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

The person you are referring to removed their own posts for their own reasons.

I would like the doctors to answer a few erosion questions I have.

I am not banded and am nervous about this complication. I am concerned with the stomach's ability to heal after erosion. What are the chances of infection and death with erosion?

Delarla requests that I appologize to the "entire obese community" for (I think) suggesting that people not to be obsessed about their bands. In the past few days I have received emails from several patients asking if they should have their perfectly functioning bands removed now, before they erode. I now see a post suggesting that all Band patients should have mandatory annual endoscopies. Does this sound like obsession to anyone?

I have never intended to offend anybody; I am only trying to offer some useful insights after dealing with many 100s of obese patients. I am indeed sorry if I have offended anybody. If you want further appologies, please email me directly.

Many people complain that insurance companies are reluctant to pay for LapBand. I humbly suggest that the best thing we can do to REALLY piss off the insurance companies is to willy-nilly require endoscopy on all our patients every year! Imagine the cost! And for what benefit? Actually not much. In fact, erosion, though devastating in its implication for the band (mandatory removal), is otherwise benign. There are actually patients with eroded bands who don't want them removed, as they are still functioning. So if your band is working, leave it alone and be happy. If you start having problems, there's plenty of time to figure it out.

Mark Pleatman MD

I'm very reassured by Dr. Pleatman's reply, since it closely echoes what the surgeons I have spoken to have to say. Thank you!

Wow, I just got through this thread...Lot of intense emotions.

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.

I agree totally. BUT as to Dr.P apologizing to everyone, I think thats nuts & so not called for. Anyone posting after that intial conversation was doing so based on emotions & or good information(although the emotions/information may be true & that person may be hurt) the comments in question weren't directed towards them.

If this would be true than every single damn thread I read that pisses me off or hurts my feelings or directly offends me & there have definetly been a few. Well than I want an apology from ALL of the people that did that.

As John S. from 20/20 would say

"GIVE ME A BREAK"

****I now have just read Dr.P statment in post #161 above. Well said Dr.Pleatman. Thank you again sir for you time & your energy. ****

After my first projectile vomit, I felt green and queasy. Instead of a normal PB, liquid and food shot out 1/2 foot across the sink with force. I don't consider having an endoscopy insurance fraud after my dramatic experience.

For me, I'd rather have a cavity filled than a root canal any day of the week, which is why insurance companies not only pay but also encourage clients to have an annual cleaning and full set of dental x-rays as part of preventative maintenance. I never see or feel pain and/or cavities, but I get the x-rays anyway. The expense of an endoscopy is nothing in comparison to a 3-day hospital stay for band removal and repair of a perforated stomach. But like I said before, the band is a very high priced device that should never be considered unless you have good insurance or a chunk in the bank.

I'm not Chuck Norris so the thought of a band potentially eating into my stomach gives me the queebies - call me odd. But I suppose there are lots of tough guys who could watch an episode of Nip Tuck then fall asleep with no problem. YIKES!

Even Dr. Billy says erosion "isn't always" an emergent situation. He said a completely eroded band would just end up as a blob inside the stomach and might eventually cause problems. Hats off to anyone willing to live in the unknown. Creeps me out.

"We now recommend that every band patient gets an upper endoscopy around 18 months after the surgery." Dr. Ortiz.

"Many people complain that insurance companies are reluctant to pay for LapBand. I humbly suggest that the best thing we can do to REALLY piss off the insurance companies is to willy-nilly require endoscopy on all our patients every year! Imagine the cost! And for what benefit? Actually not much. In fact, erosion, though devastating in its implication for the band (mandatory removal), is otherwise benign." DR. PLEATMAN

Now we have two surgeons and a moderator disagreeing in one thread. First everyone thanked Ortiz, now everyone can thank Pleatman, and then everyone is back to Square One to decide which good doctor to believe. How is this thread helpful to bandsters trying to figure it all out and make wise choices when all we see are the opposing opinions of two surgeons? How? By making your own choice. Read everything, dispute nothing, then go with your gut.

