Lap Band vs VSG

[rhowell855 0]

I am scheduled for either Lap Band or VSG in two weeks, June 28,2010. At first I was leaning towards the Lap Band, however the more research I did the less appealing I found this. I noticed the various complications which may arise and they didn't seem inviting. Moreover, being a male, my abdominal fat is intramuscular versus subcutaneous and the idea of having the access port in anyway visible under the skin is not appealing in the least. Then to find out about the various complications which may occur down the road has also made me hesitant. I have seen various videos of the VSG on you tube and it looks pretty straightforward. I haven't found any long term studies regarding the VSG. I like the idea of not having to have adjustments done periodically. It appears, once the VSG is done that is it. There is no going back. So, why should I choose the VSG over the lap band? I would like to hear from those that faced this choice. Since I don't have insurance, due to pre-existing conditions, I have to pay out of my pocket and the difference between the two isn't all that much, relatively speaking, please help with some insight. Thanks

[Can.sleeved 1]

I myself was going to go the lap band route. When I began more study I found that the VSG was the only way to go. I found way to many people that had problems with the band. Also I found many people that had the band and then had it removed to get the VSG.

I am sure if you go and do a good research you will know without any doubt the VSG is your only real choice.

Blessings Russ

[Tiffykins 673]

I've had both, and can tell you that the sleeve is far superior over the band. You're right about the fills and unfills, they're expensive, inconvenient, and overall just a pain in the butt.

Here's some information for you on the most recent statistics that have been published directly from the band manufacturer. In a nutshell, 1 in 4 band patients will have another surgery to repair, replace, remove or revise with the band. The band has the lowest and slowest weight loss of any of the surgeries.

At the very bottom, you will find some links on VSG. There is one of the 5 yr studies with very promising results. Also, remember the VSG has been done for a long time as part of the duodenal switch procedure. It is the first stage, and some patients never had to go back for the 2nd procedure due to remarkable weight loss with VSG alone.

I lost 141 pounds with VSG alone in less a year. I have zero food intolerances, food doesn't get stuck, no pain from the port, overall, the sleeve is just effortless. I just passed my 1 yr post op mark, and I can tell you that I am living fabulous life. You're also correct that the sleeve is straight forward, and the long term complications are minimal.

Best wishes in your research, and if you have any specific questions, feel free to contact me.

http://www.lapband.com/en/learn_about_lapband/safety_informa tion/

Patients can experience complications after surgery. Most complications are not serious but some may require hospitalization and/or re-operation. In the United States clinical study, with 3-year follow-up reported, 88% of the 299 patients had one or more adverse events, ranging from mild, moderate, to severe. Nausea and vomiting (51%), gastroesophageal reflux (regurgitation) (34%), band slippage/pouch dilatation (24%) and stoma obstruction (stomach-band outlet blockage) (14%) were the most common post-operative complications. In the study, 25% of the patients had their band systems removed, two-thirds of which were following adverse events. Esophageal dilatation or dysmotility (poor esophageal function) occurred in 11% of patients, the long-term effects of which are currently unknown. Constipation, diarrhea and dysphagia (difficulty swallowing) occurred in 9% of the patients. In 9% of the patients, a second surgery was needed to fix a problem with the band or initial surgery. In 9% of the patients, there was an additional procedure to fix a leaking or twisted access port. The access port design has been improved. Four out of 299 patients (1.3%) had their bands erode into their stomachs. These bands needed to be removed in a second operation. Surgical techniques have evolved to reduce slippage. Surgeons with more laparoscopic experience and more experience with these procedures report fewer complications.

