Hi all.

I've just come from my State-side fill doctor who has suggested that doctors performing band surgery who use the Pars Flaccida - also known as the proximal stitch - technique are doing the surgery incorrectly, and that a Pars Flaccida, or proximal stitch, should not be used. For those who don't already know, the proximal stitch is the stitch - or stitches - taken on the backside of the stomach, which anchors the band to the diaphram muscle. Think of the proximal stitch as the center back belt loop on your jeans - with the band being the belt of course. The purpose of the proximal stitch is to make a slip virtually impossible. I say virtually because, as we all know, ANYTHING is possible!

I called my Mexican surgeon today (Saturday - LOVE HIM!) and he tells me that the proximal stitch is the technique being taught in Italy which most Mexican surgeons use. He also tells me that the proximal stitch is an FDA approved surgery technique. I KNOW my Mexican surgeon proctored many many U.S. surgeons in lap band surgery, so now I'm curious . . .

Do you have a proximal stitch? Has it caused any problems? Back pain with your first fill? Back pain with a PB? If so, how long did the pain last? Did it recur with subsequent fills? Anyone with the proximal stitch who did in fact have a slip?

A separate - but related - question: Why are U.S. surgeons so FULL of themselves? Why do they feel the need to denegrate other surgeons with comments like (and I quote) "because all of my competition sucks" ? Any respect I might have felt for this doctor crumbled when he suggested that my doctor did me a disservice with the proximal stitch technique, and then by claiming that all his local competitors are incompetent. It seems to me that the majority of U.S. doctors have a very high opinion of themselves. This type of arrogance is not becoming in a professional in whom I am expected to place my trust. How do you trust anything that person says after a remark like that?

When I called Inamed and basically bitched them for me eroding, LOL!! they informed me that the Pars Flacida technique is the ONE that they are suggesting all Lapband Doctors use as the other technique (peri-gastric = I think that is what it was called) seemed to cause more problems.

Guess which technique my Mexico doctor used on me? Yup the old one. GRRRRRRRRRRR!!! Inamed said they had informed all Lapband Surgeons to stop using that old technique about 6 months to a year before I was banded. So guess my Mexico doctor didn't get that memo.

"Pars Flacida Technique

This is the most widely used technique in the world. This technique is named for the tunnel where the device is placed and initially accessed through a veil-like ligament named the pars flacida. It is usually safer and faster than other obsolete, rarely used techniques and results in a higher placement of the device. This technique has been related to a drastic decrease in the number of band slippages or pouch dilations that may occur."

I got this information from Lapband for Life. I was thinking that I remembered from my research that the Pars Flacida was the current technique that they are using now, which results in a lesser percentage of slippage than the older one (perigastric). Your doctor seems confused, lol!

Pars Flaccida here...according to my doc's notes. ??? I'm lots less worried about slippage than I am erosion, for some reason. Not sure why, maybe because I was so tight post-op? I have had zero problems though. The occasional PB (me to blame), one unfill (too tight first fill) and some reflux problems early on, which were treated with Prilosec and Aloe Vera juice. Okay, so that's not zero problems, but nothing horrible so far, knock on wood.

I'm very happy with my band placement. From a patient's perspective, it's been golden!

Donna B, It's my understanding that the pars flaccida technique involves tunneling through the pars flaccida, then creating the "belt loop," as you call it, by stitching the greater curve of the stomach over the band and onto the lesser curve of the stomach. Nothing is stitched to the diaphram.

Mine was placed using the pars flacida technique. According to my docs post-op note:

The Gastric Fundus was fixed to the Crura (Diaphragm) with stitches of Ethibond 2-0.

I thought this could have been the reason why I had hiccups for a week or so post op. I have read on both techniques and am glad to have had my band placed in this manner. Medical spam sucks and in this little community we have here it seems to be everywhere.

When I called Inamed and basically bitched them for me eroding, LOL!! they informed me that the Pars Flacida technique is the ONE that they are suggesting all Lapband Doctors use as the other technique (peri-gastric = I think that is what it was called) seemed to cause more problems.

That is exactly what my doctor told me when we were taking about Pars Flacida Vs Peri Gastric. He told me that the only errosions he has seen have been in bands where the Peri Gastric technique has been used.

Penni60,

Your discovery that your doctor used an outdated technique on you reminds me of a disturbing experience I had when I had breast cancer. Before surgery, one or more thin wires are inserted to guide the doctor. As a nurse, I knew to ask for the suspicious area to be "bracketed" (one wire on each side of the area). The radiologist chose to insert only one wire, and guess what? The doctor completely missed the cancer, leaving it inside me.

I later discovered that the two-wire technique was the newer, recommended technique. I was so angry I tried to sue the surgeon. BUT -- and here's the kicker -- no lawyer would take my case.:angry The reason? Although the 2-wire technique was better, many doctors still used the 1-wire technique, therefore doing so fell within the current standard of practice. Grrr! Talk about disillusioned by both the medical care I'd received and the justice system!

NancyRN

P.S. I subsequently had 2 more surgeries, which removed the cancer, and radiation. Now doing well.

I visited several doctors during my research. I must say they took every chance they could to slam the competition. I say that not lightly because this is a new trend, one we are not used to. Most surgeons have egos. You wouldn't want it anyother way. That being said, lapbanding is now big business. There is mucho grande dollars to be made. Communities are small and the competition is fierce. Everyone is joining in. Doctors that didn't do the surgery before are now doing it and cashing in. That is why, as patients, we must do our research and demand what we want. We are more informed than other patients with other surgeries.

Now I see billboards, TV ads, newspaper ads, radio spots. You don't see this with "other" types of surgeries. We must protect ourselves from those that are in it to merely profit.

hello,

well I know that I have the pars flaccida technique but without the tunnel, I specifically asked about them making the tunel around the band but I was told that there is no proof that the with the tunel less slippages occure.so I dont have the tunel.from my understanding pars flacida doesnt necessarily mean that you have the tunel.flaccida is a thin membrane that is near the stomach.