Hello, Everyone.

I have been perusing these forums for quite some time, but this is my first post.

Last night I went to the "mandatory" seminar. This one in particular was supposed to be informative about the Lap-Band and the gastric bypass surgeries. Well, I got the distinct impression that this surgeon preferred the bypass as opposed to the band. I went in determined that I wouldn't change my preference from having the band, but he made me think about some things:

He says there is a huge bell curve with the Lap-Band, that almost half the people who have it don't even lose half of their excess body fat. On the contrary, he says people with the bypass generally lose 70 to 80 percent excess. This was something to chew on.

He says that the long-term effects of the bypass have been documented, as it has been performed since 1977 as opposed to the Lap-Band which only began around 2001. He believes there could be problems 10, 15 years from now with the Lap-Band that there are not with the bypass.

He says that there is not ?malabsorption? with the band, only that it is restrictive, as with the bypass it is both. This part confused me somewhat. Something about eating a bunch but only a few of the calories actually getting into your system, some business like that.

He brought up a few good points. However, it did come up that he has done around 500 of the bypass and only about 20 Lap-Bands. I wonder if he is just more comfortable with the bypass and if that is why he favors it. But still, he got my wheels turning and now I don't know what is best. Any feedback would be greatly appreciated.

My first appointment with him is in a week, and then we're going to try to do one of the surgeries before the end of September. My husband is joining the Air Force in September, and I'll just go ahead and assume that no doctor like this is going to accept Tri-Care. Blue Cross Blue Shield will cover it they say, so you better believe I am going to take advantage of that. :clap2:

Thanks for listening/reading, and thank you for any thoughts that you may have.

Mallorie

My advice is to do alot of research on all forms of WLS and then choose which you feel would work best on you.

You will find that many are happy or displeased either way you go.

Thank you, Kathi, for your quick response. I wish it was an easier decision. Do you, or does anybody who wishes to respond, wish that they had done the bypass instead of the Band? I love to hear what people say, whether they're happy with what they did or if they would have done something else.

Check out this poll and read some of the responses, maybe it will help.

http://lapbandtalk.com/showthread.php?t=20135

For me, bypass was never on the table. I found it to be a very extreme procedure for a relatively simple problem...I eat too much and I never feel full. So something mechanically restrictive that simply limits the amount of food I can eat seems the most logical.

I also liked that the complication rate was very low, the procudure is minimally invasive and totally reversable and removable. Yes, there are risks and no, we dont know how the band will behave in the body on 20 years. But people have artificial internal body parts for many many years and it is really no different. Probably technology will evolve at some point to provide a newer/better way to keep weight off. Until then, I think the band is the best choice for me.

As for people failing to lose weight...I think that is a result of the band being a tool that involves choice and not involuntarily restrictive and malabsorbtive. Meaning, for the band to work you have to keep your fill level such that you experience restriction. Then you need to eat the types of foods that help you feel the fullness you get with restriction. One could conceivably get one fill, or no fills, eat whatever they want, etc. The choice factor is a 2 way street. Foods like ice cream and cake would have you really sick with bypass. You have the freedom to indulge somewhat when you are banded. But with the choice comes the responsibilty not to overdo it. With bypass, you face the penalty of being very sick when you have carbs and sweets. I would rather have more freedom to eat 'normal' foods in exchange for needing to keep an eye on over-indulging.

It is a personal decsion for everyone. Don't let a doctor steer you. Do lots of research. Think about your lifestyle and diets you've tried. What types of things you can see yourself able to do for life? Can you give up many foods? Bandsters have to give up some foods, too so keep that in mind? Can you maintian the fills so you have restrcition? Are youc omfortable having Vitamin supplementation for life -- which is needed with bypass. How much weight do you need to lose? Are you in need of immediate surgical intervention and rapid loss that bypass can give you? Or can you take your time and have a slower loss with the band?

Research, ask questions, and go with you gut, no pun intended!

I'm not banded yet (August) but from what I've seen and heard, there are people who have strong feelings not just about what surgery they have chosen, but about the opposing surgery. Just be prepared.

Having said that, I believe there is another study that said after 5 years lap-band and RNY patients had almost the same outcomes. Which jives with what my surgeon told me about lap-band: it's a slower loss, but a steady loss.

It's a very personal decision, but for me, I did not want any malabsorption issues (did not want to take supplements forever) and wanted a less-risky surgery.

Don't forget that lapband has been around MUCH MUCH longer than 2001...just not in North America; for instance Australia and some European countries have been doing it for over 15 yrs!

i am not one of those people that never considered gastric bypass. my decision was weighed between the two. i only had 80 lbs to lose, so it seemed more doable to me that i could cut down on food and do more conscious behaviour modification to lose. if i had say 200+ lbs, my personal decision may have been different. also, if i were a real sweet eater, my decision may have been very different.

also, i think that the 70-80% ewl stat is more like 'at some point' GB patients lose this. i don't know if that is the longer term number. people that i know who have had GB go really low then get to about where band patients are. after a while their pouch expands and their intestines begin to absorb more nutrients. so over time, their anatomy is not at the 'optimal settings' that the doctor created in the beginning. i think that the adjustable nature of the band may allow you to benefit from recalibrating over time. i would guess that in the long term, the band might allow you to actually modify your behaviour and learn new ways of being.

but i think it's great that we have different choices for surgeries to deal with different situations. even the GB has different degrees of malabsorption. then there's the duodenal switch and the vertical gastroplasty. i would just encourage you to read as much as possible before committing to any surgery and think about what your obesity is caused by and which surgery has the best chance of helping you. best wishes!

