my dr. recommended the lap band over the sleeve...thoughts?

[steph025 0]

hey guys..

so I was 99.9% sure that I was going to get the sleeve and a surgery date today. I just met with my surgeon, he didn't say "get the band," but I feel he was definitely encouraging me to really consider it. He said that based on my age, weight, and long term outcomes, he thinks it would be a really good choice. He said that there is at least 16 years of data on the band, while there are only a few years for the sleeve. He said that I have a long time to live with my choice, and since there aren't long term studies and it is absolutely irreversible..it's more of a risk. He mentioned that the difference in statistical outcome weights between the two surgeries would be within a few pounds of each other, and completely within my own control. Given that, he suggested the band because it's "safer" and reversible if absolutely necessary.

My thinking is..what are the chances of a band living to be 90 years old without complications? What are the chances of the sleeve living to be 90 without complications? I want this to be a one time procedure..with life long benefits...

I know that most of the people on this site chose the sleeve for themselves and have been very successful. I guess I'm just unsure now because of his recommendations...gosh guys, I thought I knew what to do, but now I'm just confused.

Any thoughts would be appreciated...

[Becca 108]

This has been my personal experience with the band and why I am getting rid of it. I was banded 3 1/2 years ago. My band worked alright, although it was hard work for me to lose weight. I had to exercise five times a week and the way the band worked was frustrating. It was tight in the morning, but at night it was loose and I could eat whatever I wanted. Then I stopped having restriction altogether due to a leak. I was able to eat what I wanted and I gained much of the weight I lost back. Next, I started having SEVERE pain in my stomach area that migrated to my right side. I went to the ER after days of this pain. They did a scan and found that my lapband slipped and that the tubing broke off. Right now the tube is poking me all over causing pain and I am so thankful for my upcoming revision to get rid of the band. Look at the LONG TERM statistics of the band. I believe most have to have a secondary surgery to remove or fix the band within ten years. There is lots of maintance with the band for fills and other tests. I hope my experience can help you make the best decision for YOUrself! Good luck~

[buchannon 17]

I did a lot of research on both and to me personally (and actually generally to most anyone) a sleeve seems like the much better option.

[peatie 4]

If you feel you will need the restriction to keep the weight off for your entire life, I honestly believe the sleeve is the better option. Sure, you can have a 'no-fail' band until 90, but why have to deal with all the filling/unfilling, etc..., not to mention something FOREIGN in your body that can cause issue like SCAR TISSUE which closes the opening of your stomach?

Yes, there are many more years of research on the band, but in 13 years, there will be just as much on the sleeve. lol The sleeve wasn't 'invented' yesterday. It was used for many years prior as either a first stage to weight loss for RNY or for those with stomach cancer.

Maybe you should do research on the life long outcome of those with stomach cancer who had gastrectomies. Aside from cancer returning, I doubt you'd find much in the way of the same type of complications that the band gives.

[myrori 55]

I considered the band a couple years ago, filled out all the paper work but just could not get past the idea of the foreign object in me. I then spend hours reading lap band support forums and all the talk about pain after fills, vomiting and what they called productive burping I knew was just not for me. Then I came across this sight and read about all the revisions needed and I knew then that it was going to be the sleeve or bypass for me. I chose sleeve because I am not worried about it being irreversible as I know I need the tool for life, not just a few years. I did not like the idea of life long malabsorbtion that comes with bypass so sleeved just felt right for me. I have been luck I guess as I have no heart burn and no nausea after the surgery some folks experience. I had zero complications from the surgery.

Also with the band I feared erriosion issues and damage to my esophagus and I did not like the idea of the fills. A friend of mine had the band and she let me see where her port is, as I know that would drive me nuts under the skin there!

[M2G 1,836]

This is what I tell people who ask why I didn't choose the band.

Everyone says it's REVERSIBLE, but why would I want to gain 125 lbs back :noidea:after I have to take it (the band) out? Woo hoo, it's reversible I can be FAT again!!!

[genepha 47]

Hi Steph,

I've had my band for 9 years. I was very successful and liked it for

about 7 years. I lost about 110 lbs. After I was put on bed rest when

I was pregnant with my last child, I had to have a complete unfill for

about 8 months. After our daughter was born, I could never quite get

back to the "sweet" spot. I also started having severe reflux.

