Arturo Rodriguez, MD

Originally posted 2008-09-05 01:09:58. Republished by Blog Post Promoter

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January 2, 2010

Lap Bands: Truth or Myth?

Filed under: Gastric Band surgery, Gastric Banding, Gastric band Procedure, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Weight loss surgery — Tags: Health, Lap Band, Lap Band erosion, Lap band slippage, Lap Band USA, Realize Band — Dr. Arturo Rodriguez @ 5:39 pm

Lap Bands: 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.

Originally posted 2008-09-15 21:12:18. Republished by Blog Post Promoter

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December 19, 2009

The Answers to Gastric Sleeve Failures

Filed under: Gastric Band surgery, Gastric Banding, Gastric band Procedure, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Revision Surgery, Weight loss surgery, gastric sleeve — Tags: gastric sleeve, Health, Lap Band, Lap band complication, Lap Band Failure, Lap Band procedure, Lap band surgery, Sleeve, Sleeve Gastrectomy — Dr. Arturo Rodriguez @ 12:59 pm

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.

Originally posted 2008-09-11 19:41:17. Republished by Blog Post Promoter

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December 12, 2009

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

Filed under: Gastric Band surgery, Gastric Banding, Gastric Sleeve Mexico, Gastric band Procedure, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Plastic surgery after weight loss, RYGB, Roux-n-Y, Weight loss surgery, gastric bypass, gastric sleeve — Tags: breast lift, Gastic Bypass Surgery, gastric bypass, gastric sleeve, Health, Lap Band, Lap Band Mexico, Lapband, lower body lift, plastic surgery, plastic surgery after, surgery after weight loss, tummy tuck, weight loss — Dr. Arturo Rodriguez @ 9:45 am

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.

Originally posted 2008-10-23 08:17:51. Republished by Blog Post Promoter

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November 28, 2009

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

Filed under: Gastric Band surgery, Gastric Banding, Gastric Sleeve Mexico, Gastric band Procedure, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Weight loss surgery, gastric sleeve — Tags: gastric sleeve, Gastric Sleeve Mexico, Health, Lap Band, Lap Band cost, Lap Band Mexico, Lap band price, Lap Band procedure, medical tourism — Dr. Arturo Rodriguez @ 8:04 am

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.

Inamed-Allergan Lap Band Models:

Originally posted 2008-09-16 21:12:58. Republished by Blog Post Promoter

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November 21, 2009

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

Filed under: Gastric Band surgery, Gastric Banding, Gastric band Procedure, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Stomach erosion, Weight loss surgery — Tags: Health, Inamed Band, Johnson & Johnson Band, Lap Band, lap band AP, Lap Band Mexico, lap band VG, Quick Close lap band, Realize Band, Swedish band — Dr. Arturo Rodriguez @ 7:12 am

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”

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.

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

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July 20, 2009

Why My Weight Loss Procedure Can Fail?

Filed under: Gastric Band surgery, Gastric Banding, Gastric band Procedure, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, RYGB, Revision Surgery, Roux-n-Y, Weight loss surgery, gastric bypass, gastric sleeve — Tags: Bariatric Group, Gastic Bypass Surgery, gastric bypass, gastric sleeve, Health, Lap Band, Lap Band Mexico, Lapband, Lapband procedure, Lapband surgery, Obesity surgery, Realize Band, Simplified Gastric Bypass, Sleeve Gastrectomy, weight loss procedure — Dr. Arturo Rodriguez @ 10:09 am

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

Originally posted 2008-07-10 23:25:31. Republished by Blog Post Promoter

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Lap Band Office Fills

Filed under: Gastric Band surgery, Gastric Banding, Gastric band Procedure, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Stomach erosion, Weight loss surgery — Tags: Gastric Banding, Health, Lap Band, Lap Band fill, lap band office fill, Realize Band, weight loss, weight loss procedure, Weight loss surgery, WLS — Dr. Arturo Rodriguez @ 10:09 am

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

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

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Lap Band Erosion: Clinical, Radiological and Endoscopic Correlation

Filed under: Gastric Band surgery, Gastric Banding, Gastric band Procedure, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Stomach erosion, Weight loss surgery — Tags: Gastic Bypass Surgery, Gastric Banding, Gastric erosion, Health, Lap Band, Lap band complication, Lap Band erosion, Lap Band Failure, Lap Band fill, Lap Band Mexico, lap Band migration, Lap Band procedure, Lap band surgery — Dr. Arturo Rodriguez @ 10:09 am

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.

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 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.

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.

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

Figure 1.2 Endoscopic View of Lap Band Erosion

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

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

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

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.

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.

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 itsearly stages. However, the radiological appearance of late-stageintragastric 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.

