I was just a Dr. Pleatman's website (he's in Michigan) and he states the following:

With a large number of people undergoing LapBand placement, there is also a significant number of patients (up to 25%) who have not been successful in losing weight with the Band. I have now begun performing laparoscopic Removal of the LapBand, with conversion to Roux-en-Y gastric bypass on these patients. For further information on this procedure, email me or contact the office.

First time I've seen that statistic.

Theresa:

You assume that I am a poor surgeon just because the results I post don't match what you want them to believe. All my patients get unlimited fills at no charge, unlimited access to a registered dietitian, as well as all the help I can give them. There are other published series showing similar failure rates.

Many people assume that the people who fail with the band are cheating or otherwise not "working with" the band. Though some certainly do sabotage themselves, others in fact really do try. When I do a LapBand operation, I give my patients my full support. In fact, I don't even charge them for reoperations. If I have do do a conversion from band to bypass, I do it for free. So there is no big motivation for me to be doing these operations.

By the way, a significant proportion of the conversions I do are in patients of other surgeons, both from the US and Mexico.

I congratulate you on your success (so far) and hope it continues for you. But please don't assume that everybody will have the same results as you have.

Mark Pleatman MD

I guess this intrigued me enough to join in. Why do Bandsters stick this in? I've done hundreds of posts on forums across the 'Net but I rarely thought it was important enough to include my banding date. I'm coming up on five years but (*shrug*) I didn't realize seniority was so important in qualifying what one says. Now I know, I'll make sure and preface any potentially offensive posts with this information.....

Sorry NewSho, but I had to read and re-read what Maygoddess posted trying to find what was so offensive.

I just did not read what you did, or rather how you read it. The written word is like that, it's so hard sometimes to read what other's truely intended.

Frequenly our more experienced bandsters will include how long they have been banded simply because they have more experience. And yes, their experiences tend to have more weight if you will because they have the experince. We value where they have been because they have been there. Since you are a long time bandster, your insights are of course valued.

I understand your frustration at a certian level. You feel like you are stuck with a BMI of 30, but just like any scale, the BMI scale lies. It does not take into account a person's muscle mass. You might already be at goal because your body fat is right where it should be for a woman of your age. I don't know these things specifically about you, since they are not easily handy. According to your blog, you "only" have about 16 pounds to lose, but it is quite possible you are basing that number on some arbitrary number, not one to your specific body needs.

On a broader note, I always wonder at that 25% that don't lose with the band. After taking 3 statistics courses, I have to wonder at any given statistic, it's just my nature I guess, skeptic to the core.

OK, I'll change "offensive" (which is a bit strong) to "noteworthy."

I think that's more fair.

You assume that I am a poor surgeon just because the results I post don't match what you want them to believe. All my patients get unlimited fills at no charge, unlimited access to a registered dietitian, as well as all the help I can give them. There are other published series showing similar failure rates.

Dear Mark .... I apologize, but indeed I did not mean to suggest that you are a poor surgeon in the sense of not proficient, talented or skilled. That's not what I meant at all. And I think I pushed my two major points to the max.

The two points were

1 - the necessity for ONGOING GOOD EDUCATION & SUPPORT on how to become a successful Bandster

2 - the fact that some patients are headstrong and want to determine their own course, ending up in their ...

a) failing to take advantage of educational and support opportunities,

not getting fills or staying too tightly filled, or

c) resistance to the need to change eating habits.

You say you provide unlimited free fill opportunities and that is terrific.

And you say you provide continuing contact with a nutritionist. I'm not saying it is true of your practice or nutritionist, but again and again I have heard reported how a patient discovers that they are being taught bypass rules and guidelines. And how sometimes staff and nutritionists subtly or overtly communicate to the bandster patients that they "are not okay". Sometimes this results in a patient failing to follow-up.

Doctor-sponsored support groups often meet at the same time and location --- ending up with a mixed room of bypass and banded patients. This is a terribly demoralizing, confusing and invalidating experience.

Again, I am not saying this is true of your practice... but it is important for you to give your patients ample opportunity for double-blind feedback opportunities. What comes to mind is a self-addressed envelope or post card (perhaps various ones at different visits) where patients fill in dots to indicate how well they feel their needs are being met.

