Doctor Recommeded Against Lap Band

[aubrie 6]

In my experience going to support groups, talking to friends and co-workers who have had WLS and reading this board, I have come to the conclusion that almost ALL doctors push the bypass. I think it's less time, effort and after care on thier part, they get the quick results they want, and I'll bet they make a little more money doing it. My surgeon suggested the bypass. I told him, not only "no", but HELL NO. (My personal choice and decision.) I stuck to my guns and was stubborn about it. He did my band and has actually been very pleasantly surprised with my success. He's very good and prudent about my fills, and is now doing more bands. Ultimately, it's your body and the choice is YOURS. Mine was a philosophical and ethical decision I made for myself. I had my reasons, and am now a year and a half out, still VERY happy with my decision. My best friend however has had a tough time with her band and is trying to decide whether to switch to bypass during her upcoming gallbladder surgery. She's agonizing over it. Her first surgeon was a quack out of Houston, and really botched her band. Her new surgeon has worked with her for two years to try and fix the mess he made. She's still having trouble, but it was SURGEON mistake, not band mistake in her case. She doesn't blame the band. He filled her to much to fast and caused erosion. She will lose her band regardless, but she's still undecided. It's a big choice. Be COMPLETELY certain of your choice, because with a bypass you can't change your mind and undo it once it's done. You're stuck with the choice. I didn't like those odds.

[maryrose 2]

I agree with Aubrie. My doc tried to push the bypass too. More money.

You have to do the research and do what is right for you. I agree, the band is not for everyone. You have to follow the rules.

One thing for certain, morbid obesity is a disease. Just think for a minute about any surgical procedure. If you needed back surgery you would hear a hundred horror stories if you did enough research. Who really knows why complications arise? Every person is different.

I love my band! At close to 300 lbs. I could have dropped dead at age 52 with my high blood pressure and other complications from obesity. Something had to be done.

[Oregondaisy 2,020]

Most people do love their bands at first . That's until the complications set in.

Why don't you do some research on the sleeve? There are no fills, no unfiils, no possibility of port flipping, erosion or band slippage. Once you start having complications, the band gets very expensive.

go to the sleeve section of this board and read everyone stories about why they got a revision to a sleeve and

go the the complications section of the board and read all the stories of the trouble people have had with their bands too.

[maryrose 2]

Lap bands *can* be complication free but I have to say if I lived in America and had to cope with your health system, I dont think its what I would choose. Because a band does need constant maintenance and a good relationship with your doctor - if you're flying in and out to see a doctor, paying $800 for a fill or whatever and thus having a big aggressive fill under fluoro to try to get to a sweet spot in one go, then I think its much more likely to be problematic from the start.

I live in USA and never paid more than 20 dollars for a fill!

Not all Americans have this problem and do not have to "fly" in. That is not the typical treatment here.

Sure, there are a lot of people without insurance, but not because we live in the USA.

Edited May 6, 2009 by maryrose

[SanDiegoPhotog 0]

I also live in the USA and I don't fly anywhere for my fills or pay ungodly amounts for my fills. My old insurance that paid for my band paid for my fills. Now, I am cash pay, but my fills are only $150. I am super tight right now, so I'm hoping it will be at least a year until I need another fill - - if ever.

I can also say that my surgeon is one of a few who perform the most lapbands in San Diego. I went to him because of his reputation and experience and because I hated the facility that performs the most lapbands in San Diego. My surgeon educated me on ALL of the WLS procedures, but felt I was a good candidate for the band. Ultimately, it was my decision.

But, I did talk to other surgeons who didn't perform many lapbands and ALL of them tried to convince me to switch to their preferred surgery (bypass or sleeve). One tried to convince me to be her first lapband. AS IF! LOL!

Now . . . had my preferred LAPBAND surgeon tried to convince me to go another route or tried to refer me to another surgeon, then I might have sat up and taken notice of that. That's why I still think you need to look at your doctor's motives. Is it YOU? Does she think you can't stick to the program? Is it your DOCTOR? Is she better versed in other surgeries? Or is it really that the lapband is so terrible?

