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

I am not embarrassed to admit, well I am, that IF I lost my band AND I saw NO HOPE of being able to have the GASTRIC BYPASS in place of it (MEANING MY INSURENCE will have to have to be covering it OR SOMETHING that deosnt involve me having any money.. cuz I never will have any.. EVER)

I would probably say goodbye to this world. I know that seems so dramatic, but before I got this band and even during the first few months.. I was certain in my head that If it didnt work, I refused to be a burdon to my kids, and this life any longer.. my absence would be hard on people I know, but It would be best after everyone greived and got over it.. I really was completely ready to go.. I do not see death as this horrible thing.. but me and my eventual health complications and lack of self care and blah blah blah.. I am not one to live like that.

This is the kind of thing Dr. Pleatman was referring to. I find this sad. Apparently he was on the ball because some people do need to be told to move on. I would appreciate his frankness if it were me.

Can't wait to be called mean and insensitive.

When I read Dr. Ortiz's thread, I thought how sweet and caring he was to post this. I think the reason he did this was because so many of his patients were calling/faxing him because of all the problems they were reading about on LBT. I actually think his whole reason for posting was to help these people understand more about erosion, and not to be so scared. I have to say that reading some of the posts really scared me too.

I think most of us value our doctors, and the majority of us don't want someone else putting them down. We have come to trust our doctors with our lives, so when someone says something bad about them, we are willing to stand up and fight. And, while we think the world of our doctor, not everyone is going to think the same about him/her. I learned a long time ago that every doctor is not perfect in everthing he does, but I don't need someone else telling me that! Let's just think about what we say about others doctors before we say it, it takes a long time for hurt feelings to heal.

I value the information we get on LBT from doctors and nurses. I hope they continue to come here and post.

I also value the bandsters that have lost their bands and continue to stay on and post with us. Who knows, I might be one of them someday, and I can see how they coped with it and what I have to look forward to. These people have been on LBT for a long time, and they can help with some of the problems you are having now as well as some you might have in the future. Please people, don't make these people feel bad for staying on, we need them here. I was banded because of some of these same people being such an inspiration to me while I was researching. I for one hope they stick around for a very long time.

Dr Ortiz -- thank you for sharing your knowledge with all of us. I think that the coexistence of tube & port infections with erosion is interesting -- especially interesting is the knowledge that it may happen the other way around -- ie stomach problems leading to port problems reather than the other way around! Looks like we all put the chicken before the egg! I have said too that sometimes a little knowledge can lead to alot of speculation. I love LBT and get so much great advice here, but you are right, the more there is to hear, the more you there are problems....... and often it is just the ability to access info better, or the sheer frequency with which the procedures are being performed. Thank you for coming here to share & enlighten!

I have just finished reading this thread (after my previous post) and I have to say that the hostility is scary. Everyone has there own opinions and everyone has a right to those opinions. If you are offended by someone's remarks, please remember that it is just one person and it is just one opinion. The eroded sisters are a wealth of knowlege and LBT would not be the same with out them. The Drs also offer another lset of valuable info. And to all of us in between -- our experiences are what create the mass of the LBT wealth of knowlege. I say everyone keep it coming! Let's all take what we can from these posts and use our judgement. No one persons words are the law.......take the offerings in the spirit in which they were meant -- to be helpful.

For those of you that have known me on this board, you know I am very rarely serious. this is one occasion where I will be.

I do not know any of the band docs other than my own. I do not know what kind of surgeons they are, what their facilities are like etc. Dr. Ortiz and Dr. Pleatman may be fine surgeons, and I will not debate their skills.

However, and this is a discussion I had with my band doc before I chose him, this is not about the surgery. Lap Band is a process, not just a surgical procedure, and one needs to look for a doctor who has a PROGRAM for weight loss, not just a surgical option.

With my doc, it starts pre-op. To qualify for the procedure, First you have to attend an informational seminar, otherwise he will not give you an appointment, followed up by your first visit with the surgeon. Now, you have to have your doc give you a full physical, and forwad his surgical recomendations for or against to the band doc (including weight loss attempts history, documented). Then you need to go through the normal pre-op tests, then more. You meet with a nutritionist, to go over in detail your pre-op and post-op diet plan, for which she gives you detailed documentation, handouts and papers listing your options etc. Next you meet with the PA who does most of the fills, and he goes through the fill options, procedures etc. He will also assist the doc during surgery. You meet with the patient counselor, who talks about past victories and failures (yes, my doc told me details about patients whose bands failed on the first office visit... he said that it was necessary so that I could understand the risks involved). I then had 2 sessions with their psychiatrist to discuss the psychological aspects of weight control and loss. Lastly, I met with an exercise physiologist (something he is going to make a regular part of his plan) to go over the physical aspects of the weight loss, and to develop an exercise plan to help.

This was a lot of stuff, and it was BEFORE he's do the surgery on me. Afterward, there were weekly appointments for the first couple months, then every other week, then monthly for the first year. Every other month, or as needed after that. Barrium swallow and fluoroscopy with my first fill, and every 6 months there will be another. Monthly support group meetings attended by the entire staff of the doc's office, the shrink, the exercise guy etc., and strongly encouraged for you to attend. Constant feedback, and attentive reaction to the patient. In addition, you have unlimited access to the dietician, patient care couselor, and phychiatrist from then on, in addition to your doc!

