My Doctor Really Pushed for RNY

[Daisalana 33]

The doctor I've decided to go with is great. He's very personable and friendly and I feel very comfortable having my surgery done with him

However.. I wanted to bring up some of what he's said that made me nervous, and honestly the only reason I'm still going for Lap-Banding is because of the success stories I've seen from all of you.

He had RNY done himself, and he told us his story. He has done thousands of RNY, and is a huge advocate of it. There were about 8 of us in this conference, and I was the only one wanting lap-banding. He kept emphasizing how, RNY is more successful, and that Lap-Band research shows only 36-38% excess fat loss. He said if he had to go back and do it again, he would do RNY again. But he would not do Lap Band. I asked him about this, and he said he doesn't feel it's as effective, and the 'dumping syndrome' is an effective tool to keep you on track. He mentioned frothing for lap band, which I assume is PB, but to me that would be just as reinforcing I think?

Anyway, he made it sound like lap-banding doesn't help you lose a lot of weight. But looking at you guys, I see proof otherwise. Does this just have to do with lack of statistics in the US? He said those numbers were released by the makers of the Lap Band. He does offer Lap Band, and did not try to talk me out of it, but he did keep emphasizing why he would rather do RNY.

At the end of it, I was the only one who said I wanted Lap Band. Others were on the fence, but from the session we had- all of them decided to go to RNY.

Any thoughts? :phanvan

[anonemouse 1]

He's not very knowledgeable about lap-banding, IMO. He's also not up on the latest research, which states that RNY and lap-banding have statistically equal weight loss between 3-10 years post-op (RNY is more successful the first couple of years). It also suggests that lap-band would be more successful than RNY more than 10 years post-op (8 year average weight loss with lap-band was statistically equal to the 10 year average weight loss with RNY), but there wasn't enough data to tell yet. To be honest, that's a red flag to me about his expertise with banding. Any time a surgeon tries very hard to convince people not to go with a certain procedure, it makes me wonder why they are doing it. I would really consider finding another surgeon if you decide to stay with getting a lap-band.

[tann 2]

One of my dr.s have the lapband on himself and he said he would not reccomend gastic bypass to anyone or do the operation on a patient. So it goes both ways. Dr. Grossbard has had great success with it himself and so have I.:biggrin1:

[Betsyjane 2]

Doctors who do mor eof one procedure than the other, tend to recommend the one they do and are best at.

The stats I've seen are that lap patients lose an average of 50% of their excess weight and keep it off. Gastic bypass people tend to lose 70% of their excess weight very quickly and regain 20% of it. Dr. S said to beat the odds and lose more, you can do it if you really work hard at it. I guess it's a psychological game as much as anything...feeling great about the weight lost and not having the burning motivation to fight for losing the more difficult other 50%.

[ReneBean 3]

If you feel your doc is less than enthusiastic about banding, you might want to try and find a doc that is positive about it. I, personally, would never have my intestines re-routed. There are just too many things that can go wrong with that - both in the immediate "getting up off the table" sense, and in the long term.

I don't want to go nuts from malnutrition. I don't want to be forced to take nasty supplements for the rest of my life cause I permanently changed the digestive system.

Now, not everybody has those problems - but enough people do have them to scare the crap outta me... and I am NOT talking about dumping!

I believe that the band can be as effective as the bypass, but it requires more work on your part. The band doesn't FORCE you do do anything (unlike the bypass) but it HELPS you to have better self control.

Also - any studies done on band patients that STILL retained their bands - even after the so-called "failure" are automatically invalid... because at any time, so long as the band is in place, you can get an adjustment and try again. The chance to do it right is there, so long as you have your band.

If YOU want an RNY - cause you want the immediate gratification of quick weightloss and you are willing to risk more dramatic complications to get it - then go for it. But if it's your DOC pushing you - then find another doc.

Hugs! Good Luck in your decision.

[WASaBubbleButt 41]

He had RNY done himself, and he told us his story. He has done thousands of RNY, and is a huge advocate of it.

Never forget, people will swear by their surgery type and their surgeon the way they swear by their religion.

When you find what works for you it is hard to assume that might not be best for everyone.

He is simply not telling the truth about banding. He is pushing for bypass. His stats are not even close.

