Band, Bypass or Sleeve in 2014: Which one?

[Dr-Patient 830]

I think it's important to note that this was posted in the General Forum. Not like the OP was "trespassing" on the Lapband forum, lol.

TMF: in refuting posts that you perceive as "anti-band", you do tend to use inflammatory language. To say that the OP used "obvious deceptive assertions" implies that the OP intends to deceive. That implies dishonesty and comes across as attacking the messenger rather than the message.

Just a little friendly feedback.

Thank you, Bandarella. I didn't '"bash" ANY procedure. I simply shared info within my possession that addressed what people on ALL parts of this site ask about from time to time. And isn't that what others do?

I am not misinformed, nor do I have any agenda. I'm a WLS patient just like most of us here. My post merely presented some info from a conference of weight loss surgeons. My post mentioned all the procedures and I did not change any data. If TMF doesn't like the data, that's on him. Don't jump in my butt because of what the current science says.

I simply shared info Bariatric surgeons shared with each other. Like everyone's posts on any site, consider the info or not, but for all, (as we all say), do what's best for you.

I am an honest person, and very fair. But I am not one to deal folks who are rude, nasty, and inappropriate when they are the ones assigning intents that are nowhere present.

Edited March 4, 2014 by Dr-Patient

[2muchfun 8,927]

The creator of this forum Alex Brecher posted this a few months ago for those who want a more informed, balanced and complete study of the different WLS.

DO THE MATH

164 Studies,
161,756 Patients
Over Nearly 10 Years:
What Does This Add Up To?

BARIATRIC AND METABOLIC SURGERY IS EVEN MORE EFFECTIVE THAN PREVIOUSLY REPORTED AND GETTING SAFER!

A new meta-analysis of studies carried out between 2003 and 2012 shows higher remission rates of diabetes and high blood pressure and a lower mortality rate than previously reported. The study, published online in JAMA Surgery, is an update to a meta-analysis of studies conducted between 1990 and 2003 and published in the Journal of the American Medical Association (JAMA, Buchwald et. al.) back in October 2004.

Researchers from Washington University School of Medicine in St. Louis reviewed outcomes from nearly 162,000 patients in 164 studies (37 randomized clinical trials and 127 observational studies), over almost 10 years.

They discovered 92 percent of patients in randomized clinical trials experienced diabetes remission after surgery, slightly higher than the 86 percent remission rate found in observational studies, but significantly higher than the 76.8 percent remission rate found in the 2004 JAMA study.

Remission rates for hypertension were about 75 percent in both the randomized clinical trials and observational studies, while the remission rate in 2004 was 61.7 percent. Body Mass Index (BMI) loss five years after surgery ranged from 12 to 17 in the new study. Before surgery, patients had an average BMI of 45.62.

"With the 2004 study, we now have 22 years worth of data from over 180,000 patients and 300 studies," said study co-author J. Esteban Varela, MD, MPH, MBA, Fellow of the ASMBS. "The data continues to prove bariatric surgery is not only safe and effective in providing significant and sustainable weight loss, but is the most effective treatment today for diabetes, hypertension and an array of other diseases and conditions in people with obesity."

In the new study, 30-day mortality rate was 0.08 percent, down from the 0.3 percent reported in 2004. Complication rates ranged from 10 to 17 percent and the reoperation rate was about 7 percent. Complication and reoperation rates were not reported in the previous meta-analysis.

By procedure, gastric bypass and sleeve gastrectomy resulted in the greatest weight loss, but had a higher rate of complications and mortality than adjustable gastric banding. Gastric banding had the highest reoperation rate (12% in randomized trials), while gastric bypass had the lowest at 3 percent, followed by sleeve gastrectomy, which had a reoperation rate of 9 percent. The new meta-analysis included sleeve gastrectomy, which was not available in the 1990s. Of note, sleeve gastrectomy had comparable weight loss to that of gastric bypass at 5 years.

"This is but the latest study to validate the high degree of safety and effectiveness of bariatric surgery," said Ninh T. Nguyen, MD, FACS, President of the American Society for Metabolic and Bariatric Surgery (ASMBS) and Vice-Chair of the Department of Surgery at UC Irvine School of Medicine. "Today we are performing operations that are as safe or safer than gallbladder and hernia repair surgery."

According to the Centers of Disease Control and Prevention (CDC), more than 78 million adults were obese in 2011–2012.¹ The ASMBS estimates about 24 million people have severe or morbid obesity. Individuals with a BMI greater than 30 have a 50 to 100 percent increased risk of premature death compared to healthy weight individuals as well as an increased risk of developing more than 40 obesity-related diseases and conditions including type 2 diabetes, heart disease and cancer.^2,3

[Dr-Patient 830]

I don't want to get into a pissing match, but what TMF is saying is spot on! When you posted this what kind of response did you expect to get? You have to realize this is a shared support forum for all WLS, so when you go bashing one over the other, that's what's uncalled for and you have to expect people are going to speak up.

