Newbie - How do I choose?

[Bonawanabfree 280]

@@Shakti

I went with the sleeve because I knew it would be less maintenance in the long run. i didnt want to have to deal with the fill and the possible slippage and erosion. My surgeon doesnt do the lap band anymore becasue he said that there are too many people having to come back to him with issues. If you are afraid of the anestisia dont worry, you will be fine. Just write a list of pros and cons for both and go with the one that has more pros. Good luck.

[Shakti 55]

I met with the surgeon today. Hands down he recommended the sleeve. Doesn't hardly even do lapbands anymore.

He actually suggested that I could consider the 'big 1' (as I call the roux-n-y) since I am diabetic and my A1C has been in the range of 7. However that is too drastic for me - so he is comfortable with doing the sleeve.

I need to lose about 150 lbs. Even I was shocked to see those numbers!

Hope to get medical clearance and a date before too long!

[scstxrn 213]

I agree with everyone I've read so far - definitely do your research.

Like ShrinkingPeach & Miss Mac, I wanted the fewest complications and the least rerouting.

I also suck at taking pills, and I haven't had to increase my Vitamins after the sleeve - my Protein shake has most of them in there.

Five and a half months after surgery, I have lost 115 from my high weight and 72 from my surgery day.... my loss was very fast at first and has slowed to about 10 pounds per month because of crappy food choices and the fact that I was recently diagnosed with MS and now take a medication (Tecfidera) that is much less horrible when you eat it with 200 calories of fatty food twice a day. The Lyrica that was added to my routine at the same time has a side effect of weight gain - but it is worth slow loss not to hurt.

I last weighed today's weight when I graduated from college the first time. I've been so busy and so stressed out that I haven't been smart in my food choices and my exercise has been pretty much walking to the car, to class, to work, to bed, to the bathroom, and repeat. I finish classes in one month, at which time my routine will totally change, and I anticipate making my goal well before the one year mark.

I am so grateful that I had the sleeve, and glad that I chose it when I did.

[CowgirlJane 14,261]

I think this is a very good summary of the risks with the band. What I would add to it is the real risk of "pouch dialation". I think this goes back to the old way of managing the band, relying strictly on "restriction". I was banded in 2001 and it was an epic fail for me - mostly because I was still very hungry, but also because i developed all the typical complications - reflux, could only eat sliders etc. I had to have all Fluid removed by early 2003. I didn't have the band removed until 2011 though and yes I had alot of scar tissue. Luckily, no esphogus problems and my reflux went away when the band went away.

Please bear in mind that I am a very happy and very successful bandit now 9 years post-op. I do not regret my band, would do it all over again and if I ever have to have it removed, I would hope to have a replacement.

When I was banded in 2006, it was a miracle surgery. And for some people, who accept that they will still have to work hard, it is just that. It was and still is for me. But over the years it has become clear that serious complications necessitating further surgery are much more common than originally thought, some of these are avoidable by careful eating and by not keeping the band tight; unfortunately others are beyond our control.

We used to be warned about band slips, leaks and about ( very rare) erosion into the stomach tissue but it turns out that a build up of scar tissue round the band (causing it to tighten) is quite common. It can be very difficult to get the right level of restriction and some people are tempted to keep it tight enough to physically limit food, in fact it was once thought this was how it should be. But this causes food to back up into the oesophagus and that risks problems such as oesophageal dysmotility which may be irreversible. It can also damage the vagus nerve.

Quite a number of doctors have stopped implanting bands as they found the removal rate was unacceptably high and it was too easy not to lose enough weight. Revision from band to sleeve is not uncommon!

We still need lots of will power. The band makes it easier by dimming hunger, but it does nothing for head hunger and, contrary to popular opinion, it does not and should not physically stop us eating. If it does it is too tight!

Having said all that, I love my band, I know many successful long term bandits in real life. My own experience has been good and so has that of almost all those I actually know and have met.

But don't rule out bypass. For many people the element of malabsorption is a key factor.

[sparksrn 65]

If you have reflux I've heard the sleeve makes that worse. To many people manage to gain weight again with the lap band and to many complications with it, sure the surgery itself is easier but you want something that is going to work long term for you.

[perk4756 259]

Shakti, just an opinion. I know someone who had lap band and seen many posts about this same. Alit if times they slip and have to be redone. So I would not have the band.

[CowgirlJane 14,261]

@@samuelsmom thanks for posting the article. I was banded in Europe in 2001;revised to sleeve in 2011. I was a member of online support groups and devised my own guesstimate about success rates. I always said about 1/3 do well, about 1/3 do very poorly (poor losses.or complications) and about a 1/3 lose some weight but not enough and have minor but troubling complications.

