DrWatkins

Excellent question. There is stomach wall stretching that normally happens when food stretches the wall and activates pressure receptors which turn down appetite hormones. This is a normal process and the stomach wall remains normal. The other type of stretching, pouch dilation, is abnormal. This is when the stomach tissue gets so stretched that it doesn't want to go back to the normal resting state. This is like a balloon that has been blown up with air way beyond its capacity and then when you let the air out it stays stretched instead of returning to its normal configuration. To the best of our knowledge, pouch dilation, comes from pressure. The common culprits are carbonated drinks and keeping the band too tight which causes excessive regurgitation (PB-ing). I have had patients with a dilated pouch that swore that they never drank carbonated beverages and that they never PB so I think there might be a part of this that we don't completely understand. The good news is that it is fixable. Many times deflating the band for three weeks will resolve the dilation or if severe, we can reposition the band surgically though some patients describe that the band acts different after a revisional surgery like this. Increasing your calorie burning is absolutely the right approach to getting out of a plateau. Hope that helps brad

Men tend to lose weight faster because of relatively higher muscle mass due to testosterone being the predominant hormone. We always check testosterone levels in all our male patients because sometimes it is low and it will impair their weight loss until we get their levels normal with replacement hormone therapy. Recently, we've been checking testosterone levels in women as well because female levels are supposed to be around 20-80 as opposed to the male levels of 300-800 (the actual normal range differs among labs). I have seen several female patients who struggled with weight loss, we found that they had testosterone levels below 20 and once we replaced their levels to normal female levels, they started losing weight. If a female patient asks their doctor to check their testosterone levels they will think you're crazy but we've seen this to be very important in some patients. Testosterone levels are a major influence on muscle mass and our muscle mass is a major part of our basal metabolic rate ("metabolism"). Low testosterone levels or low muscle mass from inactivity can impair successful weight loss in men and women. hope that helps brad

The best approach would be to make sure your band is properly adjusted where you are full on a small meal for 4-6 hours. If you can eat a lot of volume or you are starving within a couple of hours after a meal, have the band tightened and make it do more work. Also, make sure you are eating good healthy protein. Mushy foods will zip through the band and are not a good judge for band tightness. The best way to judge band tightness is a "test meal" of a good moist protein portion - 6ounces, 20gms (fish, chicken, beef, etc) and some steamed veggies. You should be able to eat that in less than 30 minutes and stay full on it for a long time. Perfect band tightness Perfect food choices Perfect calorie burning Perfect weight loss hope that helps brad

The best band advice is from your surgeon's practice. The best general book I've seen on band weight loss is by Jessie Ahroni, PhD. She is a very successful band patient and a brilliant person and many band patients read her book and really find it helpful. brad

Simple explanation: Lap Band has some saline in the "deflated" state. Realize band has no saline in the "deflated" state. Detailed explanation: All bands have no saline in them when they come out of the sterile package in the operating room. Lap Bands are primed with saline - the air displaced with sterile saline so that they have some saline in the "deflated state". Realize bands are simply deflated completely with no priming saline. The early Lap Band designs (9.75, 10) that we started with eight years ago when the band was first FDA approved had very little priming saline in them. The VG band had more priming saline and the new AP designs (Advanced Platform) have about 3cc of priming saline for the APS (standard) and 4cc for the APL (large). Some surgeons will put some fill in the Realize band at the time of surgery. If a Lap Band patient has a lot of swelling of the stomach tissue after surgery and they are having difficulty swallowin liquids, we can access the port, remove the priming saline and the difficulty swallowing resolves completely. Hope that helps brad

All weight loss comes from calorie deficit (burning more calories than you consume). Burning more and consuming less is what causes weight loss. The band will not force you to burn calories. The band helps with the consuming less part. It helps with this in three major ways: 1. Reduced appetite - some surgeons argue that the band is an appetite reduction operation. It has been shown to reduce appetite hormones. Patients say they don't feel hungry - they don't feel like they are on a diet. The band reduces true physical hunger. Some of us struggle with emotional hunger, phantom hunger which is not cured by the band but reducing physical hunger is very helpful at combatting head hunger. Emotional hunger comes from deep rooted emotional pain causing negative emotion that is unfortunately temporarily cured by food. 2. Fullness on small portions - the amount of stomach above the band is small. You will feel full on a much smaller portion of food if the band is properly adjusted. The fullness feeling is not a "pat your lower belly" kind of fullness. Band fullness is a very high sensation - in the chest - the feeling that the last bite of food is somewhere near the base of the tongue and another crumb will not be physically allowed. 3. The impossible nature of overeating - let's say you feel full and not hungry but you decide that you will overeat anyway. A properly adjusted band simply will not allow this. A point will be reached where the system will reject anything more. The esophagus (swallowing tube) is a transport organ; not a storage organ. The esophagus has two buttons: down and up. It will try down first. If that doesn't work, it switches to up and you get to see the food again. We've been banding for eight years and we see three groups of patients in our practice: Group 1 - gold medal superstar patients who lose easily and steadily after band surgery and send us Christmas cards that will bring tears to your eyes. Group 2 - patients who acheive the same ultimate results as Group 1 but it takes longer with more office visits and more education and slower weight loss but we still get there. The race car crosses the finish line but it's on fire and badly damaged. Group 3 - patients that will be three years out from band surgery and only down 20 or 30 pounds. The three biggest reasons patients are in this group are: 1.) unsolved emotional eating 2.) zero calorie burning 3.) Quit, give up, stop coming to the practice for band adjustments, education, etc One of the best books I've seen on emotional eating is: "Shrink Yourself" by Dr. Gould. Many patients have told me this helps. The secret to curing emotional eating is to identify the root cause of this negative emotional pain and work through it. This is the most difficult aspect of successful weight loss. The best calorie burning is the one you'll do (walking, WiiFit, Appalachian clogging, etc, whatever). Simple things like taking the stairs and parking as far away from a store entrance as possible really add up to burn calories and jumpstart weight loss. Hope that helps brad

