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

Cristan: What I don't understand is why are these eroded non-bandster staying on this board freaking everyone out.

This is the only board I've found that didn't run off people who had severe problems/complications. This is a highly unusual place.

I understand how many people are uncomfortable with being reminded that the possible complications are real - not something that just happens to no one you've ever heard of, and no one you'll ever meet. Having the eroded bandsters stay is a difficult and frightening reminder to some. I would tell all of you this: make peace with the reality of what could happen. Embrace it, learn everything about it, and then LET IT GO. Deal with YOUR day to day reality. My reality is that I eroded. Your reality is that you have not. My eroding does not increase YOUR chances of eroding. Worrying does not increase/decrease your chances. Having us off the board does not increase/decrease your chances. Remaining in denial about the possibility does not increase/decrease your chances. However, if you are educated about the possibilities, IF you end up having a complication, you will know what you are in for, and you will deal with it then. You cannot "pre-" deal with something that hasn't happened, but you can be educated. And education is empowering.

Everyone's journey is a little different, and everyone has their own unique challenges. We all handle adversity differently, and we all have our own unique coping mechanisms for when things don't go as planned.

This thread brought me to tears - in a good way. Obesity is so complicated, and so emotional. The support here is phenomenol. I appreciate Dr. Ortiz's and Dr. Pleatman's efforts to interact with us. I appreciate those who rally to protect those of us who've eroded like we are some precious commodity (I really appreciate that, and am humbled by it). I LOVE that Cristan is being advised to stick around and get to know us - this is the essence of the LBT that keeps me here. I am in awe of all the people who have joined in this conversation to add their opinions, vent, protect, over-react, restate, poke fun, bring us back to earth, etc.

I have seen a lot of posts from people relaying info they'd "heard" or been "told" about erosion that were just plain wrong. I'm glad Dr. Ortiz set the record straight in that regard.

And while most band complications are not emergent situations or immediately life threatening, I will caution that in some very rare instances emergent and life threatening situations DO arise. Not all erosions heal as they go, and sometimes stomach content leaks into the gut during the process. A very rare few do experience severe, non-reversible stomach damage - I can think of two on the Yahoo! eroded bandster board. But that is even rarer than the erosions themselves.

For many bandsters a more agressive WLS is their second option (for a couple it was their FIRST, but their insurance would only pay for the band!), so Dr. Pleatman suggesting a conversion is not out of line. However, emotions run high, and people can only assimilate information when they're ready for it. For some of us a more drastic WLS will never be an option - for others it would only be an option if things became unbearable and there was literally no other choice. For others it is the logical next step. It's an emotional issue, and emotions aren't static.

Hugs to Penni - you will get through this, and your erosion, while possibly never forgotten, will become a thing of the past. You will move forward in your own time. Never forget that life is full of amazing possibilities, and as long as we are here we have the option of exploring them. Science makes amazing discoveries everyday. Society makes amazing progress everyday in awareness and acceptance. It's not always easy, and things don't always seem right, but I believe in the basic goodness of mankind and I think we are all doing our very best at any given moment. We all have to grow, and adversity, challenge and heated discussion helps us get to where we're going. Sometimes it's painful, sometimes it's bliss, but mostly it's just... day by day.

Life has no guarantees, no magic formula. It's the journey that's important - not the destination.

IMHO

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 go to pacific Surgical in Olympia. Dr Neal. I just checked out his website to get you the name. Pacsurgical.com. They have a great new clinic. Anyone in the area should checkout this site as they are having a big convention in Seattle with 6 top Band Drs speaking. It should be very interesting. Dr Ortiz and a few other Mexican Drs as well as some from the US will be there.

They go a great job, I have had a fill in Mexico when I had my follow up with Dr Martinez ( Dr Ortiz' Partner). I have had 2 at Dr Neals. I wont go to Fox in Tacoma because he does blind fills and I think thats a shot inthe dark!

Good luck!

Banded and losing!

Agreeing with Big Paul 100%. Please be informed before making your decision. It's one of the most important that you'll probably ever make.

I also want to thank Betty for her comments. I couldn't have said it better myself. Your wisdom and kindness shine through once again.

I love all of the LBT members who have eroded, and could not imagine my life without them here. They are some of the first bandsters that I came to love, and how big of them to want to stay and encourage us, even amidst their own suffering, grief, and turmoil. You are all loved, valued, and appreciated way more than you'll ever know.

Thank you also to the doctors for coming on to offer your medical knowledge as well.