Adverse events that were considered to be non-serious, and which occurred in less than 1% of the patients, included: esophagitis (inflammation of the esophagus), gastritis (inflammation of the stomach), hiatal hernia (some stomach above the diaphragm), pancreatitis (inflammation of the pancreas), abdominal pain, hernia, incisional hernia, infection, redundant skin, dehydration, diarrhea (frequent semi-solid bowel movements), abnormal stools, constipation, flatulence (gas), dyspepsia (upset stomach), eructation (belching), cardiospasm (an obstruction of passage of food through the bottom of the esophagus), hematemsis (vomiting of blood), asthenia (fatigue), fever, chest pain, incision pain, contact dermatitis (rash), abnormal healing, edema (swelling), paresthesia (abnormal sensation of burning, prickly, or tingling), dysmenorrhea (difficult periods), hypochromic anemia (low oxygen carrying part of blood), band system leak, cholecystitis (gall stones), esophageal ulcer (sore), port displacement, port site pain, spleen injury, and wound infection. Be sure to ask your surgeon about these possible complications and any of these medical terms that you dont understand.

Back to Top What are the specific risks and possible complications?

Talk to your doctor about all of the following risks and complications:

• Ulceration
  
• Gastritis (irritated stomach tissue)
  
• Gastroesophageal reflux (regurgitation)
  
• Heartburn
  
• Gas bloat
  
• Dysphagia (difficulty swallowing)
  
• Dehydration
  
• Constipation
  
• Weight regain
  
• Death
  

Laparoscopic surgery has its own set of possible problems. They include:

• Spleen or liver damage (sometimes requiring spleen removal)
  
• Damage to major blood vessels
  
• Lung problems
  
• Thrombosis (blood clots)
  
• Rupture of the wound
  
• Perforation of the stomach or esophagus during surgery
  

Laparoscopic surgery is not always possible. The surgeon may need to switch to an "open" method due to some of the reasons mentioned here. This happened in about 5% of the cases in the U.S. Clinical Study.

There are also problems that can occur that are directly related to the LAP-BAND? System:

• The band can spontaneously deflate because of leakage. That leakage can come from the band, the reservoir, or the tubing that connects them.
  
• The band can slip
  
• There can be stomach slippage
  
• The stomach pouch can enlarge
  
• The stoma (stomach outlet) can be blocked
  
• The band can erode into the stomach
  

Obstruction of the stomach can be caused by:

• Food
  
• Swelling
  
• Improper placement of the band
  
• The band being over-inflated
  
• Band or stomach slippage
  
• Stomach pouch twisting
  
• Stomach pouch enlargement
  

There have been some reports that the esophagus has stretched or dilated in some patients. This could be caused by:

• Improper placement of the band
  
• The band being tightened too much
  
• Stoma obstruction
  
• Binge eating
  
• Excessive vomiting
  

Patients with a weaker esophagus may be more likely to have this problem. A weaker esophagus is one that is not good at pushing food through to your stomach. Tell your surgeon if you have difficulty swallowing. Then your surgeon can evaluate this.

Weight loss with the LAP-BAND? System is typically slower and more gradual than with some other weight loss surgeries. Tightening the band too fast or too much to try to speed up weight loss should be avoided. The stomach pouch and/or esophagus can become enlarged as a result. You need to learn how to use your band as a tool that can help you reduce the amount you eat.

Infection is possible. Also, the band can erode into the stomach. This can happen right after surgery or years later, although this rarely happens.

Complications can cause reduced weight loss. They can also cause weight gain. Other complications can result that require more surgery to remove, reposition, or replace the band.

Some patients have more nausea and vomiting than others. You should see your physician at once if vomiting persists.

Rapid weight loss may lead to symptoms of:

• Malnutrition
  
• Anemia
  
• Related complications
  

It is possible you may not lose much weight or any weight at all. You could also have complications related to obesity.

If any complications occur, you may need to stay in the hospital longer. You may also need to return to the hospital later. A number of less serious complications can also occur. These may have little effect on how long it takes you to recover from surgery.

