DrWatkins

Certainly, choice of procedure is a very individual one and I respect that when patients are well-informed about the true differences. Certainly band complications are no doubt much less severe than the "gut altering" procedures. For example, I would much rather have a port issue fixed with local anesthesia than peritonitis due to a leaking staple line which can be disastrous. The topic of "surgery outside the U.S." is a delicate one. At the risk of controversy I would like to provide some insight perhaps on the way U.S. surgeons view this: Please know that as far as technical ability in the operating room goes, there are many excellent band surgeons outside the U.S. That is not the problem. You also have to know that plastic is more expensive in the U.S. Many surgeons outside the U.S. purchase the band for a third of the cost American surgeons have to pay. (About $1,000 vs $3,200). Part of this difference is that manufacturing companies are far less likely to be sued outside the U.S. Liability insurance for bariatric surgeons in the U.S. is beyond outrageous. This insurance in other countries is cheap and most surgeons don't even buy it. If something really bad happened during or after surgery it would be very difficult to sue a surgeon in another country and it would be very difficult to find a lawyer to take a case like that. The majority of band patients that travel out of the U.S. to have surgery never return to the foreign practice for their follow-up care or support group. Most patients in the U.S. return to their surgical practice for adjustments and support group and this requires hiring adequate staff. American doctors that take a patient into their care after having surgery out of the U.S. are taking on a major liability that most doctors feel is simply not worth the risk. So, if I could buy the band at a third of the cost and didn't have to buy expensive liability insurance and most of my patients never returned for their fills and adjustments and support gruop, I could offer the surgery for a very low price. My desire, however, is to help patients lose as much weight as we possibly can together as a team. I always tell new patients that this is not surgery; it's a weight loss program. For patients not covered by insurance who are paying out of pocket we've always lumped the aftercare into the price because if you make patients pay for fills after the operation they don't come in as often because you have financially disincentivized their aftercare. We in essence require patients to purchase the aftercare with the operation as they are both equally important to the ultimate outcome - success! Hope that helps brad

Yes, you're in the Swelling Gone, Awaiting First Fill phase of the healing period. You can do it! Massive weight loss, coming up!

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.

Sitting at the airport after a proctor surgeon meeting on the new Ethicon REALIZE band: The website www.RealizeBand.com will be updated soon as they launch additional features. The new site will have many features to assist patients in their weight loss. The band holds a total of 9cc (I had incorrectly posted 10cc earlier - my apologies for the error). Proctoring surgeons can offer the new band now and will be proctoring other surgeons across the U.S. soon. I'll keep you updated as new information becomes available.

Swedish band (now called REALIZE band) can hold 9cc although it is tougher to withdraw all of the saline so to some degree it is more important to know the restriction you feel than the actual number. Certainly, you are too tight and should call your surgeon office for an unfill! hope that helps brad

Working with gastric band patients has been a wonderful blessing to me. You guys do amazing things and inspire me every day. It occurred to me today that you could give me some very valuable feedback on how we, as surgeons, can improve our service to you. So, please give me some feedback: What do you love about your band surgeon and their practice? What do you hate? What do we do well? What could we do better? What more could we do to help you succeed? How could we improve your customer experience with our practices? Thank you in advance for the feedback. brad

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

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

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

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

Congratulations TXbandit, Band surgeons are usually nice because the patients are so amazingly cool. It's very rewarding work to say the least. You guys do all the hard work. Surgery doesn't hurt us one bit!

There are certainly many styles of doing band adjustments and if I criticize your surgeon's approach they will just get mad at me! It sounds like you need more saline in your band to help you out. My opinion is that if a patient is still hungry and can eat too much and is having a hard time losing weight, even if it is right after a fill, I have them come back in and add more saline until we get it perfect. The band is very powerful when it is perfectly adjusted. It sounds like your band's too loose. hope that helps brad

Aubrie, I wouldn't go in a pool or submerge the incisions under Water with suture poking out. Interesting some people's skin will "spit" the dissolving sutures out. I would recommend making an appointment with your surgeon and have them take them out so the skin can move on with what it does best - heal. Hope that helps brad

Both companies have gone to bigger bands, lower pressure. I am at a meeting at the Ethicon Company today and the surgeons are arguing whether the new ones or the old style are better so there is not agreement. The good news is that all of the bands on the market are basically great products. The newer Allergan (AP) bands have little pillows so the inner balloon doesn't contact itself as it is inflated. We won't know for years whether this has advantages or not. You could go on and on about the subtle differences between the two but they are basically both great companies with great bands. Hope that helps, brad

Good idea to have your surgeon examine the port site. Sometimes you can get a seroma around the port (seroma is Fluid collecting around the port). Sometimes it's just swollen. Certainly, if the area is red and hot (suggestive of infection) you should have them take a look at it sooner than later.

