My Life with the Lapband

December 22nd, 2013

Tricia

My Life with the Lapband

My Journey…

Boy how time flies!

As I approach my 9th year Bandiversary, I started thinking how the Lapband has changed my life or how I had to change my life to live with the Lapband.

First off, I thank God every day for showing me there was an option and giving me the opportunity to have the Lapband procedure.

Like most in my situation, I tried every diet that always ended in failure. I almost got to the point where I wouldn’t want to diet because I KNEW I would gain the weight back and probably gain more. It was a horrible vicious cycle that I lived in for years.

Living with the Lapband was a continual learning process for a while. I tested foods to see what I could eat and what gave me difficulties. I tested out drinking with meals and not drinking with meals. Unfortunately, I had to learn the hard way on a lot of these issues, but the key is I learned and now the changes that I have made in living with the Lapband are part of my normal way of living. I don’t even think about it anymore.

One of the most frustrating things about the Lapband is obtaining proper restriction level. On one hand, I wish doctor’s would be a little more aggressive with the fill amounts, on the other hand, I think that working your way up to the proper restriction level is the way to go to avoid getting filled too tight which can be very uncomfortable and dangerous. I think that more discussion needs to be made about preparing one’s self for life after the lapband which includes the cost of adjustments/fills and the expectation of how many fills it may require to achieve proper restriction.

For self payers, many people use all their financial means to pay for the actual Lapband surgery and then don’t have the funds to get adjustments afterwards. This creates frustration because you just paid a lot of money and went through surgery and now want to lose the weight. Sounds reasonable……. But many feel like they wasted money when they don’t lose weight after the surgery or they feel like they can eat like they could before the surgery which is true until the band is adjusted properly.

So if someone is scheduled for lapband surgery and they ask me about the band, I make a point of preparing them for after surgery. I also try to tell them that their patience level will be tested to the max until they get their bands filled properly. I’ve heard this said by many and it’s so true “It took us a long time to become this overweight, we’re not going to lose it all overnight” It may take some time to lose weight with the Lapband, but with a little patience and following some very basic rules, you will lose weight and you will be successful.

Things that have changed for me after I was banded…

I don’t drink with meals. I found that this flushes food from my small upper pouch into my lower pouch which enables me to eat more food. This kind of defeats the band doesn’t it? I don’t want to eat more food, because this little thing called weight gain occurs if I do.  Not drinking with meals was probably the hardest thing for me to get used to, but now I don’t even think about it.

I still take small bites and have slowed down while eating. I found that taking smaller bites and slowing down while eating actually fills me up quicker. I also don’t look like I’m inhaling my food anymore, which was a very unattractive habit that I got into pre-band.

I listen to my band. It tells me when to stop eating. Oh, I’ve tried to argue with my band in the past and tell it that I could eat more even when it warned me that I have had enough, but for some reason the band was always right. I paid a small price for trying to fight the band. I would feel horrible until the food passed through the band. Sometimes I would PB (not pleasant) and learned very quickly that it’s just not worth fighting the band. It knows best, so now I listen to it.

I try to stick to protein foods first. I’m not always good at this, but it’s something that I feel is very important for Lapbanders. I have also found that when I eat protein foods first like chicken, fish, etc… then I don’t require as much food to feel full and I stay fuller longer. Not to mention the benefits to my health for eating protein.

Since I can’t eat as much as I used to, my food choices have changed. Before the band, I would eat horribly. It’s because I could eat a lot of anything I wanted. So if I wanted to snack on chips before dinner, no problem. I would still be hungry enough at dinner to eat it, and then have enough room for dessert after wards.

I now chose quality over quantity. I do this because I know I can’t eat a lot, so what I DO eat becomes very important. I have found that if I eat chips now, I will fill up on them, and I won’t feel hungry to eat what I should be eating. Then I end up feeling awful because “foods” like chips drain my energy if I try to use them as my source of nutrition. Don’t get me wrong, I still eat things like chips, but I make a point of not eating them when I’m hungry because I know that I will fill up on them and won’t eat what I need to be eating. So I will have junk food occasionally, but usually with my meal and have very little.

I don’t eat dinner late in the evening. I have a cut off time for dinner. I make sure that I don’t go to bed for about 3 hours after I eat. I also don’t drink a lot of fluids at night and I religiously take 2 Pepsid AC chewables before I go to bed. I believe that these things have decreased my chances of having acid reflux at night.

So yes, the Lapband has totally changed my life. With 155 pounds gone I’m feeling terrific! I feel that the minor things that I have changed in my life (with eating) due to the band are so minor and so worth it to help insure that I keep this weight off. Don’t get me wrong, I don’t struggle to keep the weight off, which is fantastic, but I believe that the minor changes that I have made have contributed to this.

The Lapband won’t do it all. You’ll need to help it some, but once your band is adjusted properly, the band will work for/with you instead of you working for the band.

Life is wonderful!Tricia before Lapband
Tricia after Lapband

Starting BMI 43

Current BMI 20

Tricia
Banded July 16th, 2004
Lost 155 pounds

Dr. Arturo Rodriguez

http://www.thebariatric.com

http://www.bandstersforum.com

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Lap Band, Gastric Sleeve or Gastric Bypass? That is the Question!

November 14th, 2013

Lap Band, Gastric Sleeve or Gastric Bypass? That is the Question!

The Bariatric surgical field has experienced extraordinary changes over the past 55 years.

With the initial empiric use of Intestinal Bypass surgery in 1954 by Kremen, Linner and Nelson at the University of Minnesota, severe obesity was identified as a disease that could be successfully treated.

Today, the acceptance of Bariatric Surgery is a proven surgical discipline.  It hasn’t always been that way, and has gone through a long bumpy road in a very hostile environment.  It has gone from acid critics and nonbelievers to a great demand of this kind of surgery all over the world.

The increase of obesity over the past 50 years has doubled or tripled in some countries.

One third of the population in the United States is obese (23 million) and patients seeking surgical treatment are becoming heavier each year.

The increase in weight has occurred in men, women and children of all ages.

The need of healthcare due to co-morbidities, is also rapidly escalating, which has greatly affected the public healthcare system and in the economy.

Some of the initial procedures have been abandoned because of serious complications. We have learned from these procedures what not to do, what to avoid and how to do it better.

Over the years, we have also learned about many different surgical techniques.  We have learned it’s short and long term complications, the procedures that gave poor results and the procedures that have produced good results.  We continue to be properly trained for new techniques and new procedures, how to be involved in the designs of instruments and devices and to make the surgery easier.   To help improve results of Bariatric Surgery, we learn how to apply new technology to our procedures like using the laparoscopic towers to decrease mortality, pulmonary insufficiency, operative time, hospital stay and pain.

Now we offer several procedures in which obesity would be prevented or cured by surgical means with similar long term results.

After all, we are facing 2 main problems now with so many patients that had a Bariatric Procedure and a lot of others seeking help: What would be the best Surgical Treatment to be offered to the patient?  And, how can we give the best Follow-Up care to make them succeed and avoid complications?

At where we stand now, we cannot say that one Bariatric Procedure over the others will always work for everyone. We have to recommend the best procedure for the patient.   Sitting down and talking with the patient is imperative to make the right choice for them.  We need to see what he understands and knows about different Weight Loss Procedures.  We need to get to know his habits and his environment.  We need to know what co-morbidities he has, know his fears, and most important, the commitment and the desire of making changes to his life.

Restrictive procedures like the Lap band and the Gastric Sleeve have lower operatory and long term complications.  These procedures are also less expensive than the Gastric Bypass and the Duodenal Switch but need a lot more commitment from the patient to follow diet restrictions and exercise to succeed.

It is well know that complex procedures such as Gastric Bypass and Duodenal Switch gives patients the desired weight loss during the first year, but causes unwanted Malabsorption.   Even if the procedure has failed and  the patient gains the weight back, he will have long term unwanted complications such as metabolic bone diseases which include Osteoporosis (from poor calcium absorption), Osteomalacia (from vitamin D deficiency),  Osteopenia and Osteitis Fibrosa Cystica (from Secondary Hyperparathyroidism due to low serum calcium). 

These diseases require long term, close follow-up care to prevent complications.  Our offices are sometimes not capable of providing follow-up care for different reasons. Many times the patient is unable to remember who performed his surgery or they have relocated.

Surgical goals should offer a lifetime decrease in Medical Healthcare.  Not only to offer the treatment for obesity and the actual problems that obesity creates, but to have a Follow-up System established for 15 to 20 years later.

Arturo Rodriguez, MD

Tricia Lackey

http://www.thebariatric.com

http://www.bandstersforum.com/

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Lapband Slippage: Causes & Prevention

October 20th, 2013

LapBand Slippage: Causes & Prevention

A Clinical Study

A clinical study was done in Germany to review complications following lapband surgery. Thirty-five hospitals were involved in the study, with 4138 patients that underwent gastric banding over a five-year period.  LapBand long-term complications were described in 8.6%  of all patients.  The most common complications included: pouch dilation or enlargement (5.0%), lapband slippage (2.6%), and Lapband migration or erosion (1.0%). (Stroh,C  Manger, T “Complications after adjustable gastric banding”, Chirurg, 2006, Vol 77,pag 244-250)

Normal Lapband x-ray

Normal LapBand X-Ray Under Fluoroscopy

lapband-enlarged-pouch

Enlarged LapBand Pouch

What is LapBand Slippage?

One of the long-term complications of lapband surgery is called “Lapband slippage” and can be defined as “when the Lapband and the stomach pouch are both prolapsed.”  This means that the lap band has shifted position and the enlarged stomach pouch has also shifted or twisted so that food does not go through the lapband into the rest of the stomach. This may result in pain, discomfort, decreased appetite and inability to eat or drink, and vomiting. Lapband Slippage does not happen immediately but may take several months to develop.

Huge-lapband-pouch

Large LapBand Pouch

LapBand Slippage generally develops in a progressive manner. As food intake is increased, the stomach begins to stretch and grow and the patient may stop losing weight or start to regain weight.  At this point, patients may only exhibit an enlarged stomach Lapband pouch.  This can be medically treated by deflating the lapband to release pressure and slow the growth of the pouch (successful in 70% of cases, or surgical treatment can be considered). However, if the enlarged lapband pouch continues to grow, the lapband progressively rotates until both the lapband and the enlarged pouch become prolapsed, resulting in Lapband slippage.  This is followed by functional stenosis (narrowing) of the stomach.

lapband-slippage

LapBand Slippage

Lapband Slippage Symptoms typically include progressively worsening reflux, vomiting and epigastric complaints, which may increase to sudden near-total dysphagia (inability to swallow or eat anything, including saliva).

Risk factors or causes of lapband slippage include surgical technique, model of the  lapband used, early consumption of solid foods, early inflation or filling of the band, consumption of carbonated or sparkling beverages, and frequent vomiting.

Treatment for lapband slippage requires surgical intervention. The lapband must be repositioned or removed, based on the operative findings and condition of the stomach pouch. If appropriate, the surgeon and patient may elect to choose another type of bariatric procedure such as a Gastric Sleeve.

How Do I Prevent LapBand Slippage?

In order to decrease the risk of developing lapband slippage, it is important to follow the recommended diet following surgery and to avoid introducing solid foods too early.  In addition, the fills should not be started before 6 weeks post-operatively and these Lapband fills should be very gradual.  We also recommend that fills should be done under fluoroscopy, even if you are asymptomatic (no symptoms of lapband slippage), to be able to monitor the position of the lapband, and the size of the stomach pouch and condition of the esophagus. This will allow for early diagnosis of an enlarged stomach pouch or possible lapband slippage.

Susana González, MD 

Radiologist

Arturo Rodriguez, MD

Bariatric Surgeon

http://www.thebariatric.com

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My Surgery Story–De-Banding and Gastric Sleeve

September 28th, 2013

Subject: My surgery story -  de-banding and gastric sleeve   21/08/09

Gastric Sleeve

Gastric Sleeve

 

 

 


I just got back from Mexico, where Dr. Arturo Rodriguez performed the gastric sleeve surgery for me. (Warning… long post coming up!)Four years ago tomorrow, I had the Lap-Band surgery with Dr. Rodriguez.For a variety of reasons, the band didn’t work for me. I did manage to lose

about 40 pounds with the Lap-Band surgery, so the surgery was not

a failure, but I never did get good restriction. It seemed like I ran into

roadblock after roadblock, and I had a heck of a time trying to get good

follow up care in my community. My life changed over the past 4 years,

making it impossible for me to travel and be away from home to do fills,

so follow up care in Mexico wasn’t an option for me. I recently became

a midwife, attending women at homebirths, so taking time away from my

clients is not something I can do easily. Finally, a couple of months ago,

I decided to have my band removed and have the gastric sleeve done.

My best friend and I traveled to Mexico together and, of course, received

top quality service from Dr. Rodriguez and his staff. Once we got to the

hotel, we had a quick meal and a few margaritas before I had to begin my

pre-operative fast.

The next morning, the driver picked us up at the hotel and took us to Hospital

San Pedro. I had been there before for my Lap-Band surgery and my port

relocation surgery, so it was a familiar place for me. Shortly after I arrived,

the nurses took me back for my IV, weight check, vitals, labs, etc. Oh, and

by the way, since I work in the medical field, I took great note of their attention

to cleanliness and clean technique — no worries there (in case anyone

wonders about that). After the nurses were done, the anesthesiologist came

to visit me, as did Dr. Rodriguez. Next, I was wheeled into the operating room.

I got on the operating table, and the anesthesiologist put a mask over me.

The next thing I remember is waking up in recovery afterwards. I was SORE

and groggy, and I thought, “what have I done???”

Dr. Rodriguez had to work really hard on me during my surgery. De-banding

is not an easy task, and there were a lot of adhesions he had to remove. Also,

since I was previously banded, Dr. Rodriguez was very careful to make sure I

didn’t have any erosion, which could have caused life-threatening complications.

He also took extra care to be sure that the staple line in my stomach was

reinforced by sutures, and shot blue dye through my stomach to be sure

that there were no leaks. I am so thankful for Dr. Rodriguez’s skill as a surgeon.

I have trusted him with my life twice now, and I truly believe he is an outstanding

doctor. I would recommend him to anyone considering gastric surgery.

HE IS THE BEST!!!

Dr. Rodriguez had arranged for my friend and me to stay at the big suite at San

Pedro, which, by the way, happens to be a birthing room where they do

water births — my kind of place! The room had two hospital beds, two sofas,

several chairs, a kitchen, and a bathroom. It was extremely comfortable and lovely.

I am so thankful to Dr. Rodriguez for arranging for us to stay there!!!

OK, I’m being totally honest… the first day was hell. My throat was sore from

the tube being in there during the surgery. I threw up several times, was in pain,

and was really worried that I had made a bad decision. My back and arms

hurt a lot from being on the surgical table. I could barely move. Every movement

felt like torture. The pain meds gave me a horrible headache.

Second day was better, but it was still rough. I was throwing up less often and

was drinking sips of water. Still very sore, but doing better. On the third day,

Dr. Rodriguez was concerned about my difficulties with drinking, so he arranged

for me to have a barium swallow to make sure there wasn’t an obstruction.

Everything checked out OK, so he sent me to the hotel to recuperate. Day 4 was

spent just sipping water and Riopan, and there was no more throwing up. Late

that day, Dr. Rodriguez met us at the hospital to have my drain removed. THAT

was a really weird feeling! Once the drain was out, my soreness improved greatly.

One thing I found REALLY helpful in getting liquids down was I got some honey

straws. I discovered by accident that these work really well. If you have trouble

getting liquids down, it helps to just swallow, swallow, swallow until it moves down.

Well, with the honey straws, you have to work really hard to suck the honey out,

and that action, combined with the swallowing of the little bits of honey, works really

well in propelling the food downward. If you’re getting gastric sleeve surgery,

I suggest picking up a box of these to take with you to Mexico. My friend found

some at the plaza in Monterrey, but I’ve seen them at Target in the tea section

here in the US.

Day 5, we left the hotel and headed home. My advice to anyone traveling after

this procedure – GET A WHEELCHAIR! If you have a wheelchair, you will breeze

through customs and security and life will be a whole lot easier for you.

I’ve been home now for three days and I feel much better. I am able to drink about

60 ounces of water a day now, which is about half of what I used to drink, but it is

improving daily. I am not as sore as I was, but I’m still hurting a bit. My surgical

wounds are healing nicely, and I’m starting to feel more “normal” again. I’ve lost

12 pounds in this first week, which is also pretty cool. I’ve been drinking Vitamin Water,

chicken broth, and Italian ices. Dr. Rodriguez says I am to have clear liquids for 3 weeks,

and then full liquids for 3 months. Most people would think that would be hard,

but so far, I have absolutely no desire for food and do not feel hungry at all. I have

to really force myself to drink enough to stay hydrated, so that’s my toughest

work at the moment.

Anyway, I hope to hear more from people who have had the Gastric Sleeve.

I hope this post is helpful to any of you out there thinking about having it done.

Blessings,

Kim Pekin
Midwife
Purcellville, VA
www.gentlehomebirth.com

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LapBand Erosion

August 17th, 2012

LapBand Erosion

There are many terms that have become familiar to the lap band population because they are commonly used among doctors and patients.  One popular term is “LapBand” which stands for Laparoscopic Gastric Banding.  The term “LapBand Erosion” also became very popular among the banded patients as lap band message boards increased in popularity. The patients that already had the LapBand were concerned as“erosion” was often connected to topics such as de-banding or surgical removal of the band.  However, the term actually means that the stomach has developed a penetrating ulcer and has eroded (worn away) towards the balloon of the band.

How does Stomach Erosion happen in LapBand Patients?

Intragastric band erosions have been reported at rates that vary from 3 to 10% depending on the operatory technique or surgeon´s experience, the device used and the patient’s eating behavior.  There are several different and controversial theories for the cause of erosion:

  1. The LapBand around the stomach gradually erodes into the stomach wall over time, and goes into the gastric lumen, as we have seen with other intrabdominal devices.
  2. The stomach damage done during the LapBand procedure debilitates the layers of the stomach wall, resulting in erosion at a later time.
  3. The sutures were placed too deep and trespassed all the wall layers of the stomach, causing micro perforations that generate leaking, infection and later erosion.
  4. Events that happens inside the stomach, such as frequent vomiting, medications, ingestion of irritants as spicy or hot food, alcohol, etc. as well as a large adjustment to the band system, will produce an ulcer that penetrates toward the balloon of the band.

