GeezerSue

~~~~~~ Jack, I think that 12% is right--for some of the best and most experienced surgeons inthe country. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16235124&query_hl=1 But, someone is always doing his or her first band surgery, and--in one fairly local case I've been following--when he did his first three proctored cases, at least one of those patients ended up readmitted, which means HIS current complication rate is at least 33%. In this case, the patient KNEW she was going to be the first band patient and chose to take that risk. (Somebody had to be first for every doctor.) But as insurance covers more procedures, more doctors are giving the band a try, and there are more and more who have done three or five or twenty. They probably account for higher complication rates. That study above is from a VERY talentd group of physicians, one of whom--George Fielding--had been doing LapBand placements in Australia for many years before he moved to New York. His vast experience has to have factored into the low complication rate in that practice.

You know, I don't want this to sound like an attack on YOU...but it IS challenging to maintain that stance. So let me mention this...when people want to convince themselves that THEY would NEVER find themselves in a position they don't want to be in, they often blame a victim who DOES find him or herself in an unwanted position. Someone else is making mistakes that they would NEVER make. And since THEY would never be THAT stupid, THEY don't ever have to worry about that bad thing happening to them. So...the house was burglarized because the residents left the window unlocked; and the parents of the 13-year-old weren't watching closely enough so THAT'S why he was having sex with his friend's mom; and the new moms who suffer from post-partum psychosis (not depression) and hurt their kids are just BAD moms (not SICK and not receiving medical care); and so on. Lovecats, the people who have been having problems have been banded ten or fifteen times as long as you have. You surely have the best of intentions, and I wish you all the luck in the world. But until you have a little more experience with the band, blaming other people--without scientific evidence that they did something wrong--is a real disservice. It's kinda like someone returning from their honeymoon and telling all the people who have been married ten or tweny years what they are all doing wrong. And the critical issue in slippage cases was the early placement technique, which was changed--about three years ago--to the pars flaccida technique. It had ZIP, ZERO, NADA to do with soft drinks. And the vomiting that causes some of the current slippage problems can be due to too much saline in the band, but can just as easily be caused by vomiting due to other reasons...morning sickness, stomach flu, esophageal damage.

A few things... 1--you can get insurance for anything...but the more a policy covers, the more it costs. People have BC/BS policies that pay and other people have policies that don't. You need to get a copy of YOUR policy and see what YOUR policy covers. It can be very different from the BC/BS policy the person next door has. And you'll seldom get the same answer twice from the people who work there. (Some just read better than others.) 2--a lot of what gets covered and what doesn't is in how you phrase it. My insurance is NOT in the mood to pay for a breast lift. But if WILL pay for a breast reduction and, if what is left of my breasts turns out to be lifted....well, oh my. If you ask for wls, you probably won't get it. If you ask for weight loss surgery because you're overweight, you probably won't get it. BUT, if you ask for weight loss surgery as treatment for morbid obesity, then you're at least in the ballpark. 3--your BMI is close. Most insurers want a BMI of 40. So if you are 5'9" and 265, your BMI is 39.1 and you are NOT MO. But if you are 5'8" and 265, your BMI is 40.3 and you ARE MO. So wear your heaviest jeans and several layers of clothes and, if they measure your height, have them do it while your shoes are off. Also, some insurers accept a BMI of 35 WITH comorbidities. Do you have any health problems related to your weight. (Do you snore? Have you had a sleep study?) Then, I'm going to kind of give you a hard time here: You need to read more. My answers might be right or they might be way out in left field. When you pop into an internet bulletin board and ask a question, your answers could be coming from two drunks and an inmate with nothing better to do. Get information from several sources, and don't trust any ONE source to be 100% accurate all of the time. Good luck, Sue

This is long, but I have taken the liberty of taking it off of a DS support board...I hope Melanie, the author, doesn't mind; I "bolded" the prt that most impacted me.