Since you're confused about malabsorption... malabsorption is what allows bypass patients to lose weight so quickly. Long story short, part of the intestines that absorb nutrients & stuff from food is bypassed, so even though you consume it, you don't get anything from it. It's also why the dumping syndrome bypass patients get can be so severe.

Different surgeons are biased in different directions. My surgeon, when asked by another patient, anwered that if one of his family members had to have WLS, he would want them to have the lap-band. To me, as he was my surgeon, learning that said a lot.

A very good friend of mine had bypass and lost over 140 lbs in about 8 months. She is maintining at a sz 10. She says "I now understand some of the long term complications"... but she's only 2.5 yrs out. I don't have any details b/c this was in an email, but I'm eager to find out. I know that she does not, and has not for a while, look healthy. She's gaunt, pale... her energy is constantly low, and she has to go in for regular B12 shots. She has not come out and said, "I wish I had gotten the band", but it has been strongly implied in things she has shared with me.

I have also read about "hybrid" surgeries. Those with failed bypass going in and getting the band on top of that. So you end up restricted with all the other complications.

Personally, I will take my chances with the band. I worked at a bariatric clinic one summer, and saw all the "behind the scenes" things with bypass. Trust me it is not pretty, and I want no part of that. If the band allows me to lose 50% of my excess weight, that is more than I can do on my own.

Hi. I am only 4 weeks post op and I wish I had the bypass. I think it is a much speedier weight loss. Not sure if that is good of bad. With the band, it is merely a tool. A tool that so far I have experienced as something you must put action into. I haven't had a fill yet so it is difficult for me to gauge how well I WILL do, but from where I sit, it has been very difficult to start losing weight. Having said that, I do like the fact that the band surgery isn't as invasive (of so I think). I have seen some wonderful results from Gastric bypass in friends. One thing is for sure...you can eat your way around both...so buyer beward. Good luck in your decision.

For me I do have ALOT of weight to loss and for me there was no choice but the band, for me. I actually work for my surgeon now and he does a lot of different surgeries so I have learned a lot more. There is always pros and cons to anything. Yes you loss slower w/ the band. There is no malabsoration issues w/ the band. I work w/ a girl that is 4 yrs out of the RNY and she has gained 50 or so pounds back. She can eat way more then me and is still gaining. My aunt had done the same thing. No I am not saying the band is the only way to go it's your choice....It's what you will be happy with. I have lost more then 50% of my excess body weight and plan on lossing more. If you have it in your head you are going to do it you will succeed with any surgery but it really has to be in your head you are ready to change. Did he tell you that on an average 20 - 30% of RNY patients gain 25 - 30% of their weight back between 3 - 5 yrs post op? That puts them right where the band patients average is. All docs are different and yes some prefer the rny over the band it's newer here in the states but it's been out for over 15 years outside the US.

Good Luck on your research and don't the let the doc tell you which one he wants you to have you have the one you know will work for you. It's your choice and you have the right to choose that is what is great about having choices in the surgery you want. :confused:

Before you decide to have any WLS, make sure you're well-informed about the types of surgeries themselves and are confidant in the reasons you've chosen the surgery that you have chosen.

Even though you may have "perused" the forums, that doesn't mean you understand the procedures themselves, only the individuals who have either had them or are looking into them and the questions they have had the courage to post.

With WLS, there are three different types of surgeries. A "malabsorptive" surgery, meaning that somehow through surgical intervention your body has been altered so that even though you eat food and nutrients you do not absorb the calories or the vitamins/minerals, etc. A "restrictive" procedure, meaning that you cannot eat as much as you used to, restricting the quantity of food and therefore calories. And thirdly, a combination of malabsorptive and restrictive.

Gastric bypass is a combination of malabsorptive and restrictive. Lap band is restrictive only. There are pros and cons to that and depending on what you're looking for in a WLS as well as what you are willing to risk is how you make your decision.

Research, research, research. Make sure you're confidant with your surgeon. Even though he may "prefer" one procedure over another doesn't mean you won't have success, it just means you may have to be a little more dedicated and knowledgeable.

Oh, and by the way........his statistics about losing less than 50% of excess body weight are off. It may be from the original FDA trials. I personally started off with 135 lbs to lose if I wanted to make it to that "ideal" body weight. I have lost 80 lbs which is 59% of my excess body weight as compared to that "ideal". I'd like to lose at least 40 more, which would make me only slightly overweight. With the band, a little dedication and patience, I now have hope that I will see that.

