I've been reading posts on this board for about 2 months now and am a little concerned that some people seem to feel that complications from the lapband are minimal and that RNY and DS gastric surgeries are a sure Rx for complications.

Because of pre-existing health conditions, I made the decision to have lapband surgery as well as to have the surgery done here in the United States. While it is true that lapband surgery is less involved and less invasive than other forms of gastric surgery, post-op complications do arise.

I've been an RN for MANY years and I train RNs to work in ICUs. The hospital I work in has a very big bariatric surgical program. Currently, we have a patient in the surgical ICU who opted to have lapband surgery. This patient is 43, male, a lawyer, 320 pounds, 5' 10" with no co-morbidities. He wanted to surprise his wife so he told her he had a business trip to take and went into the hospital on Friday to have his surgery. He stayed overnight and went home on Saturday.

On Monday, he was feeling "weak" and spiked a fever to 100.5 and went to the ER. He was placed on an antibiotic and sent home. Two days later, he was short of breath and his fever was 101.4 so he went back to the ER. While there, his shortness of breath worsened and he was placed on a ventilator and transferred to the surgical ICU.

The patient was diagnosed with sepsis (overwhelming blood infection) and, during the course of his 4 weeks in the ICU, he cardiac arrested twice, went to the OR to be unbanded, returned to the OR 5 times for a gastric "wash-outs," developed renal failure, was placed on dialysis, was trached (tube into the trachea) for prolonged ventilator dependency and required nutritional and physical therapy support.

The patient eventually got off the ventilator and was transferred to the floor. He will always have renal insufficiency and will need months of physical therapy but he is expected to make a "full" recovery.

My point in sharing the experience of this patient is to illustrate that ALL surgeries have risk factors. It's important to talk with your MD and research ALL available surgeries. I have seen 60 year old patients with one or more co-morbidities sail through RNY surgery while a 30 year old healthy patient having the same surgery ends up with complications in the surgical ICU.

Price should NEVER be the deciding factor when choosing a surgeon or a facility. Likewise, one should NEVER decide on one gastric surgery over another until ALL are options are researched and the pros and cons of each are addressed. My surgeon drilled me on my dietary intake. Why? He wanted to determine if I was a junk food lover or a volume eater. Why? Because if I was a junk fook lover, he would have suggested RNY for me explaining that it's easy to "cheat the band or beat the band" by consuming empty, high carb foods that easily slip through the band.

So, take the time to make the RIGHT decision for YOU and CHOOSE wisely.

Yes, Sunta, you are absolutely correct.

You make an excellent point and I agree. WLS is an elective surgery and shouldn't be taken lightly. I think some people overlook the fact that death is a real possibility....in any surgery for that matter. One needs to be smart about it and do research. In addition, I prayed and had total peace. I realize some don't do that, but personally, I couldn't face tomorrow without the Lord. :angel:

I disagree to a certain point on the RNY/band thing. Some of what you said is true however, some people cheat the RNY too and there are many that gain weight back with the band and RNY. It seems to be my motto lately (hey, I think I'll put it in my signature line) that addiction is managed, not cured. I heard Dr. Phil say that & it hit me like a ton of bricks. Regardless if what type of surgery you have, you still need to manage the food put in your mouth.

It worries me so much when Ihear of older people going to Mexico without the extensive testing that is done here in the U.S. Without the great physicians here at Vanderbilt diagnosing a very serious problem with my carotid arteries I could have been in very serious trouble had I had surgery on June 5th.

Any surgery is dangerous and every surgery is not right for everyone. It's a very personal choice. I do, however, hope and pray that people over 50 do not go to Mexico without having sleep study tests, psych evals, and thorough and complete physicals just because the price is cheaper. There is no price can be put on life itself.

Please do not take offense at the fact I'm recommending a more extensive test for older people especially. I think a person needs to go where they are most comfortable, and if Mexico is where you want to go I just ask you get all the proper testing beforehand. It could save your life.

God Bless,

Dody

Sorry for being such a grump. I forget that not all people are as awesome and as educated as most of us here I tend to get defensive about it b/c it took me over a year to decide to do it after my first consult. It was a huge decision for me and I agonized over it. I truly forget that not everyone is the same way.

I agree that any surgery is major and should be researched and carefully thought about. And like someone else has already posted he didn't fall sick b/c of the band but b/c of surgery. Having family members in the medical field and my mother who is an Anesthetist, I fully knew the complications and had heard many stories of complications from other wls. But what I also researched was the long term affects and even though when I got the band there wasn't a ton of history on it in the US it still was a major factor for me.

I was 55 when I was banded in Mexico and lived through it. I have 3-D friends who were banded in the US, and France and Germany and friends who had RnY in the US and had the DS in the US...years ago...and still haven't had a sleep study done.

While a sleep study is a good idea for any morbidly obese person, I'd vote for manometry as a pre-op test for someone considering adjustable gastric banding...especially an older person. While none of my over-50 friends died from being banded without a sleep study, a few are suffering from the late complication of dysmotility, which seems to be more common in older patients. They are, several years out, having to have revision surgeries and THAT is also more dangerous.

The danger is not in the geography...

Your post is so right on. I think my doctor really tried to talk to me too about what type of overeater I was. I think what you said was so key and that is why lapband is not for everybody. I was too scared, way too scared to consider RNY, but now I see it is also done laparoscopically (sp). From reading posts for over 6 months now, I think that is what Dr. Pleatman is trying to tell people. He is not trying to sell RNY over lapband, (as I see he has been accused here on LBT) I think he truly wants to see his patients succeed and be happy with their decision re WLS. I wish I had done RNY, I was just too scared. I am not totally unsuccessful with lapband I have lost 50% of my excess weight, but alas I am a sweet eater and was probably not the best candidate for lap through no fault of my doctor I have the best in Michigan.

