Why we should ask, "How Many LapBands have you placed?"

GeezerSue · January 4, 2004

Another recent study:

1: Surg Endosc. 2003 Nov 21 [Epub ahead of print]. Related Articles, Links

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Laparoscopic adjustable gastric banding: is there a learning curve?

Shapiro K, Patel S, Abdo Z, Ferzli G.

Department of Surgery, Staten Island University Hospital, 65 Cromwell Avenue, Staten Island, NY 10304, USA.

Background: To be certified for laparoscopic placement of adjustable gastric banding, surgeons must have advanced laparoscopic experience. Despite previous exposure to other kinds of laparoscopy, there may a learning curve specific to Lap-Band placement.

Methods: Sixty consecutive patients were prospectively separated into two groups: the first 30 patients operated on (group 1) and the second 30 patients operated on (group 2).

Results: Both groups were similar statistically in regard to gender, age, and body mass index. Operative time for group 1 was 79 +/- 31.1 min. There were 11 (37%) complications in 10 patients. Operative time for group 2 was 59 +/- 19.9 min. There were two complications (7%). All operations were completed laparoscopically. Operative time was significantly lower in group 2 ( t-test; p = 004). Complications were also significantly lower (chi-square; p = 0.005). The number of reoperations was also reduced and approached statistical significance (chi-square; p = 0.054). Readmissions, although reduced, were not statistically significant. There were no deaths in either group.

Conclusions: Despite a surgeon's history of advanced laparoscopic experience, there is a definite learning curve associated with the laparoscopically placed adjustable gastric band.

PMID: 14625767 [PubMed - as supplied by publisher]

ldauph · January 5, 2004

who did the study? I was banded by Dr. George Ferzli mentioned in this study.

GeezerSue · January 5, 2004

Originally posted by ldauph
who did the study? I was banded by Dr. George Ferzli mentioned in this study.

The authors (I imagine) did the surgeries and the study. Now the questions are:

•which group were you in; and,

•did you have any problems?

sassaay · January 5, 2004

Hi All,

I am not trying to be argumentative, but I wonder if all pre-banders refuse to have their operation by a surgeon who has yet to place at least 50 Lap-Bands... How will we ever get any additional surgeons performing this operation?

I will be banded on 2/3/03 and had a choice of two doctors:

One has performed more than 50 and the other less than 50. I have chosen the doctor who has performed less than 50 because she has a much better bedside manner and positive attitude about the Lap-Band than the other doctor. The doctor with more Lap-Band placement experience has been performing WLS for more than 30 years, but he had nothing positive to say about the Lap-Band. He obviously hasn't done much research as he made claim that he has seen no real proof that it even works and would much rather see patients get the Gastric Bypass.

On the other hand, my doctor is very positive about the benefits of Lap-Band and feels that it is the ideal choice for me. Since I have been successful in getting my insurance to approve Lap-

Band surgery and cannot afford to go to Mexico for a self-pay, I feel these 2 doctors are my only options. I understand that some of you would select the doctor with more Lap-Band placement experience, but what about other factors?

My doctor has advanced laparoscopic experience and according to her she would love to do more Lap-Band placements, but her patients have been meeting some challenges with insurance approvals and her contract with the hospital is resulting in high costs for self-pays.

I feel that she is going to try her best to complete my Lap-Band placement with no complications in order to add to the number of successful Lap-Band patients she has treated and to get to the status of over 50 performed... whereas on the other hand, the doctor with more experience I just don't trust that he would have my best interest in mind. He would already be thinking that I will fail, so let's just get it over with...

Just my thoughts and something I will have to deal with through this journey. I hope to be back here in a month telling you all that everything went well and I had no complications. Keep your fingers crossed for me.

GeezerSue · January 5, 2004

Anne,

I hate real world choices, don't you?

Okay, in response to your question, some thoughts:

•Call me selfish (and you'd be right), but I'm not willing to be part of someone's learning curve just for the benefit of others. I am glad that others are sufficiently altruistic, because I enjoy the benefits. But I'm not going to join the line-up.

•How did a band-unfriendly surgeon get that much experience? A wonderment to be sure!

•There is a VERY experienced surgeon in the midwest, who does beautiful surgeries and apparently has the bedside manner of Atilla the Hun, and an office staff of ex-drill sergeants. But his work is good. So that's probably where I'd go. (On the other hand, we'd probably argue later and part company and I'd be sorry about my decision.)

•Please note, that nobody died in either group. And, that even the more experienced surgeons had complications. So there are no guarantees, either way.

•I'm not a particularly lucky gambler, so I like the odds on my side to begin with. Not everybody feels that way.

•I'd rather be patient #1, #2, or #3, than patient #9 or #17. That's because the first three surgeries are proctored, with a thoroughly experienced LapBand surgeon in the room. My preferences are not better-informed than anyone else's, they're just mine.

We have to do what we have to do to save our lives. Remember, I just said we should ask the question...I didn't mean to make your decision for you.

Sue

sassaay · January 5, 2004

Thanks Sue. All of your points are well taken. I appreciate your input and enjoy reading your posts. I see your point and realize that you are right, we can all ask the question but must make our own decisions (and live with them) in the end.

Have a great day and thanks again.

quakergirl · January 6, 2004

Anne, in your situation, I think I'd make the same choice of going with the less-experienced but more optimistic doc.

If the first doc has done lots of band and still doesn't believe it works, it sounds like he's probably doing something wrong with aftercare or fills - which is just as important to success as placing the band properly is.

Sue does make a good point: In general, going with the more experienced doc is a good choice. But it's not set in stone.

After all, I think there's at least one person on this board who was in the FDA trials (back when ALL the American docs were inexperienced) and had great success.

Good luck to you!

sassaay · January 7, 2004

Thanks for the feedback Quakergirl. I am glad that I could share my personal experience with all the folks on this forum. Knowing that my doctor hasn't placed enough bands to rank her as an expert, has made me more determined to do my part... so that we can both be a success.

I respect everyone's input and enjoy the fact that we have this forum for such discussions.

I will keep you all up to speed on my progress.