re banding after eroded

[DeLarla 22]

My band was removed due to erosion, and I'd NEVER consider another band after my real experience. I had the band about 18 months and had it removed about 4 months ago. I 100% definitely still feel a pouch and some sort of restriction. I don't think it's safe for anyone to reconsider a second band (after erosion) at this point because there aren't enough long-term studies to date of people who eroded and were rebanded.

I'm using simple common sense based on my own reasoning. While most of the scars I've accumulated on my skin throughout life have healed to a bare fade, I have a few marks that have raised skin, red, thick hard "kiloid" scars. If the outside skin can form hard scars, then what's happening with the scars on the inside of my stomach (from the perforations that were surgically repaired during band removal?) Will my belly ever heal and go back to normal, or will I be the lucky one who always has a ghost-pouch to help keep my eating in check? OR, will my internal scarring become worse one day and block my ability to eat? Who the heck knows at this point?

The miracle (for me) is that I'm down 5 solid pounds since having my band removed. THAT'S A MIRACLE! Part of the reason is because I won't give up the fight, but my pouch prevents me from overeating. Go figure. Just like when I was banded, there are certain days when I can eat barrels, while other days I can't eat till late afternoon. I actually threw away ice cream after eating only 3/4 of the carton because it was too uncomfortable.

Another eroded friend started saving for a new band as her old one was being removed last year. Now she's decided against a new band for similar reasons as me - her stomach doesn't feel "normal" and she's not sure if it ever will.

You can't consider a 2nd band until you know the extent of the damage from the first one, and since there's no way of knowing that, I'd never recommend band life after erosion. If I ever see 300 again, I'll most likely look into a gastric bypass.

[PhotoNut 7]

*laughs* GeezerSue, what does any of that have to do with MY opinions about Dr. Pleatman? Nothing at all. I clearly stated that it was MY opinion. I don't think anyone's in danger of the doctor thinking I was speaking for anyone them. But thanks for clarifying the motivation for your post.

[cashley 0]

Tracey:

Sorry to hear about your trouble. There have been several publications on this topic. Probably the most up-to-date recommendation would be to have a gastric bypass. It can be done laparoscopically, and patients are satisfied afterwards. Though some surgeons are willing to reband, I myself would refuse to reband a patient after erosion.

Mark Pleatman MD

www.laparoscopy.com/pleatman

This nor his other post appear to be advertising... he has interesting opinions and for one I'm glad he's here.

[DrPleatman 3]

Photonut:

You can only call it advertising if my goal is to get you to come to me for the revision. There are a number of LBT members who have emailed me privately and I have always tried to steer them to someone close to them. I will admit that the more bariatric surgery I do, the more I prefer gastric bypass. There, I've said it. I have an opinion. I still do Lapbands and try to help patients who've had them placed by others. That doesn't mean I think all bands should be removed... only the ones that aren't doing what they are supposed to do. Think of your operation as an investment like a stock. If you buy a stock and it goes down, you don't ride it to the bottom. You aren't married to it. You decide it isn't working for you and sell.

That's all I'm trying to say here. If the tool isn't working for you, by all means do whatever you can to make it work, but if it continues to fail, you aren't married to it. Move on to something else.

As far as adding a Lapband to a failed bypass is concerned, that's a completely different issue. There still isn't a whole lot of data out there on it. The rationale is to restore restriction in the face of a dilated anastomosis between the pouch and small bowel. "rebypass" isn't an option (though you can redo the procedure depending on what has gone wrong). That's a completely different issue from rebanding a previously banded patient. Rebanding is certainly an option, but so is bypass, and we know it works.

Mark Pleatman MD

[mini_me 3]

I am glad PhotoNut is here.

I am glad Dr. Pleatman is here.

I am glad GeezerSue is here.

I am glad Delarla is here.

I am glad Cashley is here.

I am also glad that we do not share the exact same opinions on everything. Things would be a bit boring around here if we were all the same.

Just for the record, PhotoNut has provided me with a great deal of information on this band I have in my belly. Thanks PNut!

Just for the record, Dr. Pleatman has never made me feel, in reading his posts, that he would hope to one day have me become a GB patient. I have found most of his posts helpful and informative, to the extent that I was looking for information. ((noting that I would never solicit medical instruction, just thoughts/opinions/facts from the good doc)) Thanks Doc!!

This is a great community!

[cashley 0]

Dr. Pleatman - just out of curiousity what would the cost to convert from the band to RNY for a self-pay person?

I'm asking not because I'm ready to move to that route but my doctor does't perform RNY and I would like to know that was an option if I had erosion or wasn't losing.

I've already spend $17,500 (which I think now is a bit high) I get fills for 1 year but if it doesn't work I'm glad to know there is an alternative.