And thank you to Alexandra for keeping that ever important LBT balance in this thread as well.

Lots of love all of the way around.

Greg too Loves BIG PAUL

A truer Post could not have been written.

My hat is off to you

Big Paul does indeed ROCK!

And Kare - I love your new profile name, and I love your golden rule post!

What I don't understand is why are these eroded non-bandster staying on this board freaking everyone out. I have not seen a reason why I would want to "fit" into this group. ..

This comment really bugged me. I want to say that these non bandsters are here because myself along with ALOT of others have asked them to please stay. We want to hear there stories (good and Bad). They are not telling us their erosion experiences to scare us they are telling us to inform us and they are looking for support. If you think they don't belong here then you are dead wrong.

I also totally agree with Paul on his post. You don't just find a "good surgeon" you find a good surgeon with a great follow up program. One that follows you all the way. My Dr's Associate told me personally "We will not let you fail, if we see you slipping we will be all over your ass." I had to go through several hours of pre-op testing and family history, psych eval., dietician, exercise, and had 2 hours explaining how the band works what problems can arrise, and how they will deal with them, what my goals were...just everything. It really scares the hell out of me how many people come here and have no idea what they are suppose to do now that they have the band. Like... what to eat, how long to be on liquids, when to get fills, what is erosion, what is a port infection. But I am also glad that these same people who have asked these questions are here so that us that do have a great doctor and program can help them.

And that is why I am here...for support and to help who ever I can.

fauxnaf)

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.

nykee)

This is exactly what I was thinking and what I meant..

I understand and do not thinks its mean and insenstitive although I am sure I am the minority, (maybe not)<!-- / message --><!-- sig -->

Thank you alexandrea, you always make perfect sence to me..

Big Paul is right of course, too bad I wasnt at all in the frame of mind to be so damn smart.

And Kare - I love your new profile name, and I love your golden rule post!

Thanks Donali.

Okay ya'll don't jump on me. Big Paul had some good points, but for ME--basically, I disagree. For younger and people with less experience with WL programs it's a good idea to go somewhere with a whole program, but that isn't what I needed.

I'm a 50-yr-old, educated woman who has been thru more programs than I can count. I have a BA degree and also (while practically a poster child for WW in my 30's) became a certified Physical Fitness Expert (hardly anyone knows this, because I never used that certification [i rarely tell people because it's embarassing to be a fat fitness expert!]). I have read every study re weightloss that has come my way for DECADES. ANd when it comes to weightloss (& gain) I AM AN EXPERT. No, I don't have an MD, but I've got enough knowledge and experience to decide some things for myself. In some ways I think I understand this issue more than any skinny MD ever could. You can study how to balance on a bike and know all the physics of it without being able to ride one.

I don't need someone to tell me to eat vegetables--or ask me the calorie count of an apple vs a muffin. I KNOW THAT. Over and over and over I know that and the thought of sitting thru another lecture on it is enough to make me EAT a muffin! I find many of the HOOPS American doctors and insurance companies make people jump thru before agreeing to surgery at the least stupid and at the most negligent. When a 300# woman walks in your office you need her to see a psychologist?? No doubt most of us (including myself) could benefit from some analysis, but if we are enabled to lose 100# first we MAY find there are other issues we can spend our time--and money--on.

Now please--this is just for ME but I have to say I am more than appreciative that I could go down to Mexico and just get what I needed. For the rest of what I need--shared experiences and emotional support I come HERE. I'm within 2 hours of TJ so Dr Ortiz is close enough for an emergency and from what I have seen he is WAY MORE AVAILABLE than most American doctors. His office has a nutritionist and a support board IF you NEED it. I appreciate being treated like an adult that can take advantage of what helps me and not waste my time with what does not.

There is merit in what Paul said, but as has been said before it is a complicated issue and we all have our individual needs. Thank goodness there are choices!

Kare, I'm with you in NEVER needing another diet lecture. But there's no question that people being banded need their hands held through the initial stages at least, and even on through the first couple of years. It's not about being told to eat vegetables as much as it's about being told that PBing can really hurt you. And being responded to when you need a fill or an unfill. There's nothing intuitive about learning how to eat again once your normal capacity has been so totally changed. That's why it's unnerving when people who have already been banded are asking "why does this hurt" and "what's a fill?"

I agree, thank goodness there are choices. But no one, no matter how educated, should think that the doctor's role is limited to putting the band in place. Sadly, there are many doctors who do think that, and their patients are being very ill-served.