I believe the last theory is the most consistent and also the most frequently seen in the vast majority of patients with erosion.  Other theories,  such as a crease or a fold in the balloon, which may harm and erode the stomach lining, were not scientifically proven. We have seen erosion with all kinds of LapBands and with all kinds of balloons and find no correlation with the fold theory.

Once the erosion-ulcer is established it is not possible to cure the ulcer, not even by removing all the fluid in the band. Therefore the need to remove the band itself becomes imperative. I recommend the band be removed AS SOON AS POSSIBLE, not because this is an emergency in any way, but because there is a risk of increasing the ulcer’s size.  Removing the Lapband can help to decrease the risk of complications such as infection traveling along the hose to the port and to the skin, or stomach bleeding.

How Can LapBand Erosion be Prevented?

There are several ways to prevent erosion.  The first way that I personally recommend is to avoid “large fills” to the LapBand, in order to prevent vomiting or gastric reflux.  The second way that I recommend is to protect the stomach with anti-acids frequently, especially at bed time.  The third recommendation is to avoid alcohol, hot or spicy food, vinegar, soy sauce, and coffee.  Talk with your Doctor about the medications you are actually taking and ask about exchanging the ones that can hurt your stomach for others with the same effect but less stomach irriation.

 

Arturo Rodriguez,MD
Bariatric Surgeon

http://www.thebariatric.com

http://www.bandstersforum.com

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Safe exercises that can be done post Lap Band Surgery

March 16th, 2014

Safe exercises that can be done post Lap Band Surgery

After taking the plunge and getting Lap Band Surgery you’ll want to make sure that you are getting the most out of the procedure. First, you’ll work with your doctor to get a good diet plan going. After that you need to think about what exercise plan will work best for you.

Some of the most highly recommended activities after the Lapband are walking and swimming. These are low impact exercises that can be done at your own pace. Additionally, they can easily be done seven days a week for maximum benefit.

The first thing you might want to try after lap band surgery is some walking. Start slow, and don’t worry if you can’t walk very far right away. If you walk for 15-20 minutes every day you will be making a difference in your health. Ideally you should work yourself up to 45-60 minutes at least 4 times a week.

Swimming is also a great exercise for those who have just had Lap Band Surgery. It doesn’t matter how good you are, or how fast you swim, but just that you get in the water and try. Swimming can be very beneficial because the water provides extra resistance and helps to make you work out harder in a shorter period of time. If you aren’t comfortable actually swimming in the water you may want to try walking in the water. This combination of exercises can be great for recovery from Lap Band Surgery.

For those who have not been on a regular exercise program before it can be difficult to get into a routine. Some suggestions for those of you would be to find a workout partner you enjoy spending time with. Ask a friend or loved one to join you for your walks or swims. You do them the favor of helping them get in shape, and you can strengthen the bond you share with them as well.

The Bariatric Team

http://www.thebariatric.com

http://www.bandstersforum.com

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Here is my Lapband Story…

February 23rd, 2014

Here is my Lap Band Story…

I was overweight most of my life.  I had tried every diet out there only to gain all the weight back. I was depressed and frustrated.  I had heard so many Weight Loss Surgery success stories and realized that Lapband surgery was my only option for permanent Weight Loss. While researching my options I ran across Dr. Arturo Rodriguez’s website and decided to call.  I was skeptical about traveling outside the U.S. but after a lot of research I was certain that Dr. Arturo Rodriguez was the right doctor for me. 

An important thing I learned in my research was that the experience of your Lap-band Surgeon plays a huge role in your success with Lap-band.  Dr. Arturo Rodriguez has performed thousands more Lap-band Surgeries than any doctor I could find in the U.S.  I decided that if I was going to have this surgery I wanted the best Surgeon to do it!

My experience in Monterrey was amazing!  I was greeted at the airport and taken directly to the hospital.  When we arrived, Dr. Rodriguez and his assistant met my husband and I.  They discussed everything that would take place.  After surgery I was taken to my hospital room.  There was always a nurse to help if I needed.  I have never received such good care in any hospital in the U.S. as I did in Monterrey.

The next day I was picked up and taken to my hotel room and later that evening, one of  Dr. Arturo Rodriguez’s staff came to check on me and take my husband and I around Monterrey.  The next day someone picked us up and drove us to the airport.  We never had to worry about a single thing the entire time we were there.

My life since Lap-band Surgery has changed dramatically. I can play with my boys and not get tired, I’m more outgoing, I wake up and my back doesn’t hurt, and I have endless amounts of energy.  It’s also taught me what true portion control is and given me the skills to lifelong Weight Loss!  I’ve learned what it takes to keep the weight off forever!  Most importantly I have eliminated my chances of acquiring obesity related illnesses. 

I have Dr. Arturo Rodriguez and the Lap-band Surgery to thank for all of this.  It changed my life so much that my Mom even decided to have Gastric Bypass Surgery (by Dr. Arturo Rodriguez of course) and she too has had amazing success losing over 100 lbs and going off many of the medications she was on prior to surgery. In fact, I was so impressed by Dr. Rodriguez and his staff that when the opportunity came to work with them and to help others see the many benefits of this surgery, I jumped at the chance.

I would love to talk to you about how much this amazing Surgery can change your life and why Dr. Arturo Rodriguez is the right Surgeon for you.

shelby

Shelby, Lapband patient, http://www.thebariatric.com

 

Shelby Hashagen

Patient Coordinator / Dr. Arturo Rodriguez

(360) 304-0610

shelby@thebariatric.com

http://www.thebariatric.com

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Vertical Gastrectomy Procedures

February 16th, 2014

Vertical Gastrectomy Procedures

The original procedure, conceived by Dr. D. Johnston in England, was called The Magenstrasse and Mill Operation. The stomach is stapled vertically and divided from the incisura angularis to reach the angle of His at the gastric fundus. Dr. Johnston’s procedure of leaving a long gastric tube that resembles the German highway Magenstrasse was rapidly called that way.  The Magenstrasse, or “street of the stomach“, is a long tube fashioned from the lesser curvature of the stomach, which conveys food from the esophagus to the antral Mill without the total partition of the stomach.  The normal antral grinding of solid food and neuro-hormonal, antro-pyloric-duodenal regulation of gastric emptying and secretion are preserved.

It is now called the Vertical Sleeve Gastrectomy (VSG) but is also known as Vertical Gastroplasty. If a silastic ring or mesh is added to the technique, it is called the Vertical Banded Gastroplasty (VBG) and was suggested to help increase the restriction needed for a better weight loss.  If a silastic ring is added to the pouch of a Gastric Bypass, it is called the Fobi-Capella Procedure.

These techniques (VSG and VBG) generate weight loss by restricting the amount of food that can be eaten (Purely Restrictive Procedure) without having any bypass of the intestines or malabsorption. Both procedures have largely been abandoned due to poor long term results.

The more popular procedure known today as the Gastric Sleeve (much longer “street” than the Magenstrasse procedure) is done laparoscopically and is considered a variation of the Vertical Gastrectomy, but includes the removal of the remaining 80% of the stomach after its partition.

I met Dr. Gagner several years ago, a very friendly Canadian doctor that was living in NY and then moved later to Miami.  He is considered among bariatric surgeons as one of the fathers of the Gastric Sleeve (GS) as a primary procedure and told me that the success of the procedure was largely discovered by accident because no one expected the remarkable weight loss produced by the Gastric Sleeve.  Later medical scientific publications revealed that the driving force for the weight loss was the decreased level of Ghrelin Factor when removing the 80% of the stomach.

 GASTRIC SLEEVE Advantages:

  • Stomach volume is considerably reduced to more than 100 cc but not as much as compared to the pouch of the Lap band (15 cc) or the Gastric Bypass (30 cc).
  • The Sleeve motility gradually returns to normal functioning after 3 months following the operation, so most regular foods can then be consumed but in smaller amounts. 
  • The procedure eliminates the portion of the stomach that produces the Ghrelin Factor (the hormone that stimulates hunger).  By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are eliminated.
  • Very safe and effective as a Primary procedure, First Stage procedure for very high BMI patients or as a Revisional procedure.
  • Can be checked with a scope when needed.
  • Appealing option for people with existing anemia, Crohn’s disease, arthritis and numerous other conditions that make them too high risk for intestinal bypass procedures.
  • Success rate is 60-80% of excess weight loss.
  • Proven to work better on Type 2 Diabetes and on Metabolic Disease than other procedures because increases in the Incretins secretion which lower the sugar Insulin resistance.
  • It can be converted to almost any other weight loss procedure.

GASTRIC SLEEVE Disadvantages:

  • Poor patient cooperation will result in inadequate weight loss or weight regain like binging eaters.
  • Patients with a high BMI often need to have a second stage procedure later to lose all the remaining extra weight.
  • Two stages is safer and more effective than one operation for high BMI patients.
  • Soft and liquid calories from ice cream, milk shakes, chocolates, etc., can be absorbed and slows down the weight loss.
  • This procedure does involve stomach cutting and stapling and therefore leaks and other complications related to cutting and stapling may occur.
  • It is not a reversible procedure.
  • Considered investigational by some surgeons and insurance companies.

Arturo Rodríguez, MD.

http://www.thebariatric.com

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Talking About Several Lap Bands? The Hidden Story Behind the Lap Band…PART I

February 9th, 2014

Talking about SEVERAL Lap Bands? The hidden story behind the Lap Band…PART I

You find yourself searching through Doctors or Promoters websites and you don’t find information about the existence of different Lap Bands.  How come?  Why is this information so hard to find?  How long have there been different Lap band Models?

When you visit message boards and forums and find little information about different models of the Lap Band, the information you do find usually comes from someone with misinformation (even when they think they are informed and write with some kind of authority because they have had the Lap Band surgery done) and their contribution to this subject is manipulated by comments by others.

Why is this not discussed PROPERLY on the message boards and forums?  It is difficult to believe that nobody cares about this.  Why is there little interest in this? Is it important to know that there are several different kinds of Lap Bands? Or does it matter at all?

Why is the market distracted by the Lap Band price and not the quality of the Lapband, the patient’s satisfaction with the Lap Band procedure or the doctor’s service?  Why hasn’t anyone questioned Allergan’s practices of flooding the border town’s market with Lap bands that have been stolen from the factory?   Why is Allergan letting this happen?  What does Allergan gain from this practice?

Other important questions to ponder:

  • Can weight loss be affected by the design or size of the Lap Band?
  • Does the design of the lapband have anything to do with complications?
  • Why is this information about the lapband not on the Doctor’s websites?
  • Why is this information about the Lap band not on the Promoter’s websites?

 Is anyone going to be responsible for hiding this important information about the lapband to the patients?  Are there any legal aspects, corners or sides involved with these behavioral practices or with these different lapband models?   Why do Lap Band doctors in the U.S. say nothing about the existence of many different Inamed-Allergan models and say nothing about their results with each of them?

Why do Lap Band doctors outside the States say nothing about this on their websites and the other kind of bands they commonly use to make the Lap Band procedure cheaper?  How can you be alerted about a poor quality lapband before having Lap Band Surgery?  What should you ask about the Lap band before having surgery?

To find the Answers to these questions, read on in Part II – “Talking About Several Lap Bands…”

TO BE CONTINUED…

 

Arturo Rodríguez, MD

http://www.thebariatric.com

http://www.thebariatric.com

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Plastic Surgery after Bariatric Surgery (Lap band, Gastric sleeve or Gastric bypass)

February 2nd, 2014

Plastic Surgery after Bariatric Surgery (Lap Band, Gastric sleeve or Gastric Bypass)

I know many individuals that are attracted by the idea of starting over.  It’s important for an individual to discover what they did wrong, and how we can change.  There is a need to lose weight or to keep the weight off successfully, to change your diet, to do some kind of exercise, to get fit and to stay fit by increasing your activity, to look younger, to have a totally new body so you can improve your body image. We are often dissatisfied or discontent with what we have, especially relating to our appearance – we want more or we want to look better!

Plastic Surgery has almost become a necessity for patients that have had a Bariatric procedure such as the lap band, gastric sleeve or gastric bypass.  Patients who have undergone bariatric surgery and are looking for Plastic Surgery should know that they will need more Reconstructive Surgery than just the normal Aesthetic Procedures such as Liposuction. This means that Liposuction (the most frequent plastic surgery among all the population) or a tummy tuck would not be enough, and in most cases they will need a Plastic Surgeon who has experience working with patients that have undergone a Bariatric procedure.

Patients that have lost a lot of weight after a Bariatric procedure have different personal image concerns and plastic surgery needs.  Before performing any procedure, the doctor must consider your age, your muscle tonicity, the amount of weight loss, the skin laxity or elasticity, the skin excess and the hygiene difficulty.

Frequent Questions among Lap Band Patients

Q: When is the best time to have a Plastic surgery after my Bariatric procedure?

A: The best time for Plastic Procedures for Lap Band patients is after reaching 60% of excess weight loss.

Q: Where can I start?

A: You should discuss your needs first, the surgical options and the cost of each procedure with your Plastic Surgeon and at that point, start planning a Plastic Procedure on what you can afford, what you want to improve or what bothers you most.

Q: Should I have all plastic surgery done at once?

A:  As a Surgeon I recommend to my patients to schedule plastic surgery in phases and not to have Plastic surgery done all in one procedure.  You have to consider that most of the Plastic surgery completed on a Bariatric patient takes a lot longer than in non-obese patients and this means that the surgery will be 6-8 hrs in the OR under general anesthesia.  There is also more blood loss and many times the patient may need to have a blood transfusion if there is a lot of work needed.

Q: How long does it take?

A: The Tummy Tuck takes 2.5 to 6 hrs depending on the patient needs.  The breast Lift takes 3.5 hrs.  A lower body lift takes 3 to 6 Hrs.

Q: What is the cost?

A: The cost varies from doctor to doctor but each procedure can cost from 6 up to 10 thousand USD

What to expect after Plastic Surgery in Lap band patient

Most of the procedures require a one or two night hospital stay. You will need to be out of work for about 10 days after surgery and you will also have drains for 5 to 7 days.  The patient must also wear a compression garment for several months.  While the scar is healing, the patient will also need oral antibiotics.

Arturo Rodríguez, MD

http://www.thebariatric.com

http://www.bandstersforum.com

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THE GASTRIC BANDS AND THE LAPBAND PROCEDURE

January 26th, 2014

The Gastric Bands and the Lap Band Procedure

When the Lap Band Surgeon discusses the lap-band Weight Loss Surgery, he will also discuss the lap band surgery cost with the patient. But more important than understanding the lap-band surgery cost, the patient must understand what the lap band is and what is involved in the surgery.

The Band or “belt” is constructed of a silicone material that is placed around the upper part of the stomach during the Lap Band Procedure. This is used to limit food intake. There is a hose or tube that connects the Lap band to a port or “valve”. This port is placed in the fat of the abdominal wall. It is used to inject saline solution into the band to increase or decrease its diameter. This changes the opening of the stomach where food passes through.

Different types of Adjustable Gastric Bands differ in design, shape, smoothness and edges. There are also differences in the way that the Band is placed in the abdominal cavity. They vary in length and after closing it differs from one to another in the way it ties to the stomach (concentric, in triangular manner, or as a clip).

Some of the Adjustable Gastric Bands can be seen by x-ray as opposed to other types of bands. The Port and the way it is connected with the hose differ with each band.  The ports are made of different material and come in different shapes and sizes.

Arturo Rodríguez, MD

http://www.thebariatric.com

http://www.bandstersforum.com/

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LapBand: Truth or Myth?

January 19th, 2014

LapBand: Truth or Myth?

I can’t have a Lap Band Surgery if I am not Super-Obese: Every day we do more Lap Band Surgeries in overweight and mildly obese patients, especially if they have a family history of co-morbidities such as Type 2 Diabetes, High Blood Pressure or High Cholesterol. The tendency world wide is that patients qualify for the Lap Band Procedures with BMI of 30 and above. The Lap band works also very well in patients who don’t want to gain weight but maintain in the weight they are and this is possible due to the Lap Band versatility to be adjustable to the patient’s needs.

You have to lose more than 10 pounds the first month after a Lap band Surgery: Yes, you do… The liquid diet should help you to lose much more than 10 pounds in the first month after surgery. When patients don’t reach this minimum it is because they are drinking many liquid calories and/or are not moving at all to burn the excess fat. Your goal after the first month of your surgery would be to lose at least 2 pounds per week and exercise will help you to reach this goal.

I am eating too much therefore I should go for a fill: Getting a lap band fill should not be based on the amount of food you are eating.  As long as you are losing weight or sizes, you won’t need a fill. If you are eating more, this could mean that you are moving or exercising more than you did before, or that you are making better choices about the foods that you are eating.  If you are in a plateau or gaining weight, then you should go for a fill. The purpose of the fill is to increase the restriction to food when you quit losing weight.

Should I expect to lose weight without exercising? You can lose weight without exercise if you are eating a very low calorie diet, but normally you will need some kind of exercise in addition to the diet to lose or maintain a healthy weight. Remember that the Lap band is a tool and you have to learn how to use it – this includes the change in the bad old habits.

I was expecting not to be dieting with the Lap Band Surgery.  The Lap Band procedure is a restrictive aid for treating excess weight and needs full cooperation from the patients in order to work as desired. Even in patients with a big fill, there are calories that will pass through easily, like ice cream or chocolates, and you can gain weight if you choose too many high-calorie foods. The key is: Follow a healthy, well-balanced, low-calorie food intake and also get active – do some kind of exercise to boost your health.

The Lap Band shows me when I am over eating and that is why I vomit all the time: History of vomiting is frequently found in patients that have to be de-banded because of Lap Band Erosion or Slippage. You have to learn to be satisfied before vomiting. If you are someone that vomits frequently, you may have developed a bad habit of over eating, not chewing well or eating too fast - and at some point you will end up hurting your stomach.

I don’t need fluoroscopy for a Lap Band fill: I recommend a fluoroscopic check-up done at least once a year.  Fluoroscopy helps us to detect early complications such as anatomical changes in your stomach and esophagus, and also the functional status of the Lap Band.

My friend has a very good fill with 3 cc and I do not: Stomachs differ in size from person to person, and everyone reacts differently to the Lap Band. You can’t compare yourself with anyone. That was Inamed’s big mistake: the Lap Band was made too short to fit all the patients’ stomachs, assuming that they were equal in size. This caused some patients to have complications such as disphagia (difficulty swallowing) after having the Lap Band for several months.