Paula, A partial x-post from OH... Nutshell version of things that matter to me: RnY--your stomach is (immediately post-op) two teaspoons; you can take bites that are actually bigger than your entire stomach; the MAIN mechanism which causes weight loss is just very little food; two years out, when the stomach has stretched, you are mostly on your own. Mortality rate is about 1/200; average excess weight loss is about 60%. DS--your stomach is (immediately post-op) about 4-6 ounces; you can eat normal size bites of food; the main mechanism that causes weigh loss is malabsorption; two years out when the stomach has stretched, the malabsorption continues. Mortality rate is about 1/100 (but the majority of DS patients are Super MO or VERY Super MO and they are high risk at ANY procedure); average excess weight loss is about 75%. There are more reasons, but these are what attracted me. I hang out--in 3-D--with people who have had RnY and DS. At one gathering, some outsider/guest asked, "Well, how can I tell who had the DS?" I heard my mouthy self saying, "Easy...they're all those skinny b!tches." Lightbulb moment. And when we go out to eat, the DS'ers order what they want and the RnY people wait and TASTE what the DS'ers ordered to see if it's too sweet. (Some DS'ers might pay later on with bathroom issues, but the ones I know have few/no problems in that venue.)

I knew the stats that were available at the time and made the same decision. One of the important points for me was that the band could be removed. I don't want to go over all my problems again...but here's a link to that discussion: http://lapbandtalk.com/showthread.php?t=10829&highlight=pending

Interesting approach. But I kind of understand it. When I was three months out, I was absolutely convinced that the band was the ONLY way to go. Now that I am three years out...I guess I'm just not as well-informed about the band as I once was. AGAIN, I have already said that all of the surgeries had problems...and, I gave you my sources for the stats I quoted. I was just asking you for your source on all that 60% weight loss thing you kept referencing. I guess it wasn't available.

She had more scar tissue than expected, so it took longer...but the surgery is done and she is now in recovery. Sue

Good point...if the DS had only a 60% average ewl rate, I wouldn't be going through surgery again. I realize that I MAY have only a 60% ewl...it happens. But the average is about 85% with a rebound to about 75%. (I'm still not sure where you are getting the 60%...I have not seen that number in relation to DS.)

Citing sources would be helpful. The actual number is closer to 75% after many years. http://win.niddk.nih.gov/publications/gastric.htm The band has its own malnutrition issues...but for different reasons. DS'ers eat and still have nutritional deficits...Banded people can't always eat enough. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12527349&query_hl=16 ... Since I got that information from the manufacturer of the band, Inamed, www.lapband.com it's probably fairly accurate. Of course there are practices with FAR better results, but this is apparently the best Inamed can tell us right now. There is no single source for the DS surgery mortality rate...but it is generally accepted to be around 2%. The RnY is around 1% and the band is about .01%, last I checked. My point--and I really wanted this to be about Rachele, but I'm always up for citing sources...that damned college debate team I guess--was that even though this is a band support site, some of us who were banded--a long time ago--have done our best and have decided it is time to move on. We can just disappear, so as not to burst anyone's bubble...or show some courage in continuing to OPENLY fight the demon we all share. Many of us got the band because we did not want RnY. If/when the band fails, it is nice to know that there are other options. Remember, one of the selling points of the band is that it can be removed. Do we want people to slink off and do that silently...or are we up to hearing how that works out? I'm not telling anyone not to get a band. But I want to tell the truth about what life is like when it doesn't work.

Does that mean someone is taking this "lively debate" personally? I know what the purpose of the board is...I was there online the day Alex offered to furnish us with the board. But thanks for your input.

You have the right to disagree. But if you have a surgery that is supposed to correct a problem and it doesn't and you die from the uncorrected problem...