Yes, it is true that not all patients are good candidates for banding. And it is also true that for some of us (like me) metabolic syndrome (sky-high insulin resistance) and negative garbage that I will need a lot of head work to overcome, together make it certain that I will not be a storybook loss story without a GREAT deal of support ---- but all the available support in the world will not help me a twit if I do not ASK for what I need.

So I acknowledge this is all a very muddied picture ---- but I also think that self-defeating scenarios can set a lot of patients up to fail. The relative dangers of long-term life after the two kinds of surgery make it imperative that the surgeon follow the dictim of "First, do no harm." It is the responsibility of doctors to check into those bariatric practices with particularly good long-term outcomes and discover how their practices differ from theirs.

When I see so many bypass patients 2 and more years out who are regaining weight steadily and resorting to banding to control their appetite, then I recognize that there is NO MAGIC SURGERY. And to tell a patient that there is... is beyond the pale.

Theresa:

... just because the results I post ...

I may have missed it, but I think the burning question still is: Who is the 25%?

Dr Pleatman, would you give us the reference for the study that this statistic came from?

I perform Lap-Band, lap gastric bypass and revision surgeries. I have done Lap-Bands since Spring 2004. I have only had to remove one band to convert to a bypass. the 25% # is nuts.

David Geller, MD

Dr. Geller and Dr. Pleatman, can you share your practices' experience with erosion? We continually hear the 1-3% figure--is that where it stands with you?

As for the 25% figure, it's just a statistic like any other--essentially meaningless. "Success" with the band is largely self-defined. My BMI hovers between 30-31 but unlike NewSho I consider myself a VERY successful bandster. Numbers aren't how I measure my success, and going into this decision I deliberately ignored the statistics in the same way I ignored them when I was told I'd have a "high-risk" pregnancy.

Self-knowledge is the most important factor in deciding on the right WLS: our behaviors, our goals, our realistic abilities, our emotional states. It's a personal decision that has to be based on serious introspection, not the statistics from one small study.

Wow, it's been a while since I've seen this thread. It's very interesting. I'm reminded of the Ortiz thread where many ended up so upset with Dr. Pleatman for telling people to stop whining about the band and get a bypass.

You really do push the bypass, Dr. Pleatman. I am curious about why you do, since the national stats are showing the the bypass surgery is far more dangerous and does not have good long lasting results. I mean, why take someone who is struggling with band issues and put them into something more extreme that will be completely irreversible, has a large number of complications that the patient lives with forever, and has poor long term success? Is there some reason you promote this procedure so strongly?

>>Ah, by your standards, I'm one of those fabled 25% - but guess what. >>

NewSho,

I think you are misreading what the 25% referred to in this study. It was NOT 25% of the study patients didn't lose WITH their band...they actually LOST their band!! So I don't think you are in that "fabled 25%" as you call it. And again, this was a limited study of 300 people..not full band population..that was the point of my post..

Sorry you were so offended by my post..you are right..there are bandsters who do give it a hard try and still have problems losing weight, but after 3+ years..the people IKNOW who have struggled have not been honest with themselves. This "gal" I was referring to is in MAJOR denial...I didn't mean to say she just likes to eat..but likes to eat large volumes..larger than what is normal for even unbanded and she doesn't understand why she is unsuccessful.Hmmmm...

As I said in another post...most fat people are really in denial about how much they eat and how much they lie about what they eat(i include myself in that category!)..and also can THINK they are only eating 800 calories a day, but forget to count licks,tastes and sips throughout the day..or eat a little but drink calories all day.

My fill doctor last told me that now that I am under 200 and have less to lose, that I WILL have to work harder at this than I did before. He won't be just about fills. Since my loss has been spread out over 3 1/2 years..it has gotten harder and I do have to really be more aware and not be in denial that my juice habit is slowing my progress or that my lack of regular excercise right now could be a factor.

I don't know what you exact situation is..you just said you are stuck at 30 BMI..didn't say how much you lost or how long you have been banded and why you feel you may be "stuck at 30BMI"..but my nature likes to look at the glass half-full and say I am no longer a 48 BMI and would be fine stuck at 30 BMI in comparison...again..keeping it off for me is more important than just losing it at a certain time and speed.

I know that some of my left over weight to lose is still some fat, but also some skin and when I get there, I get there. I will have to diet and excercise more to get it off...but I will if I want it bad enough..

and to end...I don't believe in a "seniority" per se around here..but length of experience does give someone a different persepective with the band. I have lived with it for 3+ years..I definitely will know more than someone who has had the band 3 months or a year. Someone who has lived with the band 5 years..sure..has alot more experience than I do with it..

