is a very early GD diagnosis... which could mean you had Type 2 all along.

C-section has nothing to do with your stomach. I think the IV fluids could be the culprit. Could also be the post-pregnancy hormones... and things getting back to normal. I know that even though my Band has been unfilled during all of my pregnancies, sometimes I feel bizarro restriction due to hormones... similar to period tightness.

As you're in Michigan, try Dr. Pleatman. He has really great self-pay rates as he's negotiated a deal with the hospital (POH). Also, a very experienced surgeon. He was going to remove my Band and do a Vertical Sleeve Gastrectomy at the same time for around $12K. BUT, I've had to put that on hold as I'm preggers again.

I think the Band works differently on different people. Not sure if it has to do with the type of Band... fill docs... or whatever. Some people PB a ton from the get-go regardless of what they eat. Others never have a PB at all. What I do believe is that you need to work to be successful with as little fill as possible? Why? Because in general, the smaller the fill, the more healthful/normal foods you can eat. The smaller the fill, the more calories you're probably getting (although not too many), so your metabolism doesn't shut down. You also leave yourself more room for success. I know that when I got super-tight... when barely anythign would go down... that's when I turned to the junk food that somehow always made it down. At this point, I was starving... eating so little... and desperate, so I turned to food, any food, for nourishment. My nails were shot... hair looked like crap, etc. Removing some fill lead to better choices, and eventually more weight loss. Of course, now it's been three years since I've had a fill. Had to have the one I had in March (I think) removed because it gave me problems. Was planning on revising to a VSG (Vertical Sleeve)... but became preggers again. I will say that even though my Band can go crazy during pregnancy, even with no fills (like when you have your period)... it is still comforting to know that I have the Band vs. a malabsorption surgery during pregnancy. As for the MGB, I looked into having that done in 1999 when I started my WLS research. Have nothing but good things to say about Dr. Rutledge. He has published some great long-term data on the MGB, covering a ton of patients. You can check it out at his site, which used to be clos.net Not sure if that still works.

Just wanted to post about my fill experience with Dr. Pleatman in Michigan. Went very well. (Probably the sixth or seventh doctor I've had fills from... I've been around the block :rofl:) What was nice about Dr. Pleatman was that he uses a small ultrasound machine to help locate the port... without the hassle of having to go to a radiology department. Also, his price was very reasonable... $250 for the first fill, but I believe it goes down somewhat if you go back to him. Office staff very nice. Office extremely clean... tastefully decorated... etc. All in all, a great experience. Fill was painless and quick. No issues with the fact that I was a Mexican banding patient. So, if you're in the Detroit/Pontiac area, I'd totally recommend Dr. Pleatman.

I'm Banded and I've breastfed two babies (am still bfing one now!) I don't know if I'd want to breastfeed right after surgery... things were rather sore. But I think with a few pillows you could manage. The bigger concern would be getting in enough fluids immediately post-op. You'd have to push yourself more than the average patient just to be safe. I would choose a hosptial that also has a maternity ward so one could arrange to have a hospital grade pump available... lactation consultant... etc. Do what you can to make sure you succeed. Plan for success

It's pretty afordable in the US. It is done in Mexico by some docs and in Europe as well. If you're interested in Europe, look at Dr. Baltasar in Spain. He's done the most... and is one of the originators of the VSG as a stand-alone procedure. He also has impecible credentials. It's done in Brazil as well by Dr. Marchenisi (?sp...check www.duodenalswitch.com for correct spelling and website.) If you go the VSG message board/forum on Obesity Help you can find a list of surgeons. There are also FAQs at http://www.beadbaker.com/VSG/

Hi Penni: I'm waiting for a Band to VSG as well. (Need to wait until my youngest is weaned off of breastmilk.) I've been researching alternatives to my Band for a few years now, and the VSG is the one operation I feel comfortable with. The results seem to be as good as an RNY, without the whole intestinal rerouting bit. (According to LapSF guys research as well as Baltasar in Spain.) Seems to function a bit like a Band, only with no PBing... or food getting stuck. Then of course, there's the ghrelin advantage (part of your stomach that produces it is removed.... unlike with an RNY)... as well as the no blind stomach factor. All in all, it looks good. Good luck with whatever you decide. Karla

My guess is that they do not want the claim because it's difficult to determine if your doctor put it in the wrong place to begin with... or it was placed correctly and slipped. Just a thought. He also may be unwilling to admit his mistake out of fear that this will be used against him in a future case. I guess he failed to see the recent articles that most people do not sue if the doctor admits his mistake and tries to fix it. That's sad. Nonetheless, I'm glad that you've found somebody who can help you. I hope this surgery goes well...and you are off on your way to becoming a skinny version of yourself.

I was just curious as to how often people really PB... really. Also, if you want to mention how long you've been banded... that might help (assumign there is a learning curve.)

I'm also going to post this Obes Surg. 2004 Feb;14(2):256-60. Related Articles, Links Literature review of comparative studies of complications with Swedish band and Lap-Band. Fried M, Miller K, Kormanova K. Centre for Obesity Treatment, Prague, Czech Republic. docfried@volny.cz BACKGROUND: Gastric restriction is a treatment option for morbid obesity. Currently there are several types of adjustable gastric bands available, with two leading but conceptionally different systems, not just from a technical point of view but also from the long-term complication rates. METHODS: A literature search of articles published from January 1997 to December 2002 dealing with prospective or restrospective studies comparing results of treatment with the Swedish band and Lap-Band was carried out. RESULTS: 7 comparative studies fulfilled inclusion criteria, with a total of 1031 patients in the Swedish band (41-597) and 1305 patients in the Lap-band groups (34-821). Pouch dilatation/slippage and/or erosion in Swedish vs Lap-band were reported in the studies as follows: 1 vs 2 in study group 1, 0 vs 9 in study group 2, 0 vs 3 in 3, 3 vs 38 in 4, 0 vs 64 (slippages) and 4 vs 4 (erosions) in group 5. In study 6, 3 vs 3 dilatations and 0 vs 1 erosions were reported. Study 7 found 12 vs 42 long-term complications of this origin. Port-site infections, total reoperation rates and length of hospital stay were also compared. CONCLUSION: The results of this meta-analysis reveal that fall in BMI is similar with both laparoscopic bands. Long-term complication rates, despite the fact that they have been defined in a similar way in all the included studies, may be higher with more reoperation rates in Lap-band® patients.

It's also known as the vertical sleeve gastrectomy. Originally it was conceived of Michel Gagner as a two-part operation... basically it's the first part of a DS. The stomach is stapled into a long sleeve with both valves in place. Excess stomach is removed... which happens to contain the part that produces ghrelin. Operation was first done on high BMI patients who were deemed too big of a risk for a full-blown DS. Ideally, they'd lose some weight with this and then have the intestinal rerouting later (the switch). The docs noticed that a lot of these patients were not needing the second part, and it was looked at as a stand alone operation. Major players are the LapSF guys, Rosenthal at the Cleveland Clinic in Weston, Baltasar in Spain, and Gagner in NYC. Others do it (even Dr. Pleatman)...but it is just now gaining in popularity.

The oldest stats I know of are on the ILOST Site. Probably refer to the Swedish Band made by Obtech, as that was the first band... although all of the ILOST surgeons moved to the Lap-Band (now owned by Allergan.) Go to http://www.obesitylapbandsurgery.com/statmain.html