About 6 months ago, I had a hernia repair and my port replaced. When

I went for my first fill, I had so much swelling in my pouch that I

couldn't get any fill and my esophagus was dilated. While I have had

some success with the band (I regained about 80 lbs. from bed rest and

suffering an injury) the fills/unfills are brutal (at least for me). I've had

probably 20 fills/unfills in the past 2 years. For me getting a fill done

is not an easy process as it requires me to take the whole day off of

work, travel to Los Angeles, and be poked about 5-8 times with a very

long needle. With all that being said, I am most likely going to have my

band replaced and remain empty along with a plication procedure. Dr. Watkins

has performed this procedure a few times I believe, although he is not my dr.

so I won't be the first one to have it done.

The one thing that I think is amusing is that people say the thing that bugs them

about the band is having a foreign object in their body. Everyone who has

weight loss surgery has some kind of foreign object in their body whether

they have staples, suturing, or silastic (the lapband). Silastic is used in

lots of medical devices including pacemakers and shunts so I didn't have a

problem with that aspect of it. However, I am excited about the newer procedures

that are emerging in weight loss surgery and I think plication is the right

choice for me. If plication wasn't available then I would seriously consider the sleeve.

Good luck to you in your journey.

genepha

banded Dec, 2001

Awaiting insurance approval for band removal/replacement with self-pay plication

[MINI-Me 196]

"Statistics" stated that I was a prime candidate for the Band. And, I probably would have gone that way EXCEPT:

• I have 3 friends with Bands - none have met their goal weight, all have had severe complications and 1 has major scaring.
• I have 3 friends with RYN - all have regained weight (one is still losing, but very slowing). One has regained and is now larger than pre-surgery (and 2.5 years out from surgery).
• I have 2 friends with VSG. One has made goal and kept it off for 2 years this coming February. The other is still losing, but doing very well.

Based on that "personal" experience ... what would you choose? I wanted a PERMANENT solution & knew my issue was overeating due to the lack of a "full feeling". Yes, I have to work my sleeve. No, it is not a miracle cure. BUT, I firmly believe it has saved my life. And, it was reassuring to know that I don't have to have a stomach to live. Not that I want the medical concerns that come along with that, but at least I know I have options.

How much experience does your surgeon have with the sleeve? Do you think he may just be more comfortable with the LapBand due to his experience. Now ... I don't know your surgeon, so this is not directed at him ... But I've heard that some doctors push the Band because it's a known money generator due to the costs of future fills/unfills, slippage correction, revision, etc.

My surgeon does Band, Sleeve, RYN ... I had the option of the first two. He firmly believes that the Sleeve will one day be the "Gold Standard" and replace the other two.

Do you have the option of seeking the opinion of another surgeon?

Only you can make the decision. Maybe check out some of the Band forums and get their thoughts. After all, we are a little biased here!

Best of luck!

[Tiffykins 673]

I could bore you with my horrid band story, and tell you how fabulous the sleeve is, BUT, I think statistical information is always better for research purposes. This is directly from the makers of the band, not some random post or personal stories. I've highlighted some key points. At the bottom, I've included some research links, and how tons more in my blog if you'd like to friend me on here, and then peruse my blog for more information in your research.

From my personal opinion, the sleeve is amazing. The band sucked the life right out of me, and I only had it for 8 miserable months. It destroyed my stomach tissue, I puked on a regular basis, and had more food intolerances than anyone would care to count. I followed every "band rule", and the band failed me miserably.

Also, there is no maintenance with the sleeve. Think every 6-8 weeks for a fill until you hit the ever elusive sweet spot which most band patients I know never find their sweet spot, it's either too loose, too tight, or never get restriction. That does include the unfills that you might have to endure if your band is too tight. It might be reversible, but at what cost to your stomach tissue. I feel the same way about the plication. Why ever go into WLS wanting it to be reversible? ? ? Sure the band can be removed, but what damage will be done, and sometimes the damage is so bad, you can't get a revision. There's plenty of the ex-bandsters that are in that position right now. I encourage you to check out the band to sleeve revision board to see just how many of us have made the switch. Also, check out the band, complication, food issue, failed weight loss, revision, and VSG forum on Obesityhelp.com