I'm coming to believe with the band that there is a strong personality component to success. At first most people lose weight easily, but six months down the track, I am most DEFINITELY having to diet and exercise the traditional way to keep weight coming off. I need to be aware of what I'm putting in my mouth and I have to burn off those calories. I dont even believe in some ways my band helps that much, what is more important to me is that I dont regain weight when I slip up, and I'm sure I wont regain it as soon as I get to goal. I cant eat enough to seriously gain but I can certainly eat enough to not lose. However, I dont believe I've found perfect restriction yet.

I actually like having to put the hard work in. I feel I'm learning things about myself and achieving new things every day. I am loving exercising so regularly. Its a great thing in my life, something I could have done before and wish I had. I'm healthier than I've been in years, because I eat well and take care of myself.

I simply dont know why you'd want malabsorption unless you were in dire straits health wise. You almost certainly trade your healthy good looks for being normal weight if you lose weight that way. Its necessary for some people and the right choice, but I'd always always advocate the band as the first choice. You can switch later if it doesnt work for you but I wouldnt ever reroute my insides for the size weight problem I had.

I guess you have to do some soul searching about whether you really think you have what it takes to get the weight off. Some people are just so hopelessly addicted to overeating that they cant manage it even with a band, and for them, another surgery could be a better choice. But Healthwise, its better to drop the weight more slowly, gradually and gently.

I do agree with the surgeon that we dont know the long term outcome of the band yet. I know a few people that have had one 10 years or so - as its been done for a little over that time in Australia, but all have had revision surgeries. Who knows? Its a risk I was prepared to take and I truly believe that because the band works slowly and requires your effort and hard work at retraining yourself, I am learning a new lifestyle that hopefully would stick with me to some degree or another if I lost my band. I certainly wouldnt stop running and working out for one thing.

Well...time for my 2cents worth!!

1 in 200 die from Gastric Bypass....they are ALL anemic the rest of their lives....they actually bypass your stomach....which is why you must have B12 shots every month the rest of your life! :confused: Those are all tough things to live with! You absolutely cannot eat sugar or their are consequences pretty much immediately.....I have seen a good friend of mine have the bypass surgery and gain all her weight and more back!!

I think a total of 2 out of well over 100,000 internationally have died from the band! You can eat sugar....but it's not good for you!! But you can at least live a little! It has been around over 10 ys and the studies 5 ys out show the same amt of wt loss for lap band and bypass. You will PB....you will have more gas....at least I do! You will have to eat w/ a baby spoon so you eat small enough bites! It is not easy!!! The band can be removed if needed....the bypass is forever.

There is no perfect way.....it's tough all around!!! These are all just my opinions and personal experience on the band and some stats I have read recently!!!!

I am w/ everyone else RESEARCH....RESEARCH....RESEARCH!!! You have to know what your comfortable w/!!!!

God Bless,

Melody

Banded 3/20/06 -56lbs

I had heard that those original FDA trials on the band were set up where no one had any FILLS. It was strictly where the band was initially placed and that was it. NO wonder it showed such low weight loss. Yes, later studies have shown that 3-5 years out with fills, the weight loss is about the same for bypass vs. band. I think this doc is looking at old data. But as everyone else has pointed out, you need to research MORE and be comfortable with your choice. Just my .02 :confused:

Terry

To follow up on my initial response...

I have been very slow to lose any weight. All of the weight loss that I have experienced has been due to my dieting and exercising. None of my weight just came off without trying and working at it daily. I do feel the band keeps me from eating too much at each sitting and from eating the wrong types of foods (breads), but I can see that it wouldn't be too difficult to eat around the band and actually gain weight because the foods that are easier to eat are the ones that are not healthy.

I exercise daily. I alternate treadmill and aerobics. I have to diet daily to eat less than 1000 calories, and journal everything I eat to keep track. I sometimes find it hard to find anything to eat that I can eat comfortably. I knew going into this that I would have to give up all breads, pop, rice and some meats, but it is alot to wrap your head around and sometimes you wonder what is left?

The issue of fills is one that cannot be taken lightly. Fills are essential. You may take a long time to be correctly filled, especially when alot of doctors wait at least 4 weeks in between fills to do adjustments. If you are overfilled you can have serious problems. If you are underfilled you will have an even slower loss and can develope a defeatist attitude.

The one thing that I had not considered prior to banding was my port. I am not happy with the port. It causes pain periodically, and I find myself limited in motion and limited in lifting compacity.

I agree with another persons post... that the people who have had a particular surgery generally tend to have really strong feeling for their surgery of choice and tend to be completely against the alternate surgery.

I look at it this way.... So far I have spent over $11,000 to lose 7 pounds. I do have good / comfortable restriction. I have to work at my wieght loss faithfully every day, and I thought that it would come off so much easier than it has. As of right now I do wish that I had an alternate surgery ( even though I do realize that there is NO perfect surgery ).

Best of luck to you and your decision, either way you go.