We're all here to support one another regardless of what surgery we chose, we ALL came from the same place, OBESITY. What works for you is great, but that doesn't mean it's the right decision for EVERYONE. You're giving newbies or those thinking about surgery a bias opionion and yes that's all it is an opinion and you know what they say about those! I'm not going to defend my surgery and/or bash other surgeries, There's no need for that, if people want to research for answers let them, let them go through this site and research the results of band vs. sleeve vs. by-pass the results are all here for everyone to see and they can make their own assumptions/decisions.

If you read my post, and not let TMF get you off track, you will see that I did not--not in any way--bash any procedure. I didn't assert any bias, and I also didn't craft the first link's slides. It was simply info from Bariatric surgeons, the actual link to their slides.

In fact, Dr. Ponce--the doctor who presented why lapband is still an option--HIS SLIDES graphically indicate that the band (Adjustable Gastric Band: AGB) is declining in use around the world. See his slides 37-41, again at Ponce.pdf" rel="external nofollow">http://asmbs.planion.com/EvalCenter/ASMBS/images/106296_6_106296_6_LAGB_still_valid_operation-Ponce.pdf .

Uh, 2MF, follow the 'AGB' golden-colored line, if that helps you.

So again, my post wasn't an 'opinion' piece; I didn't tout one surgery over another. I simply shared info.

It's sad that folks would let 2MF misconstrue the post, assign ill intent, etc., then get others in a fuss. He obviously has anger issues and is ready to rant about anything he construes as anti-band, or if he doesn't like the data. My original post was not my opinion, or my telling anyone to do this or that. It is what I said it was: info presented at an obesity conference, provided as an fyi to do with what you will.

Anyway, have a good one!

Edited March 4, 2014 by Dr-Patient

[cheryl2586 3,053]

Okay now for my two cents. Those statistics are not true. If only 1% of the patients don't lose weight out of all the thousands that have surgery then I would say that is pretty good. Secondly the Bypass and Sleeve have more complications then the band ever could from mal nutrition to paralysis. In my nursing career if you could see how many by pass patients are deathly ill and fat because of anemia then you would definitely not choose the by pass. The sleeve you are taking away 85 percent of your stomach that you can NEVER get back. The lap bands success rate does depend on the doctor and the doctors are tired of having to follow up with their patients so much that they are pushing the other two surgeries. Once anything happens with the bypass or sleeve you are screwed. You can never get back what they took away ever in life. More bypass patients get the band over their bypass because they failed to keep the weight off. We have had more successful banders on this website then unsuccessful. You can say what you want about the lapband but I can tell you from seeing it all that the bypass and sleeve are not anything I would want done with my body. My daughter in law is so sick with her sleeve she is down to 103 pounds from not being able to eat. If you want to post things to bash the band then do it in the other forums where those people will do it also. I guess the band is not for you.

[2muchfun 8,927]

In an ever increasing lower income environment for all physicians who are being squeezed by Medicare, Medicaid, Obamacare and of course Insurance companies, the phrase "follow the money" is appropriate. Lab Bands are profitable but not as profitable as other surgical techniques. Aftercare with the band can be a heavy financial burden on those physicians who don't charge an arm and leg for it.

It's understandable that patients will be steered into more profitable and of course, more effective surgeries now and in the future. The band is a complicated physical and mental procedure and more scrutiny should be applied to candidates who seek this solution.

However, it is a viable and effective tool for most who undergo GB as are the sleeve and Bypass.

tmf

[Jim1967 3,569]

Sleeve, Band, Bypass...OH MY!! Seriously can't we all just get along? Who cares about what surgery? Support me and I sure as hell will support you and I don't care what surgery you had. Questions is what you chose...is IT working for you?

[Blondiee 278]

Oh brother...

I miss the days of Vertical Sleeve Talk! The barriers need to be put back up!!!

[Skywalker 170]

There is a newer long term study underway, but the old studies and anecdotal information, along with the device mfr info, is all we have to go on.

In the bariatric surgery community, things need to change. Everybody needs to stop protecting their own position, product, ego...do the right thing. I think a little more honesty by all of the purveyors of WLS would benefit all of the "customers".

It will be interesting to see what newer studies show; unfortunately, we're here and living with it now, so we all just have to make the best decision with the data available to us.

There are some sources that are quite obviously biased in either direction (Failed Bands and www.lapband.com), so I prefer to check out WebMD, sometimes, and nih/PubMed sources if I can find them.

Dated a couple years ago, for everyone's reference, if they want some thick (but accurate) reading:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339264/

[2muchfun 8,927]

Good find skywalker. I've never seen this study.

[Recycled 2,182]

Making comparisons on forums between procedures is for lack of a better word.."Silly". As stated by others, one can only offer valid representation of their own experience, which would only be one experience. And it is only from one online forum, which doesn't take into consideration the results from the multitudes of WLS patients not using any forums. Not exactly a true representation of the majority of patients getting any particular procedure.