For anyone to say erosion isn't dangerous hasn't experienced it themselves. The band eats into the stomach while the skin around it repairs and closes over the outside of the band. But how are we to know how strong those bonds are? According to my surgeon, one bad PB or stuck food episode might cause a potential leak. So while suggesting people walk around that way, at least suggest they live on a diet of mushy foods sipped through a straw till they can be sure the band is safely inside the stomach with no weak tissue ready to leak. Maybe I'm making a medically incorrect statement, but I know my body, and I knew I felt "off" and uncomfortable during my erosion.

Note: I sometimes edit or delete posts when I see people taking them out of context and misquoting me. I do it to protect people from relying on something I might have written out of sarcasm or as a rhetorical statement, such as when I said Pleatman owes the entire obese community an apology. Being the entire obese community consists of millions, it was obvious to me that my statement was rhetorical. Read, think, process. Then respond.

Hi,

As I mentioned earlier, I dont agree with the position that EVERYONE should get endoscopy at 18 months. I believe that only if there is a real problem , change in restriction or something on flouroscopy when checking the band or administering a fill, then a doc should commit to exploring the problem further.

Lisa is right. There is a difference in opinion just with just two doctors here within the context of this post. So the docs who come here to offer their opinion should understand that this is also a problem for bandsters who get mixed messages from their docs as well about the need for an endoscopy since many erosions are asymptomatic. The commonality of most of the erosions that seem to be presenting themselves here were not initially found by endoscopy but rather by lapbanders who had some other issue like in Donalis case, a gall bladder type pain which resulted in the endoscopy. Or an infection of the port during banding journey or change in restriction or in Michelles case, a bowel obstruction that required treatment in which she later discovered the erosion. Lisa band journey was riddled with complications from day one, so she had a good indication and a gut feeling that she was eroded. So although folks keep talking about being asymptomic there appears to be some commonality for many of the eroded folks here. I am NOT saying that there arent erosions that have happened that werent totally asymptomatic. Maybe in those instances, the patient had a gut feeling that something was wrong. I think that docs should listen to their patients and sometimes they just dont. Recently, the relationship with my surgeon and myself deteriorated because he refused to listen to me regarding the fact that I had no restriction. It was discovered by flouroscopy that my plastic surgeon accidently removed all of my fill during plastic surgery even though I only asked him to remove a little bit and even provided him with a Huber needle from the hospital to do it properly. Docs should listen to their patients and many times they dont. That is my only pet peeve.

Babs in TX

334/180ish

-150 ish

If I have any regrets about the band it is that I didn't make sure I had great follow up care.

Yes I researched the Doctors in Mexico and felt sure I made the right choice. I had the money to have the band placed and had a good job at the time that I had my surgery. Didn't think money for aftercare was going to be an issue. Well lost my job now aftercare is an issue. I just can't jump on a plane and go back to Mexico for care. Nor do I want to.

Would I have the band again yes in a heart beat. Would I have it done in Mexico or any other country NO. Why? Because if you can't find anyone to take care of you after what good is it.

Finding a doctor to care for me has been one of the biggest struggles. Right after my surgery I tried contacting Dr. Lopez office for advise on some meds and to request my records. That was a nightmare, I called and called no one ever faxed my records. I think I got the med advise from someone here.

So my advise to anyone seeking out the band, would be find someone you can depend on and that is close by. We shouldn't have to jump on a plane or travel miles and miles to find someone to take care of us.

But we should know all that before we make the decision to have the band. It would have been well worth it to pay the extra and have the comfort of knowing that your doctor is near by if you need them and knows about you and your circumstances.

This post said it best!!!!!!!!

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.

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??????????

For the record, Karen and Francesca went all the way to Mexico for a fill. Both were shocked to learn they were eroded. Neither had port problems or complications.

