DrHekier

You should be able to call your insurance company to find out if the Lap Band is covered. We generally do that for all of our patients so that before they show up for an appointment they know whether or not the insurance company will even potentially pay for it or not. Some insurance companies still don't seem to understand what the Lap Band is, and only know about the gastric bypass, so it may be easier to ask them about an exclusion for morbid obesity surgical procedures first, then ask about Lap Band specifically.

In our practice we have learned (the hard way) that even within the same insurance company, individual employers can add exclusions to policies. It's frustrating for our office to hear an exasperated patient tell us "but my friend has the same insurance I have and she got them to pay for the Band." Even with the same carrier, your individual employer can add an exclusion to the plan to exclude WLS. You would think a medical school would not do that but both hospitals in our town exclude treatment for obesity surgery.

Before you consider any form of weight loss surgery make sure your medical issues are optimized. For example, the thyroid gland is sort of the 'thermostat' of your body, and if you are significantly hypothyroid (have low thyroid function) and are not having adequate replacement through medication, your metabolism may be slowed to a a point that it is a factor in your obesity. If you do go on to consider and are a candidate for the Lap Band, with regards to patient financing call the surgeon near you that you would likely have perform the procedure and his/her office should have options available for you. Good luck, and lets count on the day when all insurance plans cover the Lap Band and stop obesity discrimination. As my partner (who happens to be my wife) says, "your insurance company would never tell you 'You got breast cancer and didn't have a mammogram in 3 years, too bad, we're not paying for surgery. You laid out in the sun as a teenager and now have skin cancer, too bad we're naot paying for surgery." Don't want to get on a soap box, but obesity may be the only disease that insurance companies do not have to provide service for. Sigh.....

The "full = not hungry" quote is right on and deserves to be a sticky! That's one of the main points we try to emphasize to our patients when they ask "how much should I eat?" I can't speak for patients who have had other procedures such as the gastric bypass or the VBG (because we don't do those) but for the Banded patients it's important to change your mindset towards food. We are genetically programmed to eat until we are full, and it takes a lot of work to change your attitude towards food and eat until you are not hungry. It's a completely different approach, but essential for weight loss success for Lap Band patients.

One of my patients last week asked about gallbladder removal during her upcoming Lap Band so I offer some thoughts: Many people who have not had weight loss surgery end up with stones in their gallbladder, but not all of those stones are symptomatic and cause pain. Since rapid weight loss or weight gain can cause the formation of gallstones it is an area of interest to bariatric physicians and patients. There is a debate among physicians as to whether or not to perform a gallbladder removal at the time of weight-loss surgery. I recall that it was a topic of discussion at the American Society of Bariatric Surgery meeting I attended a couple of years ago, and there was no consensus as to whether or not remove the gallbladder. Some laparoscopic gastric bypass surgeons commented that the placement of the instruments for the bypass is not ideal for removal of the gallbladder, and hence that makes the surgery more difficult or makes it necessary to place more ports for instruments into the patient. I am not aware of many Lap Band surgeons that remove the gallbladder at the time of surgery for the following reasons: 1) By removing the gallbladder you introduce the possibility of having bacteria enter the bloodstream or abdominal cavity, since the bile in the gallbladder can harbor bacteria. You would prefer not to do this in the presence of a foreign body, the Lap Band. 2) The port placement for the Lap Band may not be ideal for removing the gallbladder and more ports may need to be added. 3) It is felt by some that the more gradual weight loss seen with the Lap Band compared to gastric bypass makes the likelihood of developing gallstones lower. 4) While generally a safe surgery, gallbladder removal (cholecystectomy) does entail its own specific risks that are unique to that surgery, therefore adding a cholecystectomy to the Lap Band, theoretically adds to the risk of surgery. To answer Amy's original question about the recovery from the surgery: The laparoscopic cholecystectomy is generally well tolerated and most patients return to regular activity within a few days. I remember a patient who was a high school football couch and went to run practice the afternoon after his cholecystectomy. As with any surgery, everyone has a unique recovery based upon how their body responds to the surgery. Good luck!

