Sleeve or Band??

[JCMOM 1]

Hello all,

I am going through all the insurance requirements for surgery. I had orginally opted for the lap-band but have recently started researching and leaning toward the sleeve. Does anyone have any advice on which one is better/easier? Has anyone has the band but had it reversed to the sleeve? Thanks for your help!!!

[Tiffykins 673]

Here's some of my replies to other posters that you can find in the band to sleeve revision forum on the main page. And throughout the forum as well, I post this often when people ask me about band vs. sleeve.

http://www.lapband.com/en/learn_abou...y_information/

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

I'm 13 months out from my revision. I'll answer these questions/concerns with my experience only.

1. 500 calorie a day diet...how and why? That is really low. 600-800 calories per day was my guideline. It's optimal for weight loss in the beginning, and you can increase those calories as needed when you incorporate exercise and more activity.

2. Still can't drink Water with meals. It's really not that big of a deal. It pushes the food through, and you won't have satiety. It's the same when you have a regular stomach. If you drink with your meals, you'll not stay full. It's part of the reason we can fit more food in. I currently can sip with my meals. But, I broke the habit of drinking with my meals when I had the band. I don't miss drinking with my meals.

3. New small stomach can stretch like the band pouch. It does not stretch. The swelling from surgery does relax, and your stomach becomes acclimated to accepting food again. At 13 months out, I can eat the same amount that I could eat at 6-7 months out. My surgeon believes that my stomach is at maximum capacity. There is minimal stretching unlike the band or RNY pouch. The portion of the stomach that remains is mainly muscle.

4. Can still have same reactions as band...gagging, fullness but still hungry.

If you eat too fast, or eat too much, yes you can still get the gagging, foaming, sliming. This is where you have to replace bad habits with good habits. Nothing is going to fix this when we alter our anatomy be it with a band or removing 80%+ stomach tissue.

5. Isn't the lack of Ghrelin supposed to curb appetite?

Yes, it removes, or substantially decreases the physical hunger. That doesn't mean it cures head hunger, or keep you out of the fridge if you want to eat something. Again, it's more about changing bad habits. The sleeve can only do so much. But, if you want to suck down a 3000 calorie milkshake, the sleeve won't stop you.

6. Here's a new one...just read some people have this problem...hair loss.

It happens to a lot of patients that have any type of surgery. It's just not the sleeve. Band patients lose hair as well. RNY patients lose hair. I started shedding again after my gallbladder surgery this last February.

Here's an article that explains it scientifically. There is nothing you can do to stop, but you can help the regrowth by taking hair/nail/skin supplement such as Biotin. I chose to use Folicure extra care Shampoo that I picked up from Sally's beauty supply, it's also available on the internet. It's a small side effect that is totally worth it. I lost half my hair, but it's growing back in nicely, and I'd do it all again to be wearing my size 4 jeans. A little hairloss is totally worth the results I've had.

Telogen Effluvium Hair Loss

I've had amazing results with the sleeve, and lead a very normal, fully functioning social life. I drink, eat out, party, enjoy a healthy/balanced diet, and do not obsess over food. I do not experience physical hunger at all, and am maintaining for over 2 months now with a total loss of 141lbs with the VSG alone.

Best wishes in your research.

[SCTexasGirl 0]

THANK YOU FOR THE STATS!!!!!! I think that if I knew more about the sleve 2 years ago I would have done it - not the band!

[Gracey 7]

Thanks for the information, Tiffykins! I was banded in Oct 08 and hate it.

(That is MY opinion of MY experience. I know a lot of people that have had great success with their bands. Thought I'd put that in before I get jumped!)

I was reminded again of VST and am here to look around and learn. I probably couldn't do it this year but am very seriously researching to get a revision to a sleeve.

Again, thanks! Oh, one question, do you PB with a sleeve?

[Tiffykins 673]

Thanks for the information, Tiffykins! I was banded in Oct 08 and hate it.

(That is MY opinion of MY experience. I know a lot of people that have had great success with their bands. Thought I'd put that in before I get jumped!)