Patty

8/13/02

Dr Kuri

-100

I said that 20-25% of patients don't lose much weight with LapBand. Dr. Ortiz gave me his statistics, and his results are somewhat better than that, but it still remains a fact that a SIGNIFICANT proportion of LapBand patients do not lose weight... for whatever reason. They may cheat, not exercise, nibble all day. I don't know. Some are still hungry even when the band is tight. They try to eat, and then throw up. They are still hungry, so they eat something slippery that will go down. The Band just doen't work for them.

PhotoNut asks why I push the bypass. It's not that I push the bypass, I just share my statistics. Everybody loses weight with that operation (at least initially). Some can regain later, but most don't. You ask why I would push an operation that is "much" more dangerous. Yes, it is more dangerous... death rate is 0.6%. But that is still pretty safe... dangerous than being fat. The bypass is reversible. You can safely have children after bypass. Patients seem to be happier after bypass than after LapBand. This has been my personal experience after treating hundreds of patients. I didn't start out this way. In fact, I started out doing almost all LapBands. Now it's the other way around.

Mark Pleatman MD

>> I said that 20-25% of patients don't lose much weight with LapBand. >>

Dr Pleatman..I think there is some confusion on this 25% issue and what probably confused NewSho....the statistic I was quoting was something that was quoted in a follow up study of 300 lapband patients and 25% of those patients had their band removed. Some people have misread this as 25% of ALL lapband patients eventually have thier band removed.

I think you are talking different statistics about 25% of band patients don't lose weight or fail to lose all their weight..I don't know what stats you are specifically talking about..but I think this is adding to everyone's confusion on this thread.

I read in your last post that you say gastric bypass is totally reversable? Is this really the case? Would that involve recutting the intestines to "unbypass" them and then do they just leave the little stomach as is? Seems like it would be a mess of a process in comparison to the band removal which truly is much easier to reverse.

Anyway..I don;t think we need to start a "pissing contest" on a lapband board about which surgery is better..I am sure you are not intending that but that is exactly what will transpire when the bypass is mentioned on any band board..of vice versa. Everyone's stats are different..you may have a higher incidents of band to RNY conversions because of your patient experiences and follow up with the band..while another doctor has no conversions because he has a different patient base.Hard to say! Any bypass patient I PERSONALLY know ( I do know a few) have either had complications or have started gaining weight back after a tremendous and quick loss...but that is them..many others have been successful in keeping it off and have had no complications.

Anyway..I wanted to clear up this 25% discussion..two different things here...

Patty

Dr. Pleatman - Thanks for responding. I have another question. My surgeon said that the US is the only country still doing the bypass surgery because of the high mortalitly rate. Do you concur with this statement?

And you said the bypass is reversible? That's the first time I'd heard that. How is it reversible?

Susan:

This is clearly not true. Gastric bypass is still commonly done throughout the world. Just go to Pubmed and do your own literature seach. Don't believe me.

Mark Pleatman MD

Thank you, Doctor. I will do that. I've been looking for a good site with up-to-date information, so I appreciate your pointing me to this. And I will ask my doctor where he got this information since he is stating it in his presentations for those who are interetested in the Lap Band.

--------------------------------------------------------------------

Errr... I would have to pay for a subscription to this site in order to read the information. Are there no good sites with free, up-to-date, reliable information about these types of surgeries?

Also, you didn't respond to my question about the gastric bypass surgery being reversible. I would be very interested in knowing how this is reversible.

regarding http://www.PubMed.com

Errr... I would have to pay for a subscription to this site in order to read the information.

PubMed is completely free for a wide-ranging variety if information. The only thing you have to pay for is to retrieve the entire published article. However, the Abstract is free.

Go to (and bookmark) this page -

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Display&DB=pubmed

Enter the words gastric bypass and click on the GO button

On the next screen, click on the "down arrow" button on the right hand side of the first "window" labeled Display and select "Abstract"

You will then receive 2,178 articles, 20 articles to a page, 109 pages -- from Romania, Italy, Spain, Brazil, Austria, Greece, France, The Netherlands, Chile --- and a few from the USA. And that's just on the first page.

Lots of good reading.