Confused

 Ok, so I have gone into this surgery thing 110% sure I wanted Lap Band.  Now Im questioning it because Im afraid I wont lose the amount of weight I need to lose.  I have about 200lbs to lose and I dont know if most people will lose all their weight or even close to it with the band having that much to lose.  Any suggestions?  My mom works with a girl around my age 28, maybe a little younger who had laproscopic bypass and she said it wasnt that bad.  I need advice from other people though.  My mom is concerned about me having bypass but understands why I would choose that but I dont feel like I have the support from anyone else.  Im also concerned about pregnancy if I have bypass.  Anyone with any info good and bad on either PLEASE let me know.  THanks

Mary

I didn't have as much to lose as you do when I had my surgery, but one thing I will say is that you will get out of the band what you put into it.  It is just a tool and will not do the work for you.  If you are lucky and reach restriction early it will be a little easier, but you still have to put in the work.
If you are doubting your choice you need to put sometime into researching both surgeries to make the best choice for you.  Only you can make this decision that is right for you.
Good luck!

Hi Mary, My best advice is to really research all types of wls, the good, the bad, the ugly. The more you know the better you will be prepared to not only choose the surgery that is right for you but to live with it. Remember, you are going in to this as a life long thing. No wls is right for every person.

The best thing I think you can do is to read up on each surgery on the informational portion of OH, then start reading studies that show some common complications, results, etc. Your surgeon is a good resource, but remember that some surgeons like to sway people toward their pet surgeries. Don't allow that. Ask their percentages of complications, regain, low weight loss rates, etc. BTW, no (as in not one) wls provides perfect weight loss until you are skinny. You will have something to do with this, but your body will have it's say, too. The band doesn't guarantee you will lose every bit of it, though there is no time limit within to do it as there is with RNY. The DS will come closest, though there are many who stop before they want. The band and RNY end up being about even after about 3 years, though people with RNY will usually lose it faster. The sleeve is good, but not perfect, either. Read, read, read. Read on the other forums. Sometimes it is better to not even ask questions for a bit but to just read others experiences. Read blogs, too. Learn to differentiate between people who have created their own problems and those who have done the right things and have not gotten the results they wanted. It is good to know what to do and what not to do. Don't rush this phase, don't let anyone make the final decision for you. you take responsibility for you since you will be living with it.

There are distinctive problems with the band that can occur later on, like slips, erosions, and such that are reduced by good surgical technique, good follow up, and good eating habits. HOWEVER, they also happen for no explainable reasons. They are more rare now than several years ago, but we all fear them. More minor problems can be with port flips, tubing problems, etc. They may need an additional surgery to repair. Other than erosions that lead to damage, the problems are ;rarely life threatening, but you need to be aware of them. If you don't like to do follow up the band is not for you. If you aren't committed to lots of hard work the band is not for you. If you are self pay it would end up being very expensive for you, long term. Other things you need to know are that the band will do nothing to help you lose weight. You do it. When you have finally had enough fills (that could take months, and for some it never happens), the band is designed NOT to make you feel full or make you stop eating. It helps you to feel more satisfied or not experience real hunger for 3-5 hours on small meals. You may not feel full, you may just not feel true hunger for that time. That means all the head hunger battles are yours. It will not work if you eat sugary foods, white carbs, slider foods like chips, cookies, candies, ice cream, etc. Nor will any wls totally compensates for those. Sorry.

Now that I have you scared off I will say that I chose my band in spite of it all and am glad. I am new to it, though. There are others who are much farther out that I am and still love there's some that have lost much more weight than me, and some that have hated theirs. You need to find out for yourself in your research. The same goes for the other surgeries.

As far as I know there are no restrictions on pregnancy with any wls. Only that it is important that you not become pregnant for about 18 months after. Your surgeon can explain all this to you. Make sure you check your surgeon out very, very well. Their aftercare, too.

If you are not willing and prepared to make major changes in your lifestyle for the rest of your life then you should avoid wls altogether. I am so grateful for this opportunity for a new life and for the health benefits I have gotten. I also know that even a few years ago I would not have been ready to undertake this journey. It is a very tough one but well worth it to me.

Good luck to you.
Sue

Out of the four surgery choices (lapband, RNY, VSG and DS) the band has the worst stats. Lowest weight loss, highest regain, most long term complications. Check out the revision board and the other surgery boards - tons of lapband revisions. I would highly recommend VSG if you want restriction only or DS if you need malabsorption.

