Choosing between surgeons

[lapband7 0]

Hi:

I am new to the forum, and am posting because I am having trouble deciding which surgeon to go with.

I live in Washington State. I want the single-incision lap-band. There is a surgeon in Seattle who does it, as well as a surgeon in California.

The surgeon in California appears to have better statistics - lower slip rate, flip rate, erosion rate, etc. However, he doesn't do an Upper GI test after surgery to clear you to begin drinking Water, and he doesn't give prescription pain medications - only liquid tylenol. Is this common?

Also, I don't know where to get my fills in WA. All the WA hospitals with a bariatric practice refuse to accept patients who were not banded at their hospital. How many fills are required in the first year? I just don't want to have to travel to CA every time I need an exam or a fill.

The surgeon in WA is very well respected, but has a slip rate around 3% and a flip rate around 5%. Is that average? He also has only done 15 single-incision surgeries, whereas the surgeon in CA has done over 78. However, the weight loss surgery practice at which he works is very nice, I could get my fills there easily and for free, and his staff seems very caring.

Any advice on who to go with?

[Alisomniac 0]

Hi:

I am new to the forum, and am posting because I am having trouble deciding which surgeon to go with.

I live in Washington State. I want the single-incision lap-band®. There is a surgeon in Seattle who does it, as well as a surgeon in California.

The surgeon in California appears to have better statistics - lower slip rate, flip rate, erosion rate, etc. However, he doesn't do an Upper GI test after surgery to clear you to begin drinking Water, and he doesn't give prescription pain medications - only liquid tylenol. Is this common?

Also, I don't know where to get my fills in WA. All the WA hospitals with a bariatric practice refuse to accept patients who were not banded at their hospital. How many fills are required in the first year? I just don't want to have to travel to CA every time I need an exam or a fill.

The surgeon in WA is very well respected, but has a slip rate around 3% and a flip rate around 5%. Is that average? He also has only done 15 single-incision surgeries, whereas the surgeon in CA has done over 78. However, the weight loss surgery practice at which he works is very nice, I could get my fills there easily and for free, and his staff seems very caring.

Any advice on who to go with?

Personally I'd be uncomfy not meeting the surgeon beforehand. And while the single-incision surgery can be more aesthetically pleasing, is 4 small scars (which may be invisible in the end) really worth the hastle of travelling then having to scrounge around for someone to do your fills, who may not be fully abreast on your case? Especially considering each surgeon's number of procedures performed that way is so low.

My surgeon said she sees me every 6 weeks for the first year, and each appointment there will likely be some adjustment.. she said 4-6 fills year one, then depending on progress 2-3 the next year and maybe 1 or 2 the third year -it all depends on your progress and how you tolerate food.

best of luck... in your case I'd lean towards the Seattle guy - just because if you need to be seen immediately for any reason, you can be

[BetsyB 9]

In general, I think most surgeons do a competent job of installing the band. Slips and erosions do sometimes happen--but they are not generally related to surgical skill.

The rates of slip and port flip you describe for the Seattle doctor are perfectly acceptable. Again, they are not generally related to surgical skill--they're complications that just sometimes happen. Particular patients have vulnerabilities that cannot always be predicted.

I would NOT make single-incision surgery a priority; the scarring from traditional laparoscopic procedures is minimal, and I would pick the doctor (a) with the best preop patient education, and ( the best AFTERCARE. Because unlike most surgeries, when you see the surgeon once, and maybe during a single follow-up visit before you are discharged from care, banding requires an ongoing relationship.

While I'm perfectly comfortable traveling to another state to have plastic surgery---knowing that I will have a time-limited relationship with the surgeon that will terminate when I leave the city several weeks later (and resume when I return for another procedure), I would be very uncomfortable having surgery with a doctor I did not meet before making the surgery. (I will meet my plastic surgeon during the decision-making process; if we don't click, then I will find another.)

I would also be very wary of choosing a faraway surgeon---I don't believe banding is just a matter of finding the right guy to install the band, then worrying about aftercare as an afterthought. With this surgery, preoperative patient education and aftercare are key to success with weight loss and maintenance of that loss.

