XP: So undecided Band vs. VSG... So many concerns.
Ok, here's the quick and dirty of it:
I'm one month shy of 30 years old, female, 5'7'' and weigh about 250lbs, don't have children yet but plan on starting a family in the next 3-4 years. I've been on the fence about having weight loss surgery for years... know that I need help losing the weight but thus far have been unable to make a decision. Two years ago I started workup for WLS and did 6 months of nutritional education at the surgeon's office, after thinking hard and talking with surgeon decided that surgery wasn't for me.
Fast forward two years to now and I'm even heavier than I was then, and at this point am all done with pre-consultations and am ready to submit for insurance approval if I could just decide on a procedure. Surgeon suggests the VSG because of insulin resistance and hormonal benefits, but I also wonder if it's partly because they do 60% VSG and 40% other WLS combined, it's a research hospital and statistics are taken into account... though risks of band were brought up (erosion, slippage, potentially less weight loss than with VSG, etc.).
I guess I'm just wondering what people think-- I've talked with my best friend who's been banded and has lost all the weight she needed to... she's dead-set on the band, I've talked to a few MDs *****ally like the sleeve, and I've talked to some of my family and friends *****ally don't know much about either and who just want me to be healthy and comfortable inside my own body again.
As far as my lifestyle, I'm a volume eater for the most part, mostly at night when I'm at home, or on days off when I'm not being active and am mindlessly eating at home. At work (12+ hour shifts) I don't have time to take breaks except for my one lunch hour, and I don't have time to sip water/fluids throughout the day (barely time to go pee!), nor can I leave a bottle of water at any particular area in the work station (I work in healthcare and it's a violation of state health codes). So I worry with the VSG about not being able to get the proper hydration, though I'd hate to discount a good surgery and possibly the better choice for me just because of my work environment three or four days per week.
And then I think about the band, which would make it easy for me to stay hydrated, and I know that during pregnancy (sometime off in the future) you can have it unfilled for ease and comfort, but I worry about erosion and slippage, and about strictures that might develop where the band is compressing on the gastric pouch.
Sigh, I think I'm just nervous, and would appreciate any words of advice or suggestions people might have. I'm going to be emailing the nurse director of the program my surgical decision today so that she can submit for insurance approval this afternoon... I'd like to have surgery early in May when I have some planned time off from work, so that I don't use up all my sick time. I'm just so undecided and frustrated with myself over my indecision!
Thanks for listening and commenting,
Emily
In MY opinion the band is horrible. After years of fills and unfills, losing weight and gaining weight, restriction and no restriction the happiest day of my life was my revision surgery removing my band and getting sleeved. Was self pay for both and originally wanted something adjustable. WHY? It's not like I haven't been fat my whole life.
The last 2 months has been what I thought the band was going to be.
Good Luck on your decision and if you get the band there is a high possibility in the future you will need a second surgery to remove, correct or revise.
Please note this is only my opinion.
You want something permanent, you do not want to have to worry about removing your tool when it backfires on you as many do.. Many bandsters end up revising to the sleeve and say this is how they expected the band to work.. sooner or later.
I have had an easier recovery from this than I expected.. I am already getting in 60oz water, and 61g protein.. and have plenty of energy. The pain is moderate, and controlled well in the hospital- I was released with basically OTC meds and am doing great (stopped taking those yesterday.) I am comfortable, moving well (I can pick stuff up off the floor) and have been happy with my decision since my nausea in the hospital went away!
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I think having the Band though on this aspect of hydration will be infinitely easier-- no need to worry about breaking health codes by hiding tha****er bottle or stealing away into the break room and not being available on the unit because I can drink larger amounts of water at any time other than before or after meals as compaired to the VSG, which will limit the quantity of water or anything else I put into my mouth... unless I'm misunderstanding? If Banded, the restriction on fluids is nothing 30-45 min prior to or after meals, same as VSG. But if there's no finite volume to my stomach with Banding as with VSG, then during non-mealtimes there's much greater opportunity (and volume) to consume the proper hydration for people having had Banding. Does that seem right?
What I do wonder though is should I be making my decision just based on hydration? It seems silly to me, and I feel like I'm rationalizing (which I'm good at!).