Please read these studies:

Adjustable gastric band to sleeve conversions/revisions 

September 18th, 2010 Posted in Bariatric surgery, LapBand, Realize Band, Vertical gastrectomy, Weight loss surgery results, surgical weight loss, weight loss plan, weight loss surgery  As the popularity of adjustable gastric banding has increased in the United States, so have the problems associated with this approach to weight loss. Issues with band slips, erosions and most commonly inadequate weight loss surgery results or weight regain have become an increasing problem which weight loss surgery physicians must now address. Long-term data on the success of the adjustable gastric band (LapBand® and Realize® Band ) has shown consistent results with regards to surgical weight loss. Published studies in bariatric laparoscopic surgery report average percentage excess weight loss (%EWL) of 30%-60%, but vary widely.   The most accurate reports appear to indicate a range of 40%-55% EWL in patients who have been followed for more than 5 years. Perhaps a more important issue (and more neglected) is the long-term complication and failure rate of these devices. Some reports in the literature looking at results in patients 8-10 years after surgery report up to a 25% explantation (removal) rate, 6-10% rate of reoperation to address complications and 40% failure rate. With more than 400,000 adjustable gastric bands implanted worldwide, this stands to become a sizable problem.   Because of these issues, forward-thinking bariatric surgeons have implemented strategies and algorithms to deal with failures and complications of these devices. Dr. Paul Cirangle, a pioneer of and one of the world’s experts on the Vertical Sleeve Gastrectomy (VSG), deals with conversions from the adjustable gastric band (AGB) to the Sleeve Gastrectomy on a frequent basis. He has recently reviewed his extensive bariatric surgery experience with these conversions and has found some very interesting findings. The incidence of patients complaining of “troubled eating" (pain with swallowing, regurgitation, heartburn or reflux) was extremely high (>60%), even in individuals who were successful in losing weight with the band. Among those who were not successful in losing an adequate amount of weight, many stated that dense foods were so uncomfortable to consume. This results in gravitating towards softer foods such as mashed potatoes and pasta, making it essentially impossible for them to reach their surgical weight loss goals.  In the time period between July 2005 and July 2010, 69 adjustable gastric bands have been revised to a Vertical Sleeve Gastrectomy. The results in terms of %EWL, reduction of appetite and overall sense of satiety have been excellent – essentially the same as in patients undergoing a sleeve gastrectomy as a primary procedure.   When asked about the subjective difference, all patients concurred that the VSG produced little or no episodes of “troubled eating" and was universally superior in regards to satiety and suppression of appetite in comparison to the AGB.

27 June 2010

ASMBS: Gastric Banding Gets Low Marks

ASMBS:  Gastric Banding Gets Low Marks,LAS VEGAS -- Adjustable gastric banding achieves only modest weight loss, and even that benefit deteriorates over time in most patients, a Dutch surgeon said here.
Five years after surgery, about two thirds of patients maintained 25% excess weight loss. At 10 years the success rate dropped to less than a third (31%).
Using 40% excess weight loss as the standard resulted in a five-year success rate of about 50%, which declined to 20% at 10 years, Edo Aarts, MD, reported at the American Society of Metabolic and Bariatric Surgery meeting.
Control of obesity-related comorbid conditions deteriorated similarly over time.
"If you perform adjustable gastric banding, you must realize that this is not the final solution, most of the time, for your patients," said Aarts, of Rijnstate Hospital, Amhem, The Netherlands.
Reviewing the history of adjustable gastric banding, Aarts noted that initial results were encouraging when the procedure was introduced in the early 1990s. Gastric banding achieved good results with respect to excess weight loss and was associated with a low risk of morbidity and mortality.
The five-year results have been mixed, as some studies showed durable weight loss and others deterioration of initial benefits. Because of the procedure's relatively recent introduction, little information has accumulated regarding the long-term results with adjusted gastric banding, Aarts said.
Rijnstate Hospital has the most active bariatric surgery program in The Netherlands, he continued. Surgeons perform more than 800 procedures annually, and more than 3,000 patients have undergone laparoscopic adjustable gastric banding.
Aarts and colleagues evaluated results in 201 patients who had laparoscopic adjustable gastric banding procedures during 1995 to 2003. All the patients had rigorous follow-up at three-month intervals during the first year and then annually thereafter. As a result, 99% of the patients had complete follow-up data, which spanned an average of 9.6 years.
The patients had a mean baseline age of 37, and women accounted for three fourths of the cohort. Baseline body mass index averaged 46 kg/m², and 20% of the patients met the definition of super obese. Excess body weight averaged 83 kg.
Using excess weight loss >25% to define treatment success, Aarts and colleagues found that adjustable gastric banding was successful in about 80% of patients during the first three years, followed thereafter by a steady decline to 64% at 5 years and 31% at 10 years.
When treatment success was defined as band in place and excess weight loss >40%, the success rate was 70% at one year, 64% at three years, 50% at five years, and 20% at 10 years.
A third of patients had undergone reoperation after five years, increasing to 53% at 10 years. The incidence of band removal increased from 0.5% at one year to 11% at five years and 35% at 10 years. Conversion to Roux-en-Y gastric bypass accounted for half of all reoperations.
Control of diabetes, hypertension, and gastroesophageal reflux disease all deteriorated significantly (P<0.01) over time. In particular, the incidence of new-onset diabetes and hypertension increased during follow-up, as did the proportion of patients requiring acid-suppression therapy.
On the basis of the results, surgeons at the Dutch center have begun to re-evaluate their use of adjustable gastric banding for treatment of obesity. What role, if any, the procedure will play in the future has yet to be determined, said Aarts. Obes Surg. 2006 Jul;16(7):829-35.