[vonnie150 0]

I agree, you need to find another doctor who is more familiar with lap band. Just becsause a doctor is friendly and personable does not mean he is up on the latest procedures. Obviously he is bias against lap band. Also his fees would be double to triple for RNY>:phanvan

[Daisalana 33]

Well, like I said he did not in any way discourage the lap band directly, and I took it with a grain of salt that he personally had RNY and is the supporter of that. I'm sure a year after having lap band, I will tell everyone it is the end all-be all

I had my heart and mind set on lap-band once I researched it. I had thought about RNY years ago, but I was terrified of all the risks. I knew people who have had it, who are seriously ill from malnutrition, and despite massive weight loss have regretted it. So no matter what he told me of his opinion between the two, I am not swayed from my course of lap banding.

RNY is too scary for me, I did not even know lap banding existed until about 6 months ago. I did all of my online research and reading this forum and consulted with 2 doctors about it. Everything definitely steered me in a positive direction for it. Even when I read the 'horror' stories here, I keep thinking of what my real horror story would be if I don't have something done.

I did ask where he trained to do the surgery and he explained who he worked with and his whole team went up to Portland,OR. He did say RNY is not for everyone. He was very thorough with his explination of how he places the band at an angle to reduce slippage, and he does suture it in place (things I have read about, some doctors don't, etc.). The only things I did not like were his statistics, which he said he got directly from the makers of the Lap Band that he said is the only one approved by FDA in the US. Which again, I think had to do with the fact it's only been in US for 5-6 years so they don't have the good studied done on it.

And like one of you said, I read long term people are more likely to gain weight back from RNY, so I am bias, as when I talked to the other women in the room when we were waiting for our psychological appointments, I told them how I felt lap band was better because of the long term affects. I may not lose it immediately, but I don't think I'd have the likelier risk of stretching my stomach back out. Or if there's serious complications, the band can be removed, where as mutilating your intestines is hard to reverse.

Anyway..I won't be finding another doctor, and I don't mean to make it sound like he doesn't know what he's talking about, because I feel like he does. I just wanted the reassurance that the lap-band isn't set in a statistic of 36-38% weight loss.

[anonemouse 1]

I just wanted the reassurance that the lap-band isn't set in a statistic of 36-38% weight loss.

It's not. That statistic isn't anywhere near correct. I just looked at the Inamed Lap-Band brochure that I was given by my surgeon, and it states that Lap-Band weightloss is the same as RNY at five years post-op. The 36-38% statistic may be true for the first year after surgery, but it increases after that.

[GR8 1]

If you check out the Lapband Patient Book at this site:

http://www.lapbandsolutions.com/94829E_LB_Patient_Book.pdf

It has a revision date of 10/17/01 (Study is outdated) It does say:

How much weight will I lose with the

LAP-BAND System?

The average weight loss in the United States clinical

study was approximately 36-38% of excess weight, 2

and 3 years after surgery. A few people lost up to

100% of their excess weight, some did not lose any

weight, and a few got heavier.

My doctor gave me the 50% of excess weight stat. But it all depends on what WE put into it -- can be 100% of excess weight -

[WASaBubbleButt 41]

If you check out the Lapband Patient Book at this site:

http://www.lapbandsolutions.com/94829E_LB_Patient_Book.pdf

It has a revision date of 10/17/01 (Study is outdated) It does say:

How much weight will I lose with the

LAP-BAND System?

The average weight loss in the United States clinical

study was approximately 36-38% of excess weight, 2

and 3 years after surgery. A few people lost up to

100% of their excess weight, some did not lose any

weight, and a few got heavier.

My doctor gave me the 50% of excess weight stat. But it all depends on what WE put into it -- can be 100% of excess weight -

A doctor that DOES the procedure should keep up to date on the procedure he does. If he doesn't keep up with the basics it is a safe bet to say he isn't keeping up with the new surgical techniques either and THOSE are the techniques that are cutting slips and erosions down to almost nothing.

If he hasn't read the stats since 2001 then how the heck can he claim to be able to help his patients? The band was approved for use in 2001. A LOT of information has become available that this doc clearly has no clue about.

I think the OP is taking risks by going to this guy. But, she doesn't. To each their own.

[fabfatgrl 10]

The stats he is quoting is from the early days of the Band when it was just approved. I totally remember the study and the discussions it caused on the Bandster boards. This was probably 2002 or so.