Maybe it's cold feet, maybe it's my fear of elective abdominal surgery with the chance of any complications peri- or post-operatively whatsoever, but I just feel so torn. I think I might know in my heart of hearts that VSG is right for me, but then why am I dragging my feet so?
Sigh.>>>
I guess I'm wondering how, in your experience, getting those 60 OZ of fluids and 61 GM of protein is for you-- how long does it take you and over the course of the entire day, how many times approximately do you eat and drink to reach your goal? On days off for me, this is not a problem at all, but on work days, I just can't do it-- I can eat and/or drink before my shift starts, at my one scheduled lunch break, and then of course when I come home from work after 8pm, but that's it. I can imagine days that I work being a big challenge as far as ingesting enough protein and hydration with the VSG.
Just concerned I guess... and trying to see, as the surgeon sees, that this is the right procedure for me.
Do you have a water cooler? Do you have access to fresh water at work? You may need to take some extra time off in order to heal and keep yourself properly hydrated during the initial healing time, but I would also talk to your employer if you think it may be an issue.
I agree with your inner voice, you really shouldn't be making the call based on hydration.. and your job. You've got one life, and hopefully only one operation to get back to being healthy for the rest of your life.. your job should be secondary to YOU. Have you addressed any of these possible conflicts with your employer?
I had the band for 3.5 years and did not like it very much. It does help to a degree with overeating but realize that it can and will be finicky. Sometimes the area around the band may become inflammed and prevent you from even getting some thicker liquids down. Hormones and emotion also cause inflammation, not just food or chemicals...so if you're a highly emotional person(like me) then it could mess up your band.
You have to get fills and unfills....I didn't mind that too much, but you will be exposed to radation (if filled under fluroscopy), it does pinch (unless they give you a local) and you have to face the "moment" of shame or elation with the doctor (some docs really know how to make you feel like a failure if you come in with a substantial gain) everytime you go in. Also, with me, I never got that "satisfied" or "full" feeling and I know quite a few banders who didn't either. You also have risk of erosion or slip if you vomit sometimes often or just that once) you can get too tight and not be able to eat healthy foods and have to rely on multiple protein shakes per day OR learn that slippery foods go down alot easier! As you lose weight you just might have your port more visible as the fat above it thins out. I didn't mind that too much, I always like touching it but bumping up against , let's say a table edge, does hurt and of course, having others see it opens up their "right" to comment about how you took the easy way out, you're deformed, have gone against God, etc.....
I am getting the sleeve because it makes more logical sense to me overall. If part of my stomach is removed, then the full/satisfied feeling with be there because literally, the remaining stomach will be full! There is no remanent or below the band area of the stomach waiting for the food to further process down. Also there is not more stomach tissue calling out for more food. Although that is up for debate.
Once it's done, it's done....no more messing around with making/waiting for appointments, paying for fills/unfills, inflammation from food/liquids I ate/drank OR emotional/hormonal issues. No fear of erosion or slips. No fear of my port being too close to the surface of my skin (because I lost belly fat) that it INVITES comments. No flipping ports that require day surgery to replace. No fear of inexperienced doctors or techs over sticking my port causing leakage of the fill fluid making the band a mute tool....
What we have to contend with is loss or greatly diminished ability to manufacture/absorb intrinsic factor (vit B) ability to absorb vits and/or protein..at least in the first few years. That is why it is vital that we get going on BEFORE and especially after surgery a good quality vitamin/mineral regimen. Not as heavy as a DS patient, but a regimen that ALL wls patients need. Of course there are issues with the sleeve too....you can overstretch it over time, you can overstuff yourself which can be fatal, you can learn how to live on slippery foods or rely on multiple protein shakes like the band, I have heard that alcohol affects you much more rapidly. You also have to deal with social situations....people questioning you why you're not obviously eating as much as normal..etc, (that one is not too bad) and you have to learn a whole new way of looking at food because you won't be able to eat the volume you use to and that raises other emotional issues. The sleeve has been performed for years as the first stage of the DS and for gastric cancer/ulcer removal, so it does have substantial history.