    A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Suter M, Calmes JM, Paroz A, Giusti V. Department of Surgery, Hôpital du Chablais, Aigle-Monthey, Switzerland.

Abstract

BACKGROUND: Since its introduction about 10 years ago, and because of its encouraging early results regarding weight loss and morbidity, laparoscopic gastric banding (LGB) has been considered by many as the treatment of choice for morbid obesity. Few long-term studies have been published. We present our results after up to 8 years (mean 74 months) of follow-up.   METHODS: Prospective data of patients who had LGB have been collected since 1995, with exclusion of the first 30 patients (learning curve). Major late complications are defined as those requiring band removal (major reoperation), with or without conversion to another procedure. Failure is defined as an excess weight loss (EWL) of <25%, or major reoperation.   RESULTS: Between June 1997 and June 2003, LGB was performed in 317 patients, 43 men and 274 women. Mean age was 38 years (19-69), mean weight was 119 kg (79-179), and mean BMI was 43.5 kg/m(2) (34-78). 97.8% of the patients were available for follow-up after 3 years, 88.2% after 5 years, and 81.5% after 7 years. Overall, 105 (33.1%) of the patients developed late complications, including band erosion in 9.5%, pouch dilatation/slippage in 6.3%, and catheter- or port-related problems in 7.6%. Major reoperation was required in 21.7% of the patients. The mean EWL at 5 years was 58.5% in patients with the band still in place. The failure rate increased from 13.2% after 18 months to 23.8% at 3, 31.5% at 5, and 36.9% at 7 years.   CONCLUSIONS: LGB appeared promising during the first few years after its introduction, but results worsen over time, despite improvements in the operative technique and material. Only about 60% of the patients without major complication maintain an acceptable EWL in the long term. Each year adds 3-4% to the major complication rate, which contributes to the total failure rate. With a nearly 40% 5-year failure rate, and a 43% 7-year success rate (EWL >50%), LGB should no longer be considered as the procedure of choice for obesity. Until reliable selection criteria for patients at low risk for long-term complications are developed, other longer lasting procedures should be used.   PMID: 16839478 [PubMed - indexed for MEDLINE]Free Article


  Outcomes after laparoscopic adjustable gastric band repositioning for slippage or pouch dilation



   AACE/TOS/ASMBS Guidelines


  Study of Gastric Bypass vs. Banding Has Mixed Results



Laparoscopic Adjustable Gastric Banding in 1,791 Consecutive Obese Patients: 12-Year Results

