DrPleatman

Slipped bands don't need to be permanently removed; they can be fixed, generally by taking them off and replacing them in a better position. For me the better option is to remove them and convert to sleeve gastrectomy. Regarding symptoms of acid reflux... if you have a band, and you have symptoms of reflux, your band is either too tight or slipped. Taking Nexium is NOT the answer. Mark Pleatman MD Index

I worry a lot when I read all these posts about people having their slipped bands removed. I agree with removal of the band, but you should strongly consider having a same-time conversion to either RNY or vertical sleeve gastrectomy. If you needed the band in the first place, you will eventually regain your weight and need bariatric surgery again. Mark Pleatman MD Index

I suppose an update is in order. North Oakland Medical Centers closed their Bariatric Center. I am still in practice, however, as usual. I do surgery at many hospitals in the area. I am now affiliated with Harper University Hospital, a certified "Center of Excellence." The cash prices you see posted on my website ($12,500 for LapBand, $11,500 for gastric bypass or vertical sleeve gastrectomy) only apply at POH Medical Center, where the hospital charge is unbelieveably reasonable. Every other hospital is at least twice as expensive. I still continue to take care of patients banded elsewhere. Mark Pleatman MD www.laparoscopy.com/pleatman Email pleatman@laparoscopy.com

Emily: As I said previously, slippage occurs because of either not enough sutures in the right place, or (possibly) frequent vomiting or overeating. Ask your surgeon what his percentage of slippage is. Mark Pleatman MD

Pam Sorry to be the bearer of bad news, but prolapse is the same as slippage. You will need another operation to fix it. The good news is that slipped bands don't need to be removed; they can almost always be fixed with an operation that is as easy for you as was the first one. Mark Pleatman MD

No, it's blood. If it is black and looks like coffee grounds it is blood. Besides, anyone who has a Lapband and has symptoms of "reflux" has either a slipped band or a band that is too tight. In any event, you need to see your doctor. Mark Pleatman MD

Of course it is blood, and you need an unfill. Mark Pleatman MD

Donna I'm a surgeon and I don't even understand your explanation. We place the sutures from the stomach above the band to the stomach below the band. The suture pulls the stomach over the band creating a tunnel of stomach through which the band goes. The band can slip if the sutures pull loose or if there aren't enough of them. Mark Pleatman MD

Dody: I agree with much of what you say, but I also disagree with some. Remember that I do Lapbands. I agree that a 64-year-old with a history of cardiac bypass surgery would be a good candidate for Lapband; in fact, I might refuse to do a bypass on such a patient. Dody; you've misinterpreted what I've said in implying that I recommend bypass for everyone. The main thing I've said that has pissed people off here is this: People who have serious band complications ought to consider having a bypass. That's all. I have plenty of happy band patients. The band is a great tool. I recommend it frequently. You say that Vanderbilt recommends Lapband as procedure of choice for all patients. This is not true. In fact, if you look at their web site you will see that most of what they do is gastric bypass. The surgeon pictured on their site, Bill Richards, does only gastric bypass. Get your facts straight. Center of Excellence... mostly politics and BS designed to limit access to surgery and save money for the Medicare system. There is very little data to suggest that good care cannot be rendered in small centers; that being said, we've paid the big bucks they demand (more than $10,000) to get designated as a Center of Excellence, and will soon have the designation. Finally, you say, 'but I also don't believe a failed gastric bypass patient should be allowed to convert to lap banding if they fail down the road at gastric bypass. Apples and oranges...I don't think so!!' What the hell are you talking about? Banding after bypass IS done on certain occasions. You should preface all your remarks with the disclaimer, "I'm not a doctor and I don't know what I'm talking about." Cheers Mark Pleatman MD

Leatha: 50% weight loss is considered to be success, so that alone would not be an indication for conversion; but any complication requiring REMOVAL of the band would warrant conversion to another bariatric operation, since weight regain is guaranteed after removal of the band (or reversal of any bariatric operation, for that matter). Mark Pleatman MD

Photonut: You can only call it advertising if my goal is to get you to come to me for the revision. There are a number of LBT members who have emailed me privately and I have always tried to steer them to someone close to them. I will admit that the more bariatric surgery I do, the more I prefer gastric bypass. There, I've said it. I have an opinion. I still do Lapbands and try to help patients who've had them placed by others. That doesn't mean I think all bands should be removed... only the ones that aren't doing what they are supposed to do. Think of your operation as an investment like a stock. If you buy a stock and it goes down, you don't ride it to the bottom. You aren't married to it. You decide it isn't working for you and sell. That's all I'm trying to say here. If the tool isn't working for you, by all means do whatever you can to make it work, but if it continues to fail, you aren't married to it. Move on to something else. As far as adding a Lapband to a failed bypass is concerned, that's a completely different issue. There still isn't a whole lot of data out there on it. The rationale is to restore restriction in the face of a dilated anastomosis between the pouch and small bowel. "rebypass" isn't an option (though you can redo the procedure depending on what has gone wrong). That's a completely different issue from rebanding a previously banded patient. Rebanding is certainly an option, but so is bypass, and we know it works. Mark Pleatman MD

You guys are confused. Photonut... the study you posted by Ren, Ponce, and Horgan was published in 2002; the longest patient follow-up was only 2 years.. Fairly early study, actually. In that study they only had 1 band erosion; That patient with erosion was apparently asymptomatic and had refused surgical treatment. There is no mention at all in the paper of rebanding of any patient. All 3 authors are paid speakers for Inamed. Janet... doctors refuse to reband for a reason. You say you chose lapband over bypass for a reason. Presumably the reasons had to do with safety, reversibility, and minimal invasiveness. Now things have changed. Redo surgery is much more dangerous... the chance of success with rebanding is lower than it was for the first go-around. Reversibility... well, that one came back and bit you in the ass. The operation is undone even though you didn't want it undone. Minimal invasiveness is the same with either lapband or bypass. And now there are newer studies coming out showing results of rebanding... which you chose to ignore. Sorry if I'm being rough on you. I'm only here to educate and help you understand the data. Mark Pleatman MD