The last category was me as a bandster. Lost 70.... needed to lose another 50. Regained the 70 plus 40 more so my revision weight was 3 0 8. That isn't even the whole truth...at some point while banded I weighed mid 300s....So not just 150-160# overweight but more like 180plus overweight. I also had reflux if I had Fluid so regain happened when Fluid needed to be removed.

[julias1119 27]

I chose rny because it has the best outcomes for my specific co-morbidities (pcos, type 2 diabetes, nafl)

[lisaanewme67 123]

I also chose gastric bypass surgery due to my medical issues, diabetes, high blood pressure, sleep apnea and high cholesterol. I did my research, attended a few seminars and talked to people that had each procedure. Also bandèrs to sleeve. Slleevers to bypass . researched more and emailed my surgeon & team came up with my decision that I could live with that's right for me.. There is lots if research out there, great people to meet here as well. Your surgeon should have info on seminars you could attend as well. Each surgery works it just whats best for you. I hate to compare & judge which is better. Each his it's risks as with any surgery. Best luck to everyone on this journey!!

[jnt1 37]

@@Shakti As you can see from all the posts this is a personal decision. For me, the idea of possibly having to have the band removed was enough to steer me towards the sleeve. Every surgery has risks and it gets more dangerous the older we get. Also, research is not supporting the band as a great long term option. None of that means that you personally will have a problem- but the risk is there.

Below I have pasted an abstract from a long term study. There are some other studies also linked there which you may find interesting. Good Luck on this journey!

Long-term results after laparoscopic adjustable gastric banding: a mean fourteen year follow-up study

• E.O. Aarts, M.D.^, ,
• K. Dogan, M.D.,
• P. Koehestanie, M.D.,
• Th.J. Aufenacker, M.D., Ph.D.,
• I.M.C. Janssen, M.D.,
• F.J. Berends, M.D., Ph.D.

• Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.

Received 30 May 2010, Accepted 3 March 2014, Available online 5 April 2014

Show moreShow less

doi:10.1016/j.soard.2014.03.019 Get rights and content

S1550728914001427Refers To

• Allen F. Browne
• Paired Editorial to SOARD-10-151
• Surgery for Obesity and Related Diseases, Volume 10, Issue 4, July–August 2014, Page 640
• PDF (47 K)

Referred to by

• Allen F. Browne
• Paired Editorial to SOARD-10-151
• Surgery for Obesity and Related Diseases, Volume 10, Issue 4, July–August 2014, Page 640
• PDF (47 K)

Abstract Background

For over a decade, the laparoscopic adjustable gastric band (LAGB) was 1 of the most performed bariatric procedures in Europe. This study is a retrospective analysis with prospectively collected data of the experience in 1 specialized Dutch center with the adjustable gastric band over 14 years.Methods

Between 1995 and 2003, 201 patients underwent an LAGB for morbid obesity in our hospital. Data on preoperative clinical characteristic, postoperative outcome and weight loss patterns, and co-morbidities for up to 18 years are presented and evaluated using the Bariatric Analysis and Reporting Outcome System (BAROS).Results

Average follow-up was 13.6 (±2.0) years (163 mo) and 99% of patients with complete follow-up. Two thirds of patients reached an excess weight loss (EWL)>50% at some point after LAGB placement. However, due to insufficient weight loss or complications in 53% of patients, the LAGB had to be removed or converted to a Roux-en-Y gastric bypass. Additionally, half of the remaining patients had disappointing results according to the BAROS score. In total, less than one quarter (22%) of patients had a functioning band with a good result after the follow-up period. Although initially the number of patients experiencing co-morbidities was reduced, most of them returned and a large number of patients developed new co-morbidities. Complications, other than weight regain, were numerous as 47% of patients experienced at least 1. In total, 204 reoperations were performed in 137 (68%) patients. Furthermore, patients who were lost to follow-up did almost twice as bad in terms of EWL compared to patients who had regular follow-up.Conclusion

Morbid obesity is a chronic disease that can be resolved with bariatric surgery. One of the treatment options is the LAGB, which in the short term shows good results in terms of EWL and co-morbidity reduction. In the long term, however, EWL and co-morbidity reduction are disappointing, and the LAGB does not seem to live up to expectations. Besides the decrease in EWL over time, the number of reoperations required is alarming. In total, less than a quarter of patients still had a functioning band after a mean 14 years of follow-up.

The 10 year Swiss study also supports the Dutch results. It hasnt been a success long term. And erosion of the stomach is a real concern.

My experience long term confirms this and after 7 years I'm revising to bp.

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