I think you need to go with the operation you are comfortable with. Ask yourself, if I was to lose 50-60% of my Excess Weight, would that make a big difference in my quality of life?? The good and bad thing about the Band is its adjustability. You need to get regular fills... and may always need a bit of tweaking (due to permeability of the Band... they now recommend having your Fluid checked every 6 months during maintenance.) So, if this doc is not going to be pro-Band, and help you with your fills and such, you need to find another doc. Not one who is going to say... "Are you sure you don't want me to convert you to an RNY?"

I really think that each operation is great for different people. I think you'll get the best advice from surgeons who perform all of the operations--RNY, Lap-Band, DS, and VSG. Who don't have a stake one way or the other.

My Lap-Band doc was Dr. Rumbaut. At the time, pre-FDA approval, he'd done thousands of Bands. He has a Band himself. But he also does the RNY and says that it is a better choice for some people. I would try consulting with a pro-Band doctor as well... and see what the experience is like. And then, make your decision.

...because at any time, so long as the band is in place, you can get an adjustment and try again. The chance to do it right is there, so long as you have your band.

I need to disagree with this... being a long-term Bandster. I know quite a few people who had to have their Bands unfilled due to reflux issues. If they refill, they will have those problems again. BUT, for whatever reason, they're not willing to have their Bands removed. So... in theory that's correct, but in practice, not always.

Let's see what I can find for you that's more recent:

Surg Obes Relat Dis. 2007 Jan-Feb;3(1):42-50; discussion 50-1. Links

Comparative study between laparoscopic adjustable gastric banding and laparoscopic gastric bypass: single-institution, 5-year experience in bariatric surgery.

* Jan JC,

* Hong D,

* Bardaro SJ,

* July LV,

* Patterson EJ.

Oregon Weight Loss Surgery, LLC, Legacy Health System, Portland, Oregon 97210, USA.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) are common surgical procedures for morbid obesity. Few single-institution studies have compared LRYGB and LAGB. METHODS: All patients underwent LRYGB or LAGB at Legacy Health System. The data for the study were obtained from a prospectively maintained database. Preoperatively, most patients were allowed to choose between LRYGB and LAGB. Age, gender, body mass index, complications, mortality, and weight loss were examined. RESULTS: From October 2000 to October 2005, 492 patients underwent LRYGB and 406 patients underwent LAGB. The mean age was 44 +/- 10 and 47 +/- 11 years, respectively (P <.001). The mean preoperative body mass index was 49 +/- 8 and 51 +/- 9 kg/m(2) (P <.05). Patients undergoing LRYGB had longer operative times (134 +/- 41 min versus 68 +/- 26 min, P <.001) and longer hospital stays (2.5 +/- 3.5 d versus 1.1 +/- 1.1 d, P <.001). Blood loss was minimal in both groups. The percentage of excess weight loss was significantly better for patients who underwent LRYGB at all points of follow-up, except at 5 years. Total complications occurred in 32% of patients who underwent LRYGB and 24% of patients who underwent LAGB (P = .002). The 90-day mortality rate was .2% in both groups. The reoperation rate was the same (17%) in both groups. CONCLUSIONS: Patients undergoing LAGB had shorter operative times and shorter hospital stays compared with patients undergoing LRYGB. LAGB was associated with a lower complication rate. Early weight loss was significantly greater after LRYGB, but the data comparing long-term weight loss after LRYGB and LAGB have been inconclusive.

PMID: 17241936 [PubMed - indexed for MEDLINE]

Surg Obes Relat Dis. 2007 Mar-Apr;3(2):127-32. Epub 2007 Feb 27. Links

Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial.

* Angrisani L,

* Lorenzo M,

* Borrelli V.

