Question about maintenance, complications, and alternatives

[JoeMalik 0]

Hello Everyone,

I am seriously considering the Lap Band, and have an appointment scheduled with a physician to discuss it. I've spent some time researching the procedure, and have a couple of thoughts / questions I'd like some feedback on.

My primary concern is with the frequency of follow-up visits to the physician. I've read that monthly visits are required. I travel a lot, and having to go monthly would be burdensome. Does a Lap Band recipient need to plan on monthly doctor visits forever? Is it just for the first few months, then tapers off?

Next issue - I'm having a hard time getting a clear picture on the rate of complications. Some research suggests that an awfully high percentage of Lap Band patients end up with complications that require additional surgery to correct. However, various Internet user groups and polls of Lap Band patients tend to indicate that most people are quite happy with the Lap Band and glad they got it. This could be explained a couple of ways - 1. people feel that the Lap Band is worth getting despite the complications; or 2. complications are over-reported or over-emphasized.

It seems like a lot of people initially get a lap band, then end up having it removed and receive either a gastric sleeve procedure or gastric bypass. I'm not sure my weight and over-eating problems are quite severe enough for a gastric bypass, but I'm wondering if I should opt for a gastric sleeve. If I'm going to have surgery under general anesthesia anyway, might as well do something that's less likely to have complications, require less maintenance, and be more likely to work.

I would greatly appreciate any feedback on the above. I don't pretend to know the answers and just want to hear from people with more experience and knowledge than me.

Thanks,

Joe

[DELETE THIS ACCOUNT! 12,703]

Hi Joe,

Most of us have to go monthly for the first year after surgery then yearly after that. It is very important to keep your appointments to be successful with the band.

As far as complications, the majority of the complications are patient caused not band caused. It's unfortunate but the majority of the horror stories you read about the band are because the patient did something to sabotage their success. Here is a recent, long term study showing that band complications by no fault of the patient are only 5%.

http://www.futurity.org/health-medicine/weight-stays-off-long-after-lap-band-surgery/

Patient compliance is crucial for success with the band. Be it going to follow up appointments or following the band eating rules, how well the patient adheres to the requirements play a huge part in whether they're successful or not with their band.

Best wishes

[B-52 7,113]

For the first six months, I had to go to my surgeon once a month....this was crucial, because it takes a few visits and a few adjustments to get the band properly adjusted to where it is functioning efficiently, and I am also in sync and adapting to a different lifestyle with the band...it took me 4 months to get it adjusted, and maybe another 2-3 until I got my new routine....

After the first six months, I went to my Surgeon once every 3 months, and now I don't have to go back for a year....

I have never had any complications with the band at all.....a little reflux, which can be normal, but again that was due to the foods I was used to eating before WLS.

We discussed other alternatives of WLS, but like you said, I only needed to loose 100lbs for my absolute "Optimum" weight...which I achieved in one year....my issue with being over weight was that I could not control my eating...I simply ate too much and needed WLS to put a end to that....I did not have the resolve to diet, tried every one under the sun...

I was once on this diet similar to Nutri-system where they gave me my pre planned meals every week....I would have it all finished in 2 days....then be back at McDonalds after that....

But for me, lap band surgery took away my ability to over eat, took away my hunger and desire for food.....I had to change to meet the bands requirements...or I could have asked for a un-fill and eat what I wanted...the choice was mine....

As far as long term maintenance, life with the band has become an every day natural thing for me....my eating habits have changed to where I do not have to think about it all the time...I eat, exercise, and do all things my "Skinny" friends do....they do it naturally, (maybe their upbringing) I do it with help from the band....

Having said that, living a regular lifestyle, my body continued to loose weight, change it's shape and composition, until it all leveled out on it's own, exactly where it should be..reached a equilibrium so to speak......my Dr. says I am complete, and that there is no more weight I could possibly loose....(that would not be fat, meaning an unhealthy weight loss)

I know many people who are in the same boat as I...and most, if not all, choose to no longer come to this website for various reasons. They did as newbies.

