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.

<O:p</O:p

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

<O:p</O:p

- 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)

<O:p</O:p

- 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.

<O:p</O:p

- 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.

<O:p</O:p

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

<O:p</O:p

- 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.

<O:p</O:p

- 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.

<O:p</O:p

- 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

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.

What about fills? You certainly didn't expect to be banded and never see the doctor (any banding doctor, that is) again. That's what I'm talking about. It shocks me when someone who is already banded wants to know what a fill is.

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.

I COMPLETELY agree with you on this point.

(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.)

I was talking about a psychological evaluation as a preop screening tool. I do think that's important and yes, will absolutely help in people selecting the right procedure for themselves. My screening exam was irrelevant because my mind was already made up--I'd already asked myself all the tough questions and been brutally honest with myself. MANY people don't do any such thing and can end up going in with unrealistic expectations, set up for disappointment and failure. I definitely think more than one conversation with a surgeon is important to the preop process, for MOST people. (You and me excepted, of course.) :becky: :cheeky :bananajump:

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'm not suggesting that any of us should take what a surgeon says at face value, but obviously respect and courtesy should rule the roost online. And online, unless one is confronting one's OWN surgeon about one's OWN health questions, everything has to be taken for what is it--a complete generalization. And FWIW, I don't think Dr. Pleatman's comment was directed to you personally. It's very easy for us to assume the comments directly following a post we make are personal, but I certainly didn't read his that way. I took it to mean he was talking to ALL people who have had their bands removed.

If your band has eroded, get on with your life. Stop obsessing about your Band. You might consider having a gastric bypass or sleeve gastrectomy.

Mark Pleatman MD

www.laparoscopy.com/pleatman

Alexandra: I believe he was in fact speaking to me since I fall into the category of having eroded. So yes he was speaking to me. I took it that way. How else should I have taken his comment? I did in fact go back and read it just to make sure I read it right.

OK, Penni, try this:

"If anyone's band has eroded, they should get on with their lives. Stop obsessing about their band. They might consider having a gastric bypass or a sleeve gastrectomy."

Or this:

"If anyone's band has eroded, the best thing they can do is to get on with their lives since obsessing about their lost band is purely negative. If they're still concerned about weight loss, they might consider having a gastic bypass or a sleeve gastrectomy."

I prefer the second one, of course, but the first one is the same thing without the "nice" parts. Do either of those offend?

If the second one had been said then maybe it would not have hit me as hard. But the second one shows compassion and understanding which was sorely lacking in Dr. Pleatman's statment. Which is my point all along. He appears to be lacking the sensitivity I think a doctor should have.

He appears to be lacking the sensitivity I think a doctor should have.

Fair enough. But until we've met him in person we shouldn't see anything other than a message-board-induced disconnect. Not everyone can be eloquent and expressive online. :bananajump:

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.

And they can tell that from one session??? I doubt it. It's hoopla! If anyone is having depressing thoughts (and we all saw the results of the suicidal thoughts thread) then they definitely would NOT tell the Psych that. If so, they would not be passed. Case in point... my sister did her psych and did not get recommended, she returned for a re eval 3 months later with another psych and lied her ass off about the rosey aspect and postive outlook on life and VIOLA... she had her surgery. All bunk I tell ya.

I am so glad that I can have the choice to go to Mexico and make my own health decisions. Even if those decisions come at a price, medically or pocketbook. I would use my Mexico surgeon again as I think he is very competant and and expert in the field. However, I would not go back to Mexico for the surgery because I don't care how many of you say it, it is not the same medical and cleanliness standards. Let us admit one thing... if you went to Mexico and had the surgery, the appearance initially was appealing and clean. But after the surgery you spent a day or so just wallowing in the pain meds and didn't see any more than they wanted you to see.

I do feel like a ticking timebomb. I do obsess recently about the occurance of Mexico based erosions, very coincidental and suspicious. I do have issues about where I will get the money to pay for a removal. I do wonder what will I do for a "tool" in weight loss. I do worry about possible damage that can be done to my insides from the erosion. I do worry about being opened up yet again causing more scars. I do appreciate and admire those that have eroded and still participate in the boards. I respect the eroded bandsters courage and posititve outlook because if I lost my band, things would not be good and everyone around me should worry like hell if I will make it through it.

