Too tight? Or is this typical?

[jennybean 175]

Those statistics look pretty bad.

Correct me if I am wrong, but in my opinion, the statistics are being dragged down by the paitients who were either, not ready, not serious or not educated in band usage. Also being dragged down by the fact that the older bands and sugical procedures were inferior? I believe the statistics could be much better if all of those (and maybe more) issues above were addressed and under better control?

[NaNa 878]

Not to upset anyone but I did hear the word statistics so I would like to throw this out there so we can have a discussion based on actual studies rather than anecdotal evidence alone:

1.1. Allergan, the manufacturer of the Lap Band, published the following as part of their Patient Safety Information.

“In the United States clinical study, with 3-year follow-up reported, 88% of the 299 patients had one or more adverse events, ranging from mild, moderate, to severe. Nausea and vomiting (51%), gastroesophageal reflux (regurgitation) (34%), band slippage/pouch dilatation (24%) and stoma obstruction (stomach-band outlet blockage) (14%) were the most common post-operative complications. In the study, 25% of the patients had their band systems removed, two-thirds of which were following adverse events.”

1.2. Published in the journal Obesity Surgery in 2008, the study Long-Term Results of Bariatric Restrictive Procedures: A Prospective Study lap band failure rates were documented at 54% with the most frequent complications being pouch dilatation (21%) and anterior slippage (17%). 44% of the patients required repair or revision.

1.3. In the study Analysis of poor outcomes after laparoscopic adjustable gastric banding published in June of 2010 by George Washington University[ii], the authors indicate a high complication rate for gastric banding procedures including reoperation for 16.7% of the patients in the study. The majority of the patients also failed to achieve a 50% excess weight loss. They also noted that 11% of the patients in the study required revision to the sleeve gastrectomy.

1.4. In another study that included patients observed over 9 years, Long-Term Results and Complications Following Adjustable Gastric Banding[iii], 52.9% patients had at least one complication requiring reoperation and the band was removed for 28.6%.

1.5. Most significant is a recent study A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates[iv]. In this study, a group of physicians from Switzerland led by Dr. M. Suter, MD, PD, FACS, examined the long-term complications related to LapBand weight-loss surgery. The study demonstrated that LapBand long-term complications increase over time. Overall, 33.1% of patients had at least one long-term complication related to gastric banding. This study concludes:

“LGB appeared promising during the first few years after its introduction, but results worsen over time, despite improvements in the operative technique and material. Only about 60% of the patients without major complication maintain an acceptable EWL in the long term. Each year adds 3-4% to the major complication rate, which contributes to the total failure rate. With a nearly 40% 5-year failure rate, and a 43% 7-year success rate (EWL >50%), LGB should no longer be considered as the procedure of choice for obesity. Until reliable selection criteria for patients at low risk for long-term complications are developed, other longer lasting procedures should be used.

Long-Term Results of Bariatric Restrictive Procedures: A Prospective Study

Schouten R, Wiryasaputra DC, van Dielen FM, van Gemert WG, Greve JW.

Obesity Surgery, 2008

[ii] Analysis of poor outcomes after laparoscopic adjustable gastric banding.

Kasza J, Brody F, Vaziri K, Scheffey C, McMullan S, Wallace B, Khambaty F.

Surg Endosc. 2010 Jun 30.

[iii] Long-Term Results and Complications Following Adjustable Gastric Banding.

Lanthaler M, Aigner F, Kinzl J, Sieb M, Cakar-Beck F, Nehoda H.

The Journal of Metabolic Surgery and Allied Care, 2010

[iv] A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates

Suter M, Calmes JM, Paroz A, Giusti V.

Obesity Surgery, 2006

[v] Weight Loss and Quality of Life After Gastric Band Removal or Deflation

Lanthaler M, Strasser S, Aigner F, Margreiter R, Nehoda H.

Obesity Surgery, 2009

From the post: http://vsgappeal.blogspot.com/

Our bands are surgical devices and we need to remember that. We can screw them up and they do screw up on their own so to speak. We don't need to go giving them reasons to fail like throwing up all the live long day. I hear the term, baby your band, and I think that's good advice.

Also another note about revisions to the Sleeve, I am not confident about the Sleeve yet, Band to Sleeve revisions don't do as well as virgin Sleeves as far as losing weight, some do ok, but MOST DO NOT.

