Dear Friends and Colleagues:<O:p</O:p

After receiving numerous calls and email regarding the latest speculations about erosions on the boards I feel obliged to post some facts that should be of some relief and informative at the same time. There are very few reliable sources out there on Gastric Banding complications except the series that are published in the medical literature. My colleagues that post on these forums will agree that my team and I are considered one of the foremost authorities in gastric banding complications and treatments in the world and as such our intention is that our ongoing research results in a safer gastric banding procedure for everybody.

Folks, Lets start out by doing the math. Band erosions are not increasing as one would think. They have actually diminished noticeably in the past number of years. What is increasing is the number of patients having the procedure along with the ability to communicate this fact through forums such as this one. A surgeon that has performed 100 procedures may have 1% erosion, which is equivalent to 1 patient. While a surgeon with 3000 procedures under his belt will have 30 erosions, but this still represents 1%. Also the awareness of it's existence has prompted us to look for them purposely through endoscopic studies.

We now recommend that every band patient gets an upper endoscopy around 18 months after the surgery. For a surgeon to know exactly how many of his patients bands have eroded he would have to scope them all. Endoscopy is the only way to prove an erosion since some erosions are asymptomatic early on.

Erosions are unfortunate adverse reactions of gastric banding. They are also poorly understood. The term erosion has been popularized recently in the literature as one of the complications of gastric banding. It suggests the wearing out of the gastric wall, but the actual process seems to be more of a foreign body reaction where the body tries to eliminate the implant. Erosions are not new and it has been known for decades and reported in the medical literature that various materials near the stomach or intestine can slowly penetrate the wall and ultimately be eliminated through it. Implants, sutures, staples, mesh, rings, tubing, cloth and metal all have readily penetrated the gut.

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Though the actual process is not fully understood we do know the following:

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- Most bands erode from the outer edge of the implant into the stomach. Sometimes it is the tubing and not the band that penetrates the gut. This would discard the suggestion that bands that are too tight erode. (Conversely we now know that bands that are too tight actually slip more often)

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- Surgical technique is similar around the world. Most surgeons in the US and the rest of the world learned the technique from a handful of international surgeons who proctored them. In turn these surgeons have perfected the technique and the principles of band placement remain the same around the world.

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- Erosions can coexist with an infection process. Even though it would seem that the infection can start at the port and then ultimately cause an erosion, our recent studies have detected mircopenetrations of the stomach at the initial stages of the erosion (soon to be published data) then most likely stomach bacteria tract down though the tubing to the port and contaminate it. Again these ongoing studies will shed new light on the process and hopefully someday will totally eliminate the risk of gastric penetration.

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- Erosion is not selective of one band or another. Sooner or later every brand of gastric band has been reported to erode.

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- Latin bands do not erode more frequently. For one the implant used comes exactly from the same company and are made of the exact same materials. Contrary to a controversial post recently published in a forum, responsible surgeons performing gastric banding in Mexico have a comprehensive follow-up protocol. Fluoroscopy and Endoscopy is routinely performed which means that we detect the erosions more efficiently and earlier when present.

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- When an erosion is detected the band should removed. This gives the stomach time to heal and in given time receive a new band. It is the patient's responsibility to tell the doctor of his or her symptoms. The sooner it is detected the better the chances of performing a laparoscopic and uneventful surgery with a quick recovery.

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- We also stress the importance of follow-up. Most erosions have no symptoms early on, so a routine checkup with your doctor is always the best option.

NO NEED TO PANIC, erosions are still a rare occurrence, but if present when detected and treated early on the outcome is benign in nature.

You will all agree that gastric banding has touched hundreds of thousands of lives around the world. It is the safest weight-loss procedure but unfortunately no procedure is free of complications. Even though erosion rate is very low, it still exists. When present it should be detected and treated promptly. The earlier it is treated the better the outcome. In some cases patients have actually received a second band after a brief period of recovery and thus having the benefit of restriction and weight-loss again.