Kathy, I was in the same shoes as that poor girl. When I finally decided to see Dr. Billy, it was with the knowledge that I might eventually have to file bankruptcy over the band. I had to swallow that option because my health and life depended on it. Billy will see Mexican patients, but not for free. He's more reasonable than some doctors, but you're sill facing American hospital bills.

Meanwhile, the girl's nurse sees her probem as an emergency. Even though some doctors feel erosion isn't an emergency, I certainly do based on common sense. Ignore a foreign object eating into my stomach? No thanks.

Delarla that poor girl is me. And I am filing bankruptcy not because of the band but I couldn't find a job to replace my 40,000 a year salary.

I posted that post earlier this week. I have been having alot of health issues. Bronchitis, pnemonia and I had been overfilled so I thought maybe there was a posiblility that the band was involved. I don't know if my band has anything to do with what is going on with my health. I just know that it would be nice to know that it is not involved. I go to PCP she has no clue if it could or could not, I went to Dr. Neal in Olympia this last Thursday wanting to have a Endoscopy. He said that he didn't think it was necessary and we should wait until my bronchial stuff is all cleared up and he will do a fill under floro and check the band out further. So you see I don't see that I can do anything further.

I have spoken to Penni and she offered for me to come and see Billy also. I would love to jump on a plane and go have it checked out but that is just not feasible. I don't have the money for that. And so I have decided that if things get bad I will have my husband take me to a Portland Hospital I really think that is my only option.

I am feeling somewhat better today. So I am hoping that things are going to improve and I can see Dr Neal soon. But for now I can't let my self worry it is just been to difficult.

Hanging in!!!!!!!!!!!

Kathy, just so you know just about any medical provider will work with you on payments if your necessary medical treatment isn't covered. I think Dr. Neal is right, having had bronchitis myself last fall, twice. It really does mess you up all over the place, and it's really easy to think there's something wrong with the band.

Maybe there is, maybe there isn't. If your symptoms clear up the preponderance of statistical evidence would seem to indicate that there isn't anything wrong with your band. You'll know more after your fluoroscopy, and until then there's no point in worrying.

Glad to hear you're feeling better!!

After my first projectile vomit, I felt green and queasy. Instead of a normal PB, liquid and food shot out 1/2 foot across the sink with force. I don't consider having an endoscopy insurance fraud after my dramatic experience.

After events like that, there is nothing fraudulent at all about having an endoscopy. The endoscopy isn't the fraud, but making up symptoms to get one is.

For me, I'd rather have a cavity filled than a root canal any day of the week, which is why insurance companies not only pay but also encourage clients to have an annual cleaning and full set of dental x-rays as part of preventative maintenance.

Not exactly. Dental insurance is nothing more than a pre-paid discount plan. The dentists get more patients, and they are amply compensated by what they get from the carriers for their 2x/year cleanings. Believe me, no one is getting anything more than what they pay for with dental. If you add up your premiums you are more than paying for what the cleanings cost. There's no "insurance" involved, since no matter what the case there is a cap on the maximum annual benefit.

The expense of an endoscopy is nothing in comparison to a 3-day hospital stay for band removal and repair of a perforated stomach.

Very true. But the cost of tens of thousands of endoscopies far outweighs the cost of hundreds of band removal operations. That's what the insurance carriers are considering.

"We now recommend that every band patient gets an upper endoscopy around 18 months after the surgery." DR. ORTIZ.

"Many people complain that insurance companies are reluctant to pay for LapBand. I humbly suggest that the best thing we can do to REALLY piss off the insurance companies is to willy-nilly require endoscopy on all our patients every year! Imagine the cost! And for what benefit? Actually not much. In fact, erosion, though devastating in its implication for the band (mandatory removal), is otherwise benign." DR. PLEATMAN.

My guess is the reason for the doctors difference of opinion using endoscopy as a precaution is probably because of the expense. I think someone quoted $4200 for an endoscopy in the U.S.A. I paid $250 for mine in Mexico.

Kat :puke:

This will all be a moot point as soon as DeLarla's At Home Pee Stick Erosion Kits are released.