[cashley 0]

I am glad PhotoNut is here.

I am glad Dr. Pleatman is here.

I am glad GeezerSue is here.

I am glad Delarla is here.

I am glad Cashley is here.

I am also glad that we do not share the exact same opinions on everything. Things would be a bit boring around here if we were all the same.

Just for the record, PhotoNut has provided me with a great deal of information on this band I have in my belly. Thanks PNut!

Just for the record, Dr. Pleatman has never made me feel, in reading his posts, that he would hope to one day have me become a GB patient. I have found most of his posts helpful and informative, to the extent that I was looking for information. ((noting that I cannot solicit advise, just thoughts/opinions/facts from the good doc)) Thanks Doc!!

This is a great community!

If we all agreed all the time it'd get boring here.

[leatha_g 4]

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[DrPleatman 3]

Leatha:

50% weight loss is considered to be success, so that alone would not be an indication for conversion; but any complication requiring REMOVAL of the band would warrant conversion to another bariatric operation, since weight regain is guaranteed after removal of the band (or reversal of any bariatric operation, for that matter).

Mark Pleatman MD

[PhotoNut 7]

Mini Me - Youre a jewel. *hugs*

Cashley - Absolutely right! It's our differences that bring out discussions. If we all thought the same, what would be the point of posting here?

Dr. Pleatman - I fully understand and agree with what you said about not being married to the band. However, because most of us here do have bands (thus the name of the site) it would be great to hear some positive input from you about the band. I rarely see you posting on threads with positive answers to band questions or concerns. To me, it seems your answer to just about every situation is to convert to a bypass. I respect your right to that opinion, I just can't figure out why you wish to portray a negative image of the band while offering the more extreme surgeries as the answers. Isn't it true that after three years, lapband and RnY patients have lost about the same amount of weight, and that RnY patients tend to put the weight back on after that initial three years? I guess, for me, waving the bypass flag as the answer to most lapband problems is a false dream. Yes, these people will lose quickly and praise the procedure, but what about the long term complications? I'm really not trying to argue or be disrespectful to you, Dr. Pleatman. I just find it almost rude to come to a place where people gather to get support about their lapbands and the only vocal doctor here consistently professes the bypass surgery to be a much better choice. But then, I guess you'd be preaching to the choir if you were posting on a bypass board.

On last thing..

... but any complication requiring REMOVAL of the band would warrant conversion to another bariatric operation, since weight regain is guaranteed after removal of the band (or reversal of any bariatric operation, for that matter).

Um, have you met the people here who have had their bands removed that are still doing well?? DeLarla, Penni, and all the others who may struggle with a few pounds but by no means have they completely lost it. Why do you say this is guaranteed?

Note: This is my opinion. It is not meant to represent any other person here, nor is it meant to run Dr. Pleatman away - so he doesn't need defending. He is a professional who is very capable of answering questions directed to him.

By the way, I know someone who eroded and was rebanded a year and a half ago. They are doing exceptionally well with their new band and are almost to their goal weight. There are indeed people who choose to reband and do very well.

[DeLarla 22]

"Think of your operation as an investment like a stock. If you buy a stock and it goes down, you don't ride it to the bottom. You aren't married to it. You decide it isn't working for you and sell."

I was impressed with this statement and think it should run across the top of this site like a stock ticker, but Pleatman, what data suggests guaranteed regain after reversal of any bariatric operation? I realize it's only been 4 months since removal, but I'm down 5 pounds since removal, and I think that kind of negative statement might implant itself in my subconscious and play head games with me. Like tomorrow maybe donuts are going to be okay because I have that guarantee of regain. That statement is depressing; is it backed up by proof?

[Dody 0]

Dr. Pleatman,

I appreciate all opinions I hear here on the lap band forum, but I have a very serious issue with the promotion of bypass for "everyone". I have been informed in a telephone interview with a surgeon at Vanderbilt Hospital (among the leading hospitals in the nation I think you would agree) that gastric bypass is NOT for everyone. With the risk factors I have from my5-way heart bypass surgery they would not consider it until I tried banding. Now this comes from experts, who feel the risks of gastric bypass are definitely much higher than the risks of banding which are fairly easily reversible and problems are usually able to be managed. Now, if a facility with the name of Vanderbilt tells me that at 64 I am only given the option of lap banding at this point (which is truly what I want anyway) I have to give creedence to their opinion that the gastric bypass is a dangerous proceedure. You said "Medicare would not pay for it if it was dangerous", but Medicare's stand is lap banding first for anyone over 60. There are extreme conditions like weights in the 700 lb range that constitute gastric bypass as a must to save a life, but for people 100 lbs. overweight lap banding is the preferred method, and yes I spoke to the people at Medicare to clarify this too. Medicare has also opted on behalf of Medicare patients to see that they are exclusively banded at Center Of Excellence Hospitals. At first this threw a kink in my plans as my banding was going to be at a smaller hospital in Tennessee, but after thinking it over, and after being referred to Vanderbilt (which will be a 3 hour drive) I understand Medicare's stand on this. They want people on Medicare at a hospital that provides the very best of everything and the very best in both gastric bypass and lap banding (which doesn't include doctor's that have done perhaps 100 lap band or gastric bypass procedures) but experts in the field of both. They are also fully staffed for people who have had heart bypass as I have where the smaller hospitals are not. I have found out Center Of Excellence for lap banding patients means that the credentials for lap banding are excellent, and not just the overall hospital.