I was 55 when I was banded in Mexico and lived through it. I have 3-D friends who were banded in the US, and France and Germany and friends who had RnY in the US and had the DS in the US...years ago...and still haven't had a sleep study done.

While a sleep study is a good idea for any morbidly obese person, I'd vote for manometry as a pre-op test for someone considering adjustable gastric banding...especially an older person. While none of my over-50 friends died from being banded without a sleep study, a few are suffering from the late complication of dysmotility, which seems to be more common in older patients. They are, several years out, having to have revision surgeries and THAT is also more dangerous.

The danger is not in the geography...

You make an excellent point about dysmotility, Sue. Evaluating for this condition is especially important for those who are diabetic. I have a friend who has not had WLS but suffers terribly from dysmotility secondary to diabetes. She's tried acid blockers, antibiotics, and reglan and is now being considered for a gastric pacemaker.

Denise,

Congratulations of the weight loss. I'm definitely a volume eater and portion control is my biggest problem. Cookies, ice-cream, candy, fast food, etc., don't tempt me at all and that's why lapband was offered as the best choice for me. Despite your being a sweets lover, it appears you have been successful is making the band work for you.

Have to add that there have been studies done that show that sweet-eating is not a predictor of success or failure with the Lap-Band. Yes, that is the commonly held view... if you like sweets, then have an RNY because the dumping won't let you have them... but, it doesn't seem to hold true in a research study. I've also been told by a few surgeons that men tend to do better with the Band than women... because they tend to be volume eaters (of all types)... I've seen nothing study-wise to prove or disprove that.

Obes Surg. 2002 Dec;12(6):789-94. Related Articles, Links

Sweet eating is not a predictor of outcome after Lap-Band placement. Can we finally bury the myth?

Hudson SM, Dixon JB, O'Brien PE.

Monash University Department of Surgery, Alfred Hospital, Melbourne, Victoria 3181, Australia.

BACKGROUND: It is common belief that sweet eaters will do poorly after gastric restrictive surgery. There is scant evidence for this and significant evidence that sweet eating behavior is not predictive of weight outcome. Preoperative and current sweet eating behavior was assessed in subjects who have had Lap-Band surgery, to find if this influenced weight outcomes. METHOD: 200 unselected patients who had bands inserted for > 1 year completed a questionaire regarding preoperative sweet eating behavior. The last 100 patients also reported current sweet eating behavior. Sweet eating was scored using a standard dietary questionnaire. RESULTS: Mean +/- SD % excess weight loss at 1 year (% EWL1) for the 100 with the highest preoperative sweet eating scores (SES) was 47.1 +/- 16% compared with a loss of 48.2 +/- 16% by those with the lowest SES (P = 0.64). Analysis showed no significant linear or non-linear correlation between the SES and the % EWL. For the highest quintile of SES, the EWL1 was 47.3 +/- 14% and for the lowest was 46.1 +/- 16% (NS). Sweet eaters were younger (r = -0.21, P = 0.003) and had higher fasting insulin concentrations (r = -0.18, P = 0.03). Preoperative SES had no influence on % EWL1 after controlling for factors known to influence weight loss. % EWL at 2 years (n = 130) and 3 years (n = 88) were not different for sweet eaters and non-sweet eaters. Current sweet eating tendency (n = 100) also had no impact on % EWL. CONCLUSION: Sweet eaters do not have less favorable weight outcomes following Lap-Band surgery. Our study confirms the findings of two other major studies. Sweet eating behavior should not be used as a preoperative selection criterion for bariatric surgery.

PMID: 12568183 [PubMed - indexed for MEDLINE]

Thank you for the research study. My surgeon distinguishes between volume eaters and high empty carb eaters when making a recommendation as to which WLS is best for an individual. Included with sweets, are a diet rich in processed food, poor in fresh fruits and veggies, etc. Because I eat healthy but too much (volume eater), the lapband was recommended for me. Perhaps future studies should look not so much to foods high in sugar, but nutritional value of the pre-op diet.

I think that it absolutely cannot be emphasized enough that people research WLS and then research some more! I'm astonished by how many people don't know, prior to surgery, that they'll be on a liquid diet for a while post-op. Or they don't know WHY they're on a liquid diet. Or they expect the band to begin to work immediately and don't know what a fill is. Yes, the surgeon's office SHOULD be educating these people, but ultimately, it's the individual's responsibility because it is their LIFE.

Thanks Elisabeth for your great insight. Like any surgery, some "sail through" while others don't, as you mentioned. How has your journey been? Worth It? I'm considering it myself, still have concerns. The expense is hard to justify, too, for me.

For me, the Lapband has acted as a "device" that simply doesn't let me eat the way I used to. I still have a significant amount of weight to lose but don't regret getting the band.

The last few months my weight remained stable and I was having trouble with a low heart rate and dropping blood pressure. As it turns out, my thyroid stimulating hormone (TSH) was high meaning I was hypothryroid. I started on synthroid and finally have the TSH level in the normal range and am starting to lose again.

The lapband will only work if you work with it to lose weight. It's not a magic cure and foods like candy, cake, chips, icecream, etc. slide right on down. Do a lot of research, attend meetings and ask banded members questions, talk to MDs who perform the procedure, and make the decision that's best for you.

great post with very important perspectives.