While I don't want to debate, I DO want to provide accurate information: •First, some of the mortality rate of the DS is due to the fact that, in some practices, it is performed ONLY on patients with a BMI of well over 50. ANY surgery performed even PRIMARILY on those with a BMI of over 50 is going to have a higher mortality rate, because those who are super morbidly obese are dying to begin with; •Then, you might want to factor in the band removal/failure rate. When I decided I wanted my band removed, my local "bariatric center of expertise" surgeon was about to do his FIRST band removal. In Europe--where they have had the band being put IN longer--they also have more experience taking it OUT. One surgeon I contacted told me that 20% of his surgical practice was removing LapBands. I suspect that will be the case in here a few years as well, which leads to my next point... What percentage of people who get the LapBand will STILL die from Morbid Obesity, which--as we all know--has a higher mortality rate than ANY of the surgeries? A recent Swiss study says that 66% of band patients experience "success," which they define as 50% of EWL. In my case, losing 50% of my excess weight would leave me with a BMI of over 35, and--given my comorbidities--I'd STILL be a candidate for weight loss surgery. The early deaths of those who have the band and didn't die on the table but died later from not ever losing enough weight cannot be just ignored. Those untallied deaths need to be included in the mortality rate of the band. •Another reason that the band--and the RnY--are performed more extensively is that they are more profitable for the surgeon and cheaper for the insurance company. I know that Dr. Rumbaut can crank out five bands on an average surgery day...and he does that twice a week. The RnY takes a little longer, but the average surgery time is getting shorter every day. The band patient is often a 23-hour stay; the RnY is a day or two. The DS patient's surgery takes two or three hours and his or her stay in hospital STARTS at three days. Like the band and the RnY, the DS requires considerable follow-up. So...(Rachele and) I will need to be more vigilant about post-op labs, but less concerned about over-exposure to radiation. Like many banded people with problems, repeated adjustments have caused me to be exposed to FAR more radiation than I'd like to have been involved with. I know that SOME people have had great success with the band. They have achieved a "normal BMI and are usually very gracious about it because (I suspect) they realize that they are in a fairly small group (and maybe they were just gracious to begin with.) But "success" is subjective. I've had people who were several years post-op tell me that I need to follow THEIR example...and I have been (uncharacteristically) kind enough NOT to mention to them that they are STILL obese and that the whole point of MY having surgery was to NOT BE obese. So, for post-ops who are happy that they have achieved a BMI of 37 or 42...good for them. But, for me, that is FAR from my goal. Anyway, I cannot speak for Rachele. I know that she knows what her risks were going in. She has a baby and a husband and other family that are hoping that she is able to RESOLVE her obesity problem. And I hope that anyone researching the band or having problems post-op will read that--according to that recent Swiss study--one-third of those being banded do not lose even 50% of their excess weight and realize that it is NOT their fault...and not be frightened by partial information and, mostly, I hope that they see that there ARE other options if their first choice does not work for them. Good for Rachele for doing her best to win this battle.

Hey folks, She probably won't be here for a few days, but Rachele is having a LapBand-to-DS Revison today. She did great with the band at first, but then had complications. She tried to make it all work, but decided that enough was enough and that it was time to move on. For those who are not aware, the DS is the most extensive of the usually performed weight loss surgeries, but has much greater success rates than the others. (Yin and Yang and all that.) The surgery itself requires a much more experienced surgeon and there are not really many DS surgeons in the country. When she is finished with the surgery, there is a long recovery period, with rapid initial weight loss...about 30% of excess weight is gone in the first couple of months, and by six months post-op, it's closer to 50% of excess weight loss. There are lifelong malabsorption issues and routine labs must be done and Vitamins and supplements MUST be taken religiously. The payoff is about a 75-80% excess weight loss, maintained over five to ten years post-op (maybe longer) and a 99% cure rate for type II diabetes. More info is available here: http://duodenalswitch.com/ Anyway, you can see Rachele's before and after LapBand photos in her profile and, if you are so inclined, I think you can send a PM or something through there as well. Sue

Just as an aside...do NOT sign anything saying that yu will allow a gastric bypass unless you are SURE that is the surgery you want. There are more than just two wls's available and no one should have to chose between just those two. Most of the banded people I've met over the last almost-four years say they would prefer the DS if they cannot have the band. In fact, Rachele from this site is having a band-to-DS revision today and mine is in eleven days. If you didn't want the RnY when you GOT the band...you probably don't want it if/when you UN-get the band. Sue

That's my date, too! I'll be getting revised to a DS on the 28th.