S. Giovanni Bosco Hospital, Naples, Italy.

BACKGROUND: To perform a prospective, randomized comparison of laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: LAGB, using the pars flaccida technique, and standard LRYGB were performed. From January 2000 to November 2000, 51 patients (mean age 34.0 +/- 8.9 years, range 20-49) were randomly allocated to undergo either LAGB (n = 27, 5 men and 22 women, mean age 33.3 years, mean weight 120 kg, mean body mass index [bMI] 43.4 kg/m(2); percentage of excess weight loss 83.8%) or LRYGB (n = 24, 4 men and 20 women, mean age 34.7, mean weight 120 kg, mean BMI 43.8 kg/m(2), percentage of excess weight loss 83.3). Data on the operative time, complications, reoperations with hospital stay, weight, BMI, percentage of excess weight loss, and co-morbidities were collected yearly. Failure was considered a BMI of >35 at 5 years postoperatively. The data were analyzed using Student's t test and Fisher's exact test, with P <.05 considered significant. RESULTS: The mean operative time was 60 +/- 20 minutes for the LAGB group and 220 +/- 100 minutes for the LRYGB group (P <.001). One patient in the LAGB group was lost to follow-up. No patient died. Conversion to laparotomy was performed in 1 (4.2%) of 24 LRYGB patients because of a posterior leak of the gastrojejunal anastomosis. Reoperations were required in 4 (15.2%) of 26 LAGB patients, 2 because of gastric pouch dilation and 2 because of unsatisfactory weight loss. One of these patients required conversion to biliopancreatic diversion; the remaining 3 patients were on the waiting list for LRYGB. Reoperations were required in 3 (12.5%) of the 24 LRYGB patients, and each was because of a potentially lethal complication. No LAGB patient required reoperation because of an early complication. Of the 27 LAGB patients, 3 had hypertension and 1 had sleep apnea. Of the 24 LRYGB patients, 2 had hyperlipemia, 1 had hypertension, and 1 had type 2 diabetes. Five years after surgery, the diabetes, sleep apnea, and hyperlipemia had resolved. At the 5-year (range 60-66 months) follow-up visit, the LRYGB patients had significantly lower weight and BMI and a greater percentage of excess weight loss than did the LAGB patients. Weight loss failure (BMI >35 kg/m(2) at 5 yr) was observed in 9 (34.6%) of 26 LAGB patients and in 1 (4.2%) of 24 LRYGB patients (P <.001). Of the 26 patients in the LAGB group and 24 in the LRYGB group, 3 (11.5%) and 15 (62.5%) had a BMI of <30 kg/m(2), respectively (P <.001). CONCLUSION: The results of our study have shown that LRYGB results in better weight loss and a reduced number of failures compared with LAGB, despite the significantly longer operative time and life-threatening complications.

PMID: 17331805 [PubMed - in process]

Obes Surg. 2003 Jun;13(3):427-34. Links

Comment in:

Obes Surg. 2003 Dec;13(6):965.

Outcome after laparoscopic adjustable gastric banding - 8 years experience.

* Weiner R,

* Blanco-Engert R,

* Weiner S,

* Matkowitz R,

* Schaefer L,

* Pomhoff I.

Krankhenhaus Sachsenhausen, Frankfurt Center for Minimally Invasive Surgery, Section of Bariatric Surgery, Germany. rweiner@khs-ffm.de

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) has been our choice operation for morbid obesity since 1994. Despite a long list of publications about the LAGB during recent years, the evidence with regard to long-term weight loss after LAGB has been rather sparse. The outcome of the first 100 patients and the total number of 984 LAGB procedures were evaluated. METHODS: 984 consecutive patients (82.5% female) underwent LAGB. Initial body weight was 132.2 +/- 23.9 SD kg and body mass index (BMI) was 46.8 +/- 7.2 kg/m(2). Mean age was 37.9 (18-65). Retrogastric placement was performed in 577 patients up to June 1998. Thereafter, the pars flaccida to perigastric (two-step technique) was used in the following 407 patients. RESULTS: Mortality and conversion rates were 0. Follow-up of the first 100 patients has been 97% and ranges in the following years between 95% and 100% (mean 97.2%). Median follow-up of the first 100 patients who were available for follow-up was 98.9 months (8.24 years). Median follow-up of all patients was 55.5 months (range 99-1). Early complications were 1 gastric perforation after previous hiatal surgery and 1 gastric slippage (band was removed). All complications were seen during the first 100 procedures. Late complications of the first 100 cases included 17 slippages requiring reinterventions during the following years; total rate of slippage decreased later to 3.7%. Mean excess weight loss was 59.3% after 8 years, if patients with band loss are excluded. BMI dropped from 46.8 to 32.3 kg/m(2). 5 patients of the first 100 LAGB had the band removed, followed by weight gain; 3 of the 5 patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP) with successful weight loss after the redo-surgery. 14 patients were switched to a "banded" LRYGBP and 2 patients to a LRYGBP during 2001-2002. The quality of life indices were still improved in 82% of the first 100 patients. The percentages of good and excellent results were at the highest level at 2 years after LAGB (92%). CONCLUSIONS: LAGB is safe, with a lower complication rate than other bariatric operations. Reoperations can be performed laparoscopically with low morbidity and short hospitalizations. The LAGB seems to be the basic bariatric procedure, which can be switched laparoscopically to combined bariatric procedures if treatment fails. After the learning curve of the surgeon, results are markedly improved. On the basis of 8 years long-term follow-up, it is an effective procedure.