http://www.lapband.c.../safety_information/

Patients can experience complications after surgery. Most complications are not serious but some may require hospitalization and/or re-operation. 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. Esophageal dilatation or dysmotility (poor esophageal function) occurred in 11% of patients, the long-term effects of which are currently unknown. Constipation, diarrhea and dysphagia (difficulty swallowing) occurred in 9% of the patients. In 9% of the patients, a second surgery was needed to fix a problem with the band or initial surgery. In 9% of the patients, there was an additional procedure to fix a leaking or twisted access port. The access port design has been improved. Four out of 299 patients (1.3%) had their bands erode into their stomachs. These bands needed to be removed in a second operation. Surgical techniques have evolved to reduce slippage. Surgeons with more laparoscopic experience and more experience with these procedures report fewer complications.

Adverse events that were considered to be non-serious, and which occurred in less than 1% of the patients, included: esophagitis (inflammation of the esophagus), gastritis (inflammation of the stomach), hiatal hernia (some stomach above the diaphragm), pancreatitis (inflammation of the pancreas), abdominal pain, hernia, incisional hernia, infection, redundant skin, dehydration, diarrhea (frequent semi-solid bowel movements), abnormal stools, constipation, flatulence (gas), dyspepsia (upset stomach), eructation (belching), cardiospasm (an obstruction of passage of food through the bottom of the esophagus), hematemsis (vomiting of blood), asthenia (fatigue), fever, chest pain, incision pain, contact dermatitis (rash), abnormal healing, edema (swelling), paresthesia (abnormal sensation of burning, prickly, or tingling), dysmenorrhea (difficult periods), hypochromic anemia (low oxygen carrying part of blood), band system leak, cholecystitis (gall stones), esophageal ulcer (sore), port displacement, port site pain, spleen injury, and wound infection. Be sure to ask your surgeon about these possible complications and any of these medical terms that you dont understand.

Back to Top What are the specific risks and possible complications?

Talk to your doctor about all of the following risks and complications:

• Ulceration
• Gastritis (irritated stomach tissue)
• Gastroesophageal reflux (regurgitation)
• Heartburn
• Gas bloat
• Dysphagia (difficulty swallowing)
• Dehydration
• Constipation
• Weight regain
• Death

Laparoscopic surgery has its own set of possible problems. They include:

• Spleen or liver damage (sometimes requiring spleen removal)
• Damage to major blood vessels
• Lung problems
• Thrombosis (blood clots)
• Rupture of the wound
• Perforation of the stomach or esophagus during surgery

Laparoscopic surgery is not always possible. The surgeon may need to switch to an "open" method due to some of the reasons mentioned here. This happened in about 5% of the cases in the U.S. Clinical Study.

There are also problems that can occur that are directly related to the LAP-BAND� System:

• The band can spontaneously deflate because of leakage. That leakage can come from the band, the reservoir, or the tubing that connects them.
  
• The band can slip
  
• There can be stomach slippage
  
• The stomach pouch can enlarge
  
• The stoma (stomach outlet) can be blocked
  
• The band can erode into the stomach

Obstruction of the stomach can be caused by:

• Food
  
• Swelling
  
• Improper placement of the band
  
• The band being over-inflated
  
• Band or stomach slippage
  
• Stomach pouch twisting
  
• Stomach pouch enlargement

There have been some reports that the esophagus has stretched or dilated in some patients. This could be caused by:

• Improper placement of the band
  
• The band being tightened too much
  
• Stoma obstruction
  
• Binge eating
  
• Excessive vomiting

Patients with a weaker esophagus may be more likely to have this problem. A weaker esophagus is one that is not good at pushing food through to your stomach. Tell your surgeon if you have difficulty swallowing. Then your surgeon can evaluate this.

Weight loss with the LAP-BAND� System is typically slower and more gradual than with some other weight loss surgeries. Tightening the band too fast or too much to try to speed up weight loss should be avoided. The stomach pouch and/or esophagus can become enlarged as a result. You need to learn how to use your band as a tool that can help you reduce the amount you eat.

Infection is possible. Also, the band can erode into the stomach. This can happen right after surgery or years later, although this rarely happens.