The only source of reliable medical advice is your doctor. Other sources of information only lead to speculation, anxiety and worst of all delay in treatment if needed. If you are to go out of the country for surgery, select a responsible surgeon that offers follow-up. Ask if he will always be available (my patients can reach me in a moments notice, they all have my cell#) Don't be enticed to go to the cheapest, usually they go hand in hand with poor to no follow-up. You must be able to trust the doctor you have chosen.

We as Surgeons also have our official Internet forums where we exchange knowledge with each other having only your best interests in mind. Remember, ultimately it is your success that results in our success.

My best wishes to all,<O:p</O:p

Respectfully<O:p</O:p

Ariel Ortiz Lagardere

This if from another thread.. and it REALLY puts a spotlight on what we have all been trying to say in this thread:

Ok I just got off the phone with Dr. Neal's nurse. I talked to her about my problems that I have been having. Now I don't know where to turn.

She basically said that I should contact Dr. Lopez in Mexico and let him know what is going on. Well that is not a option for me like I told her. I want a american Doctor that I can depend on.

She gave me the cost of the Endoscopy and it is about 4200.00 and my insurance will not cover, if the band is eroded or there is a problem with it. From what I told her she didn't say whether she thought the band was related to my problems.

She did say that if there is a erosion and it is left untreated it is very serious.

So now what do I do? I don't have the finances for this type of procedure right now unless they take payments???

Delarla, Penni any advise. What about Dr. Billy what is the deal with him. Would he see me?

I am getting so frustrated I am about to have my husband just take me to Portland and check me into the hospital and see what they can do.

What should I do??????????

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Get the point now?

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2. to down plays ones "grief" in uncalled for by any person. No nobody died, and no loosing the band should not be compared to loosing a loved one...

I agree with your entire post with only this one slight exception.

I think losing the band could very realistically be seen as losing a loved one, or even your chance at life.

Most who opt for any weight loss surgery are at their very limits of desperation. They typically suffer from co-morbitities and are in a very real danger of death.

Having the band (or any other WLS) is an act to resolve these morbities and if it is removed and the weight is regained, so does the very real risk of untimely death.

So, I wholeheartedly agree with you, but I think we must be totally realistic. To downplay the band as anything other than a determined attempt to resolve a life threatening situation is painting a false picture.

The band, in a very real sense, offers the chance for life.

Loss of the band, can (in terms of duration, happiness, general health) could indeed cause "loss of life".

That is my humble opinion :bananajump:

paul, i agree with what you have said. Like i said in my previous post, like almost everyone on this board, i have alot of hopes and dreams invested in my band, so i can see grieving for it. Now me PERSONALLY i would never grieve losing my band like i would losing my daughter or husband. But again there is no comparing because each person brings thier own life experiences into the situation. For me, a friend of mine has lost her 2 year old daughter, i watched her morn and anguish, and its nothing i could ever imagine going through myself and i know i wouldn't feel that way about loosing my band.

Another example is when i had my hamster put to sleep, i took a day off work because i was so upset. Another person may need a week and another may not need any time off. That is the joy of being human, we have the freedom to react and express ourselfs as needed.

"5--I didn't say one bad thing about Ortiz in this thread, because now you can all read how wonderful he is in his own post."

That's funny, I don't care who y'ar.

Should I excuse the incorrect spelling because this guy is from Mexico? Should I read again the fact that he didn't use medical terminology as a dr. would. I will, therefore, assume there is someone pretending to be Dr. Ortiz on this board, though God only knows why they would want to pretend they are him. This person is playing with your head.

All I can say is "whew!" I appreciate all the input from everyone.

Just some FYI: I got a personal apology from Dr. Pleatman. It restores my respect in Dr. Pleatman that he acknowledges he could have said something that hurt my feelings.

Thank you for the apology.

Thats Great!

Should I excuse the incorrect spelling because this guy is from Mexico? Should I read again the fact that he didn't use medical terminology as a dr. would. I will, therefore, assume there is someone pretending to be Dr. Ortiz on this board, though God only knows why they would want to pretend they are him. This person is playing with your head.

