Alex Brecher

It's a done deal, no need for final vote.

Health Care Vote: Anti-Abortion Democrats Strike Deal with Obama, House Leadership

No, it isn't normal. We're moving over to a new platform shortly. Should resolve many issues around the site......

Have you checked your Gmail spam folder ?

Shalom and welcome to LapBandTalk.com! This is a new feature and we thank you for catching that issue. We'll get this fixed asap and everything will be "biseder"shortly Once it's fixed we'll reply to this thread.

I know everybody has these amazing conspiracy theories drawn up in their head. I really try hard to keep these forums as equal handed as possible. We've had a HUGE influx of posts coming from Mexico as well as other locations that are clearly from people that have only one purpose in mind, to ruin the reputation of another surgeon. We've also received multiple cease and desist letters regarding certain posts and members. If you're willing to pay the legal costs involved in fighting them, please PM me and I'll bring you on board. If someone had a first hand story that's been deleted and I can verify that they were a patient of the named surgeon, I'd be willing to discuss reposting to the board, if it's not on our C&D list.

Please PM me your IP address. You can find it by going to What Is My IP Address - Shows Your IP Address . I haven't received any complaints from members similar to yours regarding latency etc. I'll investigate and we'll try to get to the bottom of this. We're in midst of planning an entirely new design and layout for LBT. It should take care of the other issues you've mentioned above.