Complications can cause reduced weight loss. They can also cause weight gain. Other complications can result that require more surgery to remove, reposition, or replace the band.

Some patients have more nausea and vomiting than others. You should see your physician at once if vomiting persists.

Rapid weight loss may lead to symptoms of:

• Malnutrition
• Anemia
• Related complications

It is possible you may not lose much weight or any weight at all. You could also have complications related to obesity.

If any complications occur, you may need to stay in the hospital longer. You may also need to return to the hospital later. A number of less serious complications can also occur. These may have little effect on how long it takes you to recover from surgery.

If you have existing problems, such as diabetes, a large hiatal hernia (part of the stomach in the chest cavity), Barretts esophagus (severe, chronic inflammation of the lower esophagus), or emotional or psychological problems, you may have more complications. Your surgeon will consider how bad your symptoms are, and if you are a good candidate for the LAP-BAND� System surgery. You also have more risk of complications if you've had a surgery before in the same area. If the procedure is not done laparoscopically by an experienced surgeon, you may have more risk of complications.

Anti-inflammatory drugs that may irritate the stomach, such as aspirin and NSAIDs, should be used with caution.

Some people need folate and Vitamin B12 supplements to maintain normal homocycteine levels. Elevated homocycteine levels can increase risks to your heart and the risk of spinal birth defects.

You can develop gallstones after a rapid weight loss. This can make it necessary to remove your gallbladder.

There have been no reports of autoimmune disease with the use of the LAP-BAND� System. Autoimmune diseases and connective tissue disorders, though, have been reported after long-term implantation of other silicone devices. These problems can include systemic lupus erythematosus and scleroderma. At this time, there is no conclusive clinical evidence that supports a relationship between connective-tissue disorders and silicone implants. Long-term studies to further evaluate this possibility are still being done. You should know, though, that if autoimmune symptoms develop after the band is in place, you may need treatment. The band may also need to be removed. Talk with your surgeon about this possibility. Also, if you have symptoms of autoimmune disease now, the LAP-BAND� System may not be right for you.

Back to Top Removing the LAP-BAND� System

If the LAP-BAND� System has been placed laparoscopically, it may be possible to remove it the same way. This is an advantage of the LAP-BAND� System. However, an "open" procedure may be necessary to remove a band. In the U.S. Clinical Study, 60% of the bands that were removed were done laparoscopically. Surgeons report that after the band is removed, the stomach returns to essentially a normal state.

At this time, there are no known reasons to suggest that the band should be replaced or removed at some point unless a complication occurs or you do not lose weight. It is difficult, though, to say whether the band will stay in place for the rest of your life. It may need to be removed or replaced at some point. Removing the device requires a surgical procedure. That procedure will have all the related risks and possible complications that come with surgery. The risk of some complications, such as erosions and infection, increase with any added procedure.

LapSF Two Year Study

LapSF Five Year Study - abstract only

LapSF Five Year Study - presentation (requires Windows to play)

Literature review on the sleeve - requires $ to get the full text unfortunately

Sleeve best for over 50 crowd

Video of a sleeve with lots of education discussion

Video of a sleeve that is more about the operation

Ghrelin levels after RnY and sleeve

Ghrelin levels after band and sleeve

Diabetes resolution in RnY vs. Sleeve

Comparison of band to sleeve - literature review

The sleeve has been performed for 7-8 years in US as a stand -alone procedure. But, has been used for patients with BMIs exceeding 60 as part of the a 2 step surgery either to RNY or the full DS for over 15 years. They started doing it as a stand alone procedure when the results of super morbid obese patients started showing that they didn't need the 2nd surgery.

[Anita in Spokane 0]

hey guys..

so I was 99.9% sure that I was going to get the sleeve and a surgery date today. I just met with my surgeon, he didn't say "get the band," but I feel he was definitely encouraging me to really consider it. He said that based on my age, weight, and long term outcomes, he thinks it would be a really good choice. He said that there is at least 16 years of data on the band, while there are only a few years for the sleeve. He said that I have a long time to live with my choice, and since there aren't long term studies and it is absolutely irreversible..it's more of a risk. He mentioned that the difference in statistical outcome weights between the two surgeries would be within a few pounds of each other, and completely within my own control. Given that, he suggested the band because it's "safer" and reversible if absolutely necessary.

