Considering Lapband and have concerns

[finallythin@34 0]

I'm trying to decide between lapband and gastric. My concern is erosion and slipage. I'd like to know how many people suffer from either of these. I have to pay cash for my surgery so I want to make the most educated decision I possibly can.

Also, does anyone who had the lapband regret it and wish they would have had the gastric instead?

Another concern I have is that I live 150 miles from the doctor so I'd like to know about how many times I will need to make the trip for a fill.

Finally, is their less chance of weight gain with lapband then gastric in the long run?

Thanks for the advice and info in advance.

[WASaBubbleButt 41]

National stats for erosion are less than 1%. National stats for slips are around 3%. You'll want to ask your doc what HIS individual stats are. He likely has no or 1 erosion and the slips should be under 2%. Mexico has lower erosion/slips than the US but they are 10 years more experienced than docs are here. Experience means everything in the world. DON'T to go to ANYONE with less than 250 bands minimum. Personally, I wouldn't go to anyone that has done less than 500 bands. They haven't even been doing them long enough to HAVE valid stats.

Weight loss for bypass vs. band is within 1%. So virtually, there is no difference.

Bypass is dangerous, banding is not. Not in comparison.

[socalgal3 4]

I was self-pay and experienced a slip. I still do not regret having my band. I have lost a good amount of weight even though I haven't reached my goal. The upside is that even when I haven't been at my best regarding eating and exercising, I have at least maintained my weight-not gained. As far as fills, that is a very personal thing. Some people are very successful with little or no fill. Some need to be filled and unfilled numerous times to achieve proper restriction. Also, it depends on your band size. 10cc bands require more fills before good restriction is found. There are many threads here about Band vs. Bypass. Do a search and read everyone's reasons and that may help. Good luck with your decision and welcome to LBT!!

[fabfatgrl 10]

Honestly, if you live that far from a doctor, I would really be concerned how realistic the Lap-Band is for you. 99% of people need fills for their Band to work... some as many as five or more during the first year. Can you see yourself driving back and forth that often?? If you're interested in a restrictive, non-malabsorptive operation, you might want to check out the Vertical Sleeve Gastrectomy. Check out vsgfaq.com or ObesityHelp's VSG board for more. Weight loss is comparable to the Duodenal Switch so far, but without the nutritional issues. And no fills needed.

I guess for me there is such a difference between malabsorptive and restrictive-only operations... that I'm always surprised when a person is willing to consider either one. Usually people who want restrictive-only operations do not want to deal with the issues related to malabsorption. People who want malabsorptive operations usually hope that the malabsorption issues are managable and worth the potential additional weight loss.. .although, honestly I see tons of RNYers looking for revisions after 3-5 years. The only malabsorptive operations I don't see that with as much are Duodenal Switch people (who have to be much more vigilant with Vitamins and such) and MGBers.

[WASaBubbleButt 41]

I live 220 miles from my doc and I don't mind. I trusted him with my life for surgery, I trust him for my fills. We have several bandsters in my city that go to Mexico for fills and we just ride together and make a day of it. We have fun.

The real key is if you trust your surgeon. If you really like and trust him, go to him for fills.

[WASaBubbleButt 41]

I have to add something else here....

I disagree with suggesting a very invasive procedure that carries a great deal more surgical risk, is nonreversible and only for convenience? Nawww, I disagree.

[fabfatgrl 10]

I have to add something else here....

I disagree with suggesting a very invasive procedure that carries a great deal more surgical risk, is nonreversible and only for convenience? Nawww, I disagree.

WasaBubble Butt, you're a newly Banded person... 5 months, 6? Still on your Band honeymoon. I admire your love of the Band and total support for it. BUT, no surgery is right for everybody. Everybody is different. She's willing to consider a bypass, which is at least as invasive as a VSG... although in my mind, more, as not only is the stomach stapled, but the intestines are re-routed.