Based on so much success that I've seen on this board and other places (and my personal success), I have a hard time believing that the band is so terrible.

But, many of the previous posters are correct: YOU have to do what's right for YOU.

[maryrose 2]

Sandiago,

I agree with you. Here is one article I found about the sleeve. I still prefer not having my anatomy changed which is why I chose the lap band. If the band did not work, then yes, lets move to Plan B, but the sleeve is not something to rush into either.

Gastric Sleeve Resection

Wednesday May 6, 2009

One of the newer surgical options in the field of weight loss surgery is the Gastric Sleeve Resection, also known as the Vertical Sleeve Gastrectomy (VSG). This restrictive weight loss procedure permanently reduces the size of the stomach which limits the amount of food that can be eaten at any one time. While the gastric sleeve is sometimes effective as a stand-alone weight loss procedure, most bariatric surgeons consider the gastric sleeve as the first operation in a two-stage process. The second procedure, which is either gastric bypass or duodenal switch, is performed at a later time. The purpose of the two-stage approach is to make weight loss surgery safer for high-risk patients, particularly those individuals with a body mass index (BMI) greater than 60, who have health conditions that make them unacceptable patients for a combined restrictive/malabsorptive surgery.

During gastric sleeve surgery, the bariatric surgeon removes approximately 60 to 80% of the stomach along the greater curvature and leaves only a small tube, or “sleeve” for the new stomach pouch. By reducing the size of the stomach, an individual should eat less and lose weight. The stomach reduction is not reversible and the cutaway part of the stomach is removed from the body, not left in place as with other bariatric procedures. Since the normal stomach outlet and small intestine are left intact with this procedure, it is a less complicated operation than either gastric bypass or duodenal switch surgery. Compared to adjustable gastric banding surgery, the gastric sleeve does not involve implanting a medical device into the body in order to restrict eating.

Expected Weight Loss Results

Patients who undergo the gastric sleeve procedure will typically lose 30 to 50% of their excess body weight during the following six to eighteen months. This weight loss will make it safer to proceed with the second-stage of the process, either gastric bypass or duodenal switch surgery, which involves rerouting the small intestine. The timing of the second procedure will depend on the rate of weight loss following the gastric sleeve surgery.

Patient Considerations for Gastric Sleeve Surgery

• Safer option for individuals with BMI greater than 60 to undergo two-stage process of gastric sleeve followed up with duodenal switch or gastric bypass after partial weight loss
  
• Option for patients concerned about long-term side effects of weight loss surgery that involves rerouting and bypassing a portion of the small intestine, such as intestinal obstruction, ulcers, anemia, osteoporosis, Protein deficiency, and Vitamin deficiency
  
• Restrictive weight loss option for patients who are not comfortable having a medical device implanted into their body as with the LAP-BAND or REALIZE Band
  
• Surgical weight loss option for patients with health problems or complex medical issues that may prevent them from having other types of weight loss surgery, such as anemia, Crohn’s disease, anti-inflammatory drug use, or extensive prior surgery
  
• Revision option for gastric band patients experiencing problems with their band but who do not want to convert to a bypass type of operaton
  

Advantages of Gastric Sleeve Weight Loss Surgery

• Promotes weight loss by restricting amount of food that can be eaten at any one time
  
• Removes the part of the stomach that produces the hunger stimulating hormone ghrelin
  
• Digestive system it not changed and digestion occurs normally
  
• Does not cause malabsorption or nutritional deficiencies as it does not involve rerouting or bypassing the small intestine
  
• Less chance of developing ulcers than with gastric bypass surgery
  
• Dumping syndrome not likely to occur as the stomach outlet (pyloric valve) remains intact, unlike gastric bypass surgery
  
• Less complicated procedure than gastric bypass or duodenal switch surgery
  
• Can usually be performed laparoscopically on extremely obese patients
  
• Does not require a gastric band being implanted into the body
  
• Does not require adjustments or fills as with a LAP-BAND or REALIZE Band
  
• Safer than a combined restrictive/malabsorptive weight loss surgery for patients who have many health problems
  