So there you have my opinion. I am still scared of the operation (that is why I dont' have my sleeve now when I had my band removed) and to a lesser point food life afterwards. Start going to support meetings (more than one provider) get active on boards (take their advice and all sunshine posts with a grain of salt) and start doing some legwork now. Start to incorporate the diet guidelines of either surgery now. Start your vitamin/mineral and workout regimen now....you don't have to go hardcore but make an effort to learn it now because you will have no choice afterwards. Go to counseling about your fears before AND after surgery.
If you want to start a family, your time for surgery is limited...my hospital group recommends no pregnancy for AT LEAST 18 months. I'm too old now so that doesn't apply to me anymore.
Good Luck!
EDIT: The band can and does work. I know successful bandsters but I need more help. The band can be removed if necessary and your stomach will most likely return to it's normal shape which was the selling point for me when I had wls in the first place. However, it requires more work with the band (fills/unfills, etc) and my surgeon told me that it has a lifetime of approximately 10 years. I have now been informed that was wrong. So like all wls, the tool can work, but it is up to the operator to KNOW how to work it and be WILLING to work it!
I am seeing a therapist, as of January-- started for my consultation for bariatric surgery and have continued because it feels good to talk to someone unrelated to my personal or work life, and I do discuss some of these fears and issues relating to me coming first, failure and coping mechanisms with him. It's good. :)
I have been taking the vitamins for a while now-- I switched over to the chewables/gummies about a year ago when I knew bariatric surgery would be the right tool to help me on my journey towards better health. One thing I haven't really been able to stick 100% to just yet is the no fluids with meals. When I don't think about it I end up doing it just fine, but when I do really try to make the effort, fluids are the only thing on my mind and I end up drinking some when I eat. I'm getting better at that lately though, and know that by the time I have surgery I'll be a pro at it. 30-45 minutes really isn't that long to wait when you honestly consider it.
I'm just so appreciative of all of the support and advice that people offer on here-- it feels so good to know that there are resources like these forums out there to turn to with questions.
Thanks again, everyone!
Emily
I've had both. Think twice, cut once. I had every band issue out there, and it only lasted 8 months before I revised to the sleeve. Food getting stuck, not being able to eat decent food, and puking in public restrooms were trivial issues compared to the damage the band did to my stomach tissue. I lost more tissue during my revision, had a leak, and severe complications after my revision that resulted in a 3 month long, exhaustive and draining recovery. I obviously survived, and conquered every struggle, but let me just say that it was hell. I'm elated with my sleeve, and am almost 23 months out from my revision. I made it to goal in 6.5 months, lost a little more into maintenance, and maintained my loss for a year until I got pregnant and have gained about 3-4lbs in the last 11.5 weeks with the pregnancy. I'm able to eat enough to support my body and the baby. I have zero issue getting in fluids, or food, and am thriving in my pregnancy and life post-op in general. My labs are stellar, and always have been since being sleeved with zero deficiencies, and once I recovered, it's been smooth sailing. I can not imagine being pregnant with the band. I puked almost every day, throw in food intolerances, and puking on water some days with a barely filled band (I had less than 3.5cc in a 10cc band), really made staying hydrated challenging. The 64oz rule for fluid intake apply to the band as well, and I had to sip even slower with the band because the liquids have to seep out of the pouch instead of with VSG, liquids in, hit the pyloric valve and empty into the intestines.
Here is a study by the makers that might give you an idea on some of the complications that can happen. In this study, 1 in 4 (25%) of the 299 patients needed a second surgery to either repair, reposition, replace, or remove and revise the band.
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 band 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 dont understand.
Back to Top What are the specific risks and possible complications?
Talk to your doctor about all of the following risks and complications:
- Ulceration
- Gastritis (irritated stomach tissue)
- Gastroesophageal reflux (regurgitation)
- Heartburn
- Gas bloat
- Dysphagia (difficulty swallowing)
- Dehydration
- Constipation
- Weight regain
- Death
Laparoscopic surgery has its own set of possible problems. They include:
- Spleen or liver damage (sometimes requiring spleen removal)
- Damage to major blood vessels
- Lung problems
- Thrombosis (blood clots)
- Rupture of the wound
- Perforation of the stomach or esophagus during surgery
Laparoscopic surgery is not always possible. The surgeon may need to switch to an "open" method due to some of the reasons mentioned here. This happened in about 5% of the cases in the U.S. Clinical Study.
