Band in wrong place?

[rtgirl77 0]

Hi all,

I've had quite a struggle with my band. I'm 18 months out and had initially lost lots of weight (from pre and post-op diets) but gained most of it back as I added real food back. I pretty much decided to give up for about 7 months. Then recently, I realized I should give it another try. I went back and saw my surgeon's NP, enrolled in therapy and started seeing a new dietition. The first thing the NP did was order and upper GI to see where I was in terms of needing a fill or not. So, I went back two weeks later and he and the surgeon both read the films as being in good position with a small pouch and room to fill. When I got the actual dictated report by the radiologist back, the radiologist read the films totally differently.

The report said that the band was too high (on the espophagus at the gastric junction) instead of being on the gastric fundus. It states "there is no demonstrable gastric pouch". The conclusion at the end was "High lap band placement at the gastric-esophageal junction with no gastric pouch". when I discussed it with the NP, he said that he'd have it re-read by the surgeon but that sometimes the radiologist isn't completely sure about where the band should actually BE placed. So, he thinks its fine.

I'm a little freaked out though because the problem with my band has always been that I don't get full but that food feels like its getting stuck. Even when I'm a perfect little bandster and don't drink with meals, I don't get full on 4 oz of Protein (I have to cut it into very tiny pieces to get it down), 1/2 cup veggies and a little starch. The NP said that there is evidence that if the pouch is TOO small and there isn't enough stomach above the band that contains stretch receptors, the brain won't get the appropriate signals to turn off the hunger.

Should I ask to go back to the Or and get it placed a little further down? I keep telling myself that I trust my surgeon 100% and also the NP and I believe that they truly want what is best for me so I think they'd be honest if it were something that needed to be addressed but what if the position of the band is causing it not to be as effective? Any ideas?

[Kat817 19]

Is there any way of getting your films, so they can be read by an uninvolved Dr.? I have heard of bands being placed to high or too low, but I have no idea what the effects of the misplaced bands would be. Maybe just ASKING for copies of the report and the films, would make them sit up and take notice, if it does indeed need to be reset.

Let us know what the surgeon says when he looks at them again. I hope you get satisfaction from them.

Kat

[desertmom 297]

My band is placed exactly the same and my surgeon didnt want to fix it.One of the side effects for me is severe reflux.I dont have a pouch.The way I eat is slow and I feel every bite go through the band.It does however stop me from eating exactly the same amount as before the band but I have never lost a single pound in 2 years without having to be on a strict calorie restricted diet.(and carb restricted)

Over weekends sometimes I just dont want to diet and I can gain 5 pounds easily without bingeing.Just eating with everyone else makes me gain weight.

As I see it (not experienced it though) other people with the band gets full (actually feels full or cant eat to much)I can eat a huge amount if I just allow the food to go through the band one bite at a time.

If you have the option and you feel up to another operation I would certainly consider a second opion....the point is a band that is too high doesnt work like it is suppose to.Long term your esophagus loses motility and it is very bad to store food in the esophagus (which will happen if you get even a slight dilatation)

Good luck and do keep us updated as to what happens...me myself,I have come to terms with the way things are and my surgeon absconded anyway...so I will just wait and see if I can diet off another 15kg and then have the band removed..or not...depending on weather it is giving me hassles or not...

[Trace Curry 1]

I wouldn't worry too much, the radiologists frequently read these films this way. Even when I know I put the band below the esophagus because I saw it with my very own eyes, sometimes it looks like this on Xray. I stopped getting routine post op barium swallows for this very reason.

Dr. C

Cincinnati, Ohio

Got a question? Ask the doctor at www.TheBandDoctor.com

877.442.BAND

DISCLAIMER: I am not your surgeon, any comments made by me are not meant to be taken as medical advice, just general guidelines. Contact your surgeon about your specific problem!

Hi all,

I've had quite a struggle with my band. I'm 18 months out and had initially lost lots of weight (from pre and post-op diets) but gained most of it back as I added real food back. I pretty much decided to give up for about 7 months. Then recently, I realized I should give it another try. I went back and saw my surgeon's NP, enrolled in therapy and started seeing a new dietition. The first thing the NP did was order and upper GI to see where I was in terms of needing a fill or not. So, I went back two weeks later and he and the surgeon both read the films as being in good position with a small pouch and room to fill. When I got the actual dictated report by the radiologist back, the radiologist read the films totally differently.

