Sleeve or band?

[Lmcagain 2]

Which one? I was thinking band but a friend is having hers removed in favor of the sleeve. Now I'm questioning which is best. Hopefully I'll get some good answers when I have my first consult. That isn't until March 18 though.

[2muchfun 8,927]

This is a loaded question and few here want to go down this path so don't expect a large body of comments.

Both are good choices. We banders will tell you we didn't want to have 80% of our stomachs removed which is a legit concern eh?

Sleevers don't want a foreign object in their body.

The most recent studies show there are slightly higher rates of complications with the band.

The band is much less forgiving than the sleeve. That means if you don't follow the rules your band could slip or erode into your body.

You can lose weight with either one but if you feel like you can't control your hunger cravings the band could be a problem just like your friend experienced?

Here's a very large study on many patients over many years and not just one from 15 years ago.

http://www.bariatricpal.com/topic/291785-new-jama-surgery-study-shows-weight-loss-surgery-is-getting-safer-and-more-effective/

[LI Lady 64]

Just keep doing research on both. I was torn between which to have, but eventually decided on the band.

When you have your consult, have a list of questions/concerns prepared to discuss with the doctor. That is what I did. Think about the pros and cons of each with your current lifestyle. What are your long term goals and what are your expectations short and long term from the surgery.

Good luck!!

[kimk1999 450]

It's definitely a touchy subject - almost like politics or abortion or some other controversy (hehe).

For me - I debated between the two as well. My surgeon offers both. The initial seminar discussed both. I read as much as I could on both to be comfortable with my decision. Part of my deciding factors

For the band (at least what's important to me and the deciding factors):

*Fully absorb all nutrients. I hope to get pregnant after losing the weight so this was a big one for me.

*If / when I get pregnant - I can have it fills removed if necessary if I need to eat more for nutrients / sickness etc.

*It's reversible - if it doesn't work out, if you have problems, etc, you can have it removed

*It's adjustable - if you are still gaining, you can have a fill to make it tighter to help you lose. If it's too tight, you can have it loosened. It's customizable to what you need/want.

*I can always go to the sleeve or gastric bypass if this doesn't work out, but my options are limited once I have the sleeve.

*I didn't like the idea of a permanent removal of part of my stomach.

*You have more followups with your surgeon. For me, I felt that leads to better accountability and more 'hands' on attention.

I'm not sure if the sleeve will give you 'stuck' feelings due to a tight band. Some people like that it's done right out of surgery and they don't have to wait on fills. I think the sleeve you loose faster initially so you'll hit your goal faster, but getting it faster (IMO) is that you'll have more loose skin as the body couldn't keep up. I like the slower aspect, but it can be frustrating as well. Oh - one (of many) cons about the band, is that if you lose a lot of weight and become really skinny, your port may show. You could have surgery to move it to be below the muscle from what I've read. There's also low profile ports, but I think it'll still show up as a bump. That's one of my biggest concerns for when I get to my full goal weight.

Good luck. Do lots of research. In the end, you need to figure out what works for you.

[kimk1999 450]

Oh yeah - one other thing to keep in mind - and you should do this research ...

Look at failure rates / failure complications for each one. Use your mind filters as they can be scary but there are serious potential risks for both. Keep in mind the failure potentials/complaints of WW, nutrisystem, etc. There's lots of people that will complain about everything. It's just important to remember about the erosion from the band or slippage that 2muchfun mentioned. I don't think it happens that often and you just need to pay attention to warning signs but it's important to know when you're doing your research.

[Bandarella 223]

I can't recommend one or the other but here are my thoughts:

Advice for those researching Lapband:

Ask what your doctor's experience is with removing lap bands. How long can I expect to keep my band before it needs to be removed? (Bands are being removed anywhere between 2 years out and onwards. I personally know of only 3 people who have had their bands 5+ years and one of those is on band #2.)

