MI doc says 25% do not loose wgt

[SouthTX LapBand 0]

regarding http://www.PubMed.com

Errr... I would have to pay for a subscription to this site in order to read the information.

PubMed is completely free for a wide-ranging variety if information. The only thing you have to pay for is to retrieve the entire published article. However, the Abstract is free.

Go to (and bookmark) this page -

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Display&DB=pubmed

Enter the words gastric bypass and click on the GO button

On the next screen, click on the "down arrow" button on the right hand side of the first "window" labeled Display and select "Abstract"

You will then receive 2,178 articles, 20 articles to a page, 109 pages -- from Romania, Italy, Spain, Brazil, Austria, Greece, France, The Netherlands, Chile --- and a few from the USA. And that's just on the first page.

Lots of good reading.

[lambchops 0]

Ok, the Doc has me worried. 25% don't do well, or don't drop much weight?? Am I ready to gamble $15, 000 on that ( cause if you told me I had a 25% of losing my money on the slots, I would not gamble, that is just me- 5% chance, ok, that is acceptable.) I have my op in less than two weeks and I am starving on the Optifast stuff!!! Do we have anyone on this site that can tell me if they were one of the 25%, and if so what they think may be the reason they did not do so well??:think

[Alexandra 55]

Lambchops, there are lots of people who feel like they're losing slowly with the band, more slowly than they would like. Do a search for "turtle" and you'll find threads about slow or no weight loss.

IMO it's very easy to feel like a turtle with the band. A loss of 1 lb per week may not seem very inspiring after a big, expensive surgery. But you know what they say about turtles, and that's the whole reasoning behind the band. Turtles end up being winners, however long it takes them to get there. Patience and persistence are two things one needs to be a successful bandster, and which are not required for bypass patients.

[lambchops 0]

Thanks! Slow is just fine, but if I only lose 10 lbs or *gasp* gain weight I will be very upset. I have lost six pounds on two days of liquid diet (pre op) so maybe that will show me that I can do this!!! Ya!

[DrPleatman 3]

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

[PhotoNut 7]

Correct me if I'm wrong, but the same eating disorders (or issues) that prevent band patients from losing weight, i.e. eating around the band with soft foods that go down easily (ice cream, cookie dough, etc) are not going to be corrected or even circumvented by the bypass are they? If a person will not adhere to the lap band guidelines, why would a bypass fix anything. Sure, maybe it would at first with rapid weight loss. But what about long term? The long term loss is what we are all looking for. Any of us can lose the weight. It's keeping it off that seems impossible.

[DrPleatman 3]

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

[drgeller 0]

In response to a previous post about Gastric Bypass not done around the world. I am aware that Lap-Band (or other adjustable gastric bands -- there are 2 or 3 other options in Europe) make up 80% of the weight loss surgeries performed in Europe and Australia, where the Lap-Band has been performed since 1991. In the US, where the Lap-Band was only FDA approved in 6/1991, there were only about 15-20,000 Lap-Bands performed in the last year, where there were about 200,000 weight loss total surgeries performed. So about 10% of surgery in the US is the band and most of the rest is the bypass. I expect the Lap-Band to make up a larger and larger percentage of weight loss surgeries, probably to approach 50-80% in the next few years. A recent announcement by Medicare said that they will start covering the band in all ages in addition to covering the bypass which they have covered for a long time. Many of the medicare patients that I saw ended up getting a bypass even though a band was their 1st choice. I believe both the Band and the bypass are safe and effective procedures, with definite differences, I leave the choice of type of surgery up to the individual patient.

I have seen much less than that 25% failure rate, and the patients that do the worst are the least compliant. Still, the band is meant to be there forever and over a long period of time, compliance can be taught. I have removed two bands, out of about 250 and I feel those two patients could have done better with band if they worked with the band longer, but there were other circumstances that led to band removal. In one, I converted to RYGB.

David Geller, MD

[Alexandra 55]

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.

I completely agree with this, Dr. Pleatman--except for the which-is-safer part. For lots of people that's a HUGE concern, even bigger than the speed or amount of weight loss. As the seriousness of one's obesity issues increases, the concern with safety may lessen of course. But safety can't be discounted as a factor in the decision-making process. Not all morbidly obese patients need to lose weight overnight.

