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.
http://www.bandstersforum.com/
Originally posted 2009-10-23 16:31:10. Republished by Blog Post Promoter
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Dr. Rodriguez,
I was banded December 2008. The most fluid I’ve ever had in my band is 5cc in a 10cc band. I have had to steadily take fluid out and add fluid in since December of 2009 due to my band totally closing up on me on a couple of occasions. In September of 2010 I started getting occasional reflux. At that time I had 4.7 cc in my band. My surgeon’s PA took 1/2 a cc out and that relieved it for a time. The reflux started again and I was under alot of stress so I thought I had an ulcer. My PCP gave me Zantac and my surgeon took out half my fluid leaving me with 2cc. That worked until November. My PCP then put me on Nexium and referred me to a GI doc who did an EGD in January and diagnosed me w/ a hiatal hernia and told me to take all fluid out of my band and and have it repaired. My surgeon took all fluid out and I got a UGI w/ barium. The Radiologist told me I didn’t have reflux but I was still suffering from it every night. On 6/23/11 my surgeon did a diagnostic laproscopy and repaired a prolapse and my hiatal hernia. I was only given enough Lortab for 2 days and have been taking Aleeve for the pain since I went back to work yesterday. Last night at midnight, 5 hours after taking Aleeve I awoke with a feeling of my diaphram in my chest and throat. I stood up and it felt like my stomach was pulling up on my band. I tried to lay back down to see if it would pass. An hour later I got up and took some extra strength tylenol which went down but was kind of painful while going down. An hour later the pain stopped. To me, it felt like my stomach was spasming. Today I was able to take my medication and I have no trouble keeping fluid down but I’m sore in my band area. Is this normal? Is my body rejecting the new placement of the band? Will I need to have it removed?
Hello Shani,
I need to know all kind of medications you usually take besides the ones your doctor gave you for the hernia and reflux.
I Need to know also what kind of beverages you drink every day and if you ever have vomited for any reason.
It is not normal what is happening to you, what kind of repair of the hiatal hernia your doctor did? Did he put a mesh or just sutures and what type of technique did he uses?
I had the lap band put on 11/24/2010 I am 53 years old wt 258 at that time now it is allmost 11months I only lost 25 pousnes gain last month 5 pousnds. I excercisie water arobics watch what I eat I have a 10cc lap band I have 5.4cc in the lap band. I could eat normally maybe once or twice I feel like trowing up. I think the band over strech what do you think I can do I just cant belive i only lost just a little pounds in 11months please help nelsa
p s please excuse the spelling also please let me know if there is something I am doing wrong. thank you again. (p s my gyn doctor told me last week I had blood work done and said every thing is good except that I am now going thur menopause.
Hello Nelsa,
You need more adjustment of the Lapband.
Get another LapBand fill under fluoro and I think you will start again loosing weight.