I had a consult with a surgeon and he's trying to talk me into the band. Given my bmi is only 36, He thinks I will loose a great amount of weight and become malnourished. I believe there are other reason for his push on the band. Like follow ups and the fills, means more $$. I over heard him through the wall, to the room next to mine, trying to push the band on another patient. Should I give the band a try first then have revision later if it fails?? So stressed over this!

I had a consult with a surgeon and he's trying to talk me into the band. Given my bmi is only 36' date=' He thinks I will loose a great amount of weight and become malnourished. I believe there are other reason for his push on the band. Like follow ups and the fills, means more . I over heard him through the wall, to the room next to mine, trying to push the band on another patient. Should I give the band a try first then have revision later if it fails?? So stressed over this![/quote']

First I would look up people that had band to sleeve conversions, then look up all the people with complications from the band. I was talked out of it by my original surgeon and when I had to switch for insurance reasons the other doctor also said he would not do the band. More and more doctors are not doing the band. It really is your personal preference but I'm sure you will be strongly advised to not do the band. Some countries have even banned it from being used.

Good luck with your decision.

Can you get a 2nd opinion from another Dr? Maybe he's done more bands and that's where his comfort lies?

definitely get another opinion. from my research loosing 'too much' weight is not the primary issue with the sleeve. I have had patients whose surgeons tried to talk them into simpler operations, i talked with the surgeons and could not figure out their motivation. perhaps the lack of leaks?

but the failure rate for the band is much higher and besides it does not address the hunger issue as well as the sleeve or bypass does.

Yes maybe that's true. He wants me to get a GDE test. Camera down to stomach. Which the office said he was going to perform. I take medication for Gerd. He said a sleeve is not good for patients with gerd, because of the acid levels in a smaller stomach. I'm wondering if he documents my test as a failure then I would have to get the band. Only 2 surgeons in that office. I would have to move to another city and re-do everything I've already completed. Almost finished for submitting to insurance.

Many sleeve pts take a PPI (for acid) daily after surgery to aid in the healing of the stomach lining. All for different lengths of time it seems.

surgeon trying to talk me into the band.

bigbeauty78

this must be a difficult time for you - wanting the sleeve - doc pushing for the lapband

doc sounds pretty adament that he prefers the lapband

even if he DOES say ok to the sleeve - i can't help but think his heart isn't into it

i wouldn't want "that" doc to have my life in his hands

repeating what others have said - many docs don't want to do the lapband anymore

there must be a good reason

years ago, it was either gastric bypass or the lapband - they were both supposed to be terrific

we know of the malabsorption problems with the gastric bypass

and the lapband has so many problems, erosion et al

(to be fair, i never had the lapband - but i hear all these awful things concerning the procedure)

conversion from lapband to sleeve???

hmmmm, why do you think so many OP have this done if there were no problem with the lapband???

we're the sleeve board, so we're all biased towards the sleeve, but................

we all made the wise decision to have the sleeve, cuz its the best (and so are we )

just that your doc is trying to pull you towards the lapband

i would run/not walk away from his offic

there are many surgeons in the sea

find one who likes the sleeve - (that shouldn't be hard to to do)

good luck with your sleeve procedure!!!!

you will love it

take care

kathy

Do a search for GERD here. We have plenty of folks that have been sleeved with it, too. Acid is an issue for many post op, but for the vast majority it fades before the first year post op. In my case, 4-6 months and I was off my PPI. I've been on it since for my pregnancy and two other short periods when I was under an incredible amount of stress. Other than that, the issue resolved and it's this way for many.

Losing too much weight and being malnourished is hardly a concern here. You'll see the occasional voice chime in that they got smaller than they wanted, but it's rare. And you're only malnourished if you choose not to eat adequate nutrition and take your B12, multi and Iron, if needed. I did have an issue with B12 and iron, but I've always had iron/anemia deficiencies. Now I'm on supplements that help me feel better than ever before.

Additionally, you'll see many people get revised to sleeve from the band - and many of those people do it in part due to stomach damage and acid problems!

My opinion is that your doctor is just more comfortable with the band procedure. This happens and it's true that the sleeve still isn't done at the rate of the older band and bypass. Only you can make this decision, but I can tell you that I was dead set on a band and thought a sleeve was too drastic...until I did six months of research and lurked on the band talk site and saw how miserable people were with the band surgery.

Best of luck and I hope that you find a solution that makes you comfortable. I chose to self pay because my insurance covers only band and bypass.

~Cheri

All the testing and prep you did can be taken to another dr. You will not have to start over. Don't let that dr talk you into a procedure that you do not want. I have only met 1 person that lost all her weight to goal and said she was having no problems. Be very sure. You don't want to have a second surgery.

I had a consult with a surgeon and he's trying to talk me into the band. Given my bmi is only 36, He thinks I will loose a great amount of weight and become malnourished. I believe there are other reason for his push on the band. Like follow ups and the fills, means more $$. I over heard him through the wall, to the room next to mine, trying to push the band on another patient. Should I give the band a try first then have revision later if it fails?? So stressed over this!

