INAMED Band - Question of Quality

[Dunatl 0]

For those postes who suggest the INAMED bands distributed in Mexico are inferior to those distributed in the US. I just received the following e-mail from Don Mills who represents Inamed regarding this subject.

Hello ,

There is no difference in the production of the LAP-BAND or the band itself between those used in the US and those used elsewhere in the world including Mexico. The are all made to the same high quality standards.

There is one difference. Bands in the US have a larger port while the band used internationally use a smaller port. Functionally there is no difference. It is a matter of surgeon preference in the US.

We do not know why a small percent of patients have their bands erode. I would be happy to discuss some thoughts on this if you care to call.

It is true that patients banded in Mexico seem to have a higher percentage of issues with the band when compared to US patients. I am sure that this is due to less frequent follow-up care and motivation from a near by surgeon's office.

Regards,

Don Mills

INAMED Health

(800) 624-4261 x4546

[Penni60 45]

Don Mills following statement really pisses me off, "It is true that patients banded in Mexico seem to have a higher percentage of issues with the band when compared to US patients. I am sure that this is due to less frequent follow-up care and motivation from a near by surgeon's office."

Let me clarify, Don Mills cannot even begin to assume much less be "sure" of what causes erosion or not in either a US or a Mexico bandster. He cannot be "sure" or even question it because the data Inamed collects is HIGHLY inaccurate. The Mexico doctors are not bound by the same guidelines to report problems like the US doctors.

The Less frequent follow-up care and motivation has ZERO to do with whether a band erodes or not. Look at Michelle for instance, she is one of the best bandsters I know and had very good follow-up care and she still eroded.

Don Mills can kiss my, ___ well you get the picture.

[La_madam 20]

It is true that patients banded in Mexico seem to have a higher percentage of issues with the band when compared to US patients. I am sure that this is due to less frequent follow-up care and motivation from a near by surgeon's office.

Well in my case this statement is totally flase. I was banded in TJ..I have seen my Dr. in Tj more in the last 19 mopnths then I have seen my regular Dr. here in California I have had impecable aftercare being banded in MX. In 19 months I have traveled to Tj atleast a dozen times, if not more and I still eroded.

The Less frequent follow-up care and motivation has ZERO to do with whether a band erodes or not. Look at Michelle for instance she is one of the best bandsters I know and had very good follow-up care and she still eroded.

[princess_n_thep 2]

I personally have my own feelings about Don Mills. When I inquired about the possibility of the tazer training I had to go through and being shot with it as part of the training he had this to say to me...

"I don't know about the effects of the band from a tazer shot. I can not even begin to speculate about what will happen. But if you do it, please let us know what the result is or if any adverse effects happen".

Uhhhhh, no thanks!! So basically, I got the "we want your data" excuse at your own expense.

He can kiss my A$$ too.

[Dunatl 0]

La Madam - When you had the band removed, did you have the option of replacing it with a new one? If not, can you have one installed at a latter date or do you have to wait untill your BMI reaches a certain level?

[DrPleatman 3]

I don't have statistics on American vs. Mexican surgeons. What is known is that band erosion may be related to suturing technique. Early on in the band experience it was observed that sutures were required to prevent band slippage. Some surgeons went "overboard" placing many sutures to prevent slippage. If too many sutures are placed near the buckle of the band, erosion can occur at this point.

I would speculate that since Mexican surgeons started doing lapband well before we did in America, perhaps their earlier cases may have been at risk for erosion. I have removed one band placed in Mexico 5 years ago. That patient was converted to gastric bypass.

The only surgeon I know of who will put in a new band immediately after removing an eroded band is Paul Obrien. Most other surgeons will not risk putting in a new band at the same time.

Mark Pleatman MD

Bloomfield Hills, Michigan

248-334-5444

www.laparoscopy.com/pleatman

[SouthTX LapBand 0]

The only surgeon I know of who will put in a new band immediately after removing an eroded band is Paul Obrien. Most other surgeons will not risk putting in a new band at the same time.

Mark Pleatman MD

Bloomfield Hills, Michigan

248-334-5444

www.laparoscopy.com/pleatman

Hello, Dr. Pleatman. I recently read the abstract of a research paper of a group of lap band surgeons in Spain who reported good results in simultaneous removal and replacement of the band in cases of erosion.

Not having read the entire paper, it is quite possible that cases of severe erosion (where the integrity of the stomach cavity has been compromised) were not included in the study, but if you are interested, I'm almost certain I bookmarked it and will be glad to track it down for you. I am trying to remember my Google search string.

Hope this has been of some interest to you.

[DrPleatman 3]

By definition the integrity of the stomach is always compromised in cases of erosion. There is a hole in the stomach, and the band is partly inside it! Here in the USA we worry more about the medico-legal issues. If the new band gets infected, our patient will be very unhappy. My personal opinion is that the patient will be better off with a different operation after an erosion. There is so much distortion to the anatomy that a band just is no longer a good choice. Think about it... most surgeons consider previous antireflux surgery to be a contraindication to band placement. There's a heck of a lot more scarring and fibrosis after band erosion than after a Nissen fundoplication done for reflux.

Mark Pleatman MD

www.laparoscopy.com/pleatman

[SouthTX LapBand 0]

By definition the integrity of the stomach is always compromised in cases of erosion. There is a hole in the stomach, and the band is partly inside it!

Well, that showed a lack in my understanding to date --- I had THOUGHT I had learned that the stomach wall begins to grow over and encompass the band, rather like how a tree's bark grows over a wire wrapped around the trunk.... and that the band can even eventually erode through the wall of the stomach, ending up on the inside.

However, I did find that article (they were Israeli surgeons at Tel Aviv University Medical School, not Spanish) and sent you the abstract via your email address. I had read a bunch of abstracts that day and failed to remember that they HAD done surgical repairs in between the removal of the band and reinstallation of the same.

For those who are interested in their successful study, here is the link -

http://www.ingentaconnect.com/content/fd/os/2005/00000015/00000006/art00018

[DrPleatman 3]

Your analogy to the tree is reasonable. The fact that patients tolerate band erosions without getting sick implies that it is a gradual process, with the body walling off the entire process and preventing gastric Fluid from leaking out into the abdominal cavity. I have even seen a presentation on how to remove the eroded band with a gastroscope placed through the mouth!

But if you take the band out through the abdomen, whether open or laparoscopically, there will still be an opening into the stomach, and the adhesions formed by the body to wall off the process will be disturbed, requiring you (the surgeon) to close the hole to prevent leakage.

By the way, I read the abstract of that article, and it also mentioned that 11 of 16 patients develped fever after the surgery, requiring antibiotic therapy. I'm not sure I would want to risk that in my patients.

Mark Pleatman MD