Yvonne, You are absolutely correct. I have looked it up and yes there is an 11cm Band not for use in the U.S. Until just now I wasn't aware of it. I'm surprised why Dr. O'Brien, the Australian surgeon, doesn't refer to it in his paper we cited above, as he is the most prolific Lap Band surgeon in the world. In his paper he refers to the 9.75, 10, and VG sizes. Perhaps the 11cm band isn't used in Australia either. (On the internet I found Inamed's info card for the 11cm band and it has a brief paragraph in French, German, Spanish, and Italian, but not Australian.) So Yvonne is right, there is a separate 11cm Band, not used in the USA, that has a maximum fill volume of 9cc. Regards, Ron Hekier PS Sorry about the disclaimer Princess, but it was recommended to me by another physician. Sigh...the world we live in... PPS I am aware that Australians speak a form of English.

Ruthie, I wouldn't be stressed out unless you were at a maximum of 10cc filled and weren't receiving the results you wanted. See our thread on another topic: http://www.lapbandtalk.com/showthread.php?t=9192 About half way down find my message with a link to a paper by Dr. O'Brien. On page three of that paper there is a graph showing the size of the stomach opening with the 3 bands (9.75/10/11 or VG) at different fill volumes. What you will see is that at higher fill volumes, the VG band has an opening just about as small as the other bands at their higher fill volumes. I'm hopeful you will do just fine with your VG. Remember this is a journey for the rest of your life, and don''t get stressed out over one particular place in time.

The 11 cm band is the VG also known as Vanguard. My info says 10cc is the maximum but I wouldn't dwell on it. I think for most people the maximum fill volume is not an issue as you won't need to get near the maximum to have good results.

Nickie, From the information I have from Inamed, for a 9.75 cm band the maximum fill volume is considered to be 4cc. Perhaps you can stretch it a bit to 5cc, but per the Inamed material that I have, for the 9.75 and 10.0 cm Lap band, 4cc is considered the maximum. The inner balloon is rather sturdy, and I think it would be hard to 'pop' the balloon if you got a fill a bit past 4 cc. I would suspect with a 9.75 cm band you would not need to get a fill past 4cc. In fact I wonder if there is anyone on this board who has a 9.75 Lap Band and has been filled to 4cc and is not receiving good results? From a thread on this board in 2004, I found the following link. http://www.gisurgery.net/OverviewObesityBariatricSurgery.pdf It is a link to a paper by Dr. Paul O'Brien, an Australian surgeon who has probably placed more Lap Bands than anyone in the world. (Around 2500 when I attended a training course with him nearly two years ago.) I draw your attention to figure 3 on page 3 of the article. Notice the comparison of area within the band (i.e. stoma size) for the 3 Lap Bands depending on the amount of saline added, and that for the 9.75 and 10 cm bands the graph stops at 4cc. This graph in Dr. O'Brien's paper is an extrapolation of a bar graph I have seen from Inamed, the manufacturer of the Lap Band.

There are two issues here: 1) Band size 2) Fill volume There are three sizes of Inamed Lap Bands. As I understand it, the size refers to the inner diameter of the band. The 3 band sizes as per Inamed are 9.75 cm, 10.0 cm, and the VG (the Vanguard, which I believe is 11cm, but all the reps call it VG, no-one calls it the '11') Fill volume: The 9.75 and 10 cm bands can hold a maximum of about 4cc of saline. The VG holds a max of about 10 cc of saline. In medical circles I've always heard the Lap Band referred to by its size. For example, today in the OR we used "two 10's and one 9.75."

Thanks everyone. I didn't want to seem pushy and didn't know if I would be welcome to post here. I certainly don't want to intrude, but I would be happy to impart what I hope to be impartial, scientific, knowledge. Thanks for the kind words!

Spydr, Hi, my name is Dr. Ron Hekier. My wife and I are general surgeons that perform the Lap Band surgery. I think it is virtually impossible for the event described to you to occur. The Lap Band is made of an inert, smooth material, that generally does not have anything stick to it. Also, during the procedure, a small portion of the stomach is brought over the band to prevent slippage. This results in most of the Band not being exposed to other organs in the abdominal cavity. Besides, I have never heard of a case where an internal adhesion has ripped with sudden movement and caused bleeding. With the VBG (vertical banded gastroplasty or 'stomach stapling) the mesh around the top of the stomach can form adhesions to and stick to the liver. But even in those cases, you don't get bleeding from sudden movement. My $0.02. Regards,