Secondly, you need to get your facts right. It does not carry a "great deal more surgical risk." Is there more surgical risk? Yes, but the risk of death is only 0.25%. I believe the Lap-Band has a comparable risk. (And yes, I was around in the days when people thought nobody would die during Lap-Band surgery... yet I remember clearly when the council woman from Detroit did die.) Remember, the VSG was originally conceived as an initial procedure for super morbidly obese for whom regular WLS was too risky.

With that slight increased risk, you have better weight loss... better hunger control (initially... due to the removal of the portion of the stomach that produces ghrelin)... as well as not having to worry about fills or finding your sweet spot, so to speak. For some those risks are worth it.

The negative is that yes, once that portion of your stomach is removed--it is gone for good. But unlike with a RNY, you do not have a blind stomach to worry about.

And BTW, yes, the Lap-Band is reversable through surgery... although many will tell you that removing all of the fill will achieve the same result. As somebody who has done that, I can tell you that although it seems like I am back to normal 90% of the time, I still deal with PBing and sliming on occasion. Even with no fill.

Here is a good study on the VSG vs. Lap-Band. I'd also check out www.lapsf.com for more info.

Obes Surg. 2006 Nov;16(11):1450-6. Links

A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years.

BACKGROUND: Laparoscopic adjustable gastric banding (GB) is the most popular restrictive procedure for obesity in Europe. Isolated sleeve gastrectomy (SG), is less common, but more invasive and with a higher learning curve. The aim of this prospective randomized study was to compare the results of GB and SG after 1 and 3 years of surgery. METHODS: 80 patient candidates for laparoscopic restrictive surgery were operated consecutively and randomly, between January and December 31, 2002, by GB (7M, 33F) or by SG (9M, 31F) (NS). Median age was 36 (20-61) for GB versus 40 (22-65) for SG (NS). Median BMI was 37 (30-47) for GB versus 39 (30-53) for SG (NS). After 1 and 3 years: weight loss, feeling of hunger, sweet eating, gastroesophageal reflux disease (GERD), complications and re-operations were recorded in both groups. RESULTS: Median weight loss after 1 year was 14 kg (-5 to +38) for GB and 26 kg (0 to 46) for SG (P<0.0001); and after 3 years was 17 kg (0 to 40) for GB and 29.5 kg (1 to 48) for SG (P<0.0001). Median decrease in BMI after 1 year was 15.5 kg/m 2 (5 to 39) after GB and 25 kg/m(2) (0 to 45) after SG (P<0.0001); and after 3 years was 18 kg/m(2) (0 to 39) after GB and 27.5 kg/m 2 (0 to 48) after SG (P=0.0004). Median %EWL at 1 year was 41.4% (-11.8 to +130.5) after GB and 57.7% (0 to 125.5) after SG (P=0.0004); and at 3 years was 48% (0 to 124.8) after GB and 66% (-3.1 to +152.4) after SG (P=0.0025). Loss of feeling of hunger after 1 year was registered in 42.5% of patients with GB and in 75% of patients with SG (P=0.003); and after 3 years in 2.9% of patients with GB and 46.7% of patients with SG (P<0.0001). Loss of craving for sweets after 1 year was achieved in 35% of patients with GB and 50% of patients with SG (NS); and after 3 years in 2.9% of patients with GB and 23% of patients with SG (NS). GERD appeared de novo after 1 year in 8.8% of patients with GB and 21.8% of patients with SG (NS); and after 3 years in 20.5% of patients with GB and 3.1% of patients with SG (NS). Postoperative complications requiring re-operation were necessary for 2 patients after SG. Late complications requiring re-operation after GB included 3 pouch dilations treated by band removal in 2 and 1 laparoscopic conversion to Roux-en-Y gastric bypass (RYGBP), 1 gastric erosion treated by conversion to RYGBP, and 3 disconnections of the system treated by reconnection. Inefficacy affected 2 patients after GB, treated by conversion into RYGBP and 2 patients after SG treated by conversion to duodenal switch. CONCLUSION: Weight loss and loss of feeling of hunger after 1 year and 3 years are better after SG than GB. GERD is more frequent at 1 year after SG and at 3 years after GB. The number of re-operations is important in both groups, but the severity of complications appears higher in SG.