I love my surgeon and think he is a fantastic bariatric surgeon and I do recommend HIM to others but I do warn others about possible pitfalls of going to Mexico the country for their surgery. It just isn't the same and it is a risk you assume. We all knew that risk when we had our surgeries there. Some heed my warning, others have had their surgery there with him.

My thoughts reflecting: I have the band and love my band I have now. If I had to do it all over again, I would not have chosen the band and would have opted for a more permanant and solid weight loss surgery. I am seriously contemplating having the band removed now before problems arise and converting to another form of weight loss surgery. If I find a doctor who will do that with me 20 lbs from goal, then I shall start planning. I just don't feel that the band is the "for life" option it was touted originally.

Off topic: I too am intensely irritated by people who are banded and then ask a question that is obviously supposed to have been covered before surgery, either from the surgeon or the research they did to make an educated opinion. I am also irritated by postings that ask a question that can be covered by a simple search.

Grrr, damn it I posted again.

Hey, sometimes we can tell things about others that they can't see for themselves. How many times have you thought that about yourself and other people, even strangers? And psychologists are trained to ask the right questions and read the truths behind the answers.

I definitely believe it's a very important step that we all should take when contemplating something as life-altering as weight-loss surgery. Not necessarily ongoing therapy, but at least one additional conversation with someone who (we hope) has no vested interest in the outcome.

So are they supposed to make assumptions about how they think I should feel or act? I think personality is such a delicate thing. Just because someone does not exhibit the traits, characteristics, or ideals that the psychologist feels they should have does not mean that they should be able to exclude them from making a decision about their body.

I agree that is doesn't hurt to go and talk to someone to just have the additional thoughts but when that someone has the option and leisure to either promote or stop your approval for what you want done with your body, THAT I have issues with.

Well I finally read the entire thread that is/was in question. I am sorry that people's feelings were hurt & that compasion wasn't used in many many statements. I have spoken to my dearest friend which was the most important thing to do & what I care about the most. With that being said & done I only have one other thought left & that is:

"Men are from Mars & Women are from Venus" Go figure- lol lol

I hope we all can regroup & respect & for those of us that are from Venus ((hug)):bananajump: ;0)

<!-- / message --><!-- sig -->

1--I am not eroded.

2--My band has been removed. (The dysmotility is greatly improved.)

3--I'm no longer all that supportive of the band, but will try to help those who have made a decision contrary to what I'd choose.

4--I have observed Dr. Pleatman offer reasonably-priced adjustments to those whom other US-based surgeons won't touch--or those who were going to be charged mucho--because they were banded in Mexico. I've also seen him catch hell for his manner of expressing things...not unlike this episode.

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.

"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.

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.

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.

very very nice.

just a few thoughts.

1. While i appreciate Dr.Ortz taking the time to talk about the erosions, what i would like to know what his thoughts are about the number of erosions in a two month spand. Are you contacting other people who were banded during this time and requesting endo's to make sure that indeed this is just some weird unexplainable fluke and there aren't other patients walking around eroded? I am rather disappointed at both the dr. and Inamed for just kinda shrugging it off, and not being more proactive about making sure there aren't more eroded patients who are showing no symptoms and don't know to get a regular endoscopy. what i want to hear is " we are as concerned about this as you, and we are doing everything possible to figure this out" not "gee erosions just happen, we don't know why several people banded months of each other are eroded.........next patient please"

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. But think about loosing something material that meant alot to you, such as a wedding ring or family photos, an old family heirloom. yes they are just things, but there is a sentimental value to them and i know i would be devestated if i ever lost my wedding ring or my daughters photos. Would i get over it? yes with time, material things are not the be all end all, but there is something that we value more. I know i would be devestated if i lost my band, i have alot of hopes and dreams invested in this band, and having it yanked away, would take me some time to "get over it" and plan for the road ahead.

3. There are people from all sorts of stages of banding in this community, from those who are investigating getting the band, those waiting for insurance approval, new bandsters who are adjusting to their new lives, veteran bandsters giving advice, and yes even those eroded. It provides a well rounded and ACCURATE AND REALISTIC picture of the banding community. I think all are welcome no matter where they are in their journey.

Very well said Des!

Dr. Ortiz.. you there? Listening? How about a REAL response to that one?