Lap band erosion

[DrWatkins 5]

And also, the symptoms of an erosion are simply weight regain because you have no restriction.

Erosions don't typically cause any other symptom.

[mbz 0]

I had no symptoms of erosion except for no restriction, and therefore, weight re-gain. My removal was an emergency...I would think all erosions would be, due to the chance of leakage into the abdominal cavity, which is deadly. The insurance company should COVER this!!!! I would FIGHT on that one. I never even considered another band, as I was afraid this would happen to me again. My surgeon did not recommend it, either. I had to heal for over 6 months before they would even consider me for another surgery. My band was over 1/2 eroded in my stomach.

[DonHoll1 0]

Doc. Thanks for all the info. Very helpful. I asked on another thread what erosion was and last time I checked no one answered, so I was really glad to see this. Donna

[WASaBubbleButt 41]

Sometimes insurance will pay for it to be taken out because it is emergency surgery. You might check.....

Yep, I was just going to suggest this. I believe Alexandra explained that if it is an emergency situation your insurance HAS to pay for it.

I am a bit concerned that you are waiting until Jan/Feb to have it removed. One of the problems is that stomach acid can leak out into your internal organs and colon. This can cause a severe problem including infection, sepsis, etc.

What if you were to find a good Mexican surgeon to remove your band, would that be cheaper? I can't believe it would be more than $5K but I could be wrong. It's actually easier to place a band and less OR time vs. removing a band and the scar tissue around it. Also, your band surgeon should be working on this with you. They don't have to, but many of them will give significant discounts for another surgical procedure on people they banded.

Another thought, if you want to be rebanded you would need to remember that if you erode once, you are more likely to erode again. Have you considered a sleeve? Depending on where the erosion is, maybe they could remove the band and do a sleeve instead?

I am very sorry you have to go through all this. But do keep in mind one possibility. If you can get insurance to pay for the removal, that will cover all your OR time, anesthesiologist, labs, etc. If you were to convert to a sleeve procedure at the same time you'd only have to pay the difference between what insurance pays and what was charged. Might only cost you a couple thousand at that point? It's worth looking into assuming you can have a different procedure at the same time as the removal.

Please let us know if there is anything at all we can do for you.

[WASaBubbleButt 41]

And also, the symptoms of an erosion are simply weight regain because you have no restriction.

Erosions don't typically cause any other symptom.

Depending on the severity of the erosion, is it possible to do a sleeve at the same time of band removal? Could the necrotic tissue be removed and changed to a sleeve?

[Oregondaisy 2,021]

Very good questions. WasA. I worry so much about this since the symptoms are basically the same as not having a good fill.

I would almost at some point be willing to get the sleeve instead of keeping the band. I worry about how long we can keep bands long term.

[DrWatkins 5]

Fortunately erosions are rare.

The downside to rare stuff is that we don't have a lot of experience.

We had 2 erosions at our Seattle clinic (out of 2,500 patients) that presented with weight regain. (We had a third patient with an odd presentation that may or may not have been an erosion - we never had a scope beforehand to determine).

Most of what I know about erosions comes from my Australian colleagues. In their experience, erosions present with weight regain because the restriction is gone. They do not describe peritonitis although it could theoretically happen. Typically, at least on the outside of the stomach, there is scar tissue associated with the band and it would be tough for gastric contents to leak through this.

I've known surgeons who diagnose an "early" erosion, i.e. they only see a small amount of white plastic during a scope of the stomach and the patient continues to lose weight so they simply observe the patient over time (i.e. not an emergency).

Certainly every patient is different and in human medicine, anything is possible. Generally speaking, erosions are not at risk for peritonitis and can be treated electively (not emergently). There have been patients where the entire band eroded inside the stomach and it was removed by endoscopy (a scope of the stomach instead of surgery).

All that to say,

Erosions are rare.

Erosions are typically not an emergency.

The treatment is to remove the band and replace later (3-6 months)

Also, it is unlikely that a sleeve operation could be done at the same time as removing an eroded band due to scar tissue and inflammation.

Hope that helps,

brad

[Oregondaisy 2,021]

Thank you. I feel very lucky that we have you posting on here now.

Do you really think that we can keep the band in indefinitely, like a knee replacement or something? I really worry since the band really hasn't been around all that long. I know I am a worrier.

[DrWatkins 5]

Denise822,

My opinion is that gastric bands have been proven to be a powerful weight loss tool long-term and their adjustability is key. The sleeve is fairly new and non-adjustable and more radical of a surgery.

Surgeons are opinionated but I would never feel good about cutting out the majority of the stomach and throwing it in the waste bucket forever when you can have normal anatomy with the band with good long-term results. Certainly erosions are rare enough that I would worry more about the unknown and more radical aspects of the sleeve.

There are many surgeons who would disagree with the above but I try to view surgery on other people like I would if the patient were me.

Hope that helps

brad

[DrWatkins 5]

Denise822,

Since the band is a device, it is possible that it may need revisions long-term. They design it to outlast a human life so the intent of the manufacturers is for it to last longer than any of us.

A saw a patient in the emergency room one evening who had one of the original Swedish bands. Her doctors could fill it but they couldn't get any saline out. As they tried to flush it out, they kept putting more and more saline in her band. When I saw her, she wasn't even keeping saliva down.

In the operating room, I simply took the old band out and put in an 2007 model (Allergan band at the time). It was a very simple operation and she sent me a very nice note after she recovered from surgery.

Also, there are lots of patients out there with those old original bands that are doing fine.

I think bands are very durable and very simple to make perfect should anything go wrong. It has a wonderful safety profile.