If you have existing problems, such as diabetes, a large hiatal hernia (part of the stomach in the chest cavity), Barretts esophagus (severe, chronic inflammation of the lower esophagus), or emotional or psychological problems, you may have more complications. Your surgeon will consider how bad your symptoms are, and if you are a good candidate for the LAP-BAND? System surgery. You also have more risk of complications if you've had a surgery before in the same area. If the procedure is not done laparoscopically by an experienced surgeon, you may have more risk of complications.

Anti-inflammatory drugs that may irritate the stomach, such as aspirin and NSAIDs, should be used with caution.

Some people need folate and Vitamin B12 supplements to maintain normal homocycteine levels. Elevated homocycteine levels can increase risks to your heart and the risk of spinal birth defects.

You can develop gallstones after a rapid weight loss. This can make it necessary to remove your gallbladder.

There have been no reports of autoimmune disease with the use of the LAP-BAND? System. Autoimmune diseases and connective tissue disorders, though, have been reported after long-term implantation of other silicone devices. These problems can include systemic lupus erythematosus and scleroderma. At this time, there is no conclusive clinical evidence that supports a relationship between connective-tissue disorders and silicone implants. Long-term studies to further evaluate this possibility are still being done. You should know, though, that if autoimmune symptoms develop after the band is in place, you may need treatment. The band may also need to be removed. Talk with your surgeon about this possibility. Also, if you have symptoms of autoimmune disease now, the LAP-BAND? System may not be right for you.

Back to Top Removing the LAP-BAND? System

If the LAP-BAND? System has been placed laparoscopically, it may be possible to remove it the same way. This is an advantage of the LAP-BAND? System. However, an "open" procedure may be necessary to remove a band. In the U.S. Clinical Study, 60% of the bands that were removed were done laparoscopically. Surgeons report that after the band is removed, the stomach returns to essentially a normal state.

At this time, there are no known reasons to suggest that the band should be replaced or removed at some point unless a complication occurs or you do not lose weight. It is difficult, though, to say whether the band will stay in place for the rest of your life. It may need to be removed or replaced at some point. Removing the device requires a surgical procedure. That procedure will have all the related risks and possible complications that come with surgery. The risk of some complications, such as erosions and infection, increase with any added procedure.

LapSf Study that I swiped from MacMadame's profile

LapSF Educational presentation to FACS - includes some 2 year results

LapSF Two Year Study

LapSF Five Year Study - abstract only

LapSF Five Year Study - presentation (requires Windows to play)

Literature review on the sleeve - requires $$ to get the full text unfortunately

Sleeve best for over 50 crowd

Video of a sleeve with lots of education discussion

Video of a sleeve that is more about the operation

Ghrelin levels after RnY and sleeve

Ghrelin levels after band and sleeve

Diabetes resolution in RnY vs. Sleeve

Comparison of band to sleeve - literature review

[citygal 0]

Hi-clearly I'm on this site...so I have a bias towards the sleeve and you should take that into account. Like Tiff--I am a band to sleeve revision. I had many problems with overfills/underfills....and such bad acid reflux it effected my vocal chords. I am only 2 months out from my revision surgery....I've lost 38 pounds since my surgery date and feel 1000 times better with my band removed.

I travel on business and eat out 4-5 times a week...with my band...I had so many times in the 3 years it was in where I had to run to bathroom to throw up because something was stuck or I would start sliming. I gurgled from my throat to the point others could hear it...

One other thing...be SURE if you have the band that your doctor will do your fills. I had my surgery done in Mexico and had a dr in NYC who would do my fills...but when I moved to Philly for a new job...not a single Dr. in Philly would do a fill on a band they didn't insert...how's that for a bad surprise...

Whatever you decide to do...band or sleeve....I wish you a happy, healthy...safe experience.

Grace

[Jaffa 5]

If your self pay, the sleeve is much cheaper in the long run. Especially, if you factor in the probability of later needing or wanting to revise away from the band.

DON'T do a band if you are self pay. It isn't worth it, do the safest and most sure thing, the sleeve, and have no regrets.