So, what's my point? My point is this...

THIS IS NOT ABOUT SURGERY...IT IS NOT ABOUT AFTERCARE,

IT IS ABOUT A WEIGHT LOSS PROGRAM!

A program means more than just a surgical procedure. Now, I will state emphatically, that I cannot speak for anyone but myself, but, how could I garner the attention, and care that I have recieved from my LOCAL doc, if I went to another country? Would the foreign doc be able to do all those pre-op requirements in a day? No. Would I be able to get to his office weekly? No. Would I be able to go to his support group meetings, see his dietician with questions, go to the doc's exercise guru? No.

Now, if you live near Mexico, or in Mexico, then you can. But if you do not live within a reasonable distance from your SURGEON, then that's all they will ever be to you, a SURGEON... Not your WEIGHT LOSS HELP, not a part of a program. It is the program that makes this work, not just the surgery. Many of you have asked me how I lost so much, so fast, this is why. I have a TEAM working for me, non stop.

Now, before you ask, yes, I did self-pay. I had to borrow the money, I don't have it sitting around either, but I never considered looking for a discount service when it comes to my health... the PROGRAM sold me, not just the surgeon.

I am amazed when I see folks writing on this board, right after they come home from surgery, saying things like "what am I supposed to eat", "how long am I supposed to be on liquids", "Should I do a pre-op diet", "What kind of exercise should I do", " when do I get a fill" etc.

You should know these things already. They should have been given to you in detail BEFORE you had this procedure. I had those things, because my doc has a PROGRAM, not just a surgical procedure.

Now, I am not saying that is why there are erosions, why there are possible issues with certain docs, or anything like that. But, I think that if your docs were looking at more than just cutting someone open, and installing the band, then they might look at you differently. I could never imagine having my pre-op tests and then getting the surgery in less than 24 hours from each other. Unless it is emergency surgery, I'd want to have a bit more thought put into it.

Sorry so long. Hope I did not tick anyone off. I know that many folks have the surgery done in places like Mexico for very valid reasons, and that is your decision. I am just telling folks to look for more than just a good surgeon... look for a good DOCTOR.

I appreciate the surgeons that have chosen to come onto our message board. In my opinion, it is of benefit to read their educational insights and opinions. How many medical-related message boards actually have surgeons responding and replying? I feel lucky. Thank you.

Those who have experienced erosions, I am truly sorry and admire your courage for "staying in the game." You have all given us so much information and support as well. Thank you.

It's wonderful to have a place to share and hopefully be supportive.

Shawn

DeLarla loves Big Paul :kiss2:

Heather Loves BigPaul too!

Great post!!!

Right on BigPaul!

Hi Cristan, where do you go in Olympia for your fills? I'm in Olympia, had my surgery Jan 12th and am looking for a good doctor in the area to do the fills. I found a doctor in Tacoma but would prefer to have one here in town.

I am just telling folks to look for more than just a good surgeon... look for a good DOCTOR.

perfect statement. :clap2:

as for the rest of it,,, well said.

:cheer2: :rockon: Big Paul rocks! What a wonderful post!! :rockon: :cheer2:

We are never going to have any health care providers come onto this board and help us out if we continue to behave this way.

I am going to get kicked in the butt for saying this, but if the health care providers that come on here are going to be making the outright cruel comments that some have done, then they can stay away. Same for bandsters... I could do without Pleatman and his just get over it comments!

Does this mean we are "going to war"??? Hardly! You know I luv ya. I started to write my own disagreement with your opinion, but realized Alexandra said it lots better than I could have come up with...so let me just quote her for my reply.

Megan has an excellent point. Any surgeon who comes here to express opinions or share his experience should be welcomed, not jumped on. How many of us have had doctors suggest alternate procedures to us to our faces? Do we jump on them then? No.

Surgeons have a different point of view than their patients, that's perfectly understandable. People cut their surgeons slack on the "bedside manner" thing ALL THE TIME in face-to-face encounters, and I hope we'd do the same thing online. Obviously compassion and understanding are valuable qualities in a healthcare provider, and I've seen nothing that indicates any surgeon here is devoid of those qualities. Perhaps the suggestion could have been worded differently, but the advice is sound.

I agree totally!!! Please don't kick my butt! :nervous

I am amazed when I see folks writing on this board, right after they come home from surgery, saying things like "what am I supposed to eat", "how long am I supposed to be on liquids", "Should I do a pre-op diet", "What kind of exercise should I do", " when do I get a fill" etc.

You should know these things already. They should have been given to you in detail BEFORE you had this procedure. I had those things, because my doc has a PROGRAM, not just a surgical procedure.

Gotta add my kudos to Big Paul, too. I completely agree with every word of the above comment. And it has nothing to do with US vs Mexico or erosion percentages or anything else. This is a PROCESS, not just a PROCEDURE, and we should look at it that way from day one.