I think two at the same time is the only way. Otherwise, one is always following the other around trying to get a contact high off the fumes. My husband had a heart attack at age 47. So he "quit smoking" right about the time they hooked him up to the oxygen. Three days later, I drove up to the hospital, parked, put out my cigarette, put the rest of the pack down on the bench by the ashtray and went in to get him. Neither of us has had one cigarette since then. (I had a 37-year habit; his was a little shorter because he's a little younger.) My only wisdom on the topic is that I had always previously focused on the stopping. I did just fine once I stopped worrying about how to stop stoking and focused on how to BE a non-smoker. It's been five-and-a-half years and every once in a while, I think, "Boy! If I had one, I'd smoke it." And then I think, "What an idiot THAT would make you." Good luck, Sue

It was probably my post. And while it is not my intention to diminish the results of any person here--or the Dallas banded folks in general--the study looked at several hundred people who were FOUR YEARS OUT from surgery. (I'm a little over three years out, and I was 55 at the time with a BMI of about 48.) I'm emphasizing the time, because many of the problems with banding occur a couple of years down the line. Impact of age, sex and body mass index on outcomes at four years after gastric banding. Branson R, Potoczna N, Brunotte R, Piec G, Ricklin T, Steffen R, Horber FF. Departement of Surgery, Hirslanden Clinics, Bern, Switzerland. BACKGROUND: Adjustable gastric banding for weight reduction in severely obese persons allows reversible individualized restriction during postoperative follow-up. It is unknown whether preoperative age, sex and BMI might modulate treatment outcome. METHODS: 404 severely obese patients (79% women; age 42 +/- 0.5 years [mean +/- SEM]; BMI 42.1 +/- 0.2 kg/m2) completed 4-year follow-up after banding. Weight loss, complications, and Bariatric Analysis and Reporting Outcome System (BAROS) scores were recorded prospectively. RESULTS: 4 years after banding, younger (<50 years) women lost more weight than older (50 years) men (28.2 +/- 0.7% vs 19.4+/- 1.6%; P=0.001); older women and younger men lost similar weight. Patients with preoperative BMI >50 lost more weight than patients with BMI <35 (30.5 +/- 2.3% vs 22.8 +/- 2.6%; P=0.03). 22.3% of patients (n=90) had band system-related complications. Compared to women, men had more band leaks (7.0% vs 1.9%; P=0.007), and older men had more band slippages than younger men (8.4% vs 0.0%; P=0.035). Patients with preoperative BMI >50 were less likely than patients with BMI 35-40 or 40-50 to experience gastric complications (10.6%, 18.8%, 23.0%, respectively), but more likely to experience port/tube complications (15.8%, 2.4%, 7.9%, respectively; P<0.055). BAROS scores were different between men and women (P=0.05), and between younger and older people (P=0.001). Women and younger people were more likely than men and older people to score "very good" (P=0.03, P=0.001, respectively). CONCLUSIONS: Adjustable gastric banding is an effective intermediate-term treatment for severe obesity. Preoperative age, sex, and BMI are important modulators of outcome and should be considered during preoperative evaluation. PMID: 15999426 [PubMed - indexed for MEDLINE] Also, I may be reading this wrong, but in this group, although people were much happier after banding, it looks like the percentage of excess weight lost by the most successful group was 28%.