It is my belief only, and speaking with others, that there is a high failure rate with the band because the end user has too much control over how it is used....my Dr. tells me funny stories all the time about the crazy reasons people ask not to be so restricted and want a looser unfilled band....I thought they wanted to loose weight? he says, But they want their cake and eat it too....

With something like the sleeve, it is what it is...no adjustments...you HAVE to live with it....

[labwalker 1,177]

This probably depends on the surgeon, but for mine the first four visits were within 4 to 8 eight weeks of each other. The first two were within a month.

What I would like to add is that if you are having a fill, many surgeons will NOT do a fill if you will traveling and out of town within 7 days of the fill. If there is a problem, you may end up in the emergency room at a hospital where WLS surgeons don't have a practice. That will only happen if you get stuck and it doesn't clear up; or if you end up being dehydrated and needing IV intervention.

Discuss all of this with your doctor's office to work up a follow plan that meets your schedule and his requirements.

[Baba Wawa 543]

My primary concern is with the frequency of follow-up visits to the physician. I've read that monthly visits are required. I travel a lot, and having to go monthly would be burdensome. Does a Lap Band recipient need to plan on monthly doctor visits forever? Is it just for the first few months, then tapers off?

With Lapband, aftercare is frequent and essential. A minimum of 4 visits to the bariatric surgeon the first year is pretty average and some require more frequent check-ups. If, for instance you get a fill, it's a bit too much, you need to go back to get some removed...if your surgeon is close by, no big deal. Many wls patients travel long distances for surgery and follow up care, so this can be a problem. After the first year, my doctor expects to see his patients for fills and an annual check of the band.

Next issue - I'm having a hard time getting a clear picture on the rate of complications. Some research suggests that an awfully high percentage of Lap Band patients end up with complications that require additional surgery to correct. However, various Internet user groups and polls of Lap Band patients tend to indicate that most people are quite happy with the Lap Band and glad they got it. This could be explained a couple of ways - 1. people feel that the Lap Band is worth getting despite the complications; or 2. complications are over-reported or over-emphasized.

Allergan's own site, cites a 25% removal rate. There is a trend within the bariatric community of growing concern over the impact of banding on the esophagus. In speaking to my doctor the other day about my esophageal issues, he told me he is and his affiliated hospital are considering discontinuing gastric banding and are recommending other procedures. He treats esophageal issues too, so is very concerned about cases like mine. If you look up "achalasia/gastric band" on sites such as Medscape, or just google it. Many of the studies that support gastric banding are old or limited in size. Like any other medical device, it can fail. I know my band is responsible for my situation and I was absolutely compliant. I'm having my band removed in June.

If you decide to do a band, get an esophageal manometry test. This test can detect asympyomatic esophagus issues that the band can aggravate causing debilitating and truly miserable problems.

It seems like a lot of people initially get a lap band, then end up having it removed and receive either a gastric sleeve procedure or gastric bypass. I'm not sure my weight and over-eating problems are quite severe enough for a gastric bypass, but I'm wondering if I should opt for a gastric sleeve. If I'm going to have surgery under general anesthesia anyway, might as well do something that's less likely to have complications, require less maintenance, and be more likely to work.

The problem with bands is that you could suffer damage, making a revision to another surgery more difficult if not impossible. One thing that is clear to me, knowing what I know today, is I would opt for a vsg. One surgery, yes it's irreversible, yes the intitial recovery is harder and surgical risk is a bit more, but once you get thru that, you're done.

My advice is to research every surgery, talk to doctors who do bands, sleeves and DS. Get the pros and cons and be open to hearing "negative nellies" and their message. The "rules" around banding are constantly evolving and vary from surgeon to surgeon...how can you be sure you are compliant when the guidelines you are to follow vary so much. Yes, there is a lot of room for patient non compliance, there is as much room for surgical practices to vary in their perception of what compliance is. Best of luck to you.