Support Groups and Message Boards are a waste of time: It is critical for the patients to have a supportive group if they truly want to succeed. I encourage all my Lap Band patients to join our Lap Band Message Boards where they can feel comfortable exchanging and sharing experiences in a friendly environment.

Arturo Rodríguez, MD

http://www.thebariatric.com

http://www.bandstersforum.com

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INTERNAL HERNIAS RELATED TO A GASTRIC BYPASS

January 13th, 2014

INTERNAL HERNIAS RELATED TO A GASTRIC BYPASS

 

The internal hernias after a Laparoscopic Gastric Bypass may occur in 10 % of patients.  Early detection is important because they threaten the patient by causing intestinal obstruction, intestinal strangulation with perforation and peritonitis.

It is very important to know that the Internal hernias often pass unnoticed delaying the diagnosis and the treatment. 

The doctors either do not suspect the problem as a cause of the symptoms or the patients misunderstand the severity of their symptoms due to their initially vague clinical symptoms.

It is very common that the patients tend self medicate themselves delaying the prompt attention, not consulting with a doctor until symptoms are more serious with a higher risk of catastrophic complications.

Internal hernias in patients with Gastric Bypass occur most frequently 18 months after surgery, however there are reports from the first postoperative day up to 25 years after the operation.

It is important to know if your doctor completed a laparoscopic Gastric Bypassretro colic” or gastric Bypass “ante colic”.

There are 3 sites in the first case (retro colic) where hernia occurs: At the Petersen’s space, at level the jejunum-jejunostomy and at the mesocolon underneath the transverse colon; and there are two sites in the ante colic laparoscopic Gastric Bypass with a potential internal hernia presentation.

When a surgeon uses sutures during the bypass surgery the potential of a hernia space decrease the risk of the presentation of internal hernia.

In some private hospitals operatory time is very expensive and some doctors prefer to ignore this very important surgical step, on the other hand, to close these spaces also requires the development of advanced laparoscopic skills to do it correctly and in expeditious manner with intracorporeal stitches to close such potential hernia spaces and that has to be done by hand (not staplers), as a result, that explains some of the incidence of hernia with intestinal obstruction.

Common symptoms of internal hernia after a Laparoscopic Gastric Bypass are mild peri umbilical pain progressing to an intermittently cramping pain but increases in frequency and if not treated it will progress to the classic intestinal obstruction.

Occasionally the intestinal obstruction is mild and resolves quickly but may become a true surgical emergency where the life of the patient is at risk and surgical laparoscopic treatment has to be done without delay.

If you experience any of the described symptoms you must act quickly to resolve the hernia and need to be explore the area by laparoscopic means.  Closure of the hernia ring is very feasible in most cases, even more, when a bypass patient arrives with obstruction and it is diagnosed quickly needs to undergoing laparoscopic exploration to avoid complications.  If not treated immediately the chances increase due to the high possibility of a second catastrophic event.

Don’t expect that the hernia will be resolved with general measures because sooner or later the patient’s life is in jeopardy.

Dr. Arturo Rodriguez

Gastric Surgery and Obesity

http://www.thebariatric.com

http://www.bandstersforum.com

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The Answers to Gastric Sleeve Failures

January 6th, 2014

The Answers to Gastric Sleeve Failures

The Gastric Sleeve is an open procedure, and is known as part of the Duodenal Switch since 1988.  The Laparoscopic Gastric Sleeve on high risk patients started in 2004 as the first stage of the Duodenal Switch (DS) and soon after that date, several teams started Laparoscopic Gastric Sleeve programs as primary or solitary surgical procedures for morbidly obese patients. In 2007 the Gastric Sleeve was proposed as a treatment for Metabolic Disease regardless of the excess weight of the patient. 

There are no long term follow-up results currently available for Gastric Sleeve Patients as a primary procedure. However, due to the increasing popularity of the Laparoscopic Sleeve, we are starting to see an increased number of failures. What we have observed in most of the Gastric Sleeve failures is the presence of large stomachs or large sleeves instead of a small volume sleeve. We have also observed a very poor nutritional and dietary change of habits in patients exhibiting gastric sleeve failure .

gastric-sleeve-proper-size   = CLICK VIDEO

When we started performing Lap Band Procedures we were creating 50 cc pouches; soon after started creating 15 cc pouches in order to give patients restriction and to avoid failures.  We are experiencing similar conditions with the Gastric Sleeve.  The remaining stomach is too large (large sleeve) so patients don’t have adequate restriction to lose weight as we expected. The use of a smaller bougie during surgery to calibrate the size of the sleeve is imperative to avoid such technical failures. The running suture reinforcement will also help to prevent a large stretching of the sleeve.

When we started performing Gastric Sleeves we didn’t have enough appropriate follow-up care for patients because we were assuming the sleeve will work and do its job (by creating enough restriction and decreasing the Ghrelin levels to lower  hunger). The truth is that patients need to be monitored closely and assisted on a regular basis with support groups and counseling in order to succeed.

We believe that the stretching of the Sleeve over time will also play a huge role in all of the cases of failure just as we learned from the lap band. Dilated pouches (large pouches) played a huge role in Lap Band failure in the past, and now in the case of the Gastric Sleeve, failure is due primarily to a large stomach pouch or sleeve.

Arturo Rodríguez, MD

http://www.thebariatric.com

http://www.bandstersforum.com

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Making Healthy Choices after Bariatric Surgery

December 29th, 2013

Food, Glorious Food!

Making Healthy Choices after Bariatric Surgery

Bariatric surgery can help you to lose weight, but you also have to make some long-term changes to your diet in order to see the best results.  Your stomach is much smaller after bariatric surgery, and can only hold a small amount of food.  It is important to choose HEALTHY and NUTRITIOUS food in order to help reach your weight loss goal and to keep your body nourished.  Here are some general guidelines to help you in creating your own unique and healthy lifestyle.

Plan Ahead. Your new lifestyle starts at the grocery store! If you buy cookies, sweets and chips, it will be hard to resist or limit these foods when they are accessible at home. Before you buy the groceries, make a list of the foods you plan to eat during the week and include healthy choices that are easy to prepare.

Include foods from all four food groups in your diet. Vegetables and Fruits, Grain Products, Dairy and Alternatives, Meats & Alternatives. There are many healthy foods to choose from. Make your plate colorful!

Start with protein-rich foods.  Beans, lentils, chicken, fish, eggs, and dairy products are all good sources of protein.  Your body needs protein to build muscle, skin, hair, and connective tissues, and support many essential chemical reactions.  Carbohydrate-rich foods like rice, pasta and cereals are an important source of energy and vitamins, but they can fill you up quickly. Save these towards the end of your meal… and don´t forget about your vegetables and fruits, rich in vitamins and minerals too!

Eat three small meals per day.  Make sure to include breakfast every day.  Skipping breakfast can lead to over-eating at lunchtime, and you also need that energy to help you start your day.  Spread the meals out evenly throughout the day, so that you are eating every 4-6 hours.  If there is a long stretch of more than 6 hours between meals, include a small healthy “snack” to keep you going.  Perk up with a small orange (35 calories) or whole wheat crackers (2 crackers = 80 calories) with low-fat cheddar cheese (1 oz = 49 calories), instead of a chocolate bar (280 calories!) 

Drink between meals instead of with meals to help your lap band work at its best.  The lap band is designed to restrict solids, not liquids. Drinking liquids during or immediately after meals tends to flush food through your stomach pouch and you will not get the prolonged feeling of satiety that you need.  Keep your foods and liquids separate to feel fuller longer, and stay hydrated too!

 

Making Healthier Choices

Here are some simple ways to make healthier choices at meal times.

  1. Breakfast?  In your coffee or tea, replace the sugar with artificial sweetener, or add 2% milk instead of cream.  Instead of a donut or package of cookies, choose a low-fat yogurt and spoonful of granola, or a soft-boiled egg and small apple.  
  2. Lunch?  On your sandwich, use margarine instead of mayonnaise, and just spread it on one side of the bread. Add fresh vegetables to your sandwich to increase the flavor – try tomatoes, cucumbers or green peppers sliced very thin.  Mix small pieces of cooked chicken and low-fat cheese into your salad to make a fresh meal, and choose low-fat salad dressings or make your own – olive oil, balsamic vinegar, lemon juice, and a dash of pepper!

Dinner?  Steam your vegetables instead of boiling or frying them.  Try baking your fish or chicken instead of frying it in oil. If you´re looking for a flavor kick, try adding some fresh herbs and spices to your dish.  For a simple, healthy meal, wash and cut potatoes, carrots, and broccoli, and wrap them in foil together with some fresh fish and herbs – pop the foil package in the oven for 30 minutes at 400°F and enjoy a delicious hot meal!

Do I need to Avoid or Limit any Foods?

High-calorie foods.

Avoid “Empty Calorie” foods like syrup, honey, pie, jam, chips, or cake, as they contain large amounts of sugar, and will fill you up quickly while providing very little nutritional value. Although you don´t have to give up your favorite high-fat treats forever, you will need to change the amount and frequency that you indulge in these foods in order to see the best results with your lap band.  For example, if you usually eat a large bowl of ice cream in the evenings, use a smaller bowl and choose one day per week when you will enjoy your favorite flavor.  If you love soda pop, choose the diet or light version instead, but watch out – the bubbles will fill you up fast.  Remember – your bariatric surgery is a tool that you can use to help you lose weight, but it will not work without your support!

Stomach Irritants

Some foods and medications can irritate your stomach, causing inflammation which can making eating uncomfortable and increase the risk of blockages.  Avoid or limit alcohol, spicy foods like chili, and tobacco.  Some medications like aspirin or iron supplements can also cause irritation. Talk with your doctor to find a safe alternative if you require these medications, and if possible, request a liquid format.

Hard & Bulky Foods

Some foods can get stuck in your lap band or stomach pouch, which can be an uncomfortable or painful experience.  Foods like popcorn, nuts and seeds are difficult to digest and may get stuck in your lap band, blocking other foods from passing through for digestion. It is best to avoid foods that are hard or difficult to digest.  Other foods such as pasta, rice, tortillas or dry bread can be bulky and may get stuck if you do not chew them properly.  Limit these foods in order to decrease the risk of blockages.  If you eat these foods, make sure you are chewing well and eating slowly.  If you feel that they are stuck, you may need a small sip of water to help them pass through.

 

R. Pallek

Nutritionist

The Bariatric Team

http://www.thebariatric.com

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Life After Gastric Bypass Surgery

December 15th, 2013

Life After Gastric Bypass Surgery

There are a number of important things to consider for patients after they have had Gastric Bypass Surgery. Take some time to read through the information and get informed if you are considering this procedure.

Diet

After having a gastric bypass, the modifications made to your gastrointestinal tract will require permanent changes in your eating habits that must be adhered to for successful weight loss.  Without these necessary changes, such as decreasing or limiting your intake of high-fat, high-sugar foods, you may stop losing weight or even begin to gain weight again.  Limiting high intakes of sugary foods is especially important to decrease the chance of Dumping Syndrome, where these foods move too quickly through the digestive tract into the intestine and can cause cramping, pain and discomfort, among other related symptoms.

Post-surgery dietary guidelines will vary by surgeon. You may hear of other patients who are given different guidelines following their gastric bypass surgery. It is important to remember that every surgeon does not perform the exact same weight loss surgery procedure and that the dietary guidelines will be different for each surgeon and each type of bariatric procedure.

What is most important is that you adhere strictly to your surgeon’s recommended guidelines. The following are some of the dietary guidelines I recommend after a gastric bypass:

  • During 4 weeks you will go on a liquid diet and advance in steps to a puree/baby food type diet for one or two additional weeks and transition to an almost normal (solid food) diet after that.
  • When you start eating solid food it is essential that you chew thoroughly.
  • You will not be able to eat steaks or other chunks of meat if they are not ground or chewed thoroughly.
  • Don’t drink fluids while eating. They will make you feel full before you have consumed enough food or they will flush down more food than you should be taking in.
  • Omit desserts and other items with sugar listed as one of the first three ingredients.
  • Omit carbonated drinks, high-calorie nutritional supplements, milk shakes, high-fat foods and foods with high fiber content.
  • Avoid alcohol.
  • Limit snacking between meals.

Going Back to Work

Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity and the type of gastric bypass you had (open or laparoscopic). Many patients return to full pre-surgery levels of activity within six weeks of an open Gastric Bypass procedure. Patients who have had a minimally invasive laparoscopic procedure may be able to return to these activities within a week.

Birth Control & Pregnancy

It is strongly advised that women of childbearing age use effective forms of birth control during the first 16 to 24 months after a gastric bypass surgery since the fertility increases during weight loss. The added demands pregnancy places on your body and the potential for fetal damage make this a most important requirement.

Long-Term Follow-Up

Although the short-term effects of weight loss surgery are well understood, there are still some questions to be answered about the long-term effects on nutrition and body systems. Nutritional deficiencies that occur over the course of many years are well known if you don’t take the recommended supplements. You will take supplements of Vitamins and Minerals (such as calcium and iron) for life and have a full blood work test done at least once every year.

Support Groups

The widespread use of support groups has provided weight loss surgery patients an excellent opportunity to discuss their various issues.  Most learn, from example, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well-being. Most surgeons have support groups in place to assist you with short-term and long-term questions and needs. I highly recommend enrolling into a support group.

Be cautious when turning to message boards as they are full of doctor’s coordinators or brokers more concerned with increasing business in their direction than providing support. You have to be aware of their presence and not allow them to manipulate you; they are only interested in gossiping or scaring you when you are only looking for the right answers.

Most bariatric surgeons who frequently perform weight loss surgery will tell you that ongoing post-surgical support helps produce the greatest level of success for their patients.

Arturo Rodríguez, MD

Bariatric Surgeon

http://www.thebariatric.com

http://www.bandstersforum.com

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CHEAP LapBand or Gastric Sleeve Costs – What Does it All Mean?

December 8th, 2013

CHEAP Lap Band or Gastric Sleeve Costs – What Does it All Mean?

July 6 (Health Day News) — Soaring U.S. medical costs are causing many Americans to take to the skies on “medical tourism” junkets, looking for high-quality yet low-priced health care at foreign clinics but experts also warn that the booming industry does have some risks.

“My own advice would be to look carefully at the accreditation of the hospital and consider the nature of the procedure. Are you sure it is the procedure you need? And is it done well at the place you are going?” said Dr. Ann Marie Kimball, a Professor of Epidemiology and Health Services at the University of Washington School of Public Health, in Seattle.

Medical tourism isn’t without some concerns, of course. Experts in the United States worry that consumers might end up getting substandard care if they don’t choose their hospital and physician carefully.

“It may be difficult to assess the training and credentials of surgeons outside of the United States.”

The risk for complications with people seeking this kind of surgeries rise three folds in the past six months says “El Norte”, a big News Paper alerting the Mexican Health Regulatory System of a very dark business going on which involved American Citizens crossing the border for a Lap band Surgery or a Gastric Sleeve procedure under not very clear circumstances.

Getting deeper in their investigation, the news paper says that the only ones that get some benefit from this medical tourism are the very dishonest intermediaries and the promoters where they want to capture the vast majority of patients regardless the outcome, questioning the doctor’s medical capacity that are hired to perform these kind of surgeries in obese patients.

What kind of doctors would you get in Mexico to do the Lap band or the Gastric Sleeve for $500 hundred USD, and the Anesthesiologist for $150,? says Claudia who just had her surgery done.

Can you find good trained doctors with those prices they are offering you? Of course you don’t!! You have to realize that because you are going to Mexico, these are not the regular or normal Doctor’s fees.  GNP and other insurance companies paid $950 USD for appendix removal and obese procedures cost much more than that.

Ask yourself:  How can someone have such cheap prices for your surgery without sacrificing the quality and the service that you deserve?  The only way that someone can come out with such cheap prices is by not paying someone in the chain: You don’t pay for the hospital, the Lap band, the stapler or for the doctors fees. Or they are getting the medical products in the black market, or the medications are made in China.

Have you ever stopped to think ….The Lap band or the staplers are about $2000 USD. How do they get the figures with those prices? How much is the hospital? How much is the hotel, flight, internet or other advertizing they do? How much is the driver or the taxies?  How much are the medications during and after the lap band or the Gatric Sleeve?  How much is the anesthesiologist, the surgeon’s assistant and all related services like the follow-up you need in order to succeed?

Are you going to sacrifice your success or your health because of promos of a cheap procedure? This could cost you a lot more than that…Look around for stories with poor outcomes, they are all over the internet and many of the doctors have a very high reputation…. Don’t let yourself be treated as merchandise. At some point of the chain you won’t get what you deserve or what you are expecting.

Kimball’s advice: Look carefully at the accreditation of the hospital concerned and do your homework before you board the plane. “Check out the real number of surgeries done, the success rates, the years of working in obesity” Woodman added. It’s also a key to ask the surgeon you talk to if he or she will perform the operation, not an assistant.

Arturo Rodríguez, MD

http://www.thebariatric.com

http://www.bandstersforum.com

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Are you Talking about Several Lap Bands? The Hidden Story Behind the Lap Band…PART II

December 1st, 2013

Are You Talking About Several Lap Bands? The Hidden Story Behind the Lap Band…PART II

Since 2006, it has been reported world wide, that 200,000 Lap Band surgeries have been performed and that the Lap Band procedure is the fastest growing weight loss surgery in United States.  There are many different types and brands of lap bands available.  Take some time to read through the following details.

“Lap Band”

Inamed-Allergan Lap Band Models:

Lap Band Model 1: Lap Band 9.75 cm; maximum volume of 4 cc (high pressure balloon)

Lap Band Model 2: Lap Band 10 cm; maximum volume of 4 cc (high pressure balloon)

Lap Band Model 3: Lap band 11 cm; maximum volume of 9 cc (high pressure balloon)

These first 3 models of the Lap Band are almost out of the market or obtained for a very low price because of a high rate of complications such as slippage and de-banding.

Lap Band Model 4: Lap Band VG 11 cm; maximum volume of 10 cc (one inch without the low pressure balloon)

Lap Band Model 5: Lap Band AP 11 cm; maximum volume of 14 cc (360 degree low pressure balloon)

“Realize Band”

The Swedish Band was introduced in 1985.  As of 2007 in the United States, it’s now referred to as the Johnson & Johnson Realize Band, and is known as the Quick Close in Mexico. The changes made to the Realize Band and Quick Close have been to the fastening mechanism and to the port, but the length of the Lap Band or the balloon have not been altered.  Other Lap Bands available in the Latin and European markets are a lot less expensive, are not FDA approved and do not meet the minimum quality standards. By using these non FDA approved bands, the Lap Band procedure can be inadequate.

Why is the complication rate in the United States higher than in the rest of the World?

Facts:

Since June 5, 2001 the Gastric Band or Lap Band, as it is known in the United States, was FDA approved for use as an alternative for weight loss (small model). 

The only FDA approved Lap Band Model used for the first 3 years was the Inamed 9.75 cm (First out of five generations of the Lap Band).

In Mexico, this first Lap band Model hit the market in 1995.

The trials for getting the Inamed Lap Band approved by the FDA were done by surgeons with little experience in Lap Band technique and the very important Lap Band follow up and after care.

Many Bariatric Surgeons still have a poor conception of the Lap Band Procedure due to the inadequate results of the first trials.

The trials were performed with the short lap band model and without a comparative study with other Lap band devices, therefore the reports received from the Lap Band Centers, regardless of weight loss and complications, were collected incorrectly, falsely or insufficiently.

Inamed’s first three Lap Band models were short in length, very rigid and had a small high pressure balloon, resulting in more complications than the Swedish Lap Band.

The reports coming out of the United States indicate Lap Band slippage and erosion rates were higher in the USA vs. the rest of the world, because the only model used was the first Lap Band (9.75 cm).

In the end, we knew long before that poor quality and the rudimentary design of the Lap Band were responsible for the inadequate weight loss achieved and complications such as slippage and erosion because of the rigidity of the Lap Band, the small circumference and the high pressure balloon.

Promoters and brokers conceal this information to American patients traveling to Mexico for the Lap Band Surgery because they receive (and still receive) great deals and prices for selling the Lap Band (any model) across the border, resulting in high profits for them with no regard to the patient’s outcome.

 

Arturo Rodríguez, MD

http://www.thebariatric.com

http://www.bandstersforum.com

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Lapband Surgery in Mexico…The Obvious Choice

November 24th, 2013

Lapband Surgery in Mexico…The Obvious Choice

With health care costs skyrocketing in the United States, more and more medical procedures are being performed abroad. Mexico is quickly becoming a very popular country for medical procedures especially for those people who do not have insurance.

Lap Band Surgery is a surgical procedure which helps extremely overweight people return to a more healthy weight. The Lap Band is a silicone ring which is placed between the new upper pouch and the lower part of the stomach. The surgery is performed under general anesthesia and takes approximately 25 minutes. The Band is adjustable, reversible and requires no stapling, cutting or rerouting of the intestinal tract. The recovery time is usually 3-7 days and patients are given an extensive post op instruction manual which includes pain management, surgical site care and customized diet instructions. The Lap Band Surgery is also the only adjustable, reversible, surgical weight loss procedure that is approved by the FDA.

Lap Band Surgery is one of the many procedures being done more and more in Mexico. For people with no insurance, Mexico offers this medical procedure at a fraction of the cost of the United States. Lap Band Surgeons in Mexico have also been in the field of laparoscopic gastrointestinal surgery far longer than American surgeons.

Weight loss can be a very sensitive subject so privacy is another reason many choose to have the Lap Band surgery done abroad. Once you’ve had the procedure you can rest and recuperate in an exotic atmosphere without friends or family members knowing about your procedure.

There have been over 400,000 Lap Band Surgeries performed worldwide. Mexico is one of the few countries that work with the patient to assure easy transportation in and out of the country and at many of the facilities there are packages which include transportation to and from the hospital and a two or three night stay at a nearby hotel for two. The follow up fill procedures can either be done in Mexico at the medical facility where the initial surgical procedure was performed or your surgeon will work with you to find a surgeon in your area that will work with you at a reasonable cost.

Another great benefit to having surgery abroad is the tax benefit. Medical expenses, including travel, are tax deductible so many people get a large portion of their out of pocket expense refunded to them at tax time.

The Bariatric Team

http://www.thebariatric.com

http://www.bandstersforum.com/

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10 Ways to Succeed with the LapBand

November 18th, 2013

10 Ways to Succeed with the Lap Band

Here are some helpful tips to help you succeed with the Lap-Band on a long-term basis.

Before you have the Gastric LapBand:

1. Search for the Right Doctor for You
Many companies or groups claim to be the Best Experts in LapBand surgery.  However, it is important to check the qualifications and experience of your surgeon before making your decision.  Find out whether the doctor is a member of any medical organizations and whether they have any experience in bariatric surgery.  Make sure to research the company and the Doctor´s credentials, and look into the facilities and medical team.  You can also check with the companies that manufacture the lapband products, like Allergan or Johnson & Johnson, to find more recommendations.  It is very important to be in the right hands when you have surgery.  The experience of your surgeon can make a big difference in your weight loss outcome.  Surgery can be life-changing – Don´t play with your health.  Look for the right doctor, and not just the cheapest deal.

2. Double-check the Doctor´s Coordinators
Some coordinators will say anything to convince you that their team and services are the best. The personality of the coordinators or the medical team can tell you a lot about the kind of work they do.  When talking on the phone, check for signs of aggressiveness, or whether they speak poorly of other bariatric teams or surgeons.  If they tell you that they know “everything” about LapBands or bariatric surgery, this is probably not true.  Take your time to analyze their ethics and professionalism, and keep your ears and eyes open.  Be cautious of coordinators that seem too pushy or don´t respect your requests.  These coordinators are not looking out for your best interests – they are just looking for your money.  Instead, look for coordinators that demonstrate clear communication and professionalism, honesty, friendliness and a helpful and caring attitude.

3. Avoid companies that are just “moving patients through the border”
Some “coordinators” may contact you to promote weight loss surgery without an actual connection to a qualified bariatric surgeon.  They may not even work for the Doctor that they are promoting, and are just looking to make money.  They do not have your best interests in mind – you are a merchandize for them.  They might make promises that they can´t follow through with, and may get any Doctor for your surgery as long as they get paid for arranging things for you.  When researching into the company, find out as much as you can about all the details, including any hidden costs or fees.  Be sure that you feel confidant and comfortable with the people that you are working with before you make your final decision.

4. Communicate with other Banded Patients
Often, the best source of information is someone that has already gone through the experience before.  You can find out answers by asking other people that have had the lapband procedure.  Search for online forums, chat rooms, or message boards.  Some questions you might ask could be:

  • What kind of surgical weight loss procedure did they receive?
  • Was the surgery what they expected?
  • How did the Doctor and his medical team treat them?
  • Did they have any complications after surgery?
  • How long did the surgery process take?
  • How have they adjusted to life with the lap band?
  • Did they see the results that they were expecting or hoping for?
  • How soon did they see results?
  • Would they recommend their doctor to someone else looking for the same surgery?

After you have the Gastric LapBand Procedure:

5. Begin the Journey: Develop Good Habits
After LapBand surgery, you will need to make some changes to your diet and activity.  Small actions can results in big changes and lead to successful weight loss with your new lapband.  Make sure that you learn about what foods to eat and what foods to avoid after your surgery, and determine if you can make these changes.  You will also see better results if you include physical activity in your daily routine.  If you are always used to driving in the car or riding the bus, try going for a short walk or getting off the bus earlier. If you do walk, try walking faster.  Park your car farther away from where you are going so you can get some extra steps into your day. Use any excuse to move your body, like taking the dogs out or doing some gardening. Do anything that will help you to develop new, healthy habits.

6. Your LapBand Expectations
Imagine yourself at the end of the “LapBand Road” and keep Focused on that image. The vast majority of banded patients expect the band to work alone by itself, without changing any of their old habits. But the truth is that you do need to put a lot of energy into yourself and encourage yourself to improve your eating habits and activities in order to each your weight loss goals. The LapBand is a tool to help you, but it won’t do the job alone. For the best results, you need to be committed to positive change.

7.  Find the optimum LapBand Fill
My advice is to reach a “fill point” where you can keep enjoying the foods you like, while still being able to lose or maintain your weight. Too much tightness or restriction will have you at the border line for being de-banded, and stomach erosion can happen frequently in patients with large fills. Do not compete with the LapBand by trying to force food to pass through the band. If you feel excessive restriction, visit your doctor to have your band adjusted.

8. Maintain Good Communication with your Doctor
This is the most important of the 10 “keys for success.”  Make sure you can reach your Doctor whenever you need him or her.  The Bariatric Surgeons and Doctors are different than General Surgeons in the follow-up care.
Don’t hesitate to call your Doctor if you have any of the following symptoms: Heartburn, pain at the port area or in the abdomen, frequent vomiting, difficulty swallowing or reflux.

9. Have a Barium Swallow or an Endoscopy atleast once a year
This can help to indicate the condition of your stomach, esophagus, and the lapband system, including the positioning of the band and port.  This may also help to detect any problems earlier, which can allow for more time to solve the problem.

10. Have your LapBand Fills done under Fluoroscopy as often as possible
Office fills do not detect early, easily-correctable problems until it may be too late.  Slippage and erosion are more frequently seen in patients that have never had follow-ups under fluoroscopy.  Check with your Doctor to find out their process for lapband fills – if they only do office fills, ask your Doctor to recommend someone that can provide fills under fluoroscopy for you.

 

Arturo Rodriguez, MD
http://www.thebariatric.com
http://www.bandstersforum.com

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LapBand Leaks: What You Should Know

November 15th, 2013

Lap Band Leaks: What You Should Know

A Lapband leak is suspected when a patient that previously had adequate restriction feels a change in the amount of restriction. This can happen suddenly or over a period of time, depending on the size of the leak. If there is a leak of the lap band, the band will not be able to be adequately filled and will not provide restriction, or function properly.  There are four types of lapband leaks that can occur to the lapband once it is placed, based on the location: (1) Leaks at the lapband balloon, (2) Leaks at the lapband tube connections, (3) Leaks at the body of the tube, and (4) Port membrane leaks.

(1) Leaks at the Lapband Balloon

Leaks in the lap band balloon can be unintentionally caused by needle punctures during surgery, or may occur over time in certain factory weak points of the balloon.

figure-101

Leak at Lapband balloon http://www.thebariatric.com

Figure 1.0  In the figure above, you can see the lap band (white rectangular shape), which has been filled with contrast fluid.  The arrow points to a small amount of fluid that has moved outside the band from a small leak in the balloon of the lap band (VG).   

Lapband Leak

Lap-Band Leak http://www.thebariatric.com

Figure 1.1 This is another image of a lap band balloon leak.  A thin line of contrast fluid can be seen outside of the lap band, surrounding both the band and the tube.

Lapband Leak

Lapband Leak http://www.thebariatric.com

 Figure 1.2 The lap band balloon can be seen in the centre of this image (rectangular shape, slanted to the left). In this case, there is a larger leak of contrast fluid which is more easily visible around the lap band balloon (arrow).

figure-13

Lapband leak seen during surgery http://www.thebariatric.com

Figure 1.3 In this case, there was a leak in the lap band balloon, and surgery was required to remove the band.  During surgery, the leak was very clearly seen when fluid was pushed through the lap band, to reveal the location of the leak.  (The arrow points to the line of fluid leaking from the  AMI band). 

(2) Leaks at the Lapband Tube Connection

Leaks can occur within the Lapband tube connection if there is a break or fracture of the tube next to the metal connector. Breaks or fractures may be due to physical movement over time, when considering the materials of the connections (metal and silicone).   If the “fracture” is complete, it can be easily diagnosed with an x-ray film (plain film), without needing to inject contrast fluid. 

figure-20

Lapband plain x-ray film http://www.thebariatric.com

 Figure 2.0 Above, we can see the lapband port in the lower, right corner, with the tube extending to the left in the x-ray image.  There is a complete fracture (break) in the tube.  The distal end of the tube is near the port, which means the tube may still be in the abdominal wall.

Lapband leak

Lapband Leak http://www.thebariatric.com

Figure 2.1 Above, we can see the lapband port near the bottom of the x-ray image, with a complete fracture (break) in the tube, which is curled up at the top of the image.  This shows that the tube is likely still inside the abdominal cavity.

figure-22

Port of a Lapband leak http://www.thebariatric.com

Figure 2.2 Above is a photo of the lapband port that was removed during surgery from Figure 2.1. 

 If the “fracture” is incomplete, it is necessary to inject contrast inside the system in order to diagnosis the problem.

figure-23

Figure 2.3 This shows an incomplete fracture, with the tube in place.

figure-24

Port of a Lapband leak http://www.thebariatric.com

 

Figure 2.4 This is the port removed from the above case (Figure 2.3).

l

Port of a Lapband leak http://www.thebariatric.com

 Figure 2.5 In this plain x-ray film, the port can be seen in the bottom right corner. There is a slight bend in the tube at the connection point (upper right corner of the film).

lapband leak

 Figure 2.6  As a leak was suspected, contrast fluid was passed through this lapband port.  A large amount of contrast fluid is seen at the bend, in the top right (the connection point).

In some cases, it is not possible to indentify a leak with x-rays. Therefore, the diagnosis of a leak may need to be done at the time of surgery.

Lapband leak

Lap-Band Leak http://www.thebariatric.com

Figure 2.7 In this x-ray with contrast fluid, there is no evidence of a leak.

Tube leak near the port

Tube leak near the port http://www.thebariatric.com

Figure 2.8 This leak was not demonstrated with x-rays.  As the leak was suspected, surgery was required to find the location of the leak.

(3) Leaks at the Body of the Tube

These lap band leaks are usually iatrogenic. This means that the leak was caused by an unintentional needle puncture, during a fill that was done without using fluoroscopy to guide the needle. These kinds of leaks are very common in office fills. Even in the best hands, there is always a risk of puncturing the tube during a lap band adjustment. This is one of the reasons that we always recommend fills to be done under fluoroscopy.

Lapband tube puncture

Lapband tube puncture http://www.thebariatric.com

  Figure 3.0  A leak can be seen in the body of the tube, close to the connection. This leak was made with a needle at the time of an adjustment (office fill).

Lapband tube puncture

Lap-band Tube puncture http://www.thebariatric.com

Figure 3.1  The leaking portion of the tube was removed during surgery.

(4) Port Membrane Leaks

This type of leak usually occurs when the patient has received many fills, or when the adjustment was done using a standard needle. Only Huber (non-coring) needles (Figure 4.2) should be used to perform fills or adjustments.  The silicone membrane of the port may be damaged if any other type of needle is used.

figure-40

Lap-band Port Leak http://www.thebariatric.com


      Figure 4.0 The lapband leak is just in front of the port, where contrast can be seen.     

Port Membrane Leak

Lap-band Port Membrane Leak http://www.thebariatric.com

Huber Needle

Huber Needle http://www.thebariatric.com

 Figure 4.1 During surgery, we can see a leak at the port membrane as seen by the bubbles that are produced when the port is placed in water.                                

Figure 4.2 Huber (non-coring) needle.

Final Thoughts

Every day, the lap band manufacturers are improving the design and functionality of the gastric bands in order to prevent complications such as leaks. However, there is always a small risk of leaks over time. Many types of lap band leaks can be avoided by careful handelling the gastric band at the time of the surgery and by doing the lap band fill or adjustment under the fluoroscopy guide, and finally by using the right non-core  needle. 

Arturo Rodriguez, MD
Bariatric Surgeon
Susana González, MD
Radiologist
http://www.thebariatric.com

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The success rate of Lap Band Surgery

November 14th, 2013

The success rate of Lap Band Surgery

Lap band

Over 58 million Americans today or overweight or obese; this number increases everyday and now we are even seeing childhood obesity. Weight gain can be attributed to many different factors such as genetics, some medications, poor diet and lack of exercise. Fast food is often the answer for a quick meal and is often habit forming. By eating fast food, you are poisoning your system and allowing for extra fat to accumulate on your hips, buns, thighs, and stomach’s. Extra body fat is not only unattractive, but it is very harmful to our health. Many diseases are triggered because of extra body fat such as diabetes, hypertension, heart problems, and back and joint problems.

There are many different diets and diet products available to us that promise fast results in the safest possible way. Unfortunately these diets and pills do not work for most of us. There are however, other options such as surgery. One of these revolutionary surgeries is the Lap Band. Before you commit to getting surgery, you must meet a few qualifications and you must understand this as any other  surgery.

Qualifications

• You must be at least 18 years old.

• You must weigh at least twice your ideal body weight or 100 pounds more than your ideal body weight.

• You must be overweight for at least five years.

• You must have tried other serious weight loss attempts.

• These serious attempts only have had short term success.

• You must not be suffering any type of disease that may have caused your obesity.

• You must be willing to change your lifestyle greatly including eating habits and lifestyle.

• You must be willing to be monitored by a specialist.

• You cannot drink alcohol in excess.

If you meet all of these qualifications, you may be a suitable candidate for the lap band surgery.

 

What is the Lap Band?

The lap band only has a mortality rate of 0.2% and a 3% early complication rate. The lap band surgery starts by the doctor making four or five small incisions in your skin. The band is then placed around the upper part of the stomach, dividing it into two unequal parts. The upper part is your stomach and the band restricts your food intake and makes you feel full faster, in turn, that creates weight loss.

The Lap band is inflatable; saline solution is injected into the band system about six weeks after the Lap band has been placed and continues until the patient feels full after eating small amounts of food. The procedure lasts less than an hour and patients usually go home the next day. Recovery time is about seven days.

 

Success rate

The success rate really depends upon the person’s ability to change his or her lifestyle if they can stick to a certain diet. The most recent study shows that about 70 to 80% of people that have had the lap band surgery have successfully lost most of their unwanted body fat and have been able to keep it off for five years.

Only you and your doctor can decide if lap band surgery is for you. Research it thoroughly before you commit to having the surgery. It is one of the safest and most effective ways for morbidly obese patients to lose weight. Even those that did not lose all of their excess body fat experienced better mobility, higher self esteem and good overall health.

The bariatric Team

http://www.thebariatric.com

http://www.bandstersforum.com

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October 14th, 2013

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Have Lap Band Surgery for Less in Mexico

October 6th, 2013

Have Lap Band Surgery for Less in Mexico

Mexico has become the best location to obtain surgical operations for less money, especially in the areas of weight loss and plastic surgery. You can have lap band surgery for less in Mexico, yet still enjoy the same level of professionalism, technology, after-surgery care, and state-of-the-art medical facilities.

The Mexicans have developed numerous reputable medical schools in recent years, such as the University of Monterrey, and some of the best Mexican hospitals are located nearby with exceptionally skilled physicians and surgeons. Many American medical students have also obtained their education from this University. In addition to gastric bypass or gastric sleeve surgeries, one of the most common and widely available surgeries in Mexico is the Lapband procedure.

Lapband surgery is also known as gastric band surgery. It is minimally invasive, especially when compared to other types of obesity control methods. The surgery is much safer as well. When comparing the price of this surgery between the United States and Mexico, patients can receive the exact same Lap band procedure in Mexico for up to 70% less than in the states. Despite the lower price, patients are advised to avoid the cheapest clinics.

Blindly placing trust in the least expensive location is not the best idea. Patients should expect to pay somewhere between $7,000 and $12,000 for the lap band or gastric bypass procedure. Avoid going to clinics that quote an extremely low Lapband price. Often, the reason for the deeply discounted price is due to a lack of business, poor reputations, a lack of proper facilities, or a lack of qualified personnel.

Choosing where you will obtain your lap band surgery is a very important decision. Certainly, you can have lapband surgery for less in Mexico, yet you must still make an informed, educated choice between hospitals, clinics and doctors. It is always the best choice to choose full-fledged hospitals for any surgical procedure in Mexico, primarily because they have all the necessary medical equipment and emergency surgical backup if any complications should arise. Good hospitals, such as Christus Health, will have major facilities such as blood banks, XRAY, MRI, and ICU centers. Some of these same hospitals will also have boarding facilities in which patients can stay along with a friend or relative. Finally, large hospitals will also have staff who speak English fluently, which is an important factor when considering a surgical procedure in another country. You need to be able to communicate your desires, your feelings, your pain, and your concerns to your physician or surgeon.

Christus Hopsital Http://www.thebariatric.com

The Bariatric Team

http://www.thebariatric.com

http://www.bandstersforum.com

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Lap Band Erosion: Clinical, Radiological and Endoscopic Correlation

September 21st, 2013

LapBand Erosion: Clinical, Radiological and Endoscopic Correlation

Erosion is a long-term complication of lap band surgery, and occurs when the Gastric Band fastened around the upper stomach gradually erodes into the stomach wall and extends into the gastric lumen.  Intragastric LapBand Erosions have been reported at rates that vary from 0.6% to 10% depending of the operative technique, the doctor’s experience, the device used and the most important factor:the patient’s follow up.

The use of NSAIDS, alcohol and smoking have been proposed as three of the main factors contributing to hyperacidity and irritation of the mucosal layer of the stomach. This important layer prevents us from acquiring ulcers in normal conditions.  When the irritation is persistent, it can cause erosion of the wall layers of the stomach, which may allow the lapband to migrate into the stomach (“inside out” erosion theory).  Repeated vomiting has also been suggested as a possible accelerant, especially when a high degree of obstruction is present (For example, an over-filling of the lapband). Due to the erosion, saliva or food leaks through the hole or ulcer in the stomach and flows along the LapBand tubing, causing the tissue under the skin of the LapBand Port to become infected.

 intragastric-lapband-migration
Figure 1.0 Intragrastric Lap Band Migration – Drawing of radiographic findings illustrates passage of liquid contrast material (Barium) around left section of band that has eroded into the stomach (small arrow).

In some cases, Lap-band erosion occurs gradually and may be silent or go unnoticed. However, several clinical symptoms may develop and should raise the suspicion of Lap Band Erosion: (1) cessation of weight loss, (2) weight regain with loss of restriction in the lap band, or (3) a port site infection. The Clinical Symptoms and Radiological or Endoscopic findings depend on the degree of Erosion.

The diagnosis of LapBand Erosion can be made at the radiological evaluation performedunder fluoroscopy during a gastric band adjustment in both symptomatic and asymptomatic patients.  If the radiological evaluation does not show signs of lap-band erosion and the patient has the symptoms, the doctor is obligated to perform an Endoscopy.

port-infection

Lapband Port Infection http://www.thebariatric.com

Figure 1.1  LapBand Port Infection

Due to the fact that LapBand Erosions usually open with a port infection (35%), the infection will continue after removal of the port, especially if erosion was not diagnosed.  In these cases of chronic infection, further radiological and endoscopic tests are needed to demonstrate the presence of LapBand Erosion.

endoscopy-findings1

Lapband Erosion, http://www.thebariatric.com

Figure 1.2  Endoscopic View of LapBand Erosion

endoscopy-findings-tips2

Lapband Erosion, http://www.thebariatric.com

Figure 1.3 Intragastric LapBand Erosion – Note the “tips” of a Swedish band into the gastric lumen

erosion-xray

Lapband Erosion, http://www.thebariatric.com

Figure 2.0 – Intragastric LapBand Erosion – Radiological evaluation shows 2 channels of contrast material, instead of one, clearly demonstrated in the later view of Fig. 2.1

erosion-xray2

Lapband Erosion, http://www.thebariatric.com

Fig. 2.1 – Intragastric LapBand Erosion - In this lateral view you can see the “bridge” between the upper (the pouch) and the lower stomach, the barium contrast material bypasses the part of the lap band that has eroded through the stomach’s wall.

missing-port

Lapband Port infection http://www.thebariatric.com

Figure 3.0 - Missing PortAP plain film shows a lap band without the port. The Patient had a history of port removal secondary to port infection with a persistent infected fluid coming out from the port area.

fistulography

Lapband Fistulography http://www.thebariatric.com

Figure 3.1 Intragastric LapBand Erosion demonstrated by fistulography.
Note the injected contrast material at the skin level is going through the fistula into the lower stomach.

The upper GI x-ray does not reveal lap band erosion in itsearly stages. However, the radiological appearance of late-stage intragastric band erosion on the upper gastrointestinal series is pathognomonic when the “stair sign” is observed. Barium swallow during the upper GI shows a flow of contrast fluid aroundthe portion of the band that has eroded into the stomach. As mentioned before, in cases where the radiological findings are missing, an endoscopic evaluation is mandatory.

stair-sign

Lapband Erosion, http://www.thebariatric.com

Figure 4.0 Intragastric LapBand Erosion – Radiograph from upper gastrointestinal series shows characteristic appearance of intragastric lapband erosion. Note the liquid contrast material on both sides of penetrating portion of the lap-band, “the stair sign”.

 

band-migrated

Lapband Erosion, http://www.thebariatric.com

Figure 4.1 - Radiologic evaluation shows a complete eroded gastric band – Note the location of the migrated band; the lapband device is found in its totality intragastric at the level of stomach antrum (the lower stomach). The patient had not been loosing weight for 3 years.

band

Lapband Erosion, http://www.thebariatric.com

Figure 4.2 – Complete erosion of the gastric band (seen in Figure 4.1) the gastric band was removed by endoscopy

Treatment of lapband erosion requires removing the lapband by laparoscopy or by endoscopy.  Weight regain typically occurs following this procedure. However, it is necessary to remove the gastric band in order to avoid further complications.  It is recommended to treat LapBand Erosions with another bariatric procedure 6 to 8 months after a de-banding procedure (LapBand removal). This is due to the high incidence of complications and failures when the procedure is done immediately following removal, or sooner than 6 months after removal, since the portion of stomach that has been eroded is weak and prone to leaking.

It is true that LapBand Migration means the failure of the operation and leads to a second bariatric procedure; however, erosion is considered a complication with a benign course if it is managed properly.

Susana González M.D.

Radiologist

Arturo Rodriguez MD

Bariatric Surgeon

http://www.thebariatric.com

 

 

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Why My Weight Loss Procedure Can Fail?

September 14th, 2013

Why My Weight Loss Procedure Can Fail?

The first and most important step to minimize the chances of failure from a Bariatric procedure and to increase your success rate is to be well informed about each one of the surgeries before you choose any of them.

What should you know about Weight Loss Surgery?

  • How does each procedure work? How will they assist in weight loss?
  • What should you expect from the Lap Band, Gastric Sleeve, or Gastric Bypass procedures, in terms of weight loss and/or Type 2 Diabetes
  • The difference in short and long-term benefits for each procedure
  • The operative risks and complication rates for each procedure
  • How much follow-up and support will you need for each procedure
  • How much of the Total Patient Care (TPC) program services will you need
  • What kind of adjustments will you need following surgery?
  • What kind of commitment is expected from you, for each procedure
  • What should you expect from the Doctor or Bariatric Group that you choose
  • The surgical options you have for each of the procedures in case of a failure
  • Finally, the cost of each procedure

What should you know about the Doctor or Bariatric Group?

You have to be well informed about the Doctors and medical team performing the Lap Band, the Gastric Sleeve or the Gastric Bypass.  Choose your surgeon and medical team wisely in order to ensure the best results for your weight loss success.

  • Ask about their education and training credentials if you are planning to go to a Latin Country. Look for Medical Degrees in Private Colleges like Monterrey Tech, University of Monterrey, or LaSalle School of Medicine, or other reputable medical universities.
  • Ask about where they received their Surgical Training. There can be a big difference in the treatment you will receive between doctors trained in well-known Private Hospitals, rather than in the Social Governmental Health Care System.
  • Ask about their Diplomas. Did they have to write a Medical Tests to join the Medical Society or Surgeon group, or did they just pay a subscription fee to become a member?
  • Check the number of Revision Surgeries they have been involved with. This may give you an indication of the quality of their work.
  • Check their Surgical Staff for credentials and experience. Consider the Anesthesiologist and any other assistant surgeons. It is important that they have experience in Bariatric surgery.
  • Double-check the Ethics and Professionalism of their Promoters or Coordinators.
  • Finally, check the Follow Up and Support they would provide you after your surgery.

Diet Rules to Follow (Regardless of the Weight Loss Procedure you Choose)

For any weight loss method to be successful and effective, you have to make some healthy lifestyle choices regarding the foods that you eat.  Bariatric surgery is an effective way to increase the rate of weight loss, but the best results can only happen when you make healthy choices.  After Bariatric surgery, you will feel full with a smaller amount of food – make sure to choose foods with the most nutritional value to help you on the journey to a new, healthier you!

  • Follow the Diet Steps recommended by your Doctor or the Nutritionist after surgery.
  • Chewing very well will help to maintain the pouch size, preventing stomach stretching and decreasing the risk of blockages and reflux in the esophagus or stomach.
  • Eat 6 small meals a day.
  • Eat slowly; take your time at the table.
  • Preferably, hydrate or drink beverages between meals.
  • Avoid Gastric Irritants like Alcohol, Coffee, Hot or Spicy, Vinegar, Soy Sauce or other Acid Beverages.
  • Limit high calorie foods like chocolate, cream and full-fat dairy products.

Failure Features Characteristically observed with Bariatric Procedures

These “failures” can be a result of a number of different circumstances or actions, or may develop slowly over time.  Therefore, it is important to have regular follow-ups to monitor your weight loss and the status of your lap band, sleeve or gastric pouch.  Remember: If you have any concerns, don’t be afraid to ask your doctor.

  • Big Gastric Pouches
  • Mega- esophagus
  • Wide Gastric Sleeve
  • Excessive tightness of the Gastric Band
  • Wide outlet of the Bypass Gastro-Yeyuno
  • Very Short common limb of the Gastric Bypass

 

Arturo Rodríguez, MD

http://www.thebariatric.com

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Lap Band Trials – Reviewing the Results

September 7th, 2013

Lap Band Trials – Reviewing the Results

I would like to review an issue that was recently presented to me the other day regarding lap band trials.   As a number of companies produce the Lap Bands used for the surgical procedure, comparisons have been made in the past between different brands.   Testing trials were held by Inamed (in the late 90′s) and by Johnson & Johnson (three years ago) and reports have attempted to compare these two bands.  However, the information obtained is being manipulated with results that favor the use of one band over the other.

Under the marketing competition, the comparison focuses specifically on the Lap Band explantation (or de-banding) during these trials.  The huge difference shown between the two brands of lap bands is now being used to manipulate doctors and patients into using a particular brand.  The problem is that the trials were not done under the same circumstances and cannot fairly be compared.

To correctly interpret the results of the trials, we need to look at the difference in circumstances.  The Lap Band trials were all done by surgeons, and placed in obese patients in both trials.  However, the comparison between trials does not include details about the surgeons’ experience in placing the band. The main difference between the trials is the surgeon’s ability and knowledge of the Lap Band.  At the time of the Inamed trial, the doctors were Gastric Bypass surgeons and had little to no experience with lap bands, while the Johnson & Johnson Realize Band trial was done by surgeons with more experience in Gastric Banding.  Therefore, it is likely that the famous “learning curve” adversely affected the Inamed trial.

It is also true that the first three Inamed models had many factory disadvantages.  Proof of this is that they have been pulled out slowly from all world markets, and Inamed has changed those first models for two different improved devices with fewer design problems.

Regardless of this last statement, we can conclude that the trials can not be compared, as the factors involved differ.  I believe there is more to do to improve the lap bands and that we will see changes on this matter in the near future.  I am placing the result of both trials for you to review and make your own conclusions.

Johnson & Johnson’s Realize Band trial

Realize Band – U.S. Clinical Trial  N=276
Key Serious Adverse Events
Band slippage

9 (3.3%)17

Band erosion

1 (0.4%)17

Port displacement

7 (2.5%)17

Band explantations

417

Port revisions/replacements

2717

 Inamed’s Lap-Band trial

Lap-Band® - U.S. Clinical Trial  N=299
Key Serious Adverse Events
Band slippage

11 (3.7%)18

Band erosion

1 (0.3%)18

Port displacement

18(6.0%)18

Band explantations

75

Port revisions/replacements

26

 

Arturo Rodriguez, M.D

http://www.thebariatric.com

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The Laparoscopic Journey: Past and Future

August 31st, 2013

The Laparoscopic Journey: Past and Future

Our History

The knowledge that we have today about laparoscopy has developed through the patience, hard-work and determination of dedicated doctors and individuals. When we started doing laparoscopic surgery, many doctors without laparoscopic training argued that open surgery had a better view through the large incision, than from the tiny camera’s panoramic view. They also thought that the sense of touch was lost by using instruments instead of fingers tips. They stated we were introducing unnecessary risks to any procedure by doing so. However, over time we have discovered that laparoscopic surgery is a very safe method.  The view is much better with the cameras moving in all possible directions, and the tip of the instruments act as well as finger tips do after you have been trained to use the instruments.

We also were discouraged from performing laparoscopic surgery in the elderly, in the young and in the morbidly obese patients. The patients under this category were unable to have laparoscopic procedures of any kind in all major hospitals.  However, time and experience have also demonstrated the safety of this technique for higher-risk patients.  Now, everyone recognizes the laparoscopic method as the best option for many surgical procedures, and many people are now are surprised when procedures are not done using laparoscopy.

Advancement in the quality of lap band products has continued over the past 30 years.  The first lap band model in the United States was the Inamed Lap Band, approved by the FDA in 2001. Doctors in the States began using this band as it was the only approved model in the US.  We initially promoted another type of Lap Band that was developed in Europe, with a softer ring, and a bigger, low-pressure balloon to adjust to any stomach size.  This type of Lap Band was approved by the FDA in 2006, and has now become the most widely used type of lap band in the world.  A few years ago, this band was purchased by Johnson and Johnson and is now known in the US market as the Realize Band. Inamed (Now Allergan) has five different models of the Lap Band, which have been designed to emulate many of the characteristics of the Realize band.

What´s Next?

Initially, there was much resistance against treating patients with a BMI less than 35, with bariatric procedures such as the Lap Band.  The medical community now supports preventative medicine, by encouraging patients to be pro-active rather than waiting five or tens year and developing co-morbidities before they treat the medical problem.  Today, there are various procedures acceptable for patients with a BMI of less than 35, including the Gastric Band, as well as more drastic procedures such as the Gastric Bypass, Duodenal Bypass, Gastric Sleeve and Duodenal Exclusion.  These procedures are also helpful if you are looking for your patient to obtain the Metabolic Effect from these procedures, and to improve blood sugar control for patients with Type2 Diabetes, High blood pressure and High Cholesterol (Metabolic Syndrome).

Arturo Rodríguez, MD
http://www.thebariatric.com
http://www.bandstersforum.com

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Losing Weight During The Holidays

August 24th, 2013

Losing Weight During the Holidays

Holidays are a time to enjoy family and friends, and get-togethers almost always center around good food and conversation.  Everyone brings delicious foods and desserts to numerous parties and gatherings, and life can get very busy and hectic, leaving little time for your regular exercise routine. For someone who is trying to lose weight, the temptations can be overwhelming. 

Diet and exercise are the most important methods of losing weight. However, this may not always be possible or practical during holiday times. Either someone is staying at a hotel, where exercise options are limited, or they might be staying with friends or family where it is hard to get away. As well, it almost seems rude to refuse any food offered at these special occasions. However, the holidays is a time to focus on positive thinking.  Focus on ways to eat healthy and maintain your weight. For example, if you stay in a hotel, why not take the stairs to your room instead of the elevator, or check out the swimming pool? If you are staying with friends or relatives, start a game of soccer with the family or take a walk around town. When the food is on the table, choose your favorite vegetables and fruits first – and enjoy sharing a colorful, healthy meal. If the cake is calling your name, chose a smaller piece.

For people that have had a hard time losing weight, and have had little success with fad diets or “easy” solutions, you may have considered different options such as lap band surgery.  A lap band is a silicone device that is surgically placed around the stomach, and manually shrinks the size of the stomach so that the person is able to feel full with smaller amounts of food. Lap bands produce the best results when used in conjunction with a healthy diet and proper, moderate exercise. This is mostly because too much unhealthy foods can slow the results that the lapband is designed to give.  Combining the surgery with healthy diet and active living will soon results in a healthier person. If that isn’t a great holiday gift then nothing is!

For anyone who has been struggling with the idea of getting lap band surgery, or for anyone who really wants to lose weight, don’t think it is too late for you. Lapband surgery may be just the thing to put your life back on track.

The Bariatric Team

http://www.thebariatric.com

http://www.bandstersforum.com

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Kim after 8 years of Gastric Sleeve

August 21st, 2013

Kim

Today is the 8th anniversary of the life-changing surgery I had with Dr. Rodriguez. I will be eternally grateful for the gift this surgery has been for my life. I have lost over 130 pounds since then, gone from a Size 34/5X to Size 12/14. I go to the gym and workout almost every day for an hour or more. I finally have my life back! Just before the surgery, when I was 320 pounds, I felt like I did not want to live anymore. Now, I want to live every day to the fullest, and I see my life as a precious gift. Dr. Rodriguez, thank you, so very much, for helping me to do this. The surgery didn’t do it all for me. It has definitely not been the easy way out, and I knew that when I made this choice. But, it was the tool I needed to get my life back on track. I’ll have to dig for a “before” picture, but for now, here’s an after picture from last month. GOD BLESS YOU DR. RODRIGUEZ!!!

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Mary, Lap-Band Success

August 18th, 2013

Mary, Lap-Band Success

MY JOURNEY OF LIFE

Mary, Lap-band Success

Mary, Lap-band Success

 

Ok—so that may sound a little dramatic, but I truly feel that this journey of weight loss has been more than just losing weight.  It has changed more than just the number on the scale—I have a new outlook on life, a healthier way to live and a new group of friends for life.

I had been overweight since 1988—tried every diet out there—including the ones that you order food delivered to you.  I spent enough on diets to have had the lap band done several times over!  I considered bariatric surgery off and on several different times.  Being a Registered Nurse, I saw both the successful and the unsuccessful surgeries done in the U.S.   In 2004 my brother had RNY bypass surgery done—and was successful—he lost 100 lbs in over a year.  I still wasn’t sold on that idea for myself—and started hearing about a new procedure called a “band”.  I started casually researching that –but all the while, I continued to gain weight.  Every time I tried to go on a diet, I would lose a little—then gain more than I lost.

But in October 2007, I was singing with my chorus at competition.  I literally hurt from the multiple rehearsals and performances and all the walking I had to do.  When I wasn’t in a rehearsal or on stage or somewhere I had to be, I was in my room taking a pain pill.  I was truly miserable.

One of the things they do during competitions is take candid pictures during performances and then put them out to see if anyone wants to buy copies for themselves.

That was my “wake-up”.  When I was looking at the pictures, I couldn’t find myself.  I literally didn’t recognize myself.  I knew it had to be me because of the people next to me—but I didn’t know that woman.  You see, I knew what the scales said—but I was in denial about how big I really was.  I thought I was carrying the weight better than that!  But there was the proof—I didn’t even know who I was.

Before I even got home, while I was in my hotel room, I started doing research about the gastric band.  One of the links that came up was for Dr. Arturo Rodriguez in Monterrey, Mexico.  I was amazed to find out that even though the gastric band procedure was still new in the US—he had been doing bands for over 12 years (at that time). I didn’t know they had been around that long!!  So I read everything I could about Dr. R—everything on his website—went to every lap band forum and web—and I learned a lot!! 

One thing to note—the procedure is called a gastric banding.  “Lapband”, “Realize Band”, “Allergan”, “VG”—those are all brand names from which ever company made that particular band.  Each band has individual things that make them a little bit different (that old business competition thing), but they all do the same thing.  It is strictly a matter of which band the Doctor feels is best for each patient.  Some Doctors only use one brand—some use more than one brand.  It’s like choosing which “tools” you want to use.   I personally left that to the Doctor—he is the one with the experience to know which one would work best in my situation.

 

So, back to me!  I spent about 3 weeks researching, reading,  looking before I even mentioned to my husband that I was considering it.  I wanted to be totally prepared for whatever question he had to ask me.  It did surprise me how open he was to the idea.  I had expected to really have to convince him—but once he knew that I had done the research and that this was not just a whim, he was supportive of me pursuing the procedure.   I asked my pt coordinator so many questions, it’s a wonder she didn’t just mark me down as a kook!  So with my husband’s support and encouragement, I scheduled my surgery.

On December 28th, 2007, I got on a plane at DFW and in less than 2 hours, I was landing in Monterrey.  Although we have made several vacation trips to Mexico—this was a new experience for me.  I knew what I had been told to expect—but I was still anxious about what would happen.

I came through immigration and customs, and just as promised, there was Dr. R’s driver standing there with my name on a sign.  He took my bags and we proceeded to the van.  It is about a 30 minute drive from the airport to the clinic (San Pedro) where I had chosen to have my surgery done.   All the way, I was watching the “sights” of Monterrey-Walmart-Sam’s –Maytag-Mary Kay—looked just like Texas to me!!

I chose to travel and have surgery on the same day, so when I got to the clinic, things started happening.  The nurses came in and after I had changed into the “very fashionable!” hospital gown, they started the IV and drew blood for the lab tests. Then the anesthesiologist came in—and then the internist—and the nutritionist—but then Dr. Rodriguez came into the room.  From the moment I met him, I was instantly at ease and knew that I had made the right decision.  He has a manner about him that makes you very comfortable and you know that you are in good hands.  I would like to send many Dr.’s to him to learn!

I was taken to the operating room and I have to say that Dr. Santos, the anesthesiologist is great!  I have had several surgeries before, but this was absolutely the easiest anesthesia I have ever experienced.  One minute I started feeling a little sleepy—and the next I was in the recovery room. The surgery itself takes less than an hour to finish.  After I was awake from anesthesia, I went back to my room and stayed in the clinic over night.  Every few hours the nurses would come in and give me antibiotics and pain medications through the IV.  Whenever I would wake up, I would walk around in the room—and then towards morning, I was walking in the hallways. Dr. Arturo Rodriguez came in to see me that evening and to make sure that I had gotten something to drink and that I had gotten some broth and jello.  The next morning, around 9, Dr. R and everyone else was back again—and as soon as I was dressed and ready to go, the driver was there again to take me to the hotel.  I was at the hotel by around 10:30 on Saturday morning—just 24 hours after I had left DFW.

When I got to the hotel, I took a shower and a nap—in that order!  After I had some soup, on Saturday afternoon, we went to the mall.  There are a couple reasons for that trip.  Primarily to walk—because that helps in many ways—and also to stop at the grocery store(supermercado) to get a few things to have in my room at the hotel to “eat” rather than calling room service every couple hours. I got some soup and yogurt, pudding and jello, Gatorade and water, that type of thing.  Then back to the hotel.  I rested, I walked, I drank.  On Sunday, I could have gone home—but I had messed up on my airline reservation, so I stayed till Monday.  So on Sunday I did basically the same things—and also went for a walk for a few blocks around the hotel.  At all times, I felt perfectly comfortable and safe in Monterrey.

On Monday morning, there was Dr. R’s driver, ready to take me back to the aiport and I was on my way home—ready for my new life to begin.  And that is exactly what it has been.

So—where am I today?  I have gone from wearing size 18W to size 8/10—I have lost about 65 lbs –so far- and am still losing. I would like to lose about another 30 lbs—but the difference is that now I don’t worry about it.  I know it will continue to come off. I eat regular foods—not diet foods—and as long as I don’t go “crazy”, I know that unlike every diet I have been on, this time I won’t gain all the weight back again.

And the crazy thing about this is—I would have never been approved to have had the surgery in the states!!  I was told I needed to GAIN about another 20 lbs to “qualify”!  Or have multiple co-morbidities caused by the weight.  That is NUTS!  Dr. Arturo Rodriguez looks at this as a preventative measure—let’s  get the weight off BEFORE the co-morbidities develop.  THAT is true care!

Almost 1 year from my surgery, I approached Dr. Rodriguez about becoming a patient coordinator and working with him to help other people.  I knew that with my nursing training and being a lap band patient myself, that I would be able to offer a unique perspective to potential clients.  I hope that I am.

So, while I have lost weight with the band—what I have gained is much more.  I have gained a new life—a new outlook and attitude—and I gained a group of friends that will be with me forever.

 

Mary Ellis, RN

http://www.thebariatric.com

http://www.bandstersforum.com

maryellis@thebariatric.com

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Old Treatments For Weight Loss Are New For Diabetes

August 11th, 2013

Old Treatments for Weight Loss are New for Diabetes

Approximately 22% of adults in the United States and 35% of the adults in Mexico have been diagnosed with Type 2 Diabetes, which is the type that also accounts for 95% of all Diabetes cases.  About 60% of obese patients have Metabolic Syndrome (Type 2 Diabetes, High Blood Pressure and High Cholesterol) and 20% of people over 65 years are Diabetic in the US.  With an estimated over 300 million affected individuals by 2025, the lifetime risk of developing type 2 Diabetes will approximate 20%.

There is an increased interest world-wide for surgical procedures that improve Type 2 Diabetes and Metabolic Syndrome.  Many Bariatric or Weight Loss Surgeons are asked about their experience in this matter for the better understanding and treatment of this disease.  We now know after years of Gastrointestinal Weight Loss procedures, that there are two main effects achieved through bariatric surgery: one is the Bariatric Effect (successful weight loss), and the second is the Metabolic Effect (a positive change in features of Metabolic Syndrome).

People that are overweight or obese will see improvement in blood sugar levels when they lose weight. Except with the Gastric Band, other gastrointestinal weight loss procedures (Gastric Bypass, Duodenal Bypass, Gastric Sleeve, Duodenal Switch or Bilio-Pancreatic Diversion) can promote an improvement in blood sugar levels long before there is significant weight loss.  Often the improvement can be seen just days after the surgery.

Improvement of blood sugar levels for people with type 2 Diabetes can be very successful for those that receive the Gastric Band (50% of the cases), the Gastric Bypass (70%), the Gastric Sleeve (85%) or the Duodenal Exclusion Procedures with or without Sleeve (92%). Patients that need insulin, and those that have been Diabetic for a longer period of time, are more resistant to blood sugar improvements.  However, the gastric procedures have still been shown to help these patients.

There are different explanations about the Metabolic Effect.  In the gastric bypass, this effect is related to the nature of the malabsortive procedures. The Duodenal exclusion is related to the secretion changes of the Ghrelin Factor (Hunger Factor) and other Neuro-hormonal factors called Incretins as the GIP (gastric inhibitory peptide), GLP-1 (glucagon like peptide) and the YY peptide. In operated patients where the stomach and the duodenum are excluded, the increase in Incretin secretion has a direct effect on lowering the Sugar Insulin Resistance, promoting the Growth of the BETA Pancreatic Cells that produces insulin and also for the improvement of the sugar-insulin action.  For individuals with a BMI 35 or less, we observed lower weight loss with the malabsortive procedures, but the metabolic effect remained the same as seen in heavier patients.  This indicates that the procedures are very effective for improving blood sugar levels.  In the Gastric Sleeve, the effect is related to the removal of 80% of the stomach. 

Both obese patients and those with Type 2 Diabetes should discuss with the surgeon each procedure’s surgical risk, the rate of bariatric and metabolic effect, and the long-term co-morbidities that each surgical option has before deciding on any of them.

Dr. Arturo Rodriguez
http://www.thebariatric.com

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De-Banding the LapBand Can be Complicated

August 3rd, 2013

De-Banding the Lap Band Can be Complicated

Today I want to share some concepts that frequently are misunderstood by Doctors starting a bariatric program, and by Banded Patients.  There are several reasons for De-Banding a Lap-Band patient. Today I would like to focus on EROSION.  The incidence of Stomach Erosion ranges from 2 to 15% of the patients who underwent a Lap Band Procedure .  The occurence of erosion depends on the Surgeons learning curve, and various patient actions such as the consumption of alcohol, spicy or hot food, frequent vomiting or the use of some medications like Aspirin.

The concept I want to strongly point out is that De-banding due to stomach erosion could be much more challenging and difficult than the initial LAP BAND procedure itself, and requires a lot more experience and skills to do it safely and properly without having complications like leaking, intra-abdominal abscesses or infection at different levels.

Doing the De-Banding properly also means that the Surgeon has to keep in mind that the patient may require a Revision Surgery after six months, for a Re-banding, a Gastric sleeve or a Gastric Bypass Procedure.

In cases of infection or leaking during the De-Banding, the revision surgery will be very difficult, and prone to more frequent complication rates (5 to 30%), or may almost be impossible to be done because of heavy adhesions at the operatory site.  As a matter of fact, the so called “learning curve” among Doctors when doing a De-Banding procedure requires a larger number of “supervised surgeries” than with the initial lap band, and the supervisions are usually done by an experienced Surgeon teaching the new bariatric surgeons or the General Surgeons under these conditions, to provide an opportunity for those patients to receive a new bariatric procedure.

If you require De-banding, be sure to inform yourself and look into finding the most experienced and qualified surgeon.  Your health is important.

Dr. Arturo Rodriguez
Bariatric Surgeon

http://www.thebariatric.com

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Lap Band Surgery and Exercise

July 27th, 2013

Lap Band Surgery and Exercise

Exercise plays an important role in weight management after Lapband surgery, as well as overall fitness. It is important to put the emphasis on physical activity for both weight control and health.

“Weight Maintenance” rather than weight loss should be your primary focus.  We encourage people personally and at our FORUM to increase their exercise activity and reduce their sedentary activity, to lose or maintain a certain weight after Lapband surgeryIt is recommended that a minimum of 30 minutes of daily moderate to intense exercise is needed to maintain a healthy lifestyle.

The day after Lapband Surgery, you should start walking as usual.  Two weeks after Lapband surgery you can do any kind of exercise.  You can start full exercise 2 weeks after Lapband surgery.

It has been determined that there are direct links between weight gain, health risks, and obesity. With the Lapband Procedure there is a direct link between exercise and successful weight loss. One of the only factors that reduces the risks associated with obesity is exercise. After Lapband surgery, exercise is the most important factor in losing weight or at least in maintaining weight loss.

Planning an exercise program after the Lapband should be based on personal goals as well as on individual capabilities. The most important element to be considered is to think long-term and make exercise a permanent part of your life. There are several types of alternative exercise programs that are available today. It doesn’t mean that you have to join a gym or a fitness center after Lap-band surgery.  But if you join a gym or fitness center, the key is to be consistent.  You can make sensible fitness choices that are more desirable or fit your lifestyle.

Here are some examples:

Moderately Intense Activities:

  • Brisk walking (3-4 mph)
  • Cycling (10 mph)
  • Swimming or calisthenics
  • Racket sports or table tennis
  • Golf (without a cart)
  • Housecleaning, general*
  • Raking leaves*
  • Dancing*
  • Playing actively with children*

*Considered moderate only if they are performed at intensity comparable to brisk walking. (Source: Journal of the American Medical Association 273:402:1995.

Arturo Rodriguez, MD

http://www.thebariatric.com

http://www.bandstersforum.com

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LapBand Diet – After Surgery

August 24th, 2012

LapBand Diet – After Surgery

How should I Eat After Surgery?

You need to pay attention to what you eat and how you eat it during the first three weeks following your lapband surgery.  Your diet should be limited mostly to liquids and soft food. The reason for this is that the body needs time to heal and develop tissue around the gastric band or lapband, to maintain the band in its correct position.  If you eat solid food too soon after lap-band surgery , you may run the risk of dislocating the band, or developing an enlarged upper gastric pouch. Therefore, it is very important to chew your food well in order to decrease the risk of blockages or dislocation of the band.

How Much Can I Eat?

Right after LapBand surgery the stomach can not hold more than 4 to 6 ounces per meal (3/4 cup). Therefore, one should be particular about the nutritional value of the food with every bite. I have written about the lapband diet since we started doing lapband surgeries seventeen years ago.  You can find detailed information on my website: http://www.thebariatric.com/lap-band/postoperative.html

 

What´s Happening?

People seem to think that nothing will happen if they “cheat” during the liquid phase and eat solid foods.   However, The truth is that solid food may cause increased pressure and may result in lapband dislocation, and the increased pressure over the “New Stomach” or Pouch at this time could be an early cause of lapband slippages.  Eating solid foods in the early stages after surgery has also been known to cause enlarged pouches which can occur after a period of time.

I try to tell people that their stomach is moving and churning (inside) while trying to digest solid food.  Solid foods are also pushed down to the restricted area and we want to keep the stomach as still as possible for that first week “liquid phase” after lapband surgery. So even though they don’t “feel” like it’s hurting anything, they could be.  Let’s reiterate that the purpose of the diet is not for starting weight loss but for healing after the Lapband surgery.  This way you will avoid stretching the pouch and it will also help you by letting the sutures become firmly attached and to hold the lapband in the right place.

Which Diet Should I Follow?

I recommend that my patients strictly follow the liquid phase for one week post-operatively.  During this time, they can eat clear liquids (water, Gatorade, broth, tea, apple, grape or cranberry juice, fruit popsicles) and full fluids (vegetables juices, cream soups,  low-fat milk and yogurt, and pudding).  There is no concern about malnutrition or low sugar intake during this time.  The diet slowly allows the patient to “graduate” to soft foods in the second and the third week post-op.

There are some foods that should be avoided or limited in order to decrease the risk of irritation or band dislocation.  Stomach irritants such as coffee, alcohol, carbonated beverages like coke, concentrated orange juice, vinegar, spicy food, etc, maybe cause discomfort or inflammation of the stomach lining, and vomiting might occur which may cause lapband dislocation.  Fruits such as oranges or grapefruits should have both the skin and seeds removed before eating them, in order to avoid blockages in the stomach or esophagus.  Vegetables such as cucumbers should also be peeled.

Other foods which need to be avoided are high fiber vegetables like celery, sweet potatoes, spicy foods, fried foods, spices (like cinnamon) pepper or soy sauce. If one is unable to tolerate milk, then calcium and protein rich foods such as cottage cheese and dry milk can be added to foods for proper protein intake.

LapBand patients should intake at least fifty to sixty grams of protein every day to avoid protein deficiency, but protein shakes or vitamins are not required. Include adequate sources of protein in your diet such as eggs, low-fat cheese, and fish such as salmon or tuna.  Lack of protein causes hair loss, edema, fatigue, muscle weakness, and a delay in wound healing. It also causes depression, anxiety, irritability, apathy, as well as gallstones, colds, headaches, low blood pressure, anemia, irregular heart rates. The amount of protein can be monitored by your doctor with a serum albumin blood test.

For more information, visit: http://www.thebariatric.com/lap-band/postoperative.html

 

Arturo Rodríguez, MD

http://www.thebariatric.com

http://www.bandstersforum.com

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Successful Weight Loss with LapBand Surgery

August 17th, 2012

Successful Weight Loss with LapBand Surgery

Lapband surgeries are a type of restrictive procedure through which an inflatable band is surgically placed around the upper portions of the stomach, creating a small stomach pouch. This small pouch works to restrict the amount of food that can be eaten at any given time while increasing the amount of time it takes the stomach to completely empty itself. Many patients have reported successful weight loss with lapband surgery and outpatient nutritional counseling.

As a result of the lapband surgery, the patient will achieve a sustainable decrease in weight by slower digestion, reduced appetite, and limited food intake. This type of surgery is less traumatic than other types like the gastric bypass procedure. Unlike other permanent solutions to obesity, it is safe, adjustable, and reversible. The lapband provides a unique method for maintaining and achieving significant weight loss, enhancing the quality of your life, and improving your health.

During the lapband procedure, your surgeon will make a few tiny incisions into the wall of your abdomen. Using the latest laparoscopic technologies, a small adjustable silicone band is inserted and secured around the upper portions of the stomach. This lapband is then connected to specialized tubing which is then attached to an access port, which is located beneath the surface of the skin on the abdomen. This port is not visible to the naked eye, and allows the patient to make adjustments to the band as necessary.

The small pouch at the top of the stomach controls the amount of food that can be taken in at any given time. A small amount is permitted to pass through the lapband, thereby delaying the total emptying of the stomach. This process causes a sensation of fullness much sooner than normal. Eventually and over a course of time, hunger sensations decrease dramatically.

There are many advantages to lapband surgery as a method of treating obesity. Of all gastric surgery methods, lapband surgery has the lowest mortality rate. It is the least invasive surgical approach to weight loss as well. There is no stomach cutting, stapling, or intestinal re-routing. The lapband is reversible, adjustable, carries a low malnutrition risk, and has the lowest rate for operative complications among all similar procedures like gastric sleeve or gastric bypass.

Most patients that elect to have lapband surgery will not have to be hospitalized. In fact, the majority of all lapband patients go home the same day of their surgery. Normal activity can be resumed in as little as one week, while full recovery from lapband surgery takes about two to three weeks.

The Bariatric Team

http://www.thebariatric.com

http://www.bandstersforum.com

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What If my Weight Loss Procedure Fails?

August 17th, 2012

What If my Weight Loss Procedure Fails?

Patients can have minor or large complications after a LapBand, Gastric sleeve or Gastric Bypass procedure.  Many patients may need another surgery to correct the complications, which can cost them more money. However,  medical complications are not always a result of a bariatric procedure failure.  A Weight Loss Procedure is classified as a failure if the procedure is no longer working.

When a Bariatric Procedure Fails for a patient, there are several different consequences to be considered.  They include the emotional, economical, and physical impacts of the failure.

What are the emotional consequences of weight Loss Procedure Failure?

Depending on the type of procedure (LapBand, Gastric Sleeve or Gastric Bypass), the patient may regain all the weight back again. This can be emotionally devastating because it gives the patient the feeling that he or she has thrown away money for nothing.  They feel anger towards the doctor and themselves, and during this whole process, their health and life could be at risk due to the complications. It is important for patients to know they are not alone. It is also important that they take positive action to address the situation, since this increases the probability of succeeding in the future.

 What happens after a Weight Loss Procedure Failure?

We can say a Bariatric Procedure is no longer working when the patient has regained all the weight originally lost. This means that the patient needs a new procedure called Revision Surgery. The need for a revision surgery after a procedure has failed may jeopardize the health or life of the patient, as the complication rate increases from 2% to 25%. In addition, it will cost additional money for the revision surgery.

The chances for success for a second, different, Weight Loss Surgery are lower then the first time, and the morbidity increases up to 25% depending on the revision procedure to be done. This is in part because the doctor has to be able to finish a new Weight Loss Procedure over the scar tissue and be able to repair what went wrong in the first place. The decision as to which will be the chosen bariatric surgery for the second time will depend on the type of surgery first performed.

How can a patient succeed after Weight Loss Revision surgery?

The patient must be careful to avoid any mistakes made before that may have influenced the development of complications.  It is very important that you ask your doctor and yourself questions like:

  • Why didn’t the first procedure work for me?
  • Which procedure works for me best after failing the first time?
  • Am I going to be able to follow the rules for success with the procedure I am choosing?
  • How much help will I get from the doctor and his staff after revision surgery?
  • Am I looking only for the best price I can get, or for the procedure that can work best for me?

You have to analyze both the pros and cons for any procedure that you are considering, especially when considering a second procedure or revision surgery. You have more chances to succeed if you keep in mind what went wrong the first time, in order to develop a plan for success in the future.

 

Arturo Rodríguez, MD

http://www.thebariatric.com/

http://www.bandstersforum.com/

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DIET BEFORE LAPBAND

August 17th, 2012

DIET BEFORE LAPBAND

Why a low Carbs Pre Lap-band Diet is Helpful?

I am used to performing surgery on patients that have not done any pre-operatory diet mainly because many of them can’t follow any kind of diet and by asking for one just increases their stress before surgery.

Long term carbohydrates and fat diets will turn to storage and infiltration of fat into the hepatic cells. Under this condition, the liver total mass will be progressively enlarged to what’s called pre-cirrhotic stage. By this, fat infiltration of the liver and on patients, the liver will remain enlarged during the lapband Surgery, the Gastric sleeve or the Gastric bypass and the working surgical area turns into a tiny space, reduced for errors in placing the instruments in the right position.

Because there is less room to work with also makes it very difficult to see and recognize the structures, to have enough space to do the right sutures and perform a safely procedure unless the surgeon has enough experience to handle these kinds of situations and has the right bariatric instruments to work with.

We don’t know for sure how much the total liver mass will be reduced by one or two weeks with pre op-diet. My personal belief is that will not shrink too much to make a difference and that the surgeon should be able to adapt to all situations.

 

Arturo Rodriguez, MD
http://www.thebariatric.com
http://arturorodriguezmd.com
phone: 011 52 818 3783177

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Is the LapBand Procedure for Anyone?

August 17th, 2012

Is the LapBand Procedure for Anyone?

Almost 95% of individuals with a BMI of 30 or more are unable to lose weight using only diet, exercise or drugs. Actually, all individuals with a BMI lower then 35 are not accepted into any Bariatric Program and those with BMI between 35 to 40 are only accepted if they have co-morbidities such as Type 2 Diabetes, Hypertension, Heart Disease, Sleep Apnea, Asthma, etc.

The question is if we want the patients to wait 5 to 10 years until they have gained such a weight and also to wait for high risk co-morbidities to show up in order to accept them for a LapBand, which is a surgical procedure that takes 30 minutes and has proven to be the safest surgical technique to treat obesity and overweight.

I strongly believe that LapBand Surgery is a good option for those individuals considering losing weight on a long-term basis, to improve their overall health and well-being.  Gastric Banding or a Lap band can be used to safely treat morbid obesity, and can also be a preventative measure for morbid obesity by individuals with a family history of Obesity, Diabetes, High Cholesterol, or other co-morbidities.

 

Arturo Rodriguez ,MD

Bariatric Surgeon

http://www.thebariatric.com

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What is the Best Surgical Weight Loss Procedure for Me?

August 17th, 2012

What is the Best Surgical Weight Loss Procedure for Me?

I hear this question all the time and there is no single answer for every person. You have to find your own answer by asking some questions like:

Is the cost of the procedure an issue that will influence my decision on which procedure to have?
Am I looking for a simple or complex bariatric procedure?
Am I looking for the safest procedure?
Am I going to be able to follow the rules for success with the procedure I am choosing?
How much help will I get from the doctor and his staff after any of the Weight Loss Procedures?
Which of the Weight Loss Procedure fits my life style better? 

You have to be well informed about all the surgical Weight Loss Options in order to have the answers, but it is also very important for you to know about the doctors that perform the surgies (the Lap Band, Gastric Sleeve or Gastric Bypass), their bariatric experience, their surgical staff, the experience they have in revision surgeries, the ethics and professionalism of the promoters and the Weight Loss follow up and support  that they will provide for you after your surgery.

Helpful Facts About Weight Loss Surgery

  • There is no ideal Weight Loss Procedure that works for every person.  Everyday we do more revision surgeries because of Lap Band, Gastric Sleeve and Gastric Bypass failures.
  • Gastric Sleeve is the Weight Loss Procedure that results in the best response for patients with Type 2 Diabetes, Hypertension and Hyper-Cholesterol (the Metabolic Effect).
  • The Lap band is the simpler and cheapest among the Weight Loss Procedures.
  • It is not true that if you are very heavy you will need to have the most drastic procedure.
  • Young or elderly patients can have the Lap Band, the Gastric Sleeve or the Gastric Bypass.
  • The doctor’s experience influences the outcome of the Weight Loss Procedures.
  • The patient´s eating behavior can modify the outcome of any of the Weight Loss Procedures.
  • The open message boards have very many doctors’ coordinators trying to send patients their way and might confused patient’s right decisions.}
  •  The procedure with lowest surgical risk is the Lap Band.
  • The procedure with the most surgical risk is the Duodenal Switch, followed by the Gastric Bypass.
  • The average hospital stay following the Lap Band procedure is one night.
  • The average hospital stay following the Gastric Sleeve procedure is two nights.
  • The average hospital stay following the Gastric Bypass procedure is three nights.
  • The Lap band needs to be “filled” periodically in order to provide optimum weight loss results.
  • A person with a Gastric Bypass will need nutritional supplements for life to avoid deficiencies.
  • You should avoid alcohol with any bariatric procedure, due to high risk of getting an ulcer.

 

Dr. Arturo Rodriguez
Bariatric Surgeon
http://www.thebariatric.com
http://www.bandstersforum.com

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LapBand Office Fills

August 17th, 2012

LapBand Office Fills

Your LapBand fills are the most important part of the follow-up care that you need to succeed in your Weight Loss Journey. There is very little written about LapBand Office Fills. Many people assume that the “office fill” is the best way to have the LapBand adjusted.  Take some time to read through this information about office fills, and contact your Doctor if you have any questions.

Facts About LapBand Office Fills

  • It is a fast profitable growing medical business as the LapBand population increases in number
  • It is very rare that the Bariatric Surgeon is involved with the lapband fills
  • The Office Fills are cheap for most of the patients
  • No need for Doctor’s infrastructure (fluoroscopy)
  • It is easily done at the Doctor’s office
  • The Nurse is often in charge of doing the fills for patients
  • There is a learning curve to adjust the gastric band properly
  • The fill might go into the fat instead of the port, and the need to return for another fill is frequently seen
  • You can get a leak from the hose due to needle puncture or penetration (due to multiple intents to reach the port’s target area) 
  • The Doctor will not know your lapband status with an office fill
  • The Doctor can’t detect early avoidable complications

 Office fills are an option for lapband adjustments. However, we do recommend having lapband fills done under fluoroscopy guide. If this is not possible, have your lapband checked under fluoroscopy at least once a year to determine the status of your lapband system and to check for any complications.

 

Arturo Rodríguez, MD

Bariatric Surgeon

http://www.thebariatric.com

http://www.bandstersforum.com

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Getting to Know You…

August 17th, 2012


Getting to Know You…

Learn More About your Bariatric Surgeon

Dr. Arturo Rodríguez is a highly skilled, compassionate surgeon with more than 13 years of surgical experience. He is a member of the American Society for Metabolic and Bariatric Surgery and Johnson & Johnson Proctor. He has performed more than 6,500 weight loss surgeries for patients from Mexico and the United States.

Dr. Arturo Rodríguez understands the life-changing effect that Bariatric Surgery can have on an individual, and he is committed to providing long-term support for his patients as they embark on their journey to healthier and happier lives.  Dr. Rodríguez specializes in minimally invasive laparoscopic Gastric Banding Surgery-Lap Band, Gastric Sleeve and Gastric Bypass which greatly reduces scarring and postoperative recovery time.  He is highly skilled in placing and monitoring both the Lap Band and the Realize band, and he personally consults with each one of his patients to determine which procedure best suits their needs. His extensive experience and education also allows him to help patients who suffer from complications of morbid obesity.

Dr. Rodríguez and his professional medical team are dedicated to providing expert care and compassionate support from the first consultation through years of follow-up.  Patients also receive long-term support through follow-up consultations, interaction with Dr. Rodríguez in the online forum and patient reunions held in Monterrey.

To schedule an in-person or online consultation with Dr. Rodríguez and learn more about your weight loss options, you can contact him at: 

ArturoRodriguez, MD

md@thebariatric.com

http://www.thebariatric.com

http://www.bandstersforum.com

Phone: 011-52-81-8378-3177.

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Obesity: Is Fast Food Responsible?

August 10th, 2012

Obesity: Is Fast Food Responsible?

The reasons for obesity are multiple and complex.  Despite conventional wisdom, it is not simply a result of overeating.  Research has shown that in many cases, the significant underlying cause of morbid obesity is genetic. Studies have demonstrated that once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief.  

Science continues to search for answers but, until the disease is better understood, the control of excess weight is something patients must work at for their entire lives.  That is why it is very important to understand that all current medical interventions, including the Lap Band, Gastric Sleeve and Gastric Bypass procedures should not be considered medical cures. Rather, they are attempts to reduce the effects of excessive weight and alleviate the serious physical, emotional and social consequences of the disease.  

Contributing Factors  

The underlying causes of severe obesity are not known.  There are many factors that contribute to the development of obesity including genetic, hereditary, metabolic, environmental, and eating disorders.  There are also certain medical conditions that may result in some special type of obesity, such as the long term intake of steroids and some diseases such as hypothyroidism and hyper-adrenalism

Genetic Factors  

Numerous scientific studies have established that your genes play an important role in your tendency towards excess weight gain.  The body weights of adopted children show no correlation with the body weights of their adoptive parents, who feed them and teach them how to eat.  However, their weight does have an 80 percent correlation with their genetic parents, whom they have never met.  As well, identical twins with identical genes, show a much higher similarity of body weights than do fraternal twins.

Certain groups of people, such as the Pima Indian tribe in Arizona and the growing Mexican-American population have shown a very high incidence of severe obesity. They also have significantly higher rates of diabetes and heart disease than other ethnic groups.  

We probably have a number of genes directly related to weight.  Just as some genes determine eye color or height, others can affect the appetite by increasing the amount of secretion of the Ghrelin Factor by the stomach, or the ability to feel full, satisfied, or have an early age-related change in metabolism. Our fat-storing ability, and our natural activity levels may even be affected by some predetermined gene. 

Environmental Factors

Environmental and genetic factors are obviously closely intertwined.  If you have a genetic predisposition toward obesity, then the modern American lifestyle and environment may make controlling weight more difficult.  Fast food, long days sitting at a desk or in front of a TV screen or monitor, and suburban neighborhoods that require cars all magnify hereditary factors such as metabolism and efficient fat storage.   For those suffering from morbid obesity, anything less than a total change in environment usually results in failure to reach and maintain a healthy body weight.  

Metabolism

We used to think of weight gain or loss as only a function of calories ingested and then burned. Take in more calories than you burn, gain weight; burn more calories than you ingest, lose weight. But now we know the equation isn’t that simple.  Obesity researchers now talk about a theory called the “set point,” a sort of Thermostat in the brain that makes people resistant to either weight gain or loss. If you try to override the set point by drastically cutting your calorie intake, your brain responds by lowering metabolism and slowing activity. You then gain back any weight you’ve lost.

Eating Disorders & Medical Conditions

Weight loss surgery is not a cure for eating disorders. And there are medical conditions, such as hypothyroidism, that can also cause weight gain. That’s why it’s important that you work along with your doctor to find out whether you have any conditions that should be treated with medication and counseling.

 

Arturo Rodriguez, MD

http://www.thebariatric.com

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LapBand Surgery in Mexico

August 3rd, 2012

LapBand Surgery in Mexico

When most people go away on vacation, it is to soak up the sun, see new things, meet new people, and to relax and “get away from it all.”  However, more and more people are going away to experience a different kind of tourism: medical tourism. This involves a person traveling away from their native country to have a health care procedure done in a different country.   People have all sorts of medical procedures done abroad: everything from joint replacement to cosmetic surgery is performed on such medical-based trips. Mexico is a country many people go to for such procedures In fact, having lapband surgery in Mexico is becoming more and more popular.

Lapband makes restriction to food intake

Lapband makes restriction to food intake

Many people are going to Mexico for lapband surgery. This surgery is something many believe will change their lives. Lapband surgery helps people who suffer from obesity to work towards returning to a more normal or healthy weight. Because of the price, many people are forced to have the surgery done in different countries, especially since some insurance companies will not cover the procedure.

As a person usually has to pay out of pocket for a surgery that they believe will save their life, they will head to countries where the procedure is less expensive.  For many people, lap band surgery is their last shot at being healthy.  Thus, for people who do not have insurance or a regular doctor, going to Mexico is a logical choice.After all, once the surgery is done, they can then relax in a new or exotic location where no one has to know about their surgery. Privacy is a major reason for why people choose to have surgery and other medical procedures done abroad. They may not want their friends, family members, coworkers, or doctors to know that they had a little work done. This could be because they do not want to worry the people in their life, or it could be because they want to appear refreshed at all times.

There are a number of things to take into account when considering LapBand surgery - make sure you are well informed before making the decision to have the procedure.  Many Mexico based doctors have set up support forums and telephone consultations so that you can get the information you need to make a decision.  Here’s a testimonial from a patient of Dr. Arturo Rodríguez, who practices in Monterrey, Mexico:

Lapband success

“My name is Linda Pearce I’m 58 years old. I found Dr. Rodriguez’s web site and after much research I knew he was the Doctor for me.  I had my lapband surgery  Oct. 2005. I have loss 85 lbs.  My  whole life has changed because of Dr. R and his team. The hospital and care in Monterrey Mexico was awesome, better than some of the hospitals in the States. Everything went just as they told me it would from being pickup at the airport to going to the hospital and back. Thank you Dr. Rodriguez and your team. You guys are the best. My life has changed forever.”

For more information on the lapband and Realize band procedure, visit The Bariatric Group

http://www.thebariatric.com

http://www.bandstersforum.com

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Simplified Gastric Bypass

July 27th, 2012

Simplified Gastric Bypass

What is Gastric Bypass Surgery?

The Gastric Bypass is considered as the “gold standard” of Weight Loss Surgery by the American Society of Metabolic and Bariatric Surgeons (ASMBS).  Roux-n-Y Gastric Bypass Surgery (RYGB) is the most commonly practiced weight loss surgery world wide.

The Gastric Bypass is also considered by the SAGES and ASMBS as the most complex and technically challenging procedure to be done by laparoscopy and requires a large number of operations to achieve competency.

Open RYGB as treatment for obesity was introduced by Dr. Mason and Dr. Ito in 1967. The first Laparoscopic RYGB was performed in 1994 by Dr. Wittgrove following the surgical steps of the open surgery.

