Erosion, The Real Facts

[Ariel Ortiz M.D. FACS 0]

Dear Friends and Colleagues:<O:p</O:p

After receiving numerous calls and email regarding the latest speculations about erosions on the boards I feel obliged to post some facts that should be of some relief and informative at the same time. There are very few reliable sources out there on Gastric Banding complications except the series that are published in the medical literature. My colleagues that post on these forums will agree that my team and I are considered one of the foremost authorities in gastric banding complications and treatments in the world and as such our intention is that our ongoing research results in a safer gastric banding procedure for everybody.

Folks, Lets start out by doing the math. Band erosions are not increasing as one would think. They have actually diminished noticeably in the past number of years. What is increasing is the number of patients having the procedure along with the ability to communicate this fact through forums such as this one. A surgeon that has performed 100 procedures may have 1% erosion, which is equivalent to 1 patient. While a surgeon with 3000 procedures under his belt will have 30 erosions, but this still represents 1%. Also the awareness of it's existence has prompted us to look for them purposely through endoscopic studies.

We now recommend that every band patient gets an upper endoscopy around 18 months after the surgery. For a surgeon to know exactly how many of his patients bands have eroded he would have to scope them all. Endoscopy is the only way to prove an erosion since some erosions are asymptomatic early on.

Erosions are unfortunate adverse reactions of gastric banding. They are also poorly understood. The term erosion has been popularized recently in the literature as one of the complications of gastric banding. It suggests the wearing out of the gastric wall, but the actual process seems to be more of a foreign body reaction where the body tries to eliminate the implant. Erosions are not new and it has been known for decades and reported in the medical literature that various materials near the stomach or intestine can slowly penetrate the wall and ultimately be eliminated through it. Implants, sutures, staples, mesh, rings, tubing, cloth and metal all have readily penetrated the gut.

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Though the actual process is not fully understood we do know the following:

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- Most bands erode from the outer edge of the implant into the stomach. Sometimes it is the tubing and not the band that penetrates the gut. This would discard the suggestion that bands that are too tight erode. (Conversely we now know that bands that are too tight actually slip more often)

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- Surgical technique is similar around the world. Most surgeons in the US and the rest of the world learned the technique from a handful of international surgeons who proctored them. In turn these surgeons have perfected the technique and the principles of band placement remain the same around the world.

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- Erosions can coexist with an infection process. Even though it would seem that the infection can start at the port and then ultimately cause an erosion, our recent studies have detected mircopenetrations of the stomach at the initial stages of the erosion (soon to be published data) then most likely stomach bacteria tract down though the tubing to the port and contaminate it. Again these ongoing studies will shed new light on the process and hopefully someday will totally eliminate the risk of gastric penetration.

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- Erosion is not selective of one band or another. Sooner or later every brand of gastric band has been reported to erode.

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- Latin bands do not erode more frequently. For one the implant used comes exactly from the same company and are made of the exact same materials. Contrary to a controversial post recently published in a forum, responsible surgeons performing gastric banding in Mexico have a comprehensive follow-up protocol. Fluoroscopy and Endoscopy is routinely performed which means that we detect the erosions more efficiently and earlier when present.

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- When an erosion is detected the band should removed. This gives the stomach time to heal and in given time receive a new band. It is the patient's responsibility to tell the doctor of his or her symptoms. The sooner it is detected the better the chances of performing a laparoscopic and uneventful surgery with a quick recovery.

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- We also stress the importance of follow-up. Most erosions have no symptoms early on, so a routine checkup with your doctor is always the best option.

NO NEED TO PANIC, erosions are still a rare occurrence, but if present when detected and treated early on the outcome is benign in nature.

You will all agree that gastric banding has touched hundreds of thousands of lives around the world. It is the safest weight-loss procedure but unfortunately no procedure is free of complications. Even though erosion rate is very low, it still exists. When present it should be detected and treated promptly. The earlier it is treated the better the outcome. In some cases patients have actually received a second band after a brief period of recovery and thus having the benefit of restriction and weight-loss again.

The only source of reliable medical advice is your doctor. Other sources of information only lead to speculation, anxiety and worst of all delay in treatment if needed. If you are to go out of the country for surgery, select a responsible surgeon that offers follow-up. Ask if he will always be available (my patients can reach me in a moments notice, they all have my cell#) Don't be enticed to go to the cheapest, usually they go hand in hand with poor to no follow-up. You must be able to trust the doctor you have chosen.

We as Surgeons also have our official Internet forums where we exchange knowledge with each other having only your best interests in mind. Remember, ultimately it is your success that results in our success.

My best wishes to all,<O:p</O:p

Respectfully<O:p</O:p

Ariel Ortiz Lagardere

[Nykee 13]

Thank You Doctor Ortiz!!!!!!!!