• Expected weight loss is 30 to 50% of excess weight in the first one to two years
  
• May be converted to gastric bypass or duodenal switch if necessary for additional weight loss
  

Disadvantages of Gastric Sleeve Weight Loss Surgery

• As it is a purely restrictive weight loss procedure, inadequate weight loss or weight regain is more likely than with a procedure involving intestinal bypass
  
• With time, new smaller stomach pouch may stretch (also occurs with gastric bypass surgery)
  
• Although the gastric sleeve helps control hunger and limit amount of food that can be eaten at any one time, weight loss will not occur without a healthy, low-calorie diet and regular exercise (same as with other purely restrictive procedures such as LAP-BAND and REALIZE Band)
  
• If performed as the first part of a two-stage process, a second malabsorptive weight loss surgery such as the duodenal switch will need to be performed at a later time
  
• The surgery is not reversible as a portion of the stomach is permanently removed
  
• Leaks or bleeding may occur along the stomach stapling edge
  
• Procedure may not be covered by some insurance companies
  
• All surgery and anesthesia involves some level of risk including bleeding, blood clots, infection, pneumonia, or complications
  
• Lack of published data for long-term weight loss results
  

Gastric Sleeve Weight Loss Surgery

While the gastric sleeve procedure will help a person control their eating, weight loss depends on adopting a new diet and exercise lifestyle. Many bariatric surgeons recommend eating five small, healthy meals a day with no snacking in-between meals. The surgery itself does not require many food restrictions as the stomach continues to function normally, but high-calorie and high-fat foods and drinks must be avoided for weight loss to occur.

Performing the Gastric Sleeve Resection as a stand-alone weight loss surgery is a new approach and considered experimental by many bariatric surgeons and insurance companies. Long-term weight loss results are not available, although expected weight loss in the first one to two years is 30 to 50% of excess weight. At that time, a malabsorptive weight loss procedure such as the duodenal switch may be performed in order to promote further weight loss.

[WASaBubbleButt 41]

Sandiago,

I agree with you. Here is one article I found about the sleeve. I still prefer not having my anatomy changed which is why I chose the lap band. If the band did not work, then yes, lets move to Plan B, but the sleeve is not something to rush into either.

Gastric Sleeve Resection

Wednesday May 6, 2009

One of the newer surgical options in the field of weight loss surgery is the Gastric Sleeve Resection, also known as the Vertical Sleeve Gastrectomy (VSG). This restrictive weight loss procedure permanently reduces the size of the stomach which limits the amount of food that can be eaten at any one time. While the gastric sleeve is sometimes effective as a stand-alone weight loss procedure, most bariatric surgeons consider the gastric sleeve as the first operation in a two-stage process. The second procedure, which is either gastric bypass or duodenal switch, is performed at a later time. The purpose of the two-stage approach is to make weight loss surgery safer for high-risk patients, particularly those individuals with a body mass index (BMI) greater than 60, who have health conditions that make them unacceptable patients for a combined restrictive/malabsorptive surgery.

During gastric sleeve surgery, the bariatric surgeon removes approximately 60 to 80% of the stomach along the greater curvature and leaves only a small tube, or “sleeve” for the new stomach pouch. By reducing the size of the stomach, an individual should eat less and lose weight. The stomach reduction is not reversible and the cutaway part of the stomach is removed from the body, not left in place as with other bariatric procedures. Since the normal stomach outlet and small intestine are left intact with this procedure, it is a less complicated operation than either gastric bypass or duodenal switch surgery. Compared to adjustable gastric banding surgery, the gastric sleeve does not involve implanting a medical device into the body in order to restrict eating.

Expected Weight Loss Results

Patients who undergo the gastric sleeve procedure will typically lose 30 to 50% of their excess body weight during the following six to eighteen months. This weight loss will make it safer to proceed with the second-stage of the process, either gastric bypass or duodenal switch surgery, which involves rerouting the small intestine. The timing of the second procedure will depend on the rate of weight loss following the gastric sleeve surgery.