So while I do read forums, typically for any helpful information I might disseminate relating to my recovery and any particular issues I may be encountering........I did not actually consider any forums as my basis for choosing a particular procedure.

That being said and since I have already had my weight loss surgery, I am compelled to live with my choice. Second guessing or mulling over pointless comparisons of other procedures is completely unproductive and moot. Barring rare special considerations, this is not an "I changed my mind", or "exchange it for a different procedure" choice. I intend to make the most of opting for a surgical procedure to help me in reaching my weight loss goals.

So what is my point.......You shouldn't be using the unsubstantiated information you garner from forums as you basis or only source of information in making your choice of procedure and once you choose, your done. Make the best of what you have.

Good luck everyone with your weight loss.......

[Skywalker 170]

I agree with recycled that once you choose, you're done. What is the point of beating oneself up or second guessing, even if they did happen to make a less than optimal choice?

Forums are only personal/anecdotal data. Scientific studies, if they have any constructive use, are probably best for helping someone formulate their goals and what they want/expect out of surgery before any surgery has taken place.

[curiousone 3]

I am a newbie here as I consider which procedure I'm going to have. I want to THANK the OP--original poster "Dr-Patient" for that info!!! I found the links interesting and helpful.

Whoever this 'toomuchfun' person is, sounds like he changed his first post since I last saw it the other day. Is he is bitter about the procedure he had done? Why even bother reading about anything else if you're post-op? Maybe he has toomuchfun causing chaos with others.

Dr-P said "if interested." The link she posted first included slides that had medical reference sources, so (as someone else said, it wasn't "unsubstantiated". She wasn't giving her opinion, as she later posted.

Dr-P also gave the words for what the source was--ASMBS...that IS the official bariatric surgeons group. DUH. I Googled it and there was an Obesity Week conference in November last year. So for the doubter to say "so called" conference...?

The other link Dr-P provided WAS quite 'technical', and for sure, over my head for many slides so I understand why she didn't first include it, she was doing us a favor, but she DID pull from that link the important data for us all to see "IF INTERESTED".

From what I see and according to my doctor, the lapband IS going out of favor, around the world. That's not the OPs doing; that's the data presented and well known by many people who do these procedures and talk to us, though it is still being done, just not as much because of complications. I wanted the band at first, but I now know three people who have had it removed, so I'm unsure what to have done. Given my BMI I might do the bypass.

I have to do a lot of analytical reading for my work so I found TMFs rants so misguided. DP wasn't a "band denier". DP wasn't promoting one procedure or another. Dr-P had no agenda, if so she would have said the "bypass" was the way to go since the data showed a continued acceptance of that. It is TMF who has an obvious (vile) agenda and, imho, a not-too-well-reasoned way of reading data. Take a chill pill. DP didn't give any person opinions. She didn't recommend any procedure over another.

if you regret what you had done, oh well. but don't lash out, aggress, rant and rage for no valid reason.

Personally I appreciate the links to medical information. Maybe with the OP's username, she is a doctor (don't know, but we can ask), too and is simply providing to the community here some inside info and she gave links for us to see if we wanted to check it out. Or, simply...we could probably just ask for her to expound if necessary ("please post the additional link"), or we take whatever any of us share here and discuss it with our doctors.

It's likely some of our doctors was at that "Obesity Week" conference, so I'm glad for the info!!!!!!!!!!!!! I say thank you and feel free to share more inside info for my consideration, as I try to decide on what I want to have done because knowledge is a good thing, especially when it's from the group of doctors who do this type surgery. I thank the OP--original poster I think TMF should say he's sorry for his misplaced rant. It's posts like that that make folks not wish to visit boards.

I will determine what I will have done, but info is good...especially if it's "inside info", as the links obviously are. All the facts add up. She had no reason to attempt to deceive us. It seems that many here are aiming to be helpful, though some might seek to have 'fun' stirring up trouble.

[Bandarella 223]

Curiousone, good post! TMF seems to be very happy with his choice of WLS. Unfortunately, many who haven't suffered complications of banding are very enthusiastic in voicing their pro band position and in calling anyone of a different persuasion a brasher, denier, negative, etc.

This "least invasive", no rerouting, reversible device, is in fact none of the aforementioned. After 3 years of being banded, a year of undergoing some pretty invasive tests and having my GI anatomy permanently change by the device, I can speak to that. It's removable, but the damage it leaves behind is permanent.

Many who have trouble free bands just can't deal with the reality that at some point, they will most likely lose their precious tool! It's a devastating reality for many of us.

I ignore such people except when they cross the line of name calling or bullying.

Thanks for your post.

[☠carolinagirl☠ 18,721]

reality is losing weight and being healthy with whatever WLS has and

wishing each other all the best.....

[Skywalker 170]

Given my BMI I might do the bypass.

May I suggest the sleeve? Unless you're extremely heavy (like 600 or so) or looking for a quick diabetes reversal, I think the sleeve is able to help you drop some lbs, while being simpler/lower complication than the bypass and also not being malabsorptive--you can still keep the Vitamins from food you ingest.