PMID: 17132410 [PubMed - indexed for MEDLINE]

I'll add, as somebody who has been banded for over 6 years, I can tell you, that if it's not convenient for you to get fills, your Band will not work... your weight loss will not be optimal... and you will end up looking at revisions. Fills are everything for the Band.

I was one of the first Bandsters in the States--banded a few days before it received FDA approval (but in Mexico). I've been around a long time. Trust me on this. Or just go to any of the revision boards and talk to the Lap-Banders there. If you can't easily do the follow-up, it will not work for you period. And BTW, fills can last for life (including the expense). There's been research published that shows that the Band membrane is semi-permeable... and loses a small amount of Fluid regardless. So even once you've lost everything, there's a good chance that you'll still be getting fills.

Obes Surg. 2005 May;15(5):624-9. Links

Permeability of the silicone membrane in laparoscopic adjustable gastric bands has important clinical implications.

BACKGROUND: The single most important attribute of the laparoscopic adjustable gastric band (LAGB) is its adjustability. Having the correct volume of Fluid within the band is crucial for optimal performance. We observe a small reduction of the satiety-promoting effect with time. The characteristics and clinical relevance of volume change have not been adequately investigated. METHOD: One observer measured the saline volume within the 10-cm Lap-Band in 118 consecutive patients who fulfilled the entry criteria. The same observer had performed and recorded the previous adjustment. Initial volume, final volume and time between observations provide the data for analysis. In addition, a range of adjustable gastric bands currently available were bench-tested to assess broad applicability of findings. RESULTS: The difference between observations varied from 0.0 ml to -1.0 ml, median of -0.1 interquartile range (IQR) 0.0-0.2 ml. Two factors were associated with volume change: time in days between the observations (r = -0.55, P<0.001) and the initial volume within the band system (r = -0.50, P<0.001). These two independent factors accounted for a significant proportion of the variance observed (Cox and Snell R2 = 0.45, P<0.001). Replacement of any discrepancy appears to maintain effectiveness. All six bands showed similar saline loss when bench-tested. CONCLUSION: Adjustable gastric bands are semipermeable, leading to a small reduction in saline volume with time. Patients should be informed of this effect, attend for regular follow-up visits and seek help if the band's effectiveness appears reduced. We recommend that the volume present should be checked and readjusted at least every 6 months.

PMID: 15946451 [PubMed - indexed for MEDLINE]

The Band was the right operation for me back in 2001. I don't regret it at all. But I'm not going to recommend the Band for somebody who can't easily get fills. Every weight loss operation has an audience it will work best for. The Band is not for everybody.

[catzintj 1]

i have been banded a year and a half. i think the band is great. i have had 5 or 6 fills. i have had 2 unfills. it is not always easy to get the fill just right. better to be a little to loose than a little too tight. if too tight i vomit easily and can get acid reflux. but., i did learn how to avoid that. i dont eat close to bedtime or lie down after eating anything. i lost weight steady until now. i need to lose another 20 lbs. but im gonna have to sweat it off. i dont eat much but my body seems to have hit weight loss wall. i am between 190 and 195 for the last 5 months. you must be patient with the band. but, it works. good luck. i think if i had to do over , i would do the band again. cat

[NVgirl 2]

My doctor has been doing bands since they were approved for the US. Of band he's put in, he has had no issues of erosion and a less than 1% rate for slippage.

He told me today at my pre-op that the only erosions that his practice has seen have all been bands that were put in in Mexico. Not saying anything bad about Mexico, just passing on the info.

[WASaBubbleButt 41]

WasaBubble Butt, you're a newly Banded person... 5 months, 6? Still on your Band honeymoon. I admire your love of the Band and total support for it. BUT, no surgery is right for everybody. Everybody is different. She's willing to consider a bypass, which is at least as invasive as a VSG... although in my mind, more, as not only is the stomach stapled, but the intestines are re-routed.