Hope that helps

brad

[WASaBubbleButt 41]

Dr. W...

Question about surgery. Why is it with a bypass pouch they staple of the extra stomach and keep it yet with a sleeve they remove the 80% of stomach. Is there a reason for saving it in a bypass patient and not saving it for a sleeve patient?

[DrWatkins 5]

Good question.

Some surgeons (rarely) remove the rest of the stomach with gastric bypass. Most leave the rest of the stomach to hang out and do nothing forever. I guess the main reason is that it would add a lot more to the surgery for no reason, no gain.

With the sleeve, the goal is to turn the stomach into a very small sleeve so you are removing most of the stomach and leaving the sleeve. In this operation leaving the remainder of the stomach inside to just hang out and do nothing forever is not really an option because you're turning the whole thing into a small tube. The small tube makes you full and not hungry. The thing that I don't like about the sleeve is that it is not adjustable, not proven long-term and there are less-invasive options with proven long-term success (banding). There are differing opinions on this. Some surgeons are very excited about the sleeve operation and recommend it highly.

hope that helps

brad

[WASaBubbleButt 41]

Good question.

Some surgeons (rarely) remove the rest of the stomach with gastric bypass. Most leave the rest of the stomach to hang out and do nothing forever. I guess the main reason is that it would add a lot more to the surgery for no reason, no gain.

With the sleeve, the goal is to turn the stomach into a very small sleeve so you are removing most of the stomach and leaving the sleeve. In this operation leaving the remainder of the stomach inside to just hang out and do nothing forever is not really an option because you're turning the whole thing into a small tube. The small tube makes you full and not hungry. The thing that I don't like about the sleeve is that it is not adjustable, not proven long-term and there are less-invasive options with proven long-term success (banding). There are differing opinions on this. Some surgeons are very excited about the sleeve operation and recommend it highly.

hope that helps

brad

How much would it really add to the bypass OR time? Wouldn't it be a matter of finishing the staple line, stuffing it in a bag and pulling it out? I guess the thing that made me question the practice is the potential lack of blood supply and the possibility of necrosis.

I have to say that as an experienced banded person if I had it all to do over again I think I would have gone with a sleeve. I have nothing against banding, and matter of fact I am pro-band. I think the whole world should be banded just to make sure nobody ever gets fat. :huggie: But for convenience sake, I'd go with a sleeve today. When I was banded I thought it was an absolute horror to get anything that was permanent. Well, now I'm sitting here scratching my head trying to think of any reason I'd ever want to be fat again. I want permanent and forever.

I've never stretched my band pouch and it seems reasonable to say if I didn't stretch that out I wouldn't have likely stretched a sleeve either.

I don't know, Inamed is hinting around that stats are climbing for slips, etc. And then I see so many posting here with infection, erosion, constant N/V, battles with their docs over fills, dilated pouch, dilated esophagus, esophagus motility isues... With a sleeve there are no fills, no port infections, no band erosions, no fills, no anything. Just get the procedure, take your B12 and go on with life. It just seems much more reasonable to me.

[Betsyjane 2]

Who knows what will work...we all have such individual experiences. I like the band..... I've had a stretched pouch, and it was no big deal. I've had GERD from too tight a band, and the solution was no big deal. Just minor stuff. Seems like one reason the complications appear so high here is that it's a support group so people who are just cruising along are less likely to post. On the other hand, I know one person with the sleeve, and she is no longer losing weight, eats a bunch more than I do at a sitting, and is starting to gain weight. Who knows.... All I know is that I was supposed to go to the gym today and talked myself out of it. My own kind of complication....

[DrWatkins 5]

How much would it really add to the bypass OR time? Wouldn't it be a matter of finishing the staple line, stuffing it in a bag and pulling it out? I guess the thing that made me question the practice is the potential lack of blood supply and the possibility of necrosis.

I have to say that as an experienced banded person if I had it all to do over again I think I would have gone with a sleeve. I have nothing against banding, and matter of fact I am pro-band. I think the whole world should be banded just to make sure nobody ever gets fat. :huggie: But for convenience sake, I'd go with a sleeve today. When I was banded I thought it was an absolute horror to get anything that was permanent. Well, now I'm sitting here scratching my head trying to think of any reason I'd ever want to be fat again. I want permanent and forever.

I've never stretched my band pouch and it seems reasonable to say if I didn't stretch that out I wouldn't have likely stretched a sleeve either.

I don't know, Inamed is hinting around that stats are climbing for slips, etc. And then I see so many posting here with infection, erosion, constant N/V, battles with their docs over fills, dilated pouch, dilated esophagus, esophagus motility isues... With a sleeve there are no fills, no port infections, no band erosions, no fills, no anything. Just get the procedure, take your B12 and go on with life. It just seems much more reasonable to me.

There are certainly some surgeons that agree with you. For me personally, I don't like the thought of having most of my stomach in the waste bucket forever. I like leaving the GI anatomy the way we were born - the band being on the outside and completely adjustable and reversible. If the sleeve is too small - you have to just deal with it. If the sleeve is too big - you have to just deal with it. There is talk of banding sleeves that stretch out over time and my thought is why not just band in the first place and have something easily adjustable for the rest of your life. We have hundreds and hundreds of band patients doing perfectly and I do think they don't post on message boards as much for some reason so one can get a false sense that all band patients have problems.

Some surgeons love the sleeve. Not for me.

Understand these are my opinions.

When surgeons have bariatric surgery they overwhelmingly choose the band and there are many reasons for this. I tend to steer away from operations that surgeons would never choose for themselves.