[swrktp 1]

I am currently banded but considering a revision.

I have played the fill/unfill game so many times over the last year with the last one being three weeks ago that I am ready to consider a revision now.

I just can't get fills anymore as I always have to get an unfill. So it is either to loose or to tight. Last time I had an unfill it was for seven months and I gained alot of my weight back.

I still have 5cc's in a 10 cc band but I doubt I will get anymore fills. I am just tired of the fill/unfill games.

Also have had problems with being breathless alot but not sure if this is related to the band or not. I just am serious considering asking my surgeon if revision is an option.

Does anyone know if Kaiser will do revisions?

[Swiftflow 6]

There are many reasons everyone has mentioned in choosing the VSG over LapBand wheter its risk of erosion, slippage, fill issues, etc. I want to also mention the reason the VSG is much more effective--the reduction of the hunger hormone ghrelin. With the lap band you will still have to battle the full hunger feelings from ghrelin at full force. Studies with the VSG show that this hormone is reduced because the large part of the stomach producing this is removed. At 7 weeks out I don't have any hunger--granted some VSGers do still have hunger return, but the level of that hormone is going to be less and a small meal will satisfy it. I have heard of band patients that can fill the pouch and still have raving hunger because the stomach still produces ghrelin yet they can't eat more because the upper banded pouch is full. I was a person who could eat so much without feeling full before the VSG, I needed both the capacity to overeat removed and the hunger removed or greatly reduced to avoid temptations.

[mommytoethan 1]

i was banded in 2008. i did good for about a year. after my year, all my problems started. it was such a nightmare. i grew to hate my band. i was vomiting all the time, could never get my fills at that "perfect" spot, developed acid reflux, and a list of other things. after a few discussions with my doctor, we decided to remove the band and do the sleeve. my band was pretty much empty for 2 months up to my sleeve surgery. i did gain some weight back, but it wasn't a huge amount.

i had my revision surgery last week and even though i'm still on liquids for another week, i am 100% happy i did this.

i would never try to talk someone out of a specific surgery, but i would tell them my experience with the band. just do your research and pick the one you feel is best for you.

good luck!

[Oregondaisy 2,021]

All I can tell you is that living with a band is a complete nightmare . Living with the sleeve is effortless.

[sbingram12 1]

GO WITH VSG. I'm a college student, so I'm all about convenience, and the lap band fills/unfills/underfills/overfills have been HORRIBLE. I actually just called my doctor yesterday and I'm going to get a revision to the VSG. With the lap band, I was doing well in the beginning, but 6 months out, I started gaining weight again. I have PCOS, and that's what happens with PCOS, but after WLS it shouldn't happen at all. I eat correctly and exercise - I'm doing p90x right now - and since the band doesn't allow me to eat some things, I'm not getting enough nutrition because I can't get a lot of food THROUGH the band, my body is rebelling and I'm gaining weight again. Please save yourself the trouble and money and go with the VSG.

[BlackBerryJuice 349]

Thanks for the thread, exactly the information I needed. My greatgrandmother had something very similar done to treat her stomach cancer. She was never obese, but she was definitely plump before the surgery - maybe 25 lbs overweight? She couldn't eat very much right after (just 2 tbsp of oatmeal and the like per meal). She lost all her excess weight (IIRC, she had 90% of her stomach removed), but while she's thin now, she was never emaciated and she didn't seem to have any problems with Hair loss. It's been almost 2 decades now and she's capable of having moderate-size meals (bowl of Soup with a slice of bread, or some sort of Protein with a bit of grains and a small salad). Considering she was in her 70s and severely ill when this was done (many surgeons actually refused to operate - she was going into the surgery with a 10% risk of death), her recovery and subsequent lifestyle have been remarkably good. Once I connected the dots during my VSG research and realized that's basically what she had done, albeit to treat a different problem, I felt a lot less concerned about doing this.