PMID: 12841906 [PubMed - indexed for MEDLINE]

[anonemouse 1]

Here's another one that just came out recently:

Systematic review of medium-term weight loss after bariatric operations.

Obes Surg. 2006; 16(8):1032-40 (ISSN: 0960-8923)

O'Brien PE; McPhail T; Chaston TB; Dixon JB

The Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, . paul.obrien@med.monash.edu.au

BACKGROUND: Although bariatric surgery is known to be effective in the short term, the durability of that effect has not been convincingly demonstrated over the medium term (> 3 years) and the long term (> 10 years). The authors studied the durability of weight loss after bariatric surgery based on a systematic review of the published literature. METHODS: All reports published up to September, 2005 were included if they were full papers in refereed journals published in English, of outcomes after Roux-en-Y gastric bypass (RYGBP), and its hybrid procedures of banded bypass (Banded RYGBP) and longlimb bypass (LL-RYGBP), biliopancreatic diversion with or without duodenal switch (BPD+/-DS) or laparoscopic adjustable gastric banding (LAGB). All reports that had at least 100 patients at commencement, and provided > or = 3 years of follow-up data were included. RESULTS: From a total of 1,703 reports extracted, 43 reports fulfilled the entry criteria (18 RYGBP; 18 LAGB; 7 BPD). Pooled data from all the bariatric operations showed effective and durable weight loss to 10 years. Mean %EWL for standard RYGBP was higher than for LAGB at years 1 and 2 (67 vs 42; 67 vs 53) but not different at 3, 4, 5, 6 or 7 years (62 vs 55; 58 vs 55; 58 vs 55; 53 vs 50; and 55 vs 51). There was 59 %EWL for LAGB at 8 years, and 52 %EWL for RYGBP at 10 years. Both the BPD+/-DS and the Banded RYGBP appeared to show better weight loss than standard RYGBP and LAGB, but with statistically significant differences present at year 5 alone. The LL-RYGBP was not associated with improved %EWL. Important limitations include lack of data on loss to follow-up, failure to identify numbers of patients measured at each data point and lack of data beyond 10 years. CONCLUSIONS: All current bariatric operations lead to major weight loss in the medium term. BPD and Banded RYGBP appear to be more effective than both RYGBP and LAGB which are equal in the medium term.

[juliegeraci 7]

Laura, lapband weight loss is slower than RNY. The stats are 30-50% of your excess weight with a year and 1 - 2 lbs per week. The bypass is much quicker. I love being banded. There is not doubt this was the right decision for me. I am down almost 50 lbs since June. So I am running at the 1+ lb per week stat. I am happy if I hit 52 lb my first year which is 1 lb a week. I have already lost the 50% at 10 months so I am happy. Best of luck to you with your decision. If he loves RNY so much how many lapbands has he done. YOu may want to go with a surgeon who has done more.

[faithmd 14]

Another question to ask is what he means by places the band at an angle to reduce slippage? The acceptable technique is the pars flaccida technique/approach. I would ask specifically if this is the approach he uses. This approach has been documented in the literature:

http://thinforlife.med.nyu.edu/asset...pdf?RCD=J53039

to be a very successful surgical technique. If he is doing something different, I would have to question how he came to doing it that way, and if it was approved by studies or Allergan. If he meant he uses the PF approach, then I kind of wonder why he'd say he places it on an angle to reduce slippage. He should have said something like he uses the approved and proven best surgical technique for placement that we have today.

It all has to boil down to if you are comfortable with him. I'd also ask him some very pointed questions and see if he squirms or dodges them. Things like:

How many LapBands have YOU personally placed?

What is YOUR rate of slippages, erosions, infections?

How many complications have you encountered? What do you do about them?

What if you get in and for some reason have to open me, will you just choose to convert me to a RNY? (If you dont want one, you need to make sure this is discussed up front, especially if he is very RNY positive.)

How many infected bands have you had? Have you had to remove any bands, and why?

Would you always choose to remove an infected band, or would you attempt to determine the severity of the infection and then perhaps just treat that aspect (antibiotics, perhaps port removal only, etc)?

Remember you are hiring him to do work on your most valuable asset, your body. You wouldn't hire a contractor to work on your house without checking him or her out fully, first. So try not to feel funny about asking these questions, it's you that you are protecting.