The report said that the band was too high (on the espophagus at the gastric junction) instead of being on the gastric fundus. It states "there is no demonstrable gastric pouch". The conclusion at the end was "High lap band placement at the gastric-esophageal junction with no gastric pouch". when I discussed it with the NP, he said that he'd have it re-read by the surgeon but that sometimes the radiologist isn't completely sure about where the band should actually BE placed. So, he thinks its fine.

I'm a little freaked out though because the problem with my band has always been that I don't get full but that food feels like its getting stuck. Even when I'm a perfect little bandster and don't drink with meals, I don't get full on 4 oz of Protein (I have to cut it into very tiny pieces to get it down), 1/2 cup veggies and a little starch. The NP said that there is evidence that if the pouch is TOO small and there isn't enough stomach above the band that contains stretch receptors, the brain won't get the appropriate signals to turn off the hunger.

Should I ask to go back to the Or and get it placed a little further down? I keep telling myself that I trust my surgeon 100% and also the NP and I believe that they truly want what is best for me so I think they'd be honest if it were something that needed to be addressed but what if the position of the band is causing it not to be as effective? Any ideas?

[rtgirl77 0]

Thank you everyone for your responses. Dr. C, its great to know that its not unheard of for the radiologist to be wrong. I had my surgery done out of town and any revisions would be out-of-pocket so I'm really not too keen on needing another surgery.

Desertmom, I have really bad reflux too and I've been unfilled for that reason but that seemed to make things worse. I'm hoping for a fill on the 28th. I had an appt this coming up week but the NP insisted I wait for the surgeon to be in the office so that we can really go over the issue in detail.

Thanks again everyone for the responses~I feel a little better about things now!

[mypov 0]

I may be having a barium swallow in the next few weeks. To avoid a two hour drive, I asked my nurse practitioner if I could just have the local hospital do it and send the results. She told me that no, they want it done at their hospital so the doctor can actually look at it himself right then. She went on to say that they don't trust ANYone without lapband specific knowledge to read the xray's and tell them what is or is not wrong with the band. She said they have never had any success with that.

I would definitely believe your surgeon over the radiologist. Or get a 2nd opinion from another lapband surgeon.

I hope you are able to get restriction and start losing again!! Good luck!!

[DrHekier 0]

I wouldn't worry too much, the radiologists frequently read these films this way. Even when I know I put the band below the esophagus because I saw it with my very own eyes, sometimes it looks like this on Xray. I stopped getting routine post op barium swallows for this very reason.

Dr. C

Ok, I'm biased because (a) I'm also a Band surgeon and ( I'm a Dr C fan (even thought I've never met him!) but I have to agree. And I also agree with the post by 'mypov.'

A radiologist without a signficant amount of experience reading films on Lap Band patients may read a film in a way that is confusing to the surgeon who actually placed the Band in the first place.

[dinobo2 1]

I just went to my doctor (new doc not the one who did the band) today and she refused to do a fill and said it could be dangerous because the band is too high.

[Bandarella 223]

@DrHekier@Trace Curry

I recently received my surgical report from my band removal. The removing surgeon stated that the band was found 2-3 cm above the GEJ rather than 2-3 cm below. There was a thick "rind" of scar tissue under the band and the band was covered in a remarkable amount of adhesions.

I had my band about 2.5 years, had two fills of 2.5, .5 and two unfills of 1.0 and a complete unfill after which my symptoms accelerated in scope and severity. My esophagus is severely dilated, despite being completely compliant with eating instructions and diet and being on a soft/liquid diet for 9 months following unfilling the band. It wasn't until my manometry results of 0% motility that it was recommended to remove my band.

At band placement I had a hiatal hernia repair using pledgeted sutures. The band appears to have been placed just below the diaphragm. Is it possible that my band moved there or in your opinion was it placed there? I'm not interested in this for any legal recourse....I just need to figure out how this happened. Over the 2.5 years I experienced severe vomiting 3 times. I had a stomach virus at 18 months out, then had GB removed two weeks later. Appx 6 months prior to removal I had influenza A, then 2 weeks later, Influenza B. In both cases I had a fever causing prolonged and violent vomiting. Could this have caused the band to slip up over the GEJ and have this much scar tissue and adhesions???