Yeah, we are going to have to agree to disagree on your post. It does not take a person that has been banded for a long time to read a VARIETY of studies and research the core of each study.

A sleeve takes more OR time than a band, that is a risk. It means cutting more tissue, that is a risk. It is not reversible, that is a risk. There are many more risk potentials with a very INVASIVE procedure.

Being banded for a long time does not make one an expert. It just doesn't. You could have been banded your entire life, that does not make you an expert so why you are using that is beyond me.

You compared banding to sleeve, the original poster did not. You suggested this for sheer convenience. There is very little that is convenient about any WLS. To suggest a more invasive procedure and one with more potential risk because it isn't convenient to drive for fills is inappropriate in my personal opinion.

Further, you infer I made claims I most certainly did not. Please don't do that again. I respect your right to your opinion but that's all it is, just like the rest of us.

Cheers.

[WASaBubbleButt 41]

My doctor has been doing bands since they were approved for the US. Of band he's put in, he has had no issues of erosion and a less than 1% rate for slippage.

He told me today at my pre-op that the only erosions that his practice has seen have all been bands that were put in in Mexico. Not saying anything bad about Mexico, just passing on the info.

I think your doc might be a bit biased. Considering nobody (including the band manufacturer) even knows why erosion happens, it was misleading at best for him to even make such a comment.

Erosion stats are the same regardless of country. It occurs in less than 1% of the population.

[Morsaille 4]

My doctor has been doing bands since they were approved for the US. Of band he's put in, he has had no issues of erosion and a less than 1% rate for slippage.

He told me today at my pre-op that the only erosions that his practice has seen have all been bands that were put in in Mexico. Not saying anything bad about Mexico, just passing on the info.

I do not doubt that this is absolutely true, but if you think about it; there is a VERY GOOD REASON FOR THIS.

US bandsters go to their hometown surgeons. Mexico bandsters do not always follow up with their foreign surgeon or (like me) choose to find aftercare closer to home.

If you are self-pay, Mexico can be a very responsible option. For the price of the crappiest, assembly-line band doc in the US, you can get one of the best Mexico docs complete with aftercare. If you don't mind the travelling and do your background research, Mexico is the way to go.

To quote BB - 'cause it was great:

Erosion stats are the same regardless of country. It occurs in less than 1% of the population.

[WASaBubbleButt 41]

... assembly-line band doc in the US, ...

(off topic)

Thanks for this. This is the phrase that best describes why I went to Mexico for surgery. I was never able to come up with a term or phrase that explained my problem with US surgeons, this is it. Thank you.

[Alexandra 55]

I agree with those who say followup is KEY to success with the lapband. It may not be a big deal to have surgery three hours (or a plane ride) away, but if getting there on possibly short notice is not possible in the future then one crucial element of post-op life is missing. People without ready access to adjustments might be inclined to ask for tight fills and just "live with it," which is very likely a major risk factor for erosion.

That's why we always say it's absolutely critical to find local follow-up care before deciding to have surgery at a distance. Is three hours too far? Only you can say; you know your lifestyle and obligations. But do bear in mind that trips to the doctor are a NECESSARY part of banded life, at least for the first couple of years.

[fabfatgrl 10]

My doctor has been doing bands since they were approved for the US. Of band he's put in, he has had no issues of erosion and a less than 1% rate for slippage.

He told me today at my pre-op that the only erosions that his practice has seen have all been bands that were put in in Mexico. Not saying anything bad about Mexico, just passing on the info.

No doubt he was trained by a Mexican surgeon.. as Dr. Rumbaut had done over 3000 Bands before your doctor ever did his first, and was hired by Inamed to teach the technique to the US docs.

There are fabulous Mexican surgeons... better than any in the States... and there are those that are crap. Same goes for US surgeons. You cannot say that erosions or slips are only seen in Mexican surgeon's work.. nor can your surgeon. Just go the Complications board.