I was reminded again of VST and am here to look around and learn. I probably couldn't do it this year but am very seriously researching to get a revision to a sleeve.

Again, thanks! Oh, one question, do you PB with a sleeve?

You betcha, and nopers, no pb'ing, no sliming, no puking, no icky food getting stuck.

I eat bread, meats, Pasta, rice, sushi, potatoes, tortillas, wraps, umm just anything other than scrambled eggs and pork chops. Neither of those settle well with me, I do not do any of the "band" things, but they both sit very heavy in my sleeve so I don't eat them. I don't miss them LOL

[brittu 42]

Well that's an easy question :-). I had a band that helped me lose most of my weight for two years before it slipped and I had esophageal dilation. After the slip it was terrible and I had to fight the insurance company for months before they took it out - I should have just gone to the ER and had it out in emergency surgery, it was that bad. And even when it was still working it wasn't a good life. I was bent over sliming up stuck food often enough that it made my children cry and eating out was like playing Russian Roulette.

But the sleeve is everything I thought the band would be and more. I eat anything and am full somewhere between 1/4 and 1/2 a cup. I don't have any hunger. I don't like sweet stuff any more. It's just amazing. I'm down 24 pounds in 7 weeks. My primary care doctor (who is banded) is jealous.

My local surgeon things the band will be gone within a few years. I had to pull a bunch of studies together for my insurance company and the failure statistics at 5 year out are abysmal. My guess is that a class action suit is in the works. He's thrilled with the sleeve, of all the surgeries he does he says his sleeve patients are the most satisfied.

[Gracey 7]

Brit - My band doctor doesn't even do sleeve surgery "b/c there isn't enough data on it yet." How about there's a lot of not so great data on the band, toots? Just sayin'!!!

Tif - when you mentioned bread, I almost gagged just reading the word! For some reason, I always get stuck around my parents (who live in a neighboring state). I get the "oh no, are you ok" face and I hate that they worry. I also hate knowing that 15 or so people know I had the stupid band put in and know also that I've maybe lost 30 pounds. Now every pound lost is great, don't get me wrong but still!!!

My band surgeon's staff is great and they were on the ball with paperwork to the insurance. The notion of going through all that again is just daunting. A friend from LBT (lapbandtalk) is going to begin the process of looking at revision. PBing is just the grossest, unsettling, and somewhat painful thing. Ugh!

[Mary Gordon 3]

i definitely recommend the sleeve....recovery is faster and you get better results as well. goodluck:thumbup1:

[mila1013 0]

it is very difficult to answer this question, remember you are on a sleeve board. wls is very personal. never go to a surgeon that only does one or 2 surgery types as they will sway you the way of the surgeries they perform, example rny and band. also remember that information you recieve really should be of 5+ years as before that it is really the honeymoon phase, those experiences are very different as I had no issue with the band before 6+ years. The band has excellent short term results but the worse long term complications of all wls (band, sleeve, rny, and DS) I had the band going on 8 years, got down to 125lbs, excellent results no issues whatsoever but in my 7th year it was like a snowball no matter what the surgeon or I did there was jsut no fixing it, so permanent band explantation last week. I believe the band is great for short term only there should be a time limit on it like 2 years or whatever that time limit is, the allergan rx for drs specifically states it is not a permanent implant. I am waiting insurance info for my sleeve, found out wednesday they denied me, i was expecting that, now just have to wait to see why the denied me as they would not tell me on the phone, investigationa/experimental is an oldie but goodie for bcbs, but i will appeal. keep researching and talk to both sides that have been out 5+ years, for the sleeve talking to DS patients that were stagged is a good start. So your question is not easy to answer. hope that helps....good luck in your choice it is not an easy one to make when you take everything into consideration. Mila

[latoya79 1]

I say sleeve .... i was going for the lapband too... and when i talked to my dr ... and he said that the lapband wasnt good... i came here and talked to people and changed my mind... and i lovvvvvveeeeee my sleeve wish i would have done this a longtime ago... i did my one the 1st of july and alreay down 27 lbs....i love it ....

[Gracey 7]

that's great, latoya...congrats!!!