Patient Considerations for Gastric Sleeve Surgery

• Safer option for individuals with BMI greater than 60 to undergo two-stage process of gastric sleeve followed up with duodenal switch or gastric bypass after partial weight loss
  
• Option for patients concerned about long-term side effects of weight loss surgery that involves rerouting and bypassing a portion of the small intestine, such as intestinal obstruction, ulcers, anemia, osteoporosis, Protein deficiency, and Vitamin deficiency
  
• Restrictive weight loss option for patients who are not comfortable having a medical device implanted into their body as with the LAP-BAND or REALIZE Band
  
• Surgical weight loss option for patients with health problems or complex medical issues that may prevent them from having other types of weight loss surgery, such as anemia, Crohn’s disease, anti-inflammatory drug use, or extensive prior surgery
  
• Revision option for gastric band patients experiencing problems with their band but who do not want to convert to a bypass type of operaton
  

Advantages of Gastric Sleeve Weight Loss Surgery

• Promotes weight loss by restricting amount of food that can be eaten at any one time
  
• Removes the part of the stomach that produces the hunger stimulating hormone ghrelin
  
• Digestive system it not changed and digestion occurs normally
  
• Does not cause malabsorption or nutritional deficiencies as it does not involve rerouting or bypassing the small intestine
  
• Less chance of developing ulcers than with gastric bypass surgery
  
• Dumping syndrome not likely to occur as the stomach outlet (pyloric valve) remains intact, unlike gastric bypass surgery
  
• Less complicated procedure than gastric bypass or duodenal switch surgery
  
• Can usually be performed laparoscopically on extremely obese patients
  
• Does not require a gastric band being implanted into the body
  
• Does not require adjustments or fills as with a LAP-BAND or REALIZE Band
  
• Safer than a combined restrictive/malabsorptive weight loss surgery for patients who have many health problems
  
• Expected weight loss is 30 to 50% of excess weight in the first one to two years
  
• May be converted to gastric bypass or duodenal switch if necessary for additional weight loss
  

Disadvantages of Gastric Sleeve Weight Loss Surgery

• As it is a purely restrictive weight loss procedure, inadequate weight loss or weight regain is more likely than with a procedure involving intestinal bypass
  
• With time, new smaller stomach pouch may stretch (also occurs with gastric bypass surgery)
  
• Although the gastric sleeve helps control hunger and limit amount of food that can be eaten at any one time, weight loss will not occur without a healthy, low-calorie diet and regular exercise (same as with other purely restrictive procedures such as LAP-BAND and REALIZE Band)
  
• If performed as the first part of a two-stage process, a second malabsorptive weight loss surgery such as the duodenal switch will need to be performed at a later time
  
• The surgery is not reversible as a portion of the stomach is permanently removed
  
• Leaks or bleeding may occur along the stomach stapling edge
  
• Procedure may not be covered by some insurance companies
  
• All surgery and anesthesia involves some level of risk including bleeding, blood clots, infection, pneumonia, or complications
  
• Lack of published data for long-term weight loss results
  

Gastric Sleeve Weight Loss Surgery

While the gastric sleeve procedure will help a person control their eating, weight loss depends on adopting a new diet and exercise lifestyle. Many bariatric surgeons recommend eating five small, healthy meals a day with no snacking in-between meals. The surgery itself does not require many food restrictions as the stomach continues to function normally, but high-calorie and high-fat foods and drinks must be avoided for weight loss to occur.

Performing the Gastric Sleeve Resection as a stand-alone weight loss surgery is a new approach and considered experimental by many bariatric surgeons and insurance companies. Long-term weight loss results are not available, although expected weight loss in the first one to two years is 30 to 50% of excess weight. At that time, a malabsorptive weight loss procedure such as the duodenal switch may be performed in order to promote further weight loss.

Some of this info is outdated.

They started doing the sleeve as a two part procedure for mega high BMI people. If they were too high risk to have DS or bypass due to extreme weight (600#, for example) they would do a sleeve and wait until they lost a few hundred pounds and then they would go back and do the bypass or DS.