Beauty, I posted this a week ago on another thread and it sounds like you could do with reading it. As the knowledgeable ones above have said; if you're not comfortable, get a second opinion. I have a BMI of nearly 36 and there's no way, given the amount of academic research I've done, I would consider a band. Closer to home, I know a lady who had the band operation, had three corrective surgeries on it and then had to go to sleeve, which due to the scar tissue the band had left, failed, so it had to be revised into a bypass. An absolute mess. This, of course, is an isolated case - but the academic research proves that the band is simply not as effective, you don't lose as much weight, but does, on the plus side, have a lower mortality rate. If you have any queries about the below, please do not hesitate to contact me. All the best, R x

"I posted this on another forum and felt it might be useful for other people to have a read of, if like me, you like your scientific facts.

Maybe the below will provide a bit of clarity as to the 'nuts and bolts' of some of the bariatric procedures and their long-term (within the limitations of the data) efficacy.

This first academic journal quoted was published in May 2013. So, it doesn't get more 'up to date' with regards to evaluating the comparative effectiveness in the three biggest weight loss procedures. I have only reproduced the abstract and have quoted the source below as the abstract covers the salient information we'd be interested in.

The second section is all about the metrics, with a snapshot of all the procedures being evaluated in a tabulated form (the table was removed from the cutting and pasting process, so read left to right) and the risks associated with the operations. The primary and secondary sources are also cited.

Better to make decisions based on rigorous scientific research, than hearsay and charasmatic sales pitches, I feel... Hope it helps.

Article 1:

Abstract: Objective: To evaluate the comparative effectiveness of sleeve gastrectomy (SG), laparoscopic gastric bypass (RYGB), and laparoscopic adjustable gastric banding (LAGB) procedures.

Background: Citing limitations of published studies, payers have been reluctant to provide routine coverage for SG for the treatment of morbid obesity.

Methods: Using data from an externally audited, statewide clinical registry, we matched 2949 SG patients with equal numbers of RYGB and LAGB patients on 23 baseline characteristics. Outcomes assessed included complications occurring within 30 days, and weight loss, quality of life, and comorbidity remission at 1, 2, and 3 years after bariatric surgery.

Results: Matching resulted in cohorts of SG, RYGB, and LAGB patients that were well balanced on baseline characteristics. Overall complication rates among patients undergoing SG (6.3%) were significantly lower than for RYGB (10.0%, P < 0.0001) but higher than for LAGB (2.4%, P < 0.0001). Serious complication rates were similar for SG (2.4%) and RYGB (2.5%, P = 0.736) but higher than for LAGB (1.0%, P < 0.0001). Excess body weight loss at 1 year was 13% lower for SG (60%) than for RYGB (69%, P < 0.0001), but was 77% higher for SG than for LAGB (34%, P < 0.0001). SG was similarly closer to RYGB than LAGB with regard to remission of obesity-related comorbidities.

Conclusions: With better weight loss than LAGB and lower complication rates than RYGB, SG is a reasonable choice for the treatment of morbid obesity and should be covered by both public and private payers.

SOURCE: Carlin A, Zeni T, Birkmeyer N, et al. The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity. Annals Of Surgery [serial online]. May 2013;257(5):791-797. Available from: MEDLINE with Full Text, Ipswich, MA.

Article 2:

September 2012: Morbidity and mortality associated with LRYGB, LSG, and LAGB from the ACS-BSCN dataset

LRYGB LSG LAGB 30-d mortality (%) 0.14 0.11 0.05 1-y mortality (%) 0.34 0.21 0.08 30-d morbidity (%) 5.91 5.61 1.44 30-d readmission (%) 6.47 5.40 1.71 30-d reoperation/intervention(%) 5.02 2.97 0.92

SOURCE: Data from Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg 2011;254(3):410–20 [discussion: 420–2], in: Timothy D. J, Matthew M. H. Morbidity and Effectiveness of Laparoscopic Sleeve Gastrectomy, Adjustable Gastric Band, and Gastric Bypass for Morbid Obesity. Advances In Surgery [serial online]. n.d.;46(Advances in Surgery):255-268. Available from: ScienceDirect, Ipswich, MA"

Excellent share - it's always nice to see the studies!

~Cheri

i would definitely get a second opinion. there are so many doctors out there. is he not comfortable with performing the sleeve? how many sleeve gastrectomies has this surgeon and practice performed?

there is a reason he is pushing the band. according to my surgeon and his group they claim the band with will taken away in the coming years do to its inefficiency and complication rate. a lot of band patients end of converting to the sleeve or rny.

definitely do research and i would definitely find a different doctor and see what they say. that is just my opinion of course but i wouldn't be comfortable with that response from him.

also i have gerd prior to getting sleeved. mine actually got better since being sleeved. i know some people who did not have reflux prior to getting sleeved get it after but mine seems to have gotten better. i do still take a ppi but preop i did as well but i still had bouts of reflux. now i don't ever have problems unless i eat and then lay down too soon. i have woken up choking on acid 3 times from doing that.