Good points Ellisa, I think we will see lots of changes in health insurance coverage of the band until the market settles out. It is still very new and everyone's learning.

And also, the symptoms of an erosion are simply weight regain because you have no restriction. Erosions don't typically cause any other symptom.

I think that if everything is okay there is no reason to evaluate the band. Typically, when there are problems you will have symptoms. For example, if the band is too tight or the pouch is dilated or slipped you tend to have bad heartburn and obstruction. Hope that helps brad

Good idea. I had a band patient who used to weigh 593 pounds and he now rides motorcycles. Band patients are so freaking cool.

We adjust all bands (including the new Ethicon REALIZE band) at our Chicago clinic in Oak Brook, IL. You can get their contact info from our website, Synchrony Health :: Home. The surgeon, Dr. Duane Tull, is banded himself. He'd be happy to see you. Hope that helps brad

Chris Ren and George Fielding are both awesome. They are superstars amongst band surgeons. They both publish their results and have contributed many great things to the knowledge of band surgery in the U.S. I admire them greatly. I would consider myself lucky to be a patient of theirs.

Congratulations! Very cool! Be careful on that thing!

Erosion is where the band erodes into the inside of the stomach. The history of erosion: Gastric band surgery started in Europe/Australia and they were using the peri-gastric technique (the band was placed lower on the stomach). When they started seeing a high slip rate with this technique they started stitching the stomach over the top of the band to prevent all the slips they were seeing. The problem was they were stitching the stomach really tightly over the band. When you have living tissue stretched tightly over a hard object (like band plastic) the tissue will be under so much tension that it won't have good blood flow and will necrose (dead tissue) over time and then the band works itself inside the stomach. It doesn't erode into the stomach that the inner balloon is squeezing on, it erodes into the stomach that was wrapped so tightly over the top of the band. Fortunately, the European/Australian surgeons changed the procedure to the pars flaccida technique (place the band much higher on the stomach) and they learned to wrap the stomach tissue much more loosely over the top of the band. This brought the erosion rate down from 10% to less than 1% and over time and with more experience erosions are now quite rare. Every U.S. surgeon that I know uses the new pars flaccida technique. In our Seattle practice (2,500+band procedures) we had 2 erosions. When you suspect an erosion on x-ray (fluoro) it is best to proceed with a scope (EGD - scope of the stomach) to make sure the band has indeed eroded, i.e. you can see white plastic from inside the stomach. If the band has eroded, the treatment is to remove it, let everything heal for 3-6 months and then replace it. The Australians have a fair bit of experience with this and report good results replacing a new band later. In the past they would put a new band in at the same operation that they removed the eroded band but the re-erosion rate was too high and they now recommend replacing it later. Erosions vary. Some patients have a tiny erosion (can only see a small bit of the band from inside the stomach) that some surgeons will watch if the patient is still losing weight. I've heard of cases where the entire band erodes into the stomach and it was removed without surgery using a scope to retrieve it from inside the stomach. I have heard of cases where they tried unsuccessfully to remove the band from within the stomach. Hope that is useful information brad

Agree with Snowbird. A fluoroscopy would be in order to assess the position of the band and the size of the pouch. It's a good sign that your symptoms improved. If the pouch is dilated on fluoro I would leave the band deflated for 3-6 weeks and recheck (fluoro). Hope that helps brad

We will accept any patient regardless of where they were banded. We do charge for those fills but I honestly can't remember what the Cincinnati office bills for those. I would have to call the office. For an insurance company to pay for the surgery and not pay for any of the follow-up care seems absolutely insane to me, but don't get me started on insurance companies. That's like donating food containers to a homeless person without any food in it and thinking you are helping the person. Anyway, we're all in this together. The cool thing is that it is extremely gratifying to help people lose weight. I feel extremely blessed. You guys do amazing stuff. It's changed my life and I haven't lost a pound.