[Parvathi 2]

Thank you, Dr. Ortiz, for taking the time to post this information.

[MsButterKup23 1]

Yes, thanks for the information.

[Vera 7]

Dr. Ortiz, I would like to thank you as well but would like to point out the costs involved. Most seeking a band that don’t have insurance to pay for them seek services in Mexico like your own. You are aware of this and have made it your bussiness. If the erosion rate is 1% why don’t you reflect costs for complications and band removal? Why do these poor people have to pay for their bands and then pay to have them removed? This removal service should be under costs for follow-up service when the band is placed.

[Teresa A 0]

Thank you so much for the information. I have been worried about this after reading all the stories.

[rosemanl 0]

Unfortunately he didn't specifically address the issues regarding buckle placement which is a somewhat newer process adopted in band placement. If i remember correctly this has reduced the band erosion from 3% to 1%. He's seems to me to be a very articulate and eloquent Bull S---er.

[FunnyDuddies 6]

I am glad to see Dr. Ortiz coming here and stating these facts. Here are some thing that I still struggle with.

- Yes, the erosion rate is 1%, and the more patients you band, the more erosions will happen. But why are we seeing so many from Dr. Ortiz from one time period, and none from the other Dr.s who have done over 3000 procedures?

- If his office did not have such a larger number of patients who have eroded, there would not be such an uproar, and he would not feel the need to come here and explain this "epidemic"

- Why is it that eroded patients do not have everything covered when they erode? It seems that after patient care is extended and everything is covered right up until erosion usually occurs, but when someone erodes, they have to spend thousands to have it removed, and then thousands more to have a new band put in if they wish.

- Surgical technique is NOT the same across the board. Some stich or staple the band in placeon the stomach. Some even fold the stomach over the band to keep it in place. Some fill the band immediately to keep it in place. Some place the buckle differently. Some place the port in different areas. Each surgeon has their own way of doing this surgery. And those they teach pick up their method of doing the surgery. Is it possible that a technique that one doctor (or one doctor and his clinic of other doctors) uses a technique that is more prone to cause erosions? Who can tell. But unless the surgeon explains his exact way of doing the procedure, and it is scrutinized along side of many other doctors, we will never know the answer.

Again, I respect Dr. Ortiz for coming on here. I think there are a few points not covered, that are still on many people's minds. But the first step of making himself approachable with this is a great one. I know he has MANY happy customers, and that he is highly respected. I think rather than point fingers, we need to strip away all of the emotion and get down to brass tacks. Erosion is a worry for all of us. And we should all be interested in solving the issue of erosion as much as possible.

I'll step off my soap box now. LOL

Amy

[Dianechef 3]

You all have to remember something: Yes, we have seen a lot of people on this panel who eroded recently who were banded from Mexico. People who are banded in Mexico aren't able to attend a support group in their area for obvious reason. We use this forum as an outlet. There are many, many other eroded patients out in the world who were banded by American doctors. We don't know about them, simply because they aren't on this forum. I have to say that I 100% agree with Dr. Ortiz & his statistics. It doesn't matter where you get banded, 1% of the patients will erode. He was very nice to post on here & explain the procedure. The doctors in Mexico have been doing band surgeries longer then the American doctors & DO KNOW what they're talking about!!

Dr. Ortiz doesn't have a large numer of patients on this forum who have eroded. His statistics are no worse then any other doctor. I think you are confusing him with another doctor that was mentioned on here. Look back at the posts & you will see.

I don't think Dr. Ortiz needs to be defended at all. He is very capable of doing that for himself. However, we all just need to keep in mind that the patients on this forum come here for different reasons & the numbers reflected here are not accurate statistics for the world. He is a good, highly-respected doctor & I chose to go to him simply because I believe he is one of the best lapband doctors in the world!!

Erosions happen!!

[HarleyNana 10]

Erosion may happen to me tomorrow, if so, I will be in the minority. I agree we have to look at the over all picture, the amount of lapbands multiplies every day, so obviously complication rates will increase as well.

My $.02 worth.

[MeganA 35]

Well, I think we just found out which Mexican surgeon I'd be going to if I had to pay for the procedure. Some may disagree with some of the things he said, but at least he had the guts (no pun intended) to come on our forum and relieve some anxiety for a lot of people.

Megan

[Vera 7]

Erosion does happen!

Cost for having the band removed is the only issue I have here. I know if it were to happen to me Dr. Sanchez would not charge me. He knows things happen, even to the best doctors and takes account for them.

When I was crying on the phone to Dr. Sanchez because of my tubing leak, he instructed me to see him ASAP and he took care of me, when I had to have my band replaced he did not charge me one dime.