To add to that, here is some GERD specific research... On the basis of the below, I'd be asking your doctor to qualify his remarks on GERD in lapband v's sleeve patients... If anyone has any questions, please do not hesitate to ask. R x

Patrice R. Carter, Karl A. LeBlanc, Mark G. Hausmann, Kenneth P. Kleinpeter, Sean N. deBarros, Shannon M. Jones, Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy, Surgery for Obesity and Related Diseases, Volume 7, Issue 5, September–October 2011, Pages 569-572, ISSN 1550-7289, http://dx.doi.org/10.1016/j.soard.2011.01.040.

Keywords: GERD; Laparoscopic sleeve gastrectomy; Reflux; Obesity

Background

Gastroesophageal reflux disease (GERD) is a common co-morbidity identified in obese patients. It is well established that patients with GERD and morbid obesity experience a marked improvement in their GERD symptoms after Roux-en-Y gastric bypass. Conflicting data exist for adjustable laparoscopic gastric banding and GERD. Laparoscopic sleeve gastrectomy (LSG) has become a popular adjunct to bariatric surgery in recent years. However, very little data exist concerning LSG and its effect on GERD.

Methods

A retrospective chart review was performed of 176 LSG patients from January 2006 to August of 2009. The preoperative and postoperative GERD symptoms were evaluated using follow-up surveys and chart review.

Results

Of the 176 patients, 85.7% of patients were women, with an average age of 45 years (range 22–65). The average preoperative body mass index was 46.6 kg/m² (range 33.2–79.6). The average excess body weight lost at approximately 6, 12, 24 months was calculated as 54.2%, 60.7%, and 60.3%, respectively. Of the LSG patients, 34.6% had preoperative GERD complaints. Postoperatively, 49% complained of immediate (within 30 d) GERD symptoms, 47.2% had persistent GERD symptoms that lasted >1 month after LSG, and 33.8% of patients were taking medication specifically for GERD after LSG. The most common symptoms were heartburn (46%), followed by heartburn associated with regurgitation (29.2%).

Conclusion

In the present study, LSG correlated with the persistence of GERD symptoms in patients with GERD preoperatively. Also, patients who did not have GERD preoperatively had an increased risk of postoperative GERD symptoms.

Sharon Chiu, Daniel W. Birch, Xinzhe Shi, Arya M. Sharma, Shahzeer Karmali, Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review, Surgery for Obesity and Related Diseases, Volume 7, Issue 4, July–August 2011, Pages 510-515, ISSN 1550-7289, http://dx.doi.org/10.1016/j.soard.2010.09.011.

Keywords: Sleeve gastrectomy; Gastroesophageal reflux disease; Systematic review

Background

Sleeve gastrectomy (SG) has increased in popularity as both a definitive and a staged procedure for morbid obesity. Gastroesophageal reflux disease (GERD) is a common co-morbid disease in bariatric patients. The effect of SG on GERD has not been well studied; thus, the goal of the present systematic data review was to analyze the effect of SG on GERD.

Methods

A systematic data search was conducted using Medline, EMBASE, the Cochrane Database, Scopus, and the gray literature for the Keywords “sleeve gastrectomy;” “gastroesophageal reflux;” and equivalents.

Results

A total of 15 reports were retrieved. Two reports analyzed GERD as a primary outcome, and 13 included GERD as a secondary study outcome. Of the 15 studies, 4 showed an increase in GERD after SG, 7 found reduced GERD prevalence after SG, 3 included only the postoperative prevalence of GERD, and 1 did not include data on prevalence of GERD.

Conclusion

The evidence of the effect of SG on GERD did not consolidate to a consensus. The studies showed differing outcomes. Hence, dedicated studies that objectively evaluate GERD after SG are needed to more clearly define the effect of SG on GERD in bariatric patients.

Can a doctors office with hold your medical records? In the morning, I'm going to call another WL center that's 1 1/2 hours away, to consult with their weight loss coordinator. Thanks all for the helpful information. I believe this current surgeon has his heart in his pocket. Best of luck to everyone in their weight loss journey!

In answer to your question, a dr.'s office cannot refuse to give you your medical records...best to you...you have received some good advice here I think

Can a doctors office with hold your medical records? In the morning, I'm going to call another WL center that's 1 1/2 hours away, to consult with their weight loss coordinator. Thanks all for the helpful information. I believe this current surgeon has his heart in his pocket. Best of luck to everyone in their weight loss journey!

no they can not withhold them. however its typically quicker to have the new dr request them than it is for you to request them. just my experience though. you will have to sign a paper giving the dr rights to get the results. but they should be able to do it via fax or electronic fax through computers.