I'd go with the guy in Seattle, ask him how comfortable he is with the single-incision, defer to his judgment regarding the approach (though 15 procedures is probably reasonable---especially if he operates like mine does: no matter what the procedure, my surgeon and his partner are ALWAYS together in the OR. ALWAYS---two experts for the price of one.)

It's a tricky decision, with lots of things to consider---make sure the ones you're focusing on are the ones that will make the most difference in terms of your long-term success. (And remember, the stats you read regarding complications attributable to each doctor (a) may not be accurate, and (:tongue2: may not reflect anything actually attributable to the surgeon; slippage, for example, is often due to user error---or something random, like a patient who becomes ill with a virus that causes violent vomiting or coughing.)

Good luck!

[lapband7 0]

Thank you very much for your replies. I did actually have a chance to meet the surgeon in California. I went down to Los Angeles for a consult, and he seemed okay. But yes, I am definitely concerned about the aftercare. I guess I am leaning towards Seattle at this point.

The surgeon in Seattle does SILS and regular laparascopic - but that involves 5-6 incisions, not 4. The surgeon in California does 4 in his "normal" procedure.

Any thoughts on SILS? I went online and looked through pictures of post-op scars for 4 to 5 incision lap-band operations, and they all still look pretty visible to me. Do they prove over the years? If I have to have 5-6 visible scars on my stomach, I'd almost rather not have the procedure at all.

Does anyone know where I can find pictures of SILS scars?

Edited October 5, 2010 by lapband7

[elcee 3,343]

Any thoughts on SILS? I went online and looked through pictures of post-op scars for 4 to 5 incision lap-band® operations, and they all still look pretty visible to me. Do they prove over the years? If I have to have 5-6 visible scars on my stomach, I'd almost rather not have the procedure at all.

WOW!!!!

I'm gobsmacked.

Cannot believe that you are basing this decision on how many scars you may or may not have.

On the one side the op should seriously improve your health, your longevity, your fitness and definitely the way you look but you are prepared to throw that away because of the possibility of a couple of scars.

Are you hoping to become a bikini model or something once you lose weight? If you are then you will probably need a Tummy Tuck and that would give you further scars! Plus they use this thing these days called airbrushing.

Seriously how often are you going to be getting your stomach out and do you really think scars would be worse than fat???

Most people have 4 - 5 holes at the time of the surgery. 3 - 4 of these are tiny poke holes approx 1cm long. They are often situated under the bust where they are not seen and they fade so much that they are hardly noticeable. If you have a tendency for your scars to become keloid then obviously they would be more noticeable. The biggest scar is the one where your port goes and this can be in various places. It fades to a fine line which again is not really noticeable.

I know everyone is different but I don't think you should be jeopardising your future health over this. You should base your choice of surgeon on experience , aftercare etc. If the more experienced surgeon does the surgery with 5 holes that to me would be the better choice than the less experienced surgeon that uses 1.

[lapband7 0]

Hi - I am not just basing this decision on how many scars I will get, but it is a big factor. I keloid easily, and while I have absolutely no aspirations of being a bikini model, it would bug me to have 6 scars, one of which would be 2 inches long, all of which keloid.

I understand there are huge benefits, but also very real risks. I am very concerned about my port flipping, vomiting, etc. That is why I am unsure about the surgery, and being very careful about the surgeon. I didn't mean for my comment to be inflammatory, but I also don't appreciate hyperbolic and judgmental responses. The majority of this surgery would most definitely be for health, but I think most people will admit that small part of it is for vanity as well (looking better). Personally, having 6 scars would bug me. That is just something I know about myself.

I know there are benefits for health and longevity, which is why I am considering the surgery to begin with. But like I said, having 6 large scars would weigh against it. Having 1 scar would be more acceptable, given my tendency to keloid, especially as having a lap-band is no guarantee of long lasting weight loss. I will still need to work very hard. So as vain as it may sound, having 6 scars would tempt me to just try diet and exercise one more time.

Both surgeons I am considering do the 5-6 incision operation, as well as the SILS. They just have more experience with the 5-6 incision operation, as SILS came out last year. That is why I am trying to educate myself and get some input. Both surgeons are well respected, have done over 1500 operations, and offer aftercare. I have met both. Just that one is in CA, and has a little more experience with SILS, and another is in my hometown, with a less experience with SILS (but more convenient, and I think better, after-care).

Edited October 6, 2010 by lapband7