Also I read a study lately regarding a 5 year study for Band to Sleeve revisions and it was heartbreaking, very low weight loss rate and VERY HIGH Vitamin deficiency rate especially with Band to Sleeve patients, that worries me about revising to the Sleeve, they remove part of the stomach that have vital Vitamin B nutrients.....

Also the reflux I hear can get over bearing that causes similar bile reflux that happens with the lap band slips -- at least you can remove the band or fix it, the only cure with horrible reflux with the Sleeve is to revise to the Bypass...

I am just not ready for the Sleeve yet ---

Here is the long term study..

http://www.medpagetoday.com/Endocrinology/Obesity/40490

[NaNa 878]

Those statistics look pretty bad.

Correct me if I am wrong, but in my opinion, the statistics are being dragged down by the paitients who were either, not ready, not serious or not educated in band usage. Also being dragged down by the fact that the older bands and sugical procedures were inferior? I believe the statistics could be much better if all of those (and maybe more) issues above were addressed and under better control?

Correct, MOST of the lap band failures that CAN be prevented and part of this statistic are the following:

1. Poor Aftercare, not following up with the surgeon timely

2. Patients progressing their diets too quick after surgery, some people will go to a restaurant and eat solid foods when they are supposed be on liquids and mushies. The band is supposed to heal and set in place, prior to getting fills.

3. Frequent vomiting

4. Aggressive fills, fills should be done gradually every month, until you reach the green zone, starting from 4-6 weeks post, -- AND YES, some surgeons have filled the band 2 weeks post op.

5. Purging daily, and eating too much on a too tight band.

6. Keeping the band dangerously too tight, aka..not able to eat solid food without vomiting.

Honestly, if you take the above out of the equation, the REAL lap band complication rate is pretty low, such as band erosion, port infections, tubing leaks, port leaks, etc. There are also chances of developing hernias, or events that happen in the stomach or the patient may reject the band, but those are rare....but the most preventable complications are VERY COMMON.

[jennybean 175]

Thanks NaNa, this is what I suspected. Being a person who is not banded yet, looking at the statistics is a bit scary. Statistics are great but there are many variables. Thanks for the list of things NOT to do.

[NaNa 878]

Thanks NaNa, this is what I suspected. Being a person who is not banded yet, looking at the statistics is a bit scary. Statistics are great but there are many variables. Thanks for the list of things NOT to do.

Great! As the other poster mentioned you have to "baby" your band and take good care of it, especially in the first year, the band is still healing and you want to take it easy and avoid any vomiting if you can.

Also, most surgeons "prime" the band during installation and will put a little priming Fluid in it, it's really not filling the band, but surgeons will typically fill the band up, like blow it up like a balloon before they install it to make sure it does not have any leaks or defect before they install it, and then leave a little saline in it during surgery and some patients will say they got a fill during surgery, but really they did not.

And most surgeons will have readily availble different size bands to fit your stomach, they don't know which size you will need until they are in there, but some surgeons do not follow this rule and will use ONE size band...so be very about careful picking your surgeon too, you don't want a band too tight, that will not hold much saline without being too tight and you don't want a band that will take 20 fills before you reach the green zone.

Ideally most people reach good restriction within about 3-7 fills...

[donna450 130]

I agree with this study and it is VERY TRUE. I love my band and want to keep as it long as I can' date=' but I am not living in a "bubble" and ignoring FACTS.

The thing is ...why those STATS of failure long term is so high, many people use the band the opposite of how it IS suppose to work.

I NEVER kept a too tight band for long periods of time, my surgeon used the Pars Flaccida method 8 years ago, my band never did slip...BUT...my pouch got dilated VERY QUICKLY after being too tight for about 1 month, but -- I guess you can argue that the 4cc bands were more prone to pouch dilations than the AP bands are...reason that surgeons no longer use them in the US.

But there are still many people are still doing well with their 4cc bands, and have had no issues, BUT -- MANY STILL HAVE REFLUX that is controlled with PPi's and Protonix. I had heartburn from DAY 1 with my old 4cc band and had to be on PPi's for over 8 years.

Since I've gotten my new AP band -- no heartburn or reflux at all, and I don't need to take Protonix...also I had a hiatal hernia repaired that I don't believe my first surgeon repaired...so there are so many variables on why complications occur.

But -- one of the biggest mistakes and will occur with ANY band -- 4cc or AP, you cannot keep it adjusted too tight, in the red zone for long periods of time and not expect some damage to the esophagus or other issues.