They discovered that people were not needing to go back for the bypass or DS, they were getting to goal with the sleeve alone. They started watching weight loss and recording results and they discovered that the sleeve is an excellent stand alone procedure and just in the US it's been done since at least 2000. As a two part procedure for about 30 years. Not exactly new. ;o)

The weight loss stats are also outdated. New stats came to light last summer and show much better weight loss than 40-60%.

The procedure also removes Ghrelin, a hormone that tells your brain you are hungry. We sleeved folks don't really experience much hunger which obviously helps with weight loss.

There is less than 1% additional "surgical" risk with a sleeve vs. a band BUT... long term the sleeve has far fewer risks and complications than banding. Overall the sleeve is actually safer than the band with better and faster weight loss.

[Big Momma is Shrinking 0]

MaryRose....thank you so much for posting this article. I've been curious as to exactly what the sleeve process was. I really appreciate the information.

I'm still and band baby and so far love my band and ahve not had the first problem with it. It is good to know that there is an option other then by-pass if for some reason in the future I may need a change.

[maryrose 2]

Big Mama,

You are very welcome.

According to Bubblebut, some of the info is outdated, but I think that can be true of any article we find.

I really do not know a whole lot about it either. There is not a whole lot on the internet about it. I like doing research and it took me a while to even find that.

I agree, I love my band and have not had one single problem, but it differs from person to person. Knock on wood.

I chose NOT to alter my anatomy. Even with the sleeve, it is still altering your stomach and there is a lot more to it than I thought.

As far as the sleeve making you "less" hungry, that means nothing to me being a food addict. I can be on the brink of PB'ing and still wanting food.

I don't see how onother poster can say the Band is more dangerous than the sleeve having part of your stomach surgially removed. I would like to see the DATA to support that information.

[WASaBubbleButt 41]

Big Mama,

You are very welcome.

According to Bubblebut, some of the info is outdated, but I think that can be true of any article we find.

I really do not know a whole lot about it either. There is not a whole lot on the internet about it. I like doing research and it took me a while to even find that.

I agree, I love my band and have not had one single problem, but it differs from person to person. Knock on wood.

I chose NOT to alter my anatomy. Even with the sleeve, it is still altering your stomach and there is a lot more to it than I thought.

As far as the sleeve making you "less" hungry, that means nothing to me being a food addict. I can be on the brink of PB'ing and still wanting food.

I don't see how onother poster can say the Band is more dangerous than the sleeve having part of your stomach surgially removed. I would like to see the DATA to support that information.

The LONG TERM issues are greater in number with banding. You can have:

Esophageal damage,

Esophageal dilation,

Esophageal spasms,

Pouch dilation,

Stoma spasms,

Port flips,

Port infections (possible each time you get a fill),

Band intolerance,

Slips,

Obstruction due to swelling,

Erosion,

Band intolerance,

Scarring growing under the band causing too much restriction even with no fill,

Mechanical malfunctions such as tubing being disconnected, holes, leaks, kinked tubing all requiring surgery to repair.

Sleeves long term can have:

The need to take B12 Vitamins,

Strictures.

Many food cravings do disappear with sleeves because of the removal of Ghrelin. If you check out the sleeve section of LBT you'll see many (most?) people that no longer have the cravings we used to have. Not to the same degree.

I fully relate to the food addiction issue but for me it's a food obsession. We really don't go through withdrawal like a cocaine addict. We obsess over food. We think about it all the time. The difference really needs to be made because there is no effective treatment for an addiction but there is effective treatment for obsession. With an addiction you suck it up and deal with it. With an obsession you take meds and it can potentially kill your head hunger and the way you think about food all the time.

This is one area where I LOVE LOVE LOVE my doc! He will give Luvox or Paxil for food obsessions. If you are really struggling he'll treat it. I have a lot more control over food obsession today than I did three years ago. But sometimes it gets hard and I take Luvox for a few weeks and that kills my head hunger. I just quit taking it a few days ago because it's under control again. I take Luvox probably 2-3 weeks maybe 2-3 times a year.