BTW, I've lost almost 100 lb....70 from the band (emptied a year ago) and almost 30 from band-induced achalasia. The 28th is my 3rd bandiversary, but sadly I won't be celebrating my weight loss, but I will be hoping to regain some esophageal function after my band is removed.

[Lapbandster 496]

Msmaui:

Did I read correctly that allergens own website states that 25% of patients get their band removed??

If that was the case then why would the FDA approve this? And why would insurance cover it?

Can u post the link to where you saw this?

[A New New Dawn 1,695]

Msmaui:

Did I read correctly that allergens own website states that 25% of patients get their band removed??

If that was the case then why would the FDA approve this? And why would insurance cover it?

Can u post the link to where you saw this?

Yes, could you please share that link? I have never heard 25% of patients get their band removed and I cannot find that on their site. I would like to read further if that is the case, if not, we should clear that up as to not scare people considering the band as it does work well for many people.

[m1aman 944]

Yes maui please provide that link.

[Baba Wawa 543]

Unfortunately, this information is contained in the Bariatric Professionals portion of the website, which now requires a password and access code provided by Allergan. Much of the website has been rewritten, again, and as usual, intended to cover their a**. I've posted the link before. I'll see if I have the information pasted somewhere.

[Baba Wawa 543]

http://www.sutterpacific.org/bariatrics/conditions/lap-band-complications.html

This is the copy I was referring to. It's published here by a Bariatrics practice in San Francisco.

[Baba Wawa 543]

Yes' date=' could you please share that link? I have never heard 25% of patients get their band removed and I cannot find that on their site. I would like to read further if that is the case, if not, we should clear that up as to not scare people considering the band as it does work well for many people.[/quote']

The information was part of the study Allergan used to get FDA approval to sell the devices in the US. Notice that it now states that 11% experience esophageal dysmotility. This % was not mentioned when I was researching. This disorder occurs in the general population in 1:100,000, no where near 11:100. That's .00001% vs 11%.

[☠carolinagirl☠ 18,721]

for the newbies reading this:

any wls has risks

complications can happen with any surgery

if you have a great doctor, they normally go over all of this

for the most success, patients must change what they eat and exercise

wls is not a miracle and shouldnt be seen as such. ...it takes work

it wont stop people from eating...(unless those who keep their bands sooo tight they cant swallow spit)....what a horrible way to live...

i wont throw .00000% or 1 in 200 or % of whatever fancy smancy

or post stuff you find on the world wide web

i am a simple country girl with common sense

but what i will say,

do your best and get whatever surgery you want and make your life better

any questions of complications or removal...ASK YOUR DOCTOR

you will find many opinions on this forum

and my opinion is my band saved my life

and that is all i care about

and unc basketball

[☠carolinagirl☠ 18,721]

http://www.sutterpac...plications.html

This is the copy I was referring to. It's published here by a Bariatrics practice in San Francisco.

may i add, any lap band surgeon or other wls surgeons have these complications links on their sites....things happen......its major surgery...

[DELETE THIS ACCOUNT! 12,703]

The majority of complications requiring band removal are the patient's fault, not the band's fault.

Here are actual facts- a long term study showing not only is the band effective for weight loss but only 5% of bands are removed by no fault of the patient (not 25%)

"There were no deaths associated with the surgery or with any later operations that were needed in about half of the patients. About one in 20 patients had the band removed during the study period."

http://www.futurity.org/health-medicine/weight-stays-off-long-after-lap-band-surgery/

[Banjo257 920]

Joe,

Take my physicians advise, don't ask any medical questions from anyone orger than a wlsurgeon. Especially don't form your decisions based on what you read on this site. What should be a social, support group has become a soapbox venue for know it alls, bullies, and narsiscists

My doc is dead set against me being on this site. I only come on to visit a handful of PALS I've made.

Good luck to you, and again, only take what I said with a grain of salt, I am not a surgeon.