Weight loss (kg, BMI, %EWL) for the entire series is shown in Table 3 and in Figures 2, 3 and 4.
At 10 years, the average weight was 101.4 ± 27.1 kg (loss of 26.3 kg), the BMI 37.7 ± 9.1 (loss of 8.5
points) and the %EWL was 38.5 ± 27.9.
Results of morbidly obese (BMI ≤49) and superobese (BMI ≥50) were separated into two groups for evaluation/comparison and weight loss in terms of kg and BMI is reported in Table 4 and shown in Figures 5 and 6. At 10 years the weight of the morbidly obese group was 94.6 ± 18.0 kg of the superobese group and was 123.2 ± 38.5 kg, indicating weight losses of 23.8 kg and 29.6 kg, respectively.
At 10 years, the BMI in the morbidly obese group was 35.2 ± 5.4 and in the super-obese group was 44.9
± 13.9, down 7.4 and 11.3 points, respectively. The %EWL in the morbidly and super-obese groups is reported in Table 5 and shown in Figure 7. At 10 years, %EWL was 40.3 ± 27.6 and 36.0 ± 30.2, respectively.
Table 3. Weight loss (kg, BMI, %EWL) of the entire series
Time      Weight                             BMI                                                  %EWL*
0            127.7±24.3                     46.2±7.7                                                ---
1 y         103.7±21.6                     37.7±7.1                                            40.3±19.7
2 y         101.5±23.3                     36.8±7.6                                            43.7±21.7
3 y         102.5±22.5                     37.2±7.2                                            41.2±23.2
4 y         104.1±23.5                     37.8±7.5                                            38.6±24.4
5 y         105.0±23.6                     38.1±7.6                                            37.3±25.3
6 y         105.3±24.6                     38.1±8.1                                            37.4±28.2
7 y         106.8±24.3                     38.5±7.9                                            35.9±26.7
8 y         105.0±24.0                     37.8±7.9                                            37.7±26.7
9 y         103.3±26.2                     37.5±8.5                                            38.5±27.9
10 y       101.4±27.1                     37.7±9.1                                            35.4±29.6
11 y       101.2±31.9                     38.1±11.5                                          38.4±32.8
12 y         84.0±27.5                     31.6±8.5                                            49.2±49.5
Values are mean ± SD. *Based on Metropolitan tables (to put this in perspective my BMI is 38 right now, I'm 5'4" and 220 lbs)




Lap Band Complications (this information was at one time on Allegan's web site but has since been removed nope - found it  http://www.lapband.com/en/learn_about_lapband/safety_information//)
Patients can experience complications after surgery. Most complications are not serious but some may require hospitalization and/or re-operation. In the United States clinical study, with 3-year follow-up reported, 88% of the 299 patients had one or more adverse events, ranging from mild, moderate, to severe. Nausea and vomiting (51%), gastroesophageal reflux (regurgitation) (34%), band slippage/pouch dilatation (24%) and stoma obstruction (stomach-band outlet blockage) (14%) were the most common post-operative complications. In the study, 25% of the patients had their gastric banding systems removed, two-thirds of which were following adverse events. Esophageal dilatation or dysmotility (poor esophageal function****urred in 11% of patients, the long-term effects of which are currently unknown. Constipation, diarrhea and dysphagia (difficulty swallowing****urred in 9% of the patients. In 9% of the patients, a second surgery was needed to fix a problem with the band or initial surgery. In 9% of the patients, there was an additional procedure to fix a leaking or twisted access port. The access port design has been improved. Four out of 299 patients (1.3%) had their bands erode into their stomachs. These bands needed to be removed in a second operation. Surgical techniques have evolved to reduce slippage. Surgeons with more laparoscopic experience and more experience with these procedures report fewer complications.   Adverse events that were considered to be non-serious, and which occurred in less than 1% of the patients, included: esophagitis (inflammation of the esophagus), gastritis (inflammation of the stomach), hiatal hernia (some stomach above the diaphragm), pancreatitis (inflammation of the pancreas), abdominal pain, hernia, incisional hernia, infection, redundant skin, dehydration, diarrhea (frequent semi-solid bowel movements), abnormal stools, constipation, flatulence (gas), dyspepsia (upset stomach), eructation (belching), cardiospasm (an obstruction of passage of food through the bottom of the esophagus), hematemsis (vomiting of blood), asthenia (fatigue), fever, chest pain, incision pain, contact dermatitis (rash), abnormal healing, edema (swelling), paresthesia (abnormal sensation of burning, *****ly, or tingling), dysmenorrhea (difficult periods), hypochromic anemia (low oxygen carrying part of blood), band system leak, cholecystitis (gall stones), esophageal ulcer (sore), port displacement, port site pain, spleen injury, and wound infection. Be sure to ask your surgeon about these possible complications and any of these medical terms that you don't understand.


Do your research - you only want to cut once and insurance may not cover a revision in the future. If your insurance covers the band then you can fight and win for a surgery that will work for you.

Good luck!