[DeLarla 22]

"Unfortunately he didn't specifically address the issues regarding buckle placement which is a somewhat newer process adopted in band placement. If i remember correctly this has reduced the band erosion from 3% to 1%. He's seems to me to be a very articulate and eloquent Bull S---er."

I was curious of the same thing & hope we get more answers now that there's a band doc in the house.

[babsintx3 0]

Hi Dr. Ortiz,

Thanks for stopping by to address erosion issues which are a concern to all bandsters.

I agree with Vera regarding the surgeon responsibility and ethical obligation to unband eroded patients. If they are worried about costs then I think that most bandsters would be happy to pay $100 more for their total banding as a so called insurance policy that the removal and possible installation of a new band would be covered should they erode. Any surgeon who is not willing to remove a band for a patient who they gladly took CASH from (not insurance) should cover the removal. $100 dollar x 100 patients would equal a $10,000 slush fund for someone who could not afford a removal or replacement.

In reading Dr. Ortiz's statement, he did not say that all surgical technique is the same. What he said was that most of it was "SIMILAR" for which I concur. There are a few of us here trying to become doctors! LOL If there is such a huge concern about erosion rates, then before you get a band ask the tough questions about your docs erosion rate if you are newbie and if they cant answer you to your satisfaction dont get banded by them.

Many of us here seem to be stuck on this 1% rate. This is just a ROUGH statistic. The original rate was 1-3% erosion figures which were not even reported by US docs since all that was available in June 2001 post FDA approval was information that was reported from outside the US. There are less erosions in the US, because there werent any US surgeons reporting any data and they didnt have as many patients and certainly none of tenure. As an example, my surgeon banded about 120 people prior to me being banded in June 2003 as a total number cumulative beginning in 2001 whereas now he bands 300-400 people a year, sends out surveys and has more than anecedotal information about erosions, slippages, complications etc...

As Dr. Ortiz says if a surgeon has banded 3000 people, then statiscally he would have more erosions. He would have seen at least 30 erosions if these patients received aftercare and had an endoscopy. It may seem like they are coming mostly from one doctor but maybe that one doc does not discreetly handle the problem, offer a solution etc... and thus his patients are more vocal about their erosions and subsequent mistreatment.

I know that Lisa has listed a group of bandsters including herself that have eroded. I know most of these folks too (including Lisa)! It does seem coincidental that of 20 bandsters that I met and know from the Vegas Bandsters Bash, at least 25% of them have eroded in the last couple of years. But I think that it is because all of them that I know were banded in Mexico where there WAS significantly more folks being banded from 2001-2004 and a smaller number of surgeons there doing the banding vs a larger population of surgeons in the US who are banding. Since there are probably less than a dozen well known lapbanding surgeons in Mexico, its easy to pinpoint his/her population of patients. I am absolutely sure if we were to look at the US surgeons erosion rates, they would be similar, but we would have to look at a much bigger population of surgeons.

I think it is wrong to single out one surgeon in the surgical population without some kind of proof that statistically their numbers are completely out of the normal erosion rate of the general population. But I concur with others that the surgeons should offer their patients a contingency plan to cover removal. I dont think they have a responsibility to replace a band or reinstall one later since the band manufacturer does charge for a new band. But I do think they have an ethical responsibility to remove a band that has eroded since leaving it there will cause permanent damage to the patient long term.

I consider my banding experience to date to be an extremely positive one. I have had little complications (some but nothing serious) so I can empathize with others who have lost their band, but have no clue how I would feel if I were the one with the problems, or had the debt associated with cash pay or removal. I am sure I would feel differently if it were me, but before I throw daggers, I would want to be sure that my information were accurate.

Babs in TX

334/180ish

-150 ish

6/23/03 Banded in TX by Dr. C

8/4/05 Full abdominoplasty/ medial thighplasty

[Dianechef 3]

<TABLE id=HB_Mail_Container height="100%" cellSpacing=0 cellPadding=0 width="100%" border=0 UNSELECTABLE="on"><TBODY><TR height="100%" UNSELECTABLE="on" width="100%"><TD id=HB_Focus_Element vAlign=top width="100%" background="" height=250 UNSELECTABLE="off">Delarla & everyone,

There ARE a lot of Lopez erosions on this forum. It does seem that his percentage is much higher then 1%. Not sure about why or how come. Sad...

I really want it to be clear that Dr. Ortiz is not put in the "Lots of Erosions" category. I think others were getting him confused with your doctor. I know that La Madam was an Ortiz patient & she's the only one I know of on this board. I think she would fit into the 1% of his patients which is very normal. (And she STILL sings his praise!)

Dr. Ortiz truly is a kind, caring doctor who has ALWAYS answered my phone calls & I believe is truly a great doctor. He really does give everyone his cell phone number & answers it!! I would hate for him to get a bad rap because of some misunderstandings on this board. :cry

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