An important consideration on the topic of reflux symptoms after band surgery is the hiatal hernia. What we now know after doing nearly 5,000 band procedures over the past 7 years is that in essence every patient has a hiatal hernia (even if small) and needs to be repaired in every case - reinforce the hiatus with suture. This also mobilizes an intra-abdominal section of esophagus which is a very important anatomical consideration for an anti-reflux mechanism. More and more, band surgeons are now realizing the importance of hiatal hernias and fixing them at the time of surgery to prevent problems with increasing heartburn with band fills. Of course reflux/heartburn can also come from a dilated pouch, keeping the band too tight, eating too much or eating "plugging" foods such as bread, sticky rice, raw vegetables, microwaved pasta, restaurant scrambled eggs or calamari (doughy, fibrousy or rubbery foods). Before I started fixing hiatal hernias routinely in every case, I would see patients that would get heartburn when we tightened the band. This caused frustration and poor weight loss. We don't see this scenario now that we reinforce the hiatus in every case. Fixing hiatal hernias has also improved the "sweet spot" of the band and reduced dilated pouches significantly. Unfortunately, many band surgeons do not believe the hiatus is that important and there are many band surgeons out there that are ignoring important hiatal hernias at the time of surgery and this causes frustrated patients and poor weight loss. I have a lot of patients transfer their care to my practice and many of them have no sweet spot and lots of heartburn. Some of them have agreed to a hiatal hernia repair and this always creates a better sweet spot and the ability to tighten the band without reflux. Any band patient having significant heartburn should have an esophogram to rule out a dilated pouch and if the esophogram is normal consideration should be given to the hiatus. Hope that helps brad

An erosion is basically where the band works itself inside the stomach. This happened more in the early days of banding in Europe and fortunately, the European surgeons figured out how to dramatically reduce the chance for this. They started stitching the stomach over the band to help reduce the incidence of band slippage. In the beginning they stitched the stomach over the band too tightly and they stitched stomach over the buckle and the taper (section from buckle to tubing). Whenever you have living tissue stretched too tightly over plastic, the plastic will end up eroding through the tissue over time. This pressure cuts off the blood supply to the small capillaries delivering blood and over time you get tissue necrosis and plastic inside the stomach. Interestingly, the European patients didn't get sick, they simply stopped losing weight. They treated this by removing the band and replacing one later. Their knowledge and experience has brought the erosion rate from 10% to well less than 1%. The easiest way to diagnose erosion is to perform an EGD (stomach scope) and you see white plastic inside the stomach. Sometimes you can see this on a barium esophogram as well when the barium passes outside the ring. There was quite a lot of discussion at last year's ASMBS meeting that erosions were possibly the result of stomach injury during the procedure which is a newer theory behind erosions. The good news is that erosions are now rare and are treated by simply removing the band. For a time some European surgeons replaced a new band at the same time as removing an eroded band and these nearly always re-eroded so the current strategy is to remove an eroded band, let the stomach heal and then consider later replacement. Hope that helps

If you look at individual gastric band practices the average weight loss results are varied. When you look at pooled data from Europe (both bands have not been in the U.S. long enough) the average weight loss results are very similar. I have not seen any data that validates concern about band creasing. Basically, they are both great products and great companies that believe in supporting their patients. I think it is important for a patient to research both bands and for surgery practices to provide unbiased information about the two products. I believe the patient should decide which band to use as they will ultimately determine their weight loss success. I think it benefits patients to have two bands on the market as both companies are fighting for market share to the benefit of patients. hope that helps

The "360 balloon" band is the new Allergan band called Advanced Platform. It comes in two sizes, AP - standard and AP - large. The standard holds 10cc; the large holds 14cc. When we place an Allergan band (as opposed to REALIZE band), we always use the AP bands. It seems to have better restriction, less chance of dilated pouch (slippage) and fewer food intolerances. The Australians have had the AP bands for years and they like them as well compared to the older Allergan (formerly Inamed) bands which were smaller and the balloons did not come 360-degrees - they stopped at the buckle. hope that helps