And I'm with you too on thinking that insurance companies have anything BUT our health in their interests. But I do think there's a lot of sense in having candidates meet with a psychologist. We've seen many times that if someone isn't ready for the changes banding makes us embrace, they are going to fail or worse. An objective eye is very important, for everyone's sake but for the patient most of all.

The hoop I hate is the 6-month pre-op diet. That's just a hoop, no benefit at all. :bananajump:

Whew! I'm sorry I went to bed early last night. This thread has a lot of valuable information and...interesting...opinions in it, but it has come perilously close to crossing the line on personal attacks. If that continues we will have to lock it.

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.

As has been said on several other threads, erosion is not the end of the world. My surgeon's office doesn't even consider it an emergency, since the process is so slow and it doesn't automatically mean there will be a leak of gastric contents. The stomach is healing itself at the same rate that the band is doing the damage, which is why it's often asymptomatic. Yes, the band will need to be removed because if it's not, it will eventually end up inside the stomach doing nothing. But it's not a life-threatening emergency and having it removed is, thankfully, a complete fix.

Personally, I'm very glad that other options will still be there in that case, and I'm not at all insulted by someone suggesting a different procedure if someday the band no longer does the job for me. It will be up to ME to decide what the next move is--no one else's opinion matters in the least.

I am one of those people that WILL confront a surgeon, doctor, nurse if I think what they are suggesting doesn't really sound right to me. I want to know why they are suggesting an alternative and what are the ramifications and anything else I can think of. What got me so upset is that a surgeon just blatantly suggested I "get over it" and consider another WLS in it's place. That was all I was speaking about.

I guess I am one of those patients that has alot of Knowledge based on my prior RN background and know when the medical professional is pulling my leg or whatever.

I am not going to rehash all this again. I just wanted to say YES I would confront a healthcare professional on my health related issues. And YES I would do it face to face and have on many occasions. Dr. Billy and I discussed my options and he gingerly brought up the possibility of other WLS. I looked him square in the eye and said H E double hocky sticks NO!!

But no one, no matter how educated, should think that the doctor's role is limited to putting the band in place.

Well Alex, perhaps I "SHOULDN'T" think that but I do. That is all I need from my surgeon. Putting the band in place and helping me with any physical complications suits me fine.

In my (humble) opinion no one, no matter how educated, should think that the responsibility lies with anyone other than themselves to decide what is right for THEM.

ANd, just because I seem to be feelin' troublesome this morning I have to say that personally I have known too many screwy psychologists and heard people given advice that runs the gambit to put my faith in one of them as anything but an assist. (Surely you don't think psych counseling is ANY guarantee of success? How many people do you think it has chased away? My guess is LOTS.)

Hey--this is AMERICA land of the free and home of the brave! We are free to make our own choices and I will defend anyone's right to choose MEXICO!

(PLEASE READ THAT WITH THE LAUGH I'M SENDING WITH IT!)

This thread has been amazing. I just have to put in my two cents. First of all, medicine is certainly not an exact science, so even the greatest surgeon or doctor, or whatever you want to call them, can make a mistake or even if he or she doesn't make a mistake each patient reacts differently (within a certain range) to a specific form of treatment.

I don't think it is appropriate to damn all Mexican doctors. I have seen lots of posts on various boards from people who have had eroded bands that had their surgery done in the U.S. There are good and bad doctors every where.

I'm glad that people that can't afford to have the surgery in the U.S. at least have the opportunity to have it at all. I have met people who had their surgery in Mexico as far back as 1991 and have had no problems. I have talked to people who had their surgery in Australia and have had nothing but problems. I have heard of people in my city that have had the surgery here and nearly died. Then, I have read of people who had their surgery in Mexico and had problems, people in Australia who have had none and people in my city that are going great. It's a crap shoot guys!

So don't scare people off whose only hope is in Mexico, help them find the best doctor, be it here or there, and pray that they will have a great experience and a long life.

I am not going to rehash all this again. I just wanted to say YES I would confront a healthcare professional on my health related issues. And YES I would do it face to face and have on many occasions. Dr. Billy and I discussed my options and he gingerly brought up the possibility of other WLS. I looked him square in the eye and said H E double hocky sticks NO!![/color][/font][/b]

gee i never woulda thought you were the type to go face to face !?! :bananajump:

:peace: my wife and i are like that with you :pound: :pound: :pound:

gee i never woulda thought you were the type to go face to face !?! :bananajump:

:peace: my wife and i are like that with you :pound: :pound: :pound:

Too funny !!!