When I take Luvox I become one of those people that needs to remember to eat. With no head hunger and no stomach hunger it makes life easier. When both are kicking it, life is hard. Very hard.

There is actually a huge amount of information on the internet about sleeves. Thing is, you have to go to a website of a doctor that does them or the information is outdated. Long term studies just came out last summer. Many doctors have not updated their websites.

I was a little apprehensive of being sleeved but now that it's done it's no big deal. I was far more aware of my band than I am of my sleeve. I just get full quickly. It's done by lap surgery just like a band. Recovery is about the same. Having been banded and sleeved I know being sleeved is so much easier. I don't have to worry about fills, unfills, restriction issues, sweet spots, getting stuck, etc.

For the sleeve they remove the fundus of your stomach. That part of your stomach does two things, it is elastic so it holds a great deal of food and it produces Ghrelin. That's all it does. All the important stuff is still there. The nerves, the pyloric valve, etc. It's just smaller, that's all. With a band if you don't chew well you get stuck. I don't have to chew as much as I did with a band. We have to chew better than we did before when we inhaled food but nothing like with banding.

I view the fundus of my stomach the same as I would a diseased appendix or gallbladder. It does nothing positive for me. I do not want the ability to eat a large quantity of food, I want to eat small portions without chewing to a paste and be full quickly. This does it for me. You choose not to alter your anatomy. What if you had gallbladder problems such as stones? Wouldn't you alter your anatomy to remove it? I would. The fundus of my stomach was nothing short of unhealthy because it permitted me to eat, gain weight, and be obese.

And btw, you are altering your anatomy with a band. Mother Nature did not intend to put a band around your stomach and grow layers of scar tissue engulfing the band. People think that you can remove the band and your stomach is exactly like it was before banding. Not true.

Sleeves are not for everyone, bands are not for everyone. Same with Bypass and DS. You have to find what works for you and go for it.

[mljalways 1]

What a can of worms!! In nutshell everyone will have a different opinion. The concern I would have is having a surgeon do a surgery she was against. The original post stated she would do it even though she doesnt reccomend it. I wouldnt have done anything unless my surgeon was behind it 100%

[LoriPA 4]

I was taken aback by the statement that the lap band complications would be higher; in my own initial lap band consultation with my surgeon, she explained all the risks and benefits, saying that though any medical procedure has its risks, in her experience, the complications and risks with the lap band are less than 2 percent and risks with RNY were considerably higher. I guess this would vary from patient to patient, however.

[maryrose 2]

What a can of worms!! In nutshell everyone will have a different opinion. The concern I would have is having a surgeon do a surgery she was against. The original post stated she would do it even though she doesnt reccomend it. I wouldnt have done anything unless my surgeon was behind it 100%

Mjalways,

I agree! My doctor actually recommends anyone over 100 lbs. to lost to have the bypass, but I was just scared to death of having that type of surgery and am glad is went with the band. It was actually this site that helped me make my decision.

The doctor did support my band decision, but just wanted to give me the facts so I could my "my" decision wisely. He is happy with my progress so far.

Going into my third year I am still thrilled.

[LindaO 0]

I also think you need to do what you feel right about. Obviously there are pros and cons to all the WLS surgeries. I just feel like the LB is the least invasive and altering to our bodies. It is a tool to help. But the rest is up to us and how we deal with it.

[Nanook 2]

I'll just put in my 2 cents for what they're worth. I chose the lap band after I was scheduled for RNY. I was afraid of the final commitment as well as the obvious invasiveness of RNY. So I had the lap band in 8/07, had it removed 10/08 and am now going through pre-op once again for the RNY I should have gotten in the first place.

I think the real trick is figuring out which proceedure is the best one for you and I mean with your weightloss. Some people do well with the band and just the mere restriction works wonders and also some don't have complications. Those are some you can control and some you can't!

It's really your job to figure this out as I've learned. Picking the lap band because you can always revise to another is not a good reason for picking it. Do you really want to go through two surgeries+? I have no problem with the lap band just it wasn't right for me. So research as much as you can and I've started going to support groups for RNY and it's really helpful too. Good luck Nancy.:thumbsup: