Archive for the ‘Stomach erosion’ Category

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

Thursday, December 1st, 2011

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

Originally posted 2008-10-11 08:04:24. Republished by Blog Post Promoter

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Posted in Gastric band Procedure, Gastric Band surgery, Gastric Banding, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Stomach erosion, Weight loss surgery | 2 Comments »

Lap Band Erosion: Clinical, Radiological and Endoscopic Correlation

Wednesday, September 21st, 2011

Lap Band 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 Lap Band 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 lap band 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 lap band). Due to the erosion, saliva or food leaks through the hole or ulcer in the stomach and flows along the Lap Band tubing, causing the tissue under the skin of the Lap Band 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 Lap Band Erosion can be made at the radiological evaluation performed under 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  Lap Band Port Infection

Due to the fact that Lap Band 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 Lap Band Erosion.

endoscopy-findings1

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

Figure 1.2  Endoscopic View of Lap Band Erosion

endoscopy-findings-tips2

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

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

erosion-xray

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

Figure 2.0 – Intragastric Lap Band 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 Lap Band 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 Port – AP 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 Lap Band 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 its early 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 around the 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 Lap Band Erosion – Radiograph from upper gastrointestinal series shows characteristic appearance of intragastric lap band 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 lap band 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 lap band 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 Lap Band Erosions with another bariatric procedure 6 to 8 months after a de-banding procedure (Lap Band 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 Lap Band 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

http://www.thebariatric.com

 

Originally posted 2008-08-09 23:51:53. Republished by Blog Post Promoter

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Posted in Gastric band Procedure, Gastric Band surgery, Gastric Banding, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Stomach erosion, Weight loss surgery | 62 Comments »

Lap Band Trials – Reviewing the Results

Wednesday, September 7th, 2011

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

Originally posted 2008-08-13 07:55:28. Republished by Blog Post Promoter

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Posted in Gastric band Procedure, Gastric Band surgery, Gastric Banding, gastric bypass, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Stomach erosion, Weight loss surgery | No Comments »

De-Banding the LapBand Can be Complicated

Wednesday, August 3rd, 2011

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

Originally posted 2008-04-28 13:27:42. Republished by Blog Post Promoter

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Posted in gastric sleeve, Lap Band procedure, Revision Surgery, Stomach erosion | 2 Comments »

Lap Band Erosion

Tuesday, October 12th, 2010

Lap Band 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 “Lap Band” which stands for Laparoscopic Gastric Banding.  The term “Lap Band Erosion” also became very popular among the banded patients as lap band message boards increased in popularity. The patients that already had the Lap Band 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 Lap Band 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 Lap Band 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 Lap Band 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 Lap Bands 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 Lap band 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 Lap Band Erosion be Prevented?

There are several ways to prevent erosion.  The first way that I personally recommend is to avoid “large fills” to the Lap Band, 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

Originally posted 2008-06-12 21:18:18. Republished by Blog Post Promoter

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Posted in Gastric band Procedure, Gastric Band surgery, Gastric Banding, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Stomach erosion, Weight loss surgery | 203 Comments »

What If my Bariatric Procedure Fails?

Tuesday, September 28th, 2010

What If my Bariatric Procedure Fails?

Patients can have minor or large complications after a Lap Band, 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 Procedure Failure?

Depending on the type of procedure (Lap Band, 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 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, Bariatric 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 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/

Originally posted 2008-07-27 21:53:21. Republished by Blog Post Promoter

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Posted in Gastric band Procedure, Gastric Band surgery, Gastric Banding, gastric bypass, gastric sleeve, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Revision Surgery, Roux-n-Y, RYGB, Stomach erosion, Weight loss surgery | 2 Comments »

What is the Best Surgical Weight Loss Procedure for Me?

Monday, September 6th, 2010

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

Originally posted 2008-06-26 00:34:53. Republished by Blog Post Promoter

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Posted in Gastric band Procedure, Gastric Band surgery, Gastric Banding, gastric bypass, gastric sleeve, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Revision Surgery, Roux-n-Y, RYGB, Stomach erosion | No Comments »

Lap Band Office Fills

Monday, August 30th, 2010

Lap Band Office Fills

Your Lap Band 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 Lap Band Office Fills. Many people assume that the “office fill” is the best way to have the Lap Band adjusted.  Take some time to read through this information about office fills, and contact your Doctor if you have any questions.

Facts About Lap Band Office Fills

  • It is a fast profitable growing medical business as the Lap Band population increases in number
  • It is very rare that the Bariatric Surgeon is involved with the lap band 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 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 lap band status with an office fill
  • The Doctor can’t detect early avoidable complications

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

 

Arturo Rodríguez, MD

Bariatric Surgeon

http://www.thebariatric.com

http://www.bandstersforum.com

Originally posted 2008-07-19 22:32:22. Republished by Blog Post Promoter

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Posted in Gastric band Procedure, Gastric Band surgery, Gastric Banding, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Stomach erosion, Weight loss surgery | 3 Comments »

Bariatric Procedures: Being More than Fans

Monday, June 28th, 2010

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

Originally posted 2008-11-13 22:11:41. Republished by Blog Post Promoter

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Posted in Gastric band Procedure, Gastric Band surgery, Gastric Banding, gastric bypass, gastric sleeve, Gastric Sleeve Mexico, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Revision Surgery, Roux-n-Y, RYGB, Stomach erosion, Weight loss surgery | No Comments »