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”.

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.

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

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

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Lap Band Surgery in Mexico

Filed under: Gastric Band surgery, Gastric Banding, Gastric band Procedure, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Weight loss surgery — Tags: Health, Lap Band, Lap Band Mexico, Lapband, lapband in Mexico, Lapband surgery, lapband testimonial, medical tourism, Realize Band — Dr. Arturo Rodriguez @ 10:09 am

Lap Band 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 lap band surgery in Mexico is becoming more and more popular.

Lapband makes restriction to food intake

Many people are going to Mexico for lap band surgery. This surgery is something many believe will change their lives. Lap band 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:

“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 lap band 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

Originally posted 2008-12-12 21:44:47. Republished by Blog Post Promoter

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What If my Bariatric Procedure Fails?

Filed under: Gastric Band surgery, Gastric Banding, Gastric band Procedure, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, RYGB, Revision Surgery, Roux-n-Y, Stomach erosion, Weight loss surgery, gastric bypass, gastric sleeve — Tags: Gastic Bypass Surgery, gastric bypass, gastric sleeve, Health, Lap Band, Lapband, Realize Band, Revision Surgery, Simplified Gastric Bypass, weight loss procedure — Dr. Arturo Rodriguez @ 10:09 am

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.

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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10 Ways to Succeed with the Lap Band

Filed under: Gastric Band surgery, Gastric Banding, Gastric band Procedure, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Weight loss surgery — Tags: Gastric Band surgery, Gastric Banding, Health, Lap Band, Lap Band procedure, Lapband, Lapband surgery, Realize Band — Dr. Arturo Rodriguez @ 10:09 am

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 Lap Band:

1. Search for the Right Doctor for You
Many companies or groups claim to be the Best Experts in Lap Band 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 lap band 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 Lap Bands 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 lap band 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 Lap Band Procedure:

5. Begin the Journey: Develop Good Habits
After Lap Band 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 lap band. 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 Lap Band Expectations
Imagine yourself at the end of the “Lap Band 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 Lap Band 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 Lap Band 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 Lap Band 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 lap band 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 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 lap band 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

Originally posted 2008-05-31 20:39:08. Republished by Blog Post Promoter

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Old Treatments For Weight Loss Are New For Diabetes

Filed under: Gastric Band surgery, Lap band surgery, Obesity, Obesity surgery, Revision Surgery, Weight loss surgery, gastric sleeve — Tags: bilio-pancreatic diversion, Diabetes, Duodenal Bypass, duodenal switch, gastric bypass, Health, Incretins, Lap Band, Metabolic syndrome, Type 2 Diabetes — Dr. Arturo Rodriguez @ 10:09 am

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

Originally posted 2008-05-19 19:15:45. Republished by Blog Post Promoter

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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:

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.
The stomach damage done during the Lap Band procedure debilitates the layers of the stomach wall, resulting in erosion at a later time.
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.
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

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

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Lap Band Surgery and Exercise

Filed under: Gastric Band surgery, Gastric Banding, Gastric band Procedure, Lap Band procedure, Lap band surgery, Lapband, Lapband mexico, Lapband procedure, Lapband surgery, Obesity, Obesity surgery — Tags: after lap band, after lapband, Health, Lap Band, Lap Band Mexico, Lap Band procedure, Lap band surgery, Lapband, Lapband procedure, Lapband surgery — Dr. Arturo Rodriguez @ 10:09 am

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 surgery. It 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

Originally posted 2008-12-16 20:16:40. Republished by Blog Post Promoter

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Simplified Gastric Bypass

Filed under: Obesity, Obesity surgery, RYGB, Roux-n-Y, Weight loss surgery, gastric bypass — Tags: Add new tag, ASMBS, Gastic Bypass Surgery, gastric bypass, Gastric Bypass procedure, Gastric Bypass Surgery, Health, Roux-n-Y, RYGB, Simplified Bypass, Simplified Gastric Bypass — Dr. Arturo Rodriguez @ 10:09 am

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

Originally posted 2008-07-03 07:48:58. Republished by Blog Post Promoter

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Lap Band Trials – Reviewing the Results

Filed under: Gastric Band surgery, Gastric Banding, Gastric band Procedure, Lap Band procedure, Lap band surgery, Obesity, Obesity surgery, Stomach erosion, Weight loss surgery, gastric bypass — Tags: Allergan, Band explantation, Gastic Bypass Surgery, Health, Inamed Band, Lap Band, Lap Band Mexico, Lap Band procedure, Lap band surgery, Lap band trial, Lap Band USA, Lapa band, Lapband procedure, Lapband surgery, Realize Band — Dr. Arturo Rodriguez @ 10:09 am

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