The Simplified Gastric Bypass was developed by Dr. Almino Ramos in Sao Paulo, Brazil and was called Simplified Laparoscopic Gastric Bypass consisting in simplifying and standardizing the surgical steps of the traditional Gastric Bypass in a way that it can be done in the superior half of the abdomen easily, by trained Bariatric Surgeons with less operative time (average of 75 minutes) and with more efficiency.  Today, thousands of patients are operated by this technique all over the world.

The Simplified Gastric Bypass technique involves a gastric stapling, and its division (forming the gastroplasty, new gastric chamber or pouch), lowering the gastric capacity by 90% (20-30cc). The Gastric Bypass is done ante-colic (the open way was retro-colic, meaning that was done behind the transverse colon) and as far as 1.5 to 2 m (the small bowel has 4 to 7 m in length).  At the end of the procedure, the gastroplasty is connected with the deviated intestinal limb (gastrojejunostomy) by stapling and suturing them, to allow the food to pass again.

What are the Risks of Gastric Bypass Surgery?

International literature describes an average of 10% of cases with complications (morbidity), and a 2% mortality rate.  Anastomotic leak is the most serious complication of gastric bypass procedure and is associated with increased morbidity and mortality.  The ideal treatment is prevention by meticulous operatory technique and pre and postoperative care.  The leaks that are likely to result in mortality (about 15%) are those for which the patient manifests a high systemic inflammatory response, and is closely related with a high BMI, with fever, increased leukocyte count and heart rate and also signs of organ failure.

How does the Gastric Bypass Work?

This operation involves two effects: predominant gastric restriction, and intestinal malabsorption.  The food arrives at the new stomach (gastroplasty) and promotes distention on the walls of the pouch, inducing satiety and fullness with small amounts of food.  Then the food passes slowly through the calibrated gastrojejunostomy of 11 mm and proceeds for digestion (1.5 to 2m after the new formed gastric pouch).  When the fullness sensation of the small chamber is exceeded, pain or vomiting can occur.

After a Gastric  Bypass, the liquids with high concentration of carbs will not be totally absorbed, especially during the first year.  This may result in “dumping syndrome” where the food moves too quickly into the small intestine.  Symptoms include bowel irritation, abdominal pain, diarrhea, and increased heart rate with palpitation and sweating.

What happens post-op (after surgery)?

Most of the patients are discharged from the hospital within 48 to 72 hours after the operation. The complete return to normal activities occurs in about one week.  During 4 weeks following the operation, the patient should consume a liquid diet, and advance in a stepwise way to a puree/baby food type diet for one or two additional weeks, eventually evolving to an almost normal diet by the fourth week.  In this operation there is a need to supplement vitamins and minerals. Iron must be followed by regular I.V. tests and reposition is usually needed.

Who  would benefit from a Gastric Bypass?

  • Patients with a metabolic disease (Type 2 diabetes, high blood pressure, hyper-lypidemia)
  • Persons with any degree of binge eating disorder
  • Moderate risk patients (few co-morbidities)
  • High expectations (those who need to lose weight, up to 80% EWL [excess weight loss])
  • Low to moderate patient commitment

 

Arturo Rodriguez, MD

http://www.thebariatric.com

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THE IMPORTANCE OF LAPBAND POST-OP DIET

July 20th, 2012

 

 

THE IMPORTANCE OF LAPBAND POST-OP DIET

Why the post-op diet is so important, specifically the liquid phase after lapband surgery? 

Brazil bariatric Conference

Brazil bariatric Conference

People seem to think that while they are in the liquid phase and can “cheat”
by eating some solid foods nothing would happen but the truth is that lapband dislocation due to the increased force by solid food and the increased pressure over the “New Stomach” or “Pouch” at this time could be an early cause of the slippages that we can see later on a banded patient.

I try to tell people that their stomach is moving and trying to push the food down to the restricted area and churning on the inside to digest solid food and we want to keep the stomach as still as possible for that first week after surgery. So even though they don’t “feel” like it’s hurting anything, they could be.

Let’s remark that the purpose of the diet it’s not for starting the weight loss but mainly for the healing after the Lap Band surgery, that way you will avoid stretching the pouch and also will help you by letting the sutures to be firmly attached and to hold the lapband in the right position.

Stomach irritants as coffee, alcohol, coke, concentrated orange juice, vinegar, hot food, etc, will increase an early restriction to food and will also cause vomiting that appears to favor the lapband dislocation.

I like the patients to have the 1-2 diet, this means: One week of liquids, two weeks of soft foods and after that you can start with normal food.

You will achieve some weight loss during this time depending on the excess weight you started at and can be from 10 to 25 pounds. 

I personally like to recommend the “South Beach Diet” after the lapband, the sleeve or the gastric bypass because is mostly a protein diet and is a healthier diet for the circulatory system than other type of diets.

Arturo Rodriguez, MD

http://www.thebariatric.com

http://www.bandstersforum.com

http://www.bandagastricaonline.com

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Obesity: Surgery as a Weight Loss Option

July 13th, 2012

Obesity: Surgery as a Weight Loss Option

Obesity: Health Risks

Morbid obesity is a disease of excess energy stores in the form of fat (BMI >40 kg/m2).  Being overweight is associated with many physical problems which are now well recognized in both the medical community and general population.  Serious consequences of severe obesity are well documented and include cardiac dysfunction, pulmonary problems, digestive diseases, and endocrine disorders as well as obstetric, orthopedic, and dermatologic complications.  Obesity is also linked to an increased prevalence of cardiovascular risk factors known as Metabolic Syndrome. These include Hypertension, Type 2 Diabetes Mellitus, Hypertriglyceridemia, Hyperinsulinemia and low levels of high density lipoprotein (HDL) cholesterol.

The risk for diabetes has been reported to be about twofold in the mildly obese, fivefold in moderately obese and tenfold in severely obese persons. The duration of obesity is also an important determinant of the risk for developing diabetes. The association between average weight of population groups and the prevalence of non-insulin-dependent diabetes has been repeatedly observed.

Cancer mortality rates are increased in severely obese females; e.g. endometrium (5.4 times), gallbladder (3.6 times), uterine cervix (2.4 times), ovary (1.6 times), breast (1.5 times). Cancer mortality rates are increased in severely obese males; e.g. colorectum (1.7 times), and prostate (1.3 times). The morbidly obese patient is also at risk for affective, anxiety and substance abuse disorders. People who are obese often consider their condition as a greater handicap than deafness, dyslexia or blindness.

Managing Obesity: What are the Options?

For people that are overweight or obese, weight loss can results in significant improvements to their health and decrease the risks for developing many long-term chronic diseases.   Statistically significant improvements have been observed in both diabetes and hypertension, with >10 percent weight loss, and in cardiovascular conditions, with only a 5 percent weight loss of overall body fat for overweight patients.

Generally, the first option for weight loss is a change in diet and exercise.  Many people have had success when sticking to a realistic plan and making permanent lifestyle changes.  However, for those that have struggled with morbid obesity, diet and exercise may not be sufficient to see the degree of change that they require in order to improve their overall health and achieve a healthy weight.

The use of anorectic medications has recently been advocated as a long term therapeutic modality in management of what is clearly a chronic disease. In a nearly four year study, utilizing a two drug regimen of Phentermine and Fenfluramine, behavior modification, diet and exercise, the initial optimistic results have not been sustained, with a one third drop-out rate and a final average weight loss of only three pounds in those who were followed for the four years of the study. This drug combination appears to have an unacceptably high association with cardiac valvular disease and has been withdrawn from therapeutic use because of these potentially life threatening sequelae.

Bariatric Surgery

Published scientific reports document that non-operative methods alone have not been effective in achieving a medically significant long term weight loss in severely obese adults. It has been shown that the majority of patients regain all the weight lost over the next five years.

For people who have exhausted other options such as diet and exercise, Bariatric Surgery may be medically necessary to achieve long term weight control for the morbidly obese. Bariatric surgery involves reducing the size of the gastric reservoir, with or without a degree of associated malabsorption. This can assist patient to improve their eating behaviors dramatically, which reduces caloric intake and ensures that the patient practices behavior modification by eating small amounts slowly, and chewing each mouthful well.

Success of bariatric surgical treatment must begin with realistic goals and progress through the best possible use of well designed and tested operations. These have been worked out over the last thirty years, and are now standardized, clearly defined procedures, with well recognized and documented outcome results including the Lap Band, Gastric Sleeve, Gastric Bypass and Duodenal Switch.

Prevention of secondary complications of morbid obesity is an important goal of management. The biological basis for morbid obesity is unknown, though recent work has demonstrated a genetic component of between 25 and 50%. Several studies confirm the influence of genetically determined proteins produced by the fat cell to be among the many mechanisms which have a place in the control of satiety. These studies confirm that morbid obesity is a disease, not a disorder of willpower, as sometimes implied. The physiological, biochemical and genetic evidence is overwhelming that morbid obesity is a complex disorder. Contributing causes include family history, environmental, cultural, socioeconomic and psychological factors.

Is Bariatric Surgery for Anyone?

The option of surgical treatment should be offered to patients who are morbidly obese, well informed, motivated, and acceptable operative risks. The patient should be able to participate in treatment and long term follow-up. A decision to elect surgical treatment requires an assessment of the risk and benefit in each case. Increased abdominal fat or “central obesity” (apple shaped as opposed to pear shaped or “external obesity”) is an important risk factor associated with the major complications of obesity.

Functional impairments associated with obesity are also important deciding factors for surgical treatment. Patients whose BMI exceeds 40 are potential candidates for surgery if they strongly desire substantial weight loss, because obesity severely impairs the quality of their lives. They must clearly and realistically understand how their lives may change after any of the operations.

In the USA and under certain circumstances, less severely obese patients (with BMI’s between 35 and 40) also may be considered for surgery, and in Mexico, patients with BMI 30 or more are considered for surgery. Included in this category are patients with high risk co-morbidities such as life-threatening cardiopulmonary problems (e.g. severe sleep apnea, Pickwickian syndrome, obesity-related cardiomyopathy, or severe diabetes mellitus). Other possible indications for patients with BMI’s between 35 and 40 include obesity-induced physical problems that are interfering with lifestyle (e.g. musculoskeletal, neurological, or body size problems precluding or severely interfering with employment, family function and ambulation).

Available published series report that the immediate operative mortality rate for Vertical Banded Gastroplasty, Roux-en-y Gastric Bypass and Lap band is relatively low.  Morbidity in the early postoperative period (i.e. wound infections, dehiscence, leaks from staple breakdown, stomal stenosis, marginal ulcers, various pulmonary problems, and deep thrombophlebitis) may be as high as ten percent or more. Splenectomy is necessary in 0.3% of patients to control operative bleeding. However, the aggregate risk of the most serious complications of gastrointestinal leak and deep venous thrombosis is less than one per cent. In the late postoperative period, other problems may arise and may require reoperation. The mortality and morbidity rates of reoperation are higher (30%) than those of primary operations.

Complications and Risks of Bariatric Surgery

The most frequent “major” complications for bypass patients were GI leak (0.73%), GI hemorrhage or bleeding (0.44%), and small bowel obstruction (0.40%). Simple restrictive procedures (vertical banded gastroplasty, Gastric sleeve) with no bypass were reported to have GI leak (0.47%) and stoma obstruction or stenosis (0.35%) as the most frequent defined major complication. Lap band does not show leaking.

Risk and efficacy of operations for obesity must be understood in the context that severe obesity is a chronic, frequently progressive, life threatening disease. The therapeutic program applied should be designed to be beneficial throughout the patient’s lifetime. Long term follow-up is essential when reporting treatment effectiveness. Weight loss usually reaches a maximum between 18 and 24 months postoperatively. Mean percent excess weight loss at five years ranges from 48 to 74 % after gastric bypass and from 50 to 60% after vertical banded gastroplasty.

Pure gastric restrictive procedures such as vertical banded gastroplasty (VBG), silastic ring gastroplasty (SRG) and adjustable silastic gastric banding (AGB or LAPBAND) all achieve weight loss by restricting volume of intake. Intake becomes a function of the patient’s motivation to chew well and eat slowly. Failure to do so may result in repeated vomiting and isolated cases of protein and vitamin deficiency have been reported in these circumstances. Careful patient follow up is therefore mandatory, with particular emphasis on the first three postoperative months. Adjustable silastic gastric banding (LAPBAND) approved in 2001 for use in the USA following FDA trials can be considered functionally similar to vertical banded gastroplasty.

Gastric bypass with Roux-en-y (RGB) results in ingested food bypassing the gastric fundus, body, antrum, duodenum and a variable length of proximal jejunum. In consequence, these patients are at risk to develop iron deficiency secondary to lack of contact of food iron with gastric acid and consequent reduced conversion of iron from the relatively insoluble ferrous to the more absorbable ferric form. In addition, vitamin B12 deficiency may result in consequence of food no longer coming in contact with gastric intrinsic factor. Vitamin D and calcium absorption may also be reduced since the duodenum and proximal jejunum, which are the preferential sites of absorption, are bypassed by this procedure. Life long supplements of multivitamins, vitamin B12 iron and calcium are mandatory following this procedure. Long-term follow-up is essential for physical, nutritional and metabolic evaluation.

Weight Loss: Benefits

Weight loss surgery has been reported to improve several comorbid conditions such as glucose intolerance and frank diabetes mellitus, sleep apnea and obesity associated hypoventilation, hypertension, and serum lipid abnormalities.  A recent study showed that Type II diabetics treated medically had a mortality rate three times that of a comparable group who underwent gastric bypass surgery. Benefits also include increased ambulation, and decreased incidence of clinical depression, among a wide variety of improvements on a long-term basis.

 

Arturo Rodriguez, MD

http://www.thebariatric.com

http://www.bandstersforum.com

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John Daly and the Realize Band

July 6th, 2012

 John Daly and the Realize Band

From when John Daly began playing golf at the age of 4 he showed a remarkable ability to play all aspects of the game. People around him knew that someday he would be one of the great golfers of history. In 1991, John was named by the PGA as the Rookie of the Year, and the following year became the youngest player to win the most difficult and competitive course, The British Open at St. Andrews.
Along with the fame and fortune for this young golfer was also the darker side. The alcohol, the women, the gambling and his personal behavior caused him problems with the PGA and as a result he was suspended on several different occasions.

john-daly-before-lapband-golfer.jpg1 
John’s life changed dramatically from the ups and downs. With his health deteriorating and his weight increasing, John got to the point that he could hardly finish a round of the game that he was once the master of.
It took a call from his 17 year old daughter to start him on the path to reclaim his life. At now 370 lbs, John knew that his weight was an urgent need to get under control. Diets weren’t working for him, so he began to seek advice on what else could be done.
He had a picture of a Gastric Bypass patient and decided that he wanted more control over the speed and the quantity of weight loss. He also was resistant to the idea of taking medications for life to counteract the malnutrition aspect of bypass surgery.
He also looked at a relatively new procedure called a Gastric Sleeve, but decided that he couldn’t be assured of the results he was looking for. He also learned that while the Gastric sleeve procedure has been shown effective as a metabolic procedure, there aren’t long term results as a weight loss procedure.
The Lapband procedure is a very low risk, simple procedure with a very quick recovery time that would allow John to be back in the golf course and also been in control of the amount and speed of his weight loss.
John Daly took the right decision for himself, got the Lap Band AP, and now that he has returned to the game he has finished at the top 5 in 3 events in Europe and is ready for the PGA Tour again.

john-daly-Realizeband-golfer 
I am hoping he can make it to our next Get-Together the first weekend in December and play a round of golf at “La Herradura” with a bunch of fan-banded patients.

 

 

Arturo Rodríguez, MD

http://www.thebariatric.com

http://www.bandstersforum.com

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Bariatric Procedures: Being More than Fans

June 29th, 2012

Bariatric Procedures: Being More than Fans

The last 10 years I have been very busy participating in a lot of meetings around the world.  I have found, unfortunately, that we have spent such a long time discussing what procedures are the best for treating obesity that we have forgotten the main point, the core of any of the procedures’ success: the patient.

We all look like fans of a football team, cheering for their favorite team.  Some doctors cheer for the Gastric bypass as the best and only option to cure obesity. Then we have the doctors that prefer the lapband as the first option. In another corner, there are the doctors that promote the Gastric sleeve as the new treatment for obesity and Type 2 Diabetes.

There are several good medical reasons involved in the doctor’s preferences for one procedure over the other but also their preferences points toward which procedure the doctor feels more comfortable performing or is more skilful.  In Mexico, we have to add to this discussion, the place were the doctor was trained, for instance, if he was trained in the Mexican Health Care System they will know very little about the Lap band and would prefer to perform the Gastric Sleeve or the Gastric Bypass.  This is because the Lap band is not yet available for the government hospitals.  This means that these doctors started with Bariatric procedures such as the Gastric Bypass 3-4 years ago, and the Gastric Sleeve 1-2 years ago.

I personally recommend the Lap band as the first option. There is less risk for operatory complications involved, it is less expensive and it’s adjustable.   You don’t have to be overly obese to have the Lap Band.  You can have Lap band revision in case the lapband fails the first time or jump to any of the other procedures available including the Duodenal Switch. The Lap-band also helps in the control of co-morbidities related to obesity such as high blood pressure or Diabetes in almost 6 out of 10 patients.

The arguments against having the Lap band as the first option are valid with patients that have difficult behavioral control such as alcohol abuse. Arguments are also valid for patients that don’t like the idea of having lapband fills done periodically or when there isn’t a doctor or center to do the fills close to where they live.  The arguments against the Lapband that are not valid, are erosion rates (less than 2 %), slippage (less than 4 %), or obtaining insufficient weight loss as a strong argument for deciding on other surgical options such as the Gastric sleeve or Gastric Bypass.

There are no “complication free” bariatric procedures.  With any bariatric procedure there are advantages and disadvantages.  We also found that with all bariatric procedures, there is a chance for insufficient weight loss and a chance that patients may need revision surgery. Mean percent excess weight loss at five years ranged from 48 to 74 % after Gastric Bypass and from 50 to 60% after Vertical Banded Gastroplasty, the same results are for the Gastric Sleeve.

However, with all this in mind, we must remember that the best and most effective procedure will ultimately depend on the individual patient that is looking for a weight loss procedure.  The patient and doctor must work together to discover all the facts and make the best informed decision in order to be successful. Don´t rush your decision – get informed!

 

Arturo Rodríguez, MD

http://www.thebariatric.com

http://www.bandstersforum.com

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