 Thanks everyone!!  Im definitely ready for surgery, just not 100% anymore which one.  If im going to have surgery I want to have the result I want.  My doctor said I was a better candidate for Bypass because I have so much to lose but he said I could lose just as much with the band as long as I work hard.  I will definitely keep doing research.

Mary, here's something I want you to consider, okay? Most of us MO and SMO folk have no problem losing weight. Whether by conventional semi-starvation diets or through other means, most of us have lost weight before. The issue for us shouldn't be 'losing' weight but, keeping the weight off. That said, I chose as my vehicle for weight loss maintenance, the DS. I'm not here to hijack your thread or anything but, just to share my reasons for choosing the DS. My main reason is that there is no other surgery more effective for KEEPING the weight off than the DS. None. I understand folk who want to rah-rah for their particular surgery and that's okay. There are many who lose a crap ton of weight...only to put it back on over a period of the next 10 years. That's one thing I don't like about the OH forums. You get to see the rah-rah posts in the beginning but, as the weight starts to be regained, people fall away.

Also consider this. Not to say that the DS doesn't involve work (labs, taking your vits, etc.) but, I'm sure you've worked your ass off for years dieting, working out and everything else. Why not choose a surgery that you don't have to look at as a 'tool' or something you'll have to work hard on, to make it? From the science, and anecdotal evidence I've seen, your DS keeps working for you even many years after you've had the surgery. Sure, you gotta be vigilant in getting in your vits and getting your labs for the rest of your life but, this is stuff you should be doing anyway. Is this 'work' to you? If so, then it's much easier than all the dieting and crap I've done over the years. I don't get the self-flagellation that comes into play when we choose a surgery, as if we need to choose the one that makes us work the hardest, lest we fail to 'earn' our weight loss.

I think you're doing well to consider and reconsider your options. Measure twice (or more) and cut once. If you're going to do this, then do it the best way right from the start. Good luck to you!

Nicely said, Mark!

To the OP, check out my profile. I had to lose almost 200 pounds.

Even each doc I spoke with who sold the band in Chicago said I would never lose all my excess weight with it and that I would probably gain back at least half of my lost weight after a few years. Now, that's also what they said about the gastric bypass (RNY), so those horrible stats from the very sellers of those procedures made me seek an alternative: the duodenal switch (DS). Man, am I happy I did!!!!

You have some competent DS surgeons in Ohio. Go get a consult with at least one of them. Find them on the list at www.dsfacts.com. See what you think after meeting with them.

You have more options than thr damn band and RNY.

Nicolle

Sue (Grannymedic) says it brilliantly.

Just to agree, unless you have a complication (and these can happen with any surgery) you get out of the band what you put into it. All my band does for me is give me an on-off eating switch which i never had before! It doesn't stop me eating all the wrong foods! You have to work with your band and it is not as easy as some people expect it to be!

But there are many people who have lost large amounts of weight. I "only" had just over 100 to lose and that went in 15 months.

Kate

Kate,
I just have to say I enjoy you and a couple others on this board.   I'm having my lap band surgery in 6 days.  I'm going thru the liquid/protein diet right now.   But that is not why I'm writing.   I don't write on here much since I pretty much get my answers from what others have asked already.    But I'm so glad to see long time bandsters like you on here.   It gives me hope on what I am about to do.   Not that I'm not scared.   I really am.   But I know it's the best for me.   And at the top of my list I was NOT expecting this surgery to be the cure all for my weight loss.   If it was there would not be any heavy people walking around!!!   And very rich doctors!!!   I know that I'm getting another tool to use for my weight loss.   Between this band telling me when I've had enough to eat, the diet & exercise I know I'll make it.  I have great support both at home and at the support group I attend.    It may take me a year or two but I believe I'll make it.  I feel sorry for Mary on this board she's getting alot of  "advice" from people.   Anyway I just wanted to let you know you are an inspiration and I'll keep looking for your posts.  

Susan

Susan, my best wishes. peopel who had the band and for whom it did not work are often, very understandably, bitter - and we do need to hear their stories. But the band stats can genuinely be misleading as far as complcations are concerned as to be of any use stats must go back over  years. And the design and the method of implantation of the band have changed. I actually wrote to Allergan about the stats they quote on their website (which show high levels of complication) and they said that in recent years the stats are improving but that as studies are over time, the earlier bands are still skewing the figures.

And the lower loss stats are as you woudl expect bearing in mind that whether we lose or not is much more down to us than it is with other surgeries.

Kate