What long term negative effects have your patients experienced with Lapband? Lapband is a high pressure system. The band creates a great deal of pressure on the lower esophageal sphincter. The esophagus, in attempting to move food into the pouch, puts tremendous pressure on the LES, as well. Over time this causes damage and the sphincter fails to open. This creates a feeling of being "stuck" but your food hasn't even made it to the pouch. This situation is becoming more and more common in the banded population and causes permanent long term damage that cannot be reversed. This is what is called "difficulty swallowing" on the disclosure. It's actually band induced achalasia. Often on the various wls forums or social media groups, people will speak of random tightness, difficulty with swallowing yogurt, liquids, etc, regurgitation of meals despite cutting their food, chewing thouroghly and eating only 1/2 cup meals.

What's your practice's re operation %?

(Re operation following Lapband is upwards of 50%) any claims of lower % might mean your doctors patients are seeking help elsewhere when problems arise.

How many of your Lapband patients have reached goal weight? (Average EW loss is in the 40-60% range...if you have 100 lb to lose, you can expect to lose 40-60 lb.)

What do you consider compliance?

-attendance at support meetings?

-weighing, measuring, logging food intake?

-adherence to a particular diet?

-steady weight loss?

-monthly, quarterly, bi-annual or annual band check ups?

-what is the protocol for fills?

(Many doctors consider failure to lose 1-2 lb per week noncompliance despite their patients claiming to adhere to a strict protocol.)

I hear a lot about certain complications such as: achalasia, gastroparesis, adhesions of stomach to liver, erosion, band slips, band tightening without a recent fill. What's your experience with these issues. (More and more banded patients are experiencing these complications starting as early as 1 year post op and as long as 9-10 years out.)

Will you band someone with autoimmune disorders? (This is a mixed bag...my personal experience is that having a foreign object in my body exacerbated my IBS)

Do you screen for contraindications using EGD, esophageal manometry and upper GI? (These tests should be done to evaluate your ability to tolerate banding)

If I have a hiatal hernia, what procedure do you use to repair it? What type of sutures do you use? (Nissen fundoplication and pledgeted sutures are never used in conjunction with bariatric surgery to repair existing hiatal hernia).

As a final warning, recently there have been increasing reports of cardiac issues following banding...irregular heartbeat, arrhythmias, palpitations, etc. The heart and the esophagus lie sued by side in the chest. The vagus nerve(controls heart rate, breathing and GI tract) is also in the same area. Food retained in the esophagus puts pressure on the nerve and heart. This is not good.

I'm posting this because although I lost over 100 lb while I had my band, I now have permanent esophageal damage, cardiac problems and I'm on additional medications to manage the complications caused by my band. I was compliant with diet and lifestyle changes. Part of the problem was that my hiatal hernia was repaired using a nissen fundoplication and pledgeted sutures. Also, upon removing my band it was found to be placed very high on the stomach. I didn't have esophageal manometry testing prior to my band placement. (My band doctor was recently named as one of Seattle's Best Bariatric Surgeons for 2013.) 3 years later I had 0% motility when tested. I never had swallowing problems before banding. I still have difficulty with many foods.

Bands are a money maker for doctors who are still implanting them. They get paid to put them in, fill them, empty them and remove them, then revise their patients. Many reputable medical institutions will no longer implant a band and many who still do, consider it a short term device and remove within 2-3 years then revise to gastric sleeve before permanent damage is done.

I thought the band was least invasive. I have 15 incisions on my belly I didn't have when I started this. 3 surgeries, dozens of diagnostic, invasive tests, $150,000 later and I don't have a WL tool. I have a cardiac condition I didn't have, esophageal dilation and achalasia + 3 new meds costing me $150/month out of pocket.

Do your research and be open to hearing the "negative" along with the positive...it might save you from years of suffering.

[Bandista 7,466]

I did not consider anything other than the band -- I knew it was right for me. I knew I did not want anything irreversible and I didn't want part of my stomach removed as I could never get that back. But that's just me. Know that whatever you do you are choosing yourself and your healthy future and that is very powerful. Best wishes to you!

[valarie kk 103]

I never considered anything else either. I know I have plenty of weight to lose, but not so much I wanted my stomach cut out. I like the the band is adjustable and reversible if need be. The lap band fits my personal individual needs. I don't think there is a right or wrong choice. Just the choice that is right for you.

[☠carolinagirl☠ 18,721]

which ever WLS you get, best of luck