This being said, the surgeons at the Bariatric Center at Vanderbilt confer on each and every patient and there are hundreds a week, and have come to the conclusion that lap banding is the way to go first if possible. They don't think you should ever take drastic measures until you have given banding a try and move on from that direction. To jump right into gastric bypass is a huge shock physically and emotionally and they don't feel you are ever ready for that huge life change to start with. Therefore, the top surgeons in the world are on the bandwagon for lap-banding. I don't know where you qualify hospital or dr. wise as far as being an expert, but I do know and have studied Vanderbilt and am thoroughly impressed and very grateful that they have accepted me. I am not the every day run-of-the-mill case I agree, not with my medical history, but I am a very good candidate for lap banding in their opinion.

I thank you for your opinions but do feel that being biased is not a good thing. There are those of us for which gastric bypass is not the answer. There is also a lot more psychological investigation that should be given to this huge lifestyle change and not just a simple talk with a psychologist.

That being said I welcome you as a member of this board, but I know in my heart and mind that these surgeons, among the best qualified in the world, do know what is best for me.

Thank you for your time and opinions, but they aren't for everyone. You are hearing from people on here for whom the band is working wonderfully and from those that for whatever reason have had problems. Naturally, if people are having success with the band they are very happy with it and not very happy with your touting of gastric bypass. I think the lap banding patients have made their choice, and if medical reasons down the road change that choice they are well informed on their own as to what the next step should be. I do, however, agree that re-banding should not be an option, but I also don't believe a failed gastric bypass patient should be allowed to convert to lap banding if they fail down the road at gastric bypass. Apples and oranges...I don't think so!!

I have personally left out the Mexican doctors in this thread because they will operate on anyone that shows up with money and do any surgery. Like it or not you that went to Mexico know you didn't need sleep studies or any of the requirements in the states for your surgery. Perhaps that is why without an upper GI a lot of you suffered esophageal problems. I wouldn't be banded in Mexico on someone else's dime. They have a huge erosion rate and they don't even require a diet beforehand to shrink the liver. It has to make you wonder if that may not be one reason for erosion...the liver is too big to get the band high enough on the stomach. I think there are lots more erosions from Mexico because the surgery is but a plane ride and a walk in the part for $10,000. That's just my 2 cents for what it is worth. I would rather jump (or step gingerly) through the hoops to have an excellent surgeon in the U.S.

[HeatherGurl 0]

At this point in time, almost 5 months out and down 60 pounds, I would be re-banded after erosion, IF and ONLY IF~my Dr. would advise so. If my Dr. said yes, then I would. I do not ever want to be without my band. If for some reason that isn't an option, than I will diet and exercise my ass off for the rest of my life.

Bypass is not for me!

[Dody 0]

If your band slips and doesn't fix itself (sometimes it will with an unfill and liquid diet) it is fine to be rebanded. I'm talking about people with deep erosions that have damaged the stomach walls. That is where the people at Vanderbilt say they would not reband, because there is much too much damage and danger of infection. You don't get to choose rebanding, your dr. has to think you are ready for it. If you have gone 6 or 8 mo. and an endoscopy shows complete healing it might be an option. It's one I would have to think about, but I would definitely want it before Gastric Bypass Surgery. I also think if you are not going to reband, you should not be converting failed GB patients to the band...makes no sense to me. Good Luck.

[paula 4]

I think LBT should start a Surgeons Q & A forum. I hate the thought of asking this question on Tracey Anderson's post - but its the place where our good house Doc may surface.

Dr. Pleatman,

If a patient has band removal due to erosion (or esophageal issues - as Leatha mentioned), would the GBP be able to be performed at the same time as removal? (I guess it would depend on the severity of the erosion??)

Also, could you give us some links to info about the Gastric Sleeve.

One more...

Would (or Could) the GS be classified as a GBP for insurance to cover the procedure?