Also, constantly vomiting puts pressure on those sutures and they can come loose from the band, I've seen this reported this too over the years. --

A few stuck episodes (Pbing) will not cause damage, but if this is done repeatedly daily, it can damage either the esophagus and the pouch, you actually don't have to be too tight to cause band damage, you can vomit daily to cause damage too.

Ideally, most lap banders SHOULD be able to eat moist lean meats of about 1-3 oz per meal, if and a few bites of soft veggies per meal that average about 1/2 cup to 1 full cup and sometimes 1-1/2 cups of solid food per meal, THAT IS THE GREEN ZONE.

Restriction will never be the same each day, some days most bandsters IN THE GREEN ZONE can eat a bit more and sometimes a bit less, depends on the ebb flow of the band and what is going on with them personally.

Also this still does not keep complications from occurring, events in the stomach, or other issues can cause complications, so nothing is full proof, but staying in the green zone most of the time, and avoiding vomiting, will lessen the chances of band complications.[/quote']

Whether u agree or disagree with her method of of information she has had experience. I take away frim what she has said on how it will effect me and my decisions. I just don't think everything is written in stone. Use your own mind and see what works for you. If you take everything at face value....not saying NaNa is right or wrong...her opinion. You should take out of what anyone says and use it or forget it. But don't make her out to be the bad guy. She's helping in her way. If the newbies accept or reject and don't at least consider the opinion of others then why the sites for exchange of ideas and experiences? My exoerience is limited as I am a newbie. I've had a few problems but I search and cinsuder and weigh each opinion as pertained to my circumstances. And btw I've learned alot more here than from my doctor although I do what he says. But before that I didn't even know what questions to ask if I hadn't read the info on these sites. My opinion only.

[GuyMontag 1,264]

Also another note about revisions to the Sleeve, I am not confident about the Sleeve yet, Band to Sleeve revisions don't do as well as virgin Sleeves as far as losing weight, some do ok, but MOST DO NOT.

Also I read a study lately regarding a 5 year study for Band to Sleeve revisions and it was heartbreaking, very low weight loss rate and VERY HIGH Vitamin deficiency rate especially with Band to Sleeve patients, that worries me about revising to the Sleeve, they remove part of the stomach that have vital Vitamin B nutrients.....

Also the reflux I hear can get over bearing that causes similar bile reflux that happens with the lap band slips -- at least you can remove the band or fix it, the only cure with horrible reflux with the Sleeve is to revise to the Bypass...

I am just not ready for the Sleeve yet ---

Here is the long term study..

http://www.medpageto...y/Obesity/40490

Which is ironic because isn't the band supposed to be 'reversible'? Yeah...sure it is. I'm still a band advocate but I also think there's a lot of misinformation out there and people are sold on something that isn't quite what they're told it is.

[NaNa 878]

Which is ironic because isn't the band supposed to be 'reversible'? Yeah...sure it is. I'm still a band advocate but I also think there's a lot of misinformation out there and people are sold on something that isn't quite what they're told it is.

I don't the band is truly reversible, it's definitely removal-able, it depends on how bad of a complication someone has when they get their band removed, but for most people the stomach usually go back the same, but probably with some scarring...

Also...people need to make sure they have a very skilled surgeon when they remove the band too because if the adhesion's and scar tissue that the band creates...can some some pain and discomfort for many....

So if someone is thinking about band removal they need to ask their surgeon to please remove most of the scar tissue.

[GuyMontag 1,264]

Those statistics look pretty bad.

Correct me if I am wrong, but in my opinion, the statistics are being dragged down by the paitients who were either, not ready, not serious or not educated in band usage. Also being dragged down by the fact that the older bands and sugical procedures were inferior? I believe the statistics could be much better if all of those (and maybe more) issues above were addressed and under better control?

There's always ways to spin statistics. I was just trying to at least elevate the discussion above anecdotal evidence. I mean, I've known TONS of people who's bands have failed and it seems to happen more and more the older their bands get. I still see old timers come back into chat or the forums upset because of problems with their band. Many times it was something like, they wanted to lose that last ten pounds so they went in for a fill for the first time in a year...and BAM...started throwing up and they dilated their pouch or worse, slipped their band. I don't want to scare newbies but this is a surgery, not a walk in the park.

[GuyMontag 1,264]

I don't the band is truly reversible, it's definitely removal-able, it depends on how bad of a complication someone has when they get their band removed, but for most people the stomach usually go back the same, but probably with some scarring...

Also...people need to make sure they have a very skilled surgeon when they remove the band too because if the adhesion's and scar tissue that the band creates...can some some pain and discomfort for many....