My thinking is..what are the chances of a band living to be 90 years old without complications? What are the chances of the sleeve living to be 90 without complications? I want this to be a one time procedure..with life long benefits...

I know that most of the people on this site chose the sleeve for themselves and have been very successful. I guess I'm just unsure now because of his recommendations...gosh guys, I thought I knew what to do, but now I'm just confused.

Any thoughts would be appreciated...

[Anita in Spokane 0]

I think that if you are wanting Sleeve for your choice & your Dr. is suggesting the Band....Its time for another doctor.

[myrori 55]

Wow Tiff, If I had read that when I was thinking about the band a couple of years ago, it would have been over before I ever filled out the paperwork.

[steph025 0]

Wow. Thank you so much for your input. I was pretty sure I didn't want it before reading everyone's responses, and now I am absolutely positive it's not something I want to do. I have an appointment with a different surgeon tomorrow..and have a tentative date for Jan 13th!

I know the stats are really scary for the band..after we make it through the first few months after the sleeve, we are more or less in the clear right? Once the suture line is healed...it's not likely to just open up and cause a leak?

Tiff, do you know of a site that has the break down like that for the sleeve?

Everyone on this site has is so helpful, thank you!

[Tiffykins 673]

Wow. Thank you so much for your input. I was pretty sure I didn't want it before reading everyone's responses, and now I am absolutely positive it's not something I want to do. I have an appointment with a different surgeon tomorrow..and have a tentative date for Jan 13th!

I know the stats are really scary for the band..after we make it through the first few months after the sleeve, we are more or less in the clear right? Once the suture line is healed...it's not likely to just open up and cause a leak?

Tiff, do you know of a site that has the break down like that for the sleeve?

Everyone on this site has is so helpful, thank you!

The staple line heals in 6-8 weeks after that the risk of a leak is pretty non-existent and yes, you're in the clear for leaks. Now, there are other risks you can encounter with the sleeve, Strictures are rare but can occur. It's where scar tissue causes narrowing of the stomach, it's a risk, but I've only read 2 stories of someone getting a stricture. Following the post-op diet to a "T" regardless of how difficult it is really decreases your risk, along with an experienced surgeon. Most leaks occur within the first 2 weeks. The first 4-6 months are considered the "honeymoon" phase, it's peak weight loss time. Once the swelling goes down, and your body learns to accept food again, you'll be able to eat more. This isn't necessarily sleeve "stretching", but our stomachs can't stay the size of a sharpie marker forever. Keeping up with your Fluid intake, Protein, and Vitamins are essential for healing and recovering.

Best wishes with your new surgeon ! ! !

[Cinderella 2]

I guess this sounds a little crazy, but here. goes anyway.

For several years now, I wanted the BAND. Reseached it, priced it, even went through all the insurance paperwork and got approved to get it. But over those years, as I followed it closely, I began to read about more and more people having problems with it, or having it converted into something else.

When it finally came time to get the Band, after my insurance approvals, I found out that the surgeon I selected had two young women DIE shortly after band surgery, and punctured another woman's intestines during surgery, so I decided to change surgeons.

When I came to my present surgeon, he and his whole staff told me YOU DON'T WANT THE BAND. They told me that while the surgical risks with the Sleeve are MUCH higher during, and after surgery, they go down sharply, whereas with the Band, the risks are very LOW during and after sugery, but begin to rise up sharply as time goes on. They drew this little graph, there is a point at which the "risk lines" cross, and the longer you have a Band, the greater your risk of complication.

This surgeon (Dr. Pomp, NYP) was so good, and I began reading this forum every day, that I changed my mind, changed my insurance approval, and got the sleeve.

I also had this strange image of... if I got the band... me being a very old woman with the Band, and then eventually dying.... and there I would be in my coffin, and eventually I would waste away into dust.. and all that would be left was this BAND. In my coffin... and for some reason, this bizarre image really disturbed me.... that the band would outlast my body. Sorry if that's too much information, LOL, I told you it woudl sound crazy!

Anyway, I am now two+ weeks out from surgery with the Sleeve and very happy.

Good luck to you, whatever you decide.

Cinderella