Vertical Sleeve Gastrectomy Information by Dr. Gregg Jossart Welcome to vertical sleeve talk. This forum is dedicated to providing patients with accurate and comprehensive information on the VSG procedure. This procedure is extremely appealing to many individuals considering weight loss surgery, but have been hesitant to proceed due to concerns about other, widely established procedures. If you have knowledge or questions about this topic, please participate by posting to our message board and introducing yourself. History The Vertical Sleeve Gastrectomy procedure (also called Vertical Gastrectomy, Sleeve Gastrectomy, Greater Curvature Gastrectomy, Parietal Gastrectomy, Gastric Reduction, Logitudinal Gastrectomy and even Vertical Gastroplasty) is performed by more than 50 surgeons worldwide. The procedure is titled VSG to include the two most common terms for the procedure(vertical and sleeve). The earliest forms of this procedure were conceived of by Dr. Jamieson in Australia(Long Vertical Gastroplasty, Obesity Surgery 1993)- and by Dr. Johnston in England in 1996 (Magenstrasse and Mill operation- Obesity Surgery 2003). In 1997, Dr. Gary Anthone refined the Duodenal Switch procedure to just the VSG in a patient with special indications. In 2001, Dr Gagner, in New York, offered the Laparoscopic VSG to a high risk patient who could not safely undergo a Duodenal Switch. In 2007, Dr Jossart and Dr. Cirangle in San Francisco published the largest series of over 200 patients with results comparable to other stapling procedures and superior to adjustable gastric banding. Their experience is now over 1300 patients. Several surgeons worldwide have now adopted the procedure and have offered it to low BMI and low risk patients as an alternative to laparoscopic banding of the stomach or as a safer option for higher risk, higher BMI patients. Anatomy This procedure generates weight loss through gastric restriction (reduced stomach volume) and possibly by hormonal mechanisms. The stomach is restricted by stapling and dividing it vertically and removing more than 85% of it. This part of the procedure is not reversible. The stomach that remains is shaped like a very slim banana and measures from 1-5 ounces (30-150cc), depending on the surgeon performing the procedure. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while reducing the volume. Comparison to prior Gastroplasties(stomach stapling of the 70-80s) The Vertical Gastrectomy is a significant improvement over prior gastroplasty procedures for a number of reasons: 1) Rather than creating a pouch with silastic rings or polypropylene mesh, the VSG actually resects or removes the majority of the stomach. The portion of the stomach which is removed is responsible for secreting Ghrelin, which is a hormone that is responsible for appetite and hunger. By removing this portion of the stomach rather than leaving it in-place, the level of Ghrelin is reduced to near zero, actually causing loss of or a reduction in appetite (Obesity Surgery, 15, 1024-1029, 2005). Currently, it is not known if Ghrelin levels increase again after one to two years. Patients do report that some hunger and cravings do slowly return. An excellent study by Dr. Himpens in Belgium(Obesity Surgery 2006) demonstrated that the cravings in a VSG patient 3 years after surgery are much less than in LapBand patients and this probably accounts for the superior weight loss. 2) The removed section of the stomach is actually the portion that stretches the most. The long vertical tube shaped stomach that remains is the portion least likely to expand over time and it creates significant resistance to volumes of food. Remember, resistance is greatest the smaller the diameter and the longer the channel. Not only is appetite reduced, but very small amounts of food generate early and lasting satiety(fullness). 3) Finally, by not having silastic rings or mesh wrapped around the stomach, the problems which are associated with these items are eliminated (infection, obstruction, erosion, and the need for synthetic materials). An additional discussion based on choice of procedures is below. Alternative to a Roux en Y Gastric Bypass The Vertical Gastrectomy is a reasonable alternative to a Roux en Y Gastric Bypass for a number of reasons: 1) Because there is no intestinal bypass, the risk of malabsorptive complications such as Vitamin deficiency and Protein deficiency is minimal. 2) There is no risk of marginal ulcer which occurs in over 2% of Roux en Y Gastric Bypass patients. 3) The pylorus is preserved so dumping syndrome does not occur or is minimal. 4) There is no intestinal obstruction since there is no intestinal bypass. 5) It is relatively easy to modify to an alternative procedure should weight loss be inadequate or weight regain occur. 6) The limited two year and 6 year weight loss data available to date is superior to current Banding and comparable to Gastric Bypass weight loss data(see Lee, Jossart, Cirangle Surgical Endoscopy 2007). First stage of a Duodenal Switch In 2001, Dr. Gagner performed the VSG laparoscopically in a group ofvery high BMI patients to try to reduce the overall risk of weight loss surgery. This was considered the first stage of the Duodenal Switch procedure. Once a patient's BMI goes above 60kg/m, it is increasingly difficult to safely perform a Roux-en-Y gastric bypass or a Duodenal Switch using the laparoscopic approach. Morbidly obese patients who undergo the laparoscopic approach do better overall in their recovery, while minimizing pain and wound complications, when compared to patients who undergo large, open incisions for surgery (Annals of Surgery, 234 (3): pp 279-291, 2001). In addition, the Roux-en-Y gastric bypass tends to yield inadequate weight loss for patients with a BMI greater than 55kg/m<(Annals of Surgery, 231(4): pp 524-528. The Duodenal Switch is very effective for high BMI patients but unfortunately it can also be quite risky and may be safer if done open in these patients. The solution was to stage the procedure for the high BMI patients. The VSG is a reasonable solution to this problem. It can usually be done laparoscopically even in patients weighing over 500 pounds. The stomach restriction that occurs allows these patients to lose more than 100 pounds. This dramatic weight loss allows significant improvement in health and resolution of associated medical problems such as diabetes and sleep apnea, and therefore effectively downstages a patient to a lower risk group. Once the patients BMI is lower (35-40) they can return to the operating room for the second stage of the procedure, which can either be the Duodenal Switch, Roux en-Y gastric bypass or even a Lap-Band . Current, but limited, data for this two stage approach indicate adequate weight loss and fewer complications. Vertical Gastrectomy as an only stage procedure for Low BMI patients(alternative to Lap-Band and Gastric Bypass). The Vertical Gastrectomy has proven to be quite safe and quite effective for individuals with a BMI in lower ranges. The following points are based on review of existing reports: Dr. Johnston in England, 10% of his patients did fail to achieve a BMI below 35 at 5 years and these tended to be the heavier individuals. The same ones we would expect to go through a second stage as noted above. The lower BMI patients had good weight loss (Obesity Surgery 2003). In San Francisco, Dr Lee, Jossart and Cirangle initiated this procedure for high risk and high BMI patients in 2002. The results have been very impressive. In more than 1300 patients, there were no deaths, no conversions to open and a leak rate of less than .6%. The two year weight loss results are similar to the Roux en Y Gastric Bypass and the Duodenal Switch (81-86% Excess Weight Loss). Results comparing the first 216 patients are published in Surgical Endoscopy.. Earlier results were also presented at the American College of Surgeons National Meeting at a Plenary Session in October 2004 and can be found here:shakes, etc can be absorbed and may slow weight loss. This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur. Because the stomach is removed, it is not reversible. It can be converted to almost any other weight loss procedure. Considered investigational by some surgeons and insurance companies. Technique and outcomes are still variable based on surgeons experience or inexperience. Frequently Asked Questions How big will my stomach be after surgery? The size of your stomach will vary depending on the surgeon. All surgeons use a tube to guide them when stapling the stomach. This tube size can vary from as small as 32 French Bougie(1-2 ounces) to as large as 64 French Bougie(6-8 ounces). This is a very important question to ask when considering this surgery, since those patients with larger pouches may have less weight loss. How can I select a surgeon for this relatively new procedure? The best results are usually going to correlate with surgeon experience. Any surgeon who has done more than 500 procedures for over 5 years in one location has probably optimized all elements of the operation and aftercare to obtain the best possible results. In addition, since the VSG stomach is the same as the Duodenal Switch stomach, any surgeon who has been doing duodenal switches laparoscopically is probably quite experienced with the VSG! Is removing the stomach safe? This type of stomach removal has been performed with the Duodenal Switch procedure since the mid 1980's. It does involve stapling, just like in the gastric bypass and has similar risks. Interestingly, patients do not ever return asking for their stomach back but many do wonder if it is possible to reduce the size of it again. Will I need to take Vitamins? Vitamin deficiencies are rare with this procedure because there is no intestinal bypass. However, the procedure is very restrictive so most surgeons recommend that patients take a Multivitamin, Calcium and possibly a B12 vitamin after surgery. Will I regain weight? All patients undergoing weight loss surgery are at risk for weight regain. None of the operations can prevent this. Those patients who maintain good dietary habits and exercise patterns are more likely to keep the weight off than those who do not exercise and who snack frequently. What will my diet be like after surgery? The diet will progress over the first year. It usually starts with 2-4 weeks of liquid Protein drinks and Water. Patients gradually progress to thicker food items and by two months are able to eat seafood, eggs, cheese and other regular foods. The diet generally recommended is low calorie(500 per day), high protein(70gm per day), low fat(30 gm per day) and low carbohydrates(40 gm per day). The calorie intake increases over the first year and by 12 months many patients have achieved their goal weight and consume between 900 and 1500 calories per day. This final calorie intake depends on level of activity, age and gender(men can usually consume more calories and maintain their weight).