There are also problems that can occur that are directly related to the LAP-BAND� System:
- The band can spontaneously deflate because of leakage. That leakage can come from the band, the reservoir, or the tubing that connects them.
- The band can slip
- There can be stomach slippage
- The stomach pouch can enlarge
- The stoma (stomach outlet) can be blocked
- The band can erode into the stomach
Obstruction of the stomach can be caused by:
- Food
- Swelling
- Improper placement of the band
- The band being over-inflated
- Band or stomach slippage
- Stomach pouch twisting
- Stomach pouch enlargement
There have been some reports that the esophagus has stretched or dilated in some patients. This could be caused by:
- Improper placement of the band
- The band being tightened too much
- Stoma obstruction
- Binge eating
- Excessive vomiting
Patients with a weaker esophagus may be more likely to have this problem. A weaker esophagus is one that is not good at pushing food through to your stomach. Tell your surgeon if you have difficulty swallowing. Then your surgeon can evaluate this.
Weight loss with the LAP-BAND� System is typically slower and more gradual than with some other weight loss surgeries. Tightening the band too fast or too much to try to speed up weight loss should be avoided. The stomach pouch and/or esophagus can become enlarged as a result. You need to learn how to use your band as a tool that can help you reduce the amount you eat.
Infection is possible. Also, the band can erode into the stomach. This can happen right after surgery or years later, although this rarely happens.
Complications can cause reduced weight loss. They can also cause weight gain. Other complications can result that require more surgery to remove, reposition, or replace the band.
Some patients have more nausea and vomiting than others. You should see your physician at once if vomiting persists.
Rapid weight loss may lead to symptoms of:
- Malnutrition
- Anemia
- Related complications
It is possible you may not lose much weight or any weight at all. You could also have complications related to obesity.
If any complications occur, you may need to stay in the hospital longer. You may also need to return to the hospital later. A number of less serious complications can also occur. These may have little effect on how long it takes you to recover from surgery.
If you have existing problems, such as diabetes, a large hiatal hernia (part of the stomach in the chest cavity), Barretts esophagus (severe, chronic inflammation of the lower esophagus), or emotional or psychological problems, you may have more complications. Your surgeon will consider how bad your symptoms are, and if you are a good candidate for the LAP-BAND� System surgery. You also have more risk of complications if you've had a surgery before in the same area. If the procedure is not done laparoscopically by an experienced surgeon, you may have more risk of complications.
Anti-inflammatory drugs that may irritate the stomach, such as aspirin and NSAIDs, should be used with caution.
Some people need folate and vitamin B12 supplements to maintain normal homocycteine levels. Elevated homocycteine levels can increase risks to your heart and the risk of spinal birth defects.
You can develop gallstones after a rapid weight loss. This can make it necessary to remove your gallbladder.
There have been no reports of autoimmune disease with the use of the LAP-BAND� System. Autoimmune diseases and connective tissue disorders, though, have been reported after long-term implantation of other silicone devices. These problems can include systemic lupus erythematosus and scleroderma. At this time, there is no conclusive clinical evidence that supports a relationship between connective-tissue disorders and silicone implants. Long-term studies to further evaluate this possibility are still being done. You should know, though, that if autoimmune symptoms develop after the band is in place, you may need treatment. The band may also need to be removed. Talk with your surgeon about this possibility. Also, if you have symptoms of autoimmune disease now, the LAP-BAND� System may not be right for you.
Back to Top Removing the LAP-BAND� System
If the LAP-BAND� System has been placed laparoscopically, it may be possible to remove it the same way. This is an advantage of the LAP-BAND� System. However, an "open" procedure may be necessary to remove a band. In the U.S. Clinical Study, 60% of the bands that were removed were done laparoscopically. Surgeons report that after the band is removed, the stomach returns to essentially a normal state.
At this time, there are no known reasons to suggest that the band should be replaced or removed at some point unless a complication occurs or you do not lose weight. It is difficult, though, to say whether the band will stay in place for the rest of your life. It may need to be removed or replaced at some point. Removing the device requires a surgical procedure. That procedure will have all the related risks and possible complications that come with surgery. The risk of some complications, such as erosions and infection, increase with any added procedure.
SW 270lbs GW 150lbs CW Losing Pregancy Weight Maintenance goal W 125-130lbs