He may be from Mexico, but he attended school in the US and is a US resident, north of the border. There are advantages to having a practice south of the border. As far as the spelling errors and medical terminology...you should SEE his book!

BTW, guess who pockets WAY more money on a banding...an Ohio surgeon or a Tijuana surgeon?

This if from another thread.. and it REALLY puts a spotlight on what we have all been trying to say in this thread:

Ok I just got off the phone with Dr. Neal's nurse. I talked to her about my problems that I have been having. Now I don't know where to turn.

She basically said that I should contact Dr. Lopez in Mexico and let him know what is going on. Well that is not a option for me like I told her. I want a american Doctor that I can depend on.

She gave me the cost of the Endoscopy and it is about 4200.00 and my insurance will not cover, if the band is eroded or there is a problem with it. From what I told her she didn't say whether she thought the band was related to my problems.

She did say that if there is a erosion and it is left untreated it is very serious.

So now what do I do? I don't have the finances for this type of procedure right now unless they take payments???

Delarla, Penni any advise. What about Dr. Billy what is the deal with him. Would he see me?

I am getting so frustrated I am about to have my husband just take me to Portland and check me into the hospital and see what they can do.

What should I do??????????

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

Get the point now?

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I offered to go with this person to see DR. BILLY. I am sure he would see her. He has taken care of lots of Mexico patients in the past from all over.

I saw that you did, Penni. You're such a sweetheart. I'm sure there are doctors who are compassionate enough to help where others shy away for fear of medical malpractice suits, but the point is.. here is yet another person who was banded by this same group in Mexico and is now having problems AND is frantically trying to find someone here to help them.

I have to point to Big Paul's post again. This is not just about finding someone who can get that band in you and send you on your way. It's about thinking ahead, thinking smart, covering your bases, and being prepared. If you can get to Mexico for after care and you have a good relationship with your doctor there, that's awesome. But if you're thinking about putting all of your savings into a quick trip to Mexico and you know you won't have the money or whatever you need to get you back down there when and if things go wrong.. you might want to pay that extra bit upfront and find a surgeon with a completel plan for your well being here in the states.

Again, Penni.. you're a sweetheart! *hugs*

And I sincerely wish the best to all pre-bandsters who are struggling with their decisions, and for those who are in the same position as this gal is. There are so many choices to be made, and none of us can see into the future to know for sure if our choice was the right one. We can take all of the information we have gathered and make what we consider to be an intelligent, well-thought-out deicion and still end up with problems. Life is fickle.

Hi Guys,

It took me some time to read through all these posts! Wow! I wanted to add that an endoscopy is very important for bandsters. At more than 2 years out, I have not had one. Most lapband surgeons here in the US do NOT want to do endoscopy unless they suspect there is a problem. IT is an expensive procedure and that seems to be the reason they dont suggest doing it. Some of my bandster pals here in the DFW area have been having a debate about this. I have two banded friends that wanted an endoscopy to check their bands out and were turned down. This is a whole other topic but I thought I would bring it up since we were talking about erosion and the suggestion of Dr. Ortiz was to have endoscopy at 18 months.

I know some may disagree with this position, but I am of the opinion that if it if it aint broke dont fix it. I am only of this position if you really truly are not having problems at all and you have had regular flouroscopy with all your fills, little problems and no major changes in restriction or digestion. Anybody have anything to comment about this?

And how do you get your doctors to support endoscopy if they dont?

Babs inTX

334/180ish

-150 ish

Pleatman owes the entire obese community an apology. I haven't received one.

Babs, several of my eroded friends didn't know they were eroded. The only reason they found out was because during their fills, their surgeon wasn't happy with how the barium flowed around the band instead of through it, which prompted an endo to confirm erosion. There aren't always symptoms, and the longer the band erodes the more damage it can do to your stomach.