I just posted a blog post at Differences between the Realize Band and LAP-BAND which compares the differences between the Realize Band and LAP-BAND.

Should be working now.....thanks.

See my Blog Post Differences between the Realize Band and LAP-BAND System - LAP-BAND Surgery and LAP-BAND Discussion Forum

I've been reading many posts lately from members wondering about the differences between the Realize Band and LAP-BAND System. My first suggestion to these members is to contact their surgeon and ask them to explain their level of experience with each band and what the differences are for the bands. I'd like to reiterate that both bands offer great online support programs and for more information on the differences, check out: http://www.lapband.com/get_informed/obesity_weight_loss/lapband_realizeband/ . I'd like to point out that there are two LAP-BAND sizes and two ports for the surgeon to select the best option for each patient. There seems to be some confusion and talk about the Realize Band port been slimmer—the 1mm is negligible—good marketing perhaps but definitely not something I'd base my decision on. I've also read a few posts stating there is more online support for patients with the Realize Band. Allergan provides My LAP-BAND® Journey with the FitDay™ food diary, health comorbidity trackers, appointment reminders, goal tracker, weight tracker and the LAP-BAND® friendly Recipe Box free of charge for anybody that's had the LAP-BAND procedure. I'd also like to clarify misinformation — the Realize Band being smooth vs. the LAP-BAND System pillows is not a benefit. The pillows are 3rd generation technology and were designed to eliminate crease folds that can cause leaks requiring re-operation and enhance performance. You can see a more detailed comparison at http://www.lapband.com/get_informed/obesity_weight_loss/lapband_realizeband/ or you can read about the differences below: LAP-BAND AP® System Allergan has patented the 360° OMNIFORM™ technology (soft pillow-like sections for evenly distributed pressure), which is the most advanced technology. The 7 pre-curved, pillow-like sections embrace the stomach with a natural shape for evenly distributed soft pressure, which provides band stability, reliable restriction, and the ability to personalize your adjustments to control food portion sizes for optimal weight loss. REALIZE-C Band REALIZE-C Band is 1 long tube-shaped balloon that may “kink” like a rubber hose when filled with higher levels of saline (see photo above). This “kinking” is called a crease-fold. It is possible that over time this may cause the band to leak saline, which may require an operation to replace the band.

Thanks! I updated the link. Let me know if you come across any others.