I want to comment on a couple of things...First, it's great that your daughter is doing so well. Then, even though it's not a surgery I would choose, I have to say that gastric bypass does NOT have "a higher mortality rate than most surgeries." It has a higher mortality rate than the LapBand and a lower mortality rate than the DS. (And to compare it to an angioplasty, it has a lower mortality rate than angioplasties done on the oldest patients by the least experienced surgeons and a higher mortality rate than angioplasties done on younger patients by very experienced surgeons. Which kinda means nothing, but I thought I'd throw that in there.) Also, I suspect that at "almost 59," I'm a little older than your daughter. I'm scheduled for the DS which is a more extensive surgery than the bypass, and I really hope I survive. I've been through a lot but have a rather resilient physiology, so I'm playing the odds. Finally, about age and wls. Actually, patients over 55 years of age are now considered rather poor candidates for a successful LapBand journey. Some of the problem is of the old-dogs-new-tricks variety, but esophageal dysmotility and other problems are often a function of age. To add in the band may expedite those problems in those who were going to have them or cause those problems in those who were not going to have them. So, actually, the LapBand is a less dangerous surgery, per se, for older patients, but it has rather limited success and more complications for those patients, as well.

...just a lot of roads to the same (intended, at least) destination.

Yes, Melissa, the old Jejunoileal bypass (JI) was horrid. I'm sorry that your mother had to go through that. A surgeon I know told me to find out what was different about the JI and the newer DS before I did anything, because he spent his early years as a sugeon doing take-downs of that surgery on a regular basis. The DS is a different surgery. But just to make sure we're on the same page on the "RnY vs Ds thing," the BPD/DS surgery permanently removes the gall bladder and the appendix. The stomach is made smaller than normal (but it is about six times bigger than the RnY "pouch"), and the stomach (in both cases) eventually stretches out. I don't know that we can say that the band always leaves the anatomy intact. It didn't leave MINE intact, as the esophagus is compromised. And I don''t think it left Donali's intact as it eroded through the stomach (although I haven't visited with her lately and HOPE that is all repaired/repairing.) But, most importantly, with the DS, the pyloric valve remains intact and the "switch" part of the surgery can--if the need arises--be "unswitched."

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

Most of what they are looking for--positioning (a slip) and how fast the barium move through the band--they can find with the barium swallow at the adjustment. They can also see if the esophagus is widening (dilatation.) Then, it can get tricky. Esophageal dysmotility is not necessarily an easily found problem. Sometimes my food went through. Sometimes it didn't. You have to be lucky and run a test at a time it's acting up. At an Upper GI, they saw it, but didn't document it well. This time, as I got unfilled, they could see the barium just sitting there, so THAT'S how they were able to diagnose the dysmotility. Ersosion is best diagnosed with endoscopy, where they look at the inside of the stomach with a little camera and can see if the band has worn through. (I HOPE I don't have that one!) So, yes and no. some swtuff they will notice at an adjustment. Some, not.

First, it it no longer band vs. bypass. There is another surgery, the DS. http://www.duodenalswitch.com/ Cornell just published a study showing that the DS worked better than the RnY. And, if all your surgeon does is those two surgeries, it's best to find another surgeon to get a consult on that third option. I VERY lucky in that I'm getting a second chance at this...but I relate to having only one chance. Then, there is no guarantee that you can keep getting adjustments with the band. I think that about 20% of us can't even tolerate ANY saline in the band without causing problems. That, of course means that 80% of the banded patients can tolerate adjustments...but that's four out of five. Finally, while there ARE people who lose tremendous amounts of weight with the band (and we all want to be in that group), when you look at the large numbers, people with higher BMI's just don't do well enough for BC of Calif to keep paying for it. The study they use is one that shows that the percentage of weight lost--about 50-60%--is not enough to move heavier people out of Morbid Obesity. According to the charts, I needed to lose about the same amount of weight as you. If I had lost 50-60% of my excess weight and kept it off, I'd have been within a couple of pounds of STILL being MO. Good luck on choosing, but consider ALL the options, and listen to those who have done well and those who have done so-so and those who are having it all yanked out. Good luck on your choosing. Sue

To do band RESEARCH, you also have to hit the medical journals and the Inamed site. A number of people here have had complications, but may not notice the post or maybe they have gone on to other methods. But, in partial answer, "Am I sorry I got the band?" No. "Knowing what I now know, would I recommend that my fictional identical twin sister get the band today?" No.