Tracey: Sorry to hear about your trouble. There have been several publications on this topic. Probably the most up-to-date recommendation would be to have a gastric bypass. It can be done laparoscopically, and patients are satisfied afterwards. Though some surgeons are willing to reband, I myself would refuse to reband a patient after erosion. Mark Pleatman MD www.laparoscopy.com/pleatman

Let me clarify that a bit more. Most patients with slipped bands can undergo successful repairs, and then continue to do well. I only encourage conversion for patients whose bands can't be salvaged. Mark Pleatman MD

I've never had a band erode, though I recently took care of a patient with an erosion whose band was placed in Mexico. I removed it and 6 months later did a gastric bypass for her. I've had my share of band slippages. They generally don't need to be removed, but can just be fixed. A few patients chose to have them removed, and they regain their weight. I try to encourage them to have a conversion to either sleeve gastrectomy or gastric bypass. All the conversion patients have done well, and were happy with their decisions. Mark Pleatman MD

Dody: I keep the bands to use as samples to show patients who are considering having them. That's all. Mark Pleatman MD

Dody: Your surgeon is bullshitting you. As a surgeon, I have never been asked to return eroded or slipped bands to Inamed. I've got a drawer full of them. Mark Pleatman MD

Elizabeth: Tell your surgeon to get the band for you. As you say, you paid for it. It's yours. If they are worried about it being contaminated with your body fluids, it can be sterilized in the autoclave. Mark Pleatman MD

I thought it interesting that someone was selling LapBands on Ebay. Recently a seller named "granitegrp" sold 2 "new" lapbands to a buyer named "endoscopic62." The LapBands were still in the original packaging material, but both had expired in 2004. Though I personally believe that the bands are probably fine, and would perform the same as new unexpired ones, I wonder about the ethics of one who would implant them in an unsuspecting patient who paid full price... aside from the fact that doing so would be highly illegal. In case anyone wants to check it out, you can look up the auction id numbers, which are 7577019063 and 7577019163. Mark Pleatman MD www.laparoscopy.com/pleatman

Susan: I suppose safety is a matter of perspective. For an operation as complex as gastric bypass, 1 in 200 mortality is considered safe. Several large studies have showed lower mortality in morbidly obese patients who have undergone gastric bypass as compared to those who did not have bariatric surgery at all. Pick your poison. As far as reversibility is concerned, the gastric bypass does not involve removal of any part of any organ. The stapled stomach can be put back together, and the roux-en-Y can be undone. Certainly it is more difficult than snipping off a lapband, but that does not mean it is not possible. Mark Pleatman MD

Susan: Bypass doesn't just work based on food consistency. After a bypass you just aren't hungry. THat's the most powerful part of the operation. In addition, high sugar foods can make you sick, so patients very quickly find that they don't like them anymore. Mark Pleatman MD

Alex: I dream about having Band patients lose 1 pound per week. The fact is that some don't. Some even GAIN weight. The bottom line here is that you have to have an honest discussion with your surgeon, and look into the reasons you eat, decide which surgical TOOL will work best for you. You can't pick based on which is cooler, which is safer, or which one worked for your friend. You have to decide based on which will work for YOU. The safest easiest operation isn't worth crap if it won't work for you. Mark Pleatman MD

Susan: This is clearly not true. Gastric bypass is still commonly done throughout the world. Just go to Pubmed and do your own literature seach. Don't believe me. Mark Pleatman MD

I said that 20-25% of patients don't lose much weight with LapBand. Dr. Ortiz gave me his statistics, and his results are somewhat better than that, but it still remains a fact that a SIGNIFICANT proportion of LapBand patients do not lose weight... for whatever reason. They may cheat, not exercise, nibble all day. I don't know. Some are still hungry even when the band is tight. They try to eat, and then throw up. They are still hungry, so they eat something slippery that will go down. The Band just doen't work for them. PhotoNut asks why I push the bypass. It's not that I push the bypass, I just share my statistics. Everybody loses weight with that operation (at least initially). Some can regain later, but most don't. You ask why I would push an operation that is "much" more dangerous. Yes, it is more dangerous... death rate is 0.6%. But that is still pretty safe... dangerous than being fat. The bypass is reversible. You can safely have children after bypass. Patients seem to be happier after bypass than after LapBand. This has been my personal experience after treating hundreds of patients. I didn't start out this way. In fact, I started out doing almost all LapBands. Now it's the other way around. Mark Pleatman MD

Theresa: You assume that I am a poor surgeon just because the results I post don't match what you want them to believe. All my patients get unlimited fills at no charge, unlimited access to a registered dietitian, as well as all the help I can give them. There are other published series showing similar failure rates. Many people assume that the people who fail with the band are cheating or otherwise not "working with" the band. Though some certainly do sabotage themselves, others in fact really do try. When I do a LapBand operation, I give my patients my full support. In fact, I don't even charge them for reoperations. If I have do do a conversion from band to bypass, I do it for free. So there is no big motivation for me to be doing these operations. By the way, a significant proportion of the conversions I do are in patients of other surgeons, both from the US and Mexico. I congratulate you on your success (so far) and hope it continues for you. But please don't assume that everybody will have the same results as you have. Mark Pleatman MD