The article link has been updated to The Post-surgery Diet for Bariatric Patients: What to Expect .

We're working on the issue, thanks for letting me know about it.

LapBandTalk: Great article on "How Long Does It Take To Reprogram My Hard Drive?" by Warren L. Huberman, Ph.D. just posted at http://bit.ly/33INtj More...

LapBandTalk: Great article on "How To Stop Stress Eating At Your Desk" by Melissa McCreery, PhD, ACC just posted at http://bit.ly/bvqFx More...

Please reference http://www.lapbandtalk.com/f228/compare-lap-band-realize-band-96761/ for an in depth comparison between the LAP-BAND vs. Realize Band.

Threads merged

This thread is now open. I'd like to reiterate the LBT rules once again: LapBandTalk Forum Rules Registration to this forum is free! We do insist that you abide by the rules and policies detailed below. If you agree to the terms, please check the 'I agree' checkbox and press the 'Register' button below. If you would like to cancel the registration, click here to return to the forums index. The basic ground rules for discussions on Lap Band Talk are simple: be polite, use common sense, don't break the law and don't post any message that even hints at advertising. We don't intend to censor messages based on the opinions expressed within posts, but we will enforce the policies outlined both here and on the Forum. We reserve the right to remove, modify or move posts at our discretion and without explanation. Please contact us if you do not understand any of the rules, guidelines or policies outlined below. 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However, we may monitor content and remove it at any time and without notice. We will do this if content violates these guidelines or we believe it will improve our community. We also will suspend or terminate forum access to those individuals who violate these guidelines. If you have a concern about any post, alert the moderators by using the Report Bad Post button. It's at the top of every post (the exclamation point in the triangle)

Thank you so much for your kind and inspiring words. It's posts like yours that keep us all going!!

This needed to end, right here and now. I will not allow these personal attacks to continue on LBT. Enough is enough. I'm TEMPORALLY closing this thread. If you have an itch to post, go help a member who needs some support. Just for the record, we aren't required to provide members with "official" warnings before they're banned. When a member signs up they agree to abide by the LBT TOS. **CLEARLY** the members that were banned decided that they were above he law and didn't need to abide by these simple set of common sense rules. I took the liberty to personally ban all members involved. It's time for everyone involved to step back and take a hot shower and get some sleep. (I surely could use both.)

I'm really glad you've shown your true colors. If I was living off the so called "profits" of LBT I'd literally be on welfare right now. Do you know the actual costs of running this web site ? There's extremely redundant and load balanced hardware, bandwidth, electricity, collocation facilities, full time developers, part time graphic artists plus many other costs in running LBT. Did you know for years and years I personally laid out of my own pocket every single month for these fees and expenses without receiving a dime in compensation ? Let's not go in to how much time and effort I put in daily to make sure LBT is running smoothly without any hiccups or interruptions. Like someone mentioned previously, we have 1,292,000 posts and almost 73,000 members. I think we're doing something right. If you ever make it down to New York I'll personally open my books to you. You're invited to my office any time you'd like. I had the LAP-BAND procedure a long time ago. I felt the best way to service the Lap-BAND community was the best way I knew how and that was offering my technological and marketing expertise. That's why I launched LBT the same day I came home from the hospital after my procedure. That isn't to say that it would be a bad thing if we actually were extremely profitable one day and I was able to afford an executive LapBandTalk plane to fly around and meet our amazing members one by one.

I agree with everyone, rinse them under cold water as much as you can! They're OK, but personally I didn't find them very filling or appetizing after a few times.

I'm trying to work on the LBT peace accord behind the scenes and now I have to be busy explaining privacy policies . You've been around long enough to know that I'm usually fair and I do the right thing at the end of the day. I'm not favoring Susan over any other mod or member. HH personally sent me a message stating that he understood why he was banned. Please be more specific. What in heavens are you talking about ? Ahhhhhhhhh come on! (Yes, that's me shouting out loud in frustration.) HH was banned. He knew why he was banned. After he was banned, he signed up under multiple new aliases because he was ticked off. This is an extremely clear cut case for banning a member if I ever had to pick one. As you can see, the topic did pique my interest :biggrin:. I'm all ears......I'd still prefer PMs for specific private member or mod complaints. I play by the golden rule, treat others as you want to be treated. If my LBT peace deal goes through I think it might solve some of the issues at hand. It's a tough job guarding privacy and having publicly available checks and balances.