My current surgeon never required regular endoscopies, either. But now that he's seeing so many people erode around 18 months out, he said he’d start requiring them on everybody at least annually.

I was also denied an endoscopy when I requested one. Insurance doesn't pass them out, your doc has to find it medically necessary. I had a projectile vomit and went to the doc holding my guts. At that point he felt it was medically necessary. ** Edited because my sarcasm was taken too seriously.

I know some may disagree with this position, but I am of the opinion that if it if it aint broke dont fix it. I am only of this position if you really truly are not having problems at all and you have had regular flouroscopy with all your fills, little problems and no major changes in restriction or digestion. Anybody have anything to comment about this?

And how do you get your doctors to support endoscopy if they dont?

Babs, my doctors agree with you, and so do I. I've asked repeatedly about the need for an endoscopy in the absence of symptoms, and the surgeons always say it's not a "screening" test to catch the small percentage of people who might have erosion with no symptoms. If there is an indication or need of some kind, absolutely. But it's an expensive test and doing it on 100 bandsters without symptoms to catch the very fractional few who might have erosion without symptoms is a waste of everyone's money.

If anyone wants one badly enough, one can always pay for it oneself. But making up symptoms where none actually exist so that a carrier will approve an expensive test has another name: insurance fraud.

Wow, I just got through this thread...Lot of intense emotions. I just have a couple things I want to state:

1. I think Dr. Ortiz deserves both our respect and gratitude for making this post. I think he is a great surgeon with wonderful after-care and a supportive staff. Whenever I have any questions, I am always well taken care of. Categorizing him with any other "mexican surgeon" is not quite fair. He should not be attacked for attempting to help state the facts about erosion - how many of your surgeons are on here trying to educate us? Hmmm?

2. I don't know what it's like to have an erosion or any other serious complication with the band & I do feel very sympathetic to all of you that have. I thank you for voicing your feelings on this board and sharing your experiences so we all can learn from you. I think that Dr Pleatman was rather harsh in his initial statement, but he did make an apology - and, I personally appreciate him bringing his professional opinion to this forum as well. That being said, I agree with him in the fact that when one suffers with a complication, we need to try & pick up the pieces and move on. I know those were not his exact words- but I think that was his point - that's how I took it at least. C'mon we got the band to try and be proactive right? So if our band isn't there anymore, we still need to be proactive right? Unless you're going to give in to the Obesity Demons, you've got to still work at it - hell, banded or not! Like Michelle-look at her! I really respect that woman. She's been through it all - but she is remaining strong and maintaining control - not attacking her Dr (actually she still is quite complimentary of him) and she's MOVING ON. There's a grief period of course and everyone deals with it differently, but please don't wallow in your misery. Stand up, be the strong man or woman that you are and take charge of your life again! Give all the rest of us something to look up to and be encouraged by. You've had to deal with a great loss, but it wasn't the band alone that made you lose the weight remember? You did it too! And you still can.

Again, thanks to Dr.O for coming on this forum in the first place and trying to help educate all of us and to Dr Pleatman as well even though he is not as eloquent as some, he is also trying to share with us from a professional perspective the facts about erosion.

Some of us see a man who deserves our respect and gratitude for trying to educate us. Some of us see a guy who jumped in to try to prevent any further damage to his reputation. I'm looking at a stark-naked emperor, myself.

The people I respect and owe gratitude are in a whole different category. But, to each his/her own.

I read this thread tonight, but couldn't find any posts by this person who said they were "disgusted with us". Someone has removed them. I guess I have to ask why, and yet I guess I know why, but it makes it hard for anyone to follow what was said by this person in the forum. There are other forums out there that this person can join, and I would highly suggest it. I think it is fair to say you can "vent" or state your views and they can be different from others, but I don't think verbally attacking the whole forum is going to make you any lifetime friends.

I guess I question why this person's remarks were removed and yet the answers to it were left. It makes you wonder exactly what the complaints were to begin with. Anyone care to fill me in?