Dr. Geller, thanks for your comments!

[chameleon 0]

I have read and read and read some more on lap band vs. rny. I continue to research them both as I can choose either one, so far my research backs up SouthTX post. Although, I am very leery of the origins of articles and what kind of propaganda are floating out here in cyberspace! I was mildly amused to find that there i already a HUGE rivalry between bandsters and rny people on a lot of message boards out there! What the hell....why fight about it....our one commonality is that WE ARE ALL FAT or we would not be considering either one.....right? Anyway....what I have reduced my months of research down to now is actually that many of the rny patients who have stretched out there pouches are having to go back and gey banded to restrict their restriction!! ALSO, I think that these patients would also be the patient with failed band surgeries or failed rny procedures because as southTX said....BOTH procedure are TOOLS you can sabotage them both. Many people are fat because the FAT is a tool they have learned to use to their advantage also...IF they don't have that heart to heart with themselves prior to either procedure they will, without a doubt FAIL.

[PhotoNut 7]

With respect to both doctors who are posting on this thread.. how can either of you consider the gastric bypass surgery "safe" when the mortality rate is approximately 1 in every 200?

Dr. Pleatman, please reply to my question about your statement that the bypass is reversible. Everything I have read clearly states that this operation is not reversible.

Thank you both for the time you take to post here.

[doubletrouble 0]

In the book I received prior to banding did mention 25% failure rate. But they did not mention why. But hey 75% did have success. I think if any of us were in that 25% we would not be on this forum.

[PhotoNut 7]

So true DoubleTrouble! :scared:

I have seen much less than that 25% failure rate, and the patients that do the worst are the least compliant. Still, the band is meant to be there forever and over a long period of time, compliance can be taught.

I know that many do not want to hear this. But I also know that it is a fact. The band will not do it all. I do not believe a bypass would do it all either. There are far too many fat people out there living with the bypass that didn't help after the initial and (in my opinion) unhealthy weightloss.

Fact is, we can sit for ten years with a shovel in our hand, but unless we start shovelling.. the whole won't get dug!

[vinesqueen 2]

P'nut, not all RNY is done where they cut away and remove the stomach or part of the intestines. Some RNY procedures are done where part of the stomach is walled off, sometimes by cutting it and sewing it back together so it maintains integrity. Also, the blood supply is left intact so the walled off bits will survive inside just fine.

Some RNY procedures are done where they cut and remove, but not all of them. If they are cut and removed then they can't really be reversed.

I wonder how many of your patients who do not lose with the band have Cushing's syndrom or Cusshing's disease, or if not some form of Cushing's, what they are calling "metabolic syndrom X."

After being banded for, what, 8 months, and not losing, I went to my PCP who didn't have a clue why I wasn't losing and suggested thyroid medication, which hasn't helped with my weight loss, but I'm not completely exhausted all the time. Since that didn't do the trick I went to see an internist who diagnosed me with Cushing's. I'm currently in the beginning stages of that battery of tests.

I know that I and many of my Turtle Tribe are doing everything we can to lose weight but we simply are not successful. We work really hard and see little or no results. I spent a month at 700 calories or less and lost a whopping 1.5 pounds that month, which was only slightly better than I've done at 1600, 1200 or 1000 calories a day.

So Dr. P., of the people you have converted to RNY from the band, how many did you send for metabolic testing before you converted them? Did it even occur to you to do metabolic testing? If not, why not? Will you consider having people tested in the future for metabolic issues,? if not, why not? I know that Cushing's is rare, with something like 15 ot 25 out of a million people, but psudo-Cushing's is a tiny bit more common.

(I'm sure that comes off sounding accusitory, which it is not, nor is it my intention to pick a fight. I understand the limitations of text, and I appoligise if it comes off with me being a jerk.)

[PhotoNut 7]

Thanks Vines. I knew that there were/are variations of RNY surgery. I have always thought that Dr. P was talking about the full cut and re-rout procedure. I guess I'm still a bit confused, though. If you cut part of the stomach and sew it together to wall off a small section from the rest, it is possible to undo this and reattach both portions for complete reversal? Has this been successfully done?

Thanks Canadian Bander! I'm going to be questioning my doc as to why he made those claims if they weren't true!