So if someone is thinking about band removal they need to ask their surgeon to please remove most of the scar tissue.

I like the term removable vs. reversible for sure. Good point.

[NaNa 878]

There's always ways to spin statistics. I was just trying to at least elevate the discussion above anecdotal evidence. I mean, I've known TONS of people who's bands have failed and it seems to happen more and more the older their bands get. I still see old timers come back into chat or the forums upset because of problems with their band. Many times it was something like, they wanted to lose that last ten pounds so they went in for a fill for the first time in a year...and BAM...started throwing up and they dilated their pouch or worse, slipped their band. I don't want to scare newbies but this is a surgery, not a walk in the park.

Exactly and SO TRUE! You truly have a different mentally once you've lived with the band greater than 5-6 years..things change and the band starts to behave strangely..LOL...

My advice to people is once you've had the band for many years...and you can eat more food, sometimes it's not needing a fill, especially if eating too much is accompanied with reflux and sometimes you may need to get to a small unfill, and let things rest...especially if you've had some boo boos's LOL of getting food stuck and vomiting.

No one's perfect, everyone sooner or later will experience getting food stuck or a horrible stuck episode where you may vomit for hours...the point is let those episodes be rare and not every single day....

Sometimes the band needs a rest and pressure released off the pouch after so many years and then slowly filler up again...it's just a revolving process

I truly believe the band CAN last for some people a life time, but it has to be well managed and you have to have a good band surgeon that will diagnose and treat any issues promptly that you have.

[Tony21726 6]

Well from everything I read this is a heated forum place. I will throw in my two cents just because it helps me as much as it will help you. I have found that I continue to spin my wheels when it comes to eating because I am battling my subconscious. Now I was told not to eat carbs or to eat them last, the truth is I have chosen to say I will not eat any carbs. The reason I have made this choice is as follows:

Earlier this week I was talking to a co-worker, she shared with me that in 1998 she had a stomach by-pass done and lost 100 lbs. She warned me that gaining weight after having had any kind of gastric surgery is totally different from before the surgery. The conversation was so intriguing to say the least. She told me she was ecstatic after having lost the weight and she was a great mentor for those seeking gastric bypass however, 4 years later she started driving a big rig and started gaining weight. At first she didn’t think anything of it because the weight came on so slowly, approximately 9-10 lbs. a year. Now she is 80 lbs. overweight. Those same old habits snuck into her life and took over again, now we have an advantage she doesn’t in that the Lap Band needs adjusting. Seeing a doctor and having the opportunity to adjust the lap-band is just one more step to protect us from gaining weight. However, it would be helpful if we could intervene in our destructive behavior before actually stuffing food in our mouths. Ultimately the choice is yours, it really doesn't matter to me which you choose but you know what I chose because when I made the decision to have this thing done it was for permanent change. I hope you found this helpful. ttfn

[NaNa 878]

I like the term removable vs. reversible for sure. Good point.

Another point I used to tell some other long term banders, what used to help me if I got reflux at night, I would chew a few papaya enzymes (from GNC) before bed and right after a meal and this helps break down food in the pouch and my reflux went away...but this was with my old 4cc band, and I took a cocktail of chewable Pepcid and this helped me with any night time reflux...BUT ..this does not work if there is severe band damage and slippage with 'stuff' coming up in your nose...LOL..

[GuyMontag 1,264]

Another point I used to tell some other long term banders, what used to help me if I got reflux at night, I would chew a few papaya enzymes (from GNC) before bed and right after a meal and this helps break down food in the pouch and my reflux went away...but this was with my old 4cc band, and I took a cocktail of chewable Pepcid and this helped me with any night time reflux...BUT ..this does not work if there is severe band damage and slippage with 'stuff' coming up in your nose...LOL..

As long as I don't eat too late I don't have problems at night. If I do it's about 4am and drainage starts pooling at the back of my throat. GROSS! I just wake up, sit up, try and wait for a little bit before thinking, another night with the band, and go back to sleep.< /p>

[charlesoakes68 62]

I don't have to be tight not to tolerate rice. For some it's easier than for others. I can still eat most things now but rice is usually a no-no even with minimal restriction.

My old band wouldn't tolerate shrimp early on too but with the new band' date=' I don't have any problems eating it. Neither intolerance affected how long I could stave hunger off before needing to eat again, so I put up with the intolerances as they occur, and just avoid those foods henceforth without using them as a yardstick on whether I'm too tight or not.[/quote']

Old band- new band- why did you get a replacement band?