Banded Plication

I went to the surgeon who originally placed my lap band today to talk about the surgery I need to have to remove it due to erosion and subsequent revision surgery.  I had my head completely reconciled with having vertical sleeve revision and then he threw in a new option.

For the past year, he has been doing banded plication surgery.  In my particular situation, due to the erosion, we would do the surgery to remove my band first, give my stomach time to heal, and then I would have a second surgery to revise to the banded plication.

For those of you who are not familiar with this procedure, it involves folding the stomach in on itself and stitching it to achieve a sleeve like effect.  This is a similar procedure to the old stomach stapling procedure but much more effective due to technique and the usage of sutures as opposed to staples.  Then, he will place another band at the top of the sleeve thereby essential having two weight loss surgeries at one time. 

My understanding is that the plication is better for achieving immediate weight loss, the band is better for long term weight loss.  Combining them is essentially the best of both worlds with a few added benefits.

First, because you have restriction from the plication, you don't have to fill the band as fast or as much in order to achieve satisfactory restriction.

Second, because of the more slender shape of the stoma*****idences of slippage are greatly reduced.

Third, there is no need to dissect 90% of your stomach.

Fourth, if you do have a problem with the band, it can be removed and you will still have restriction from the plication.

As always, there can be complications.  Sutures can come undone.  There can be necrosis of the upper part of the stomach right below the band.  My understanding is that so far, the complication rate is extremely minimal and weight loss results have been comparable to the sleeve.

I have to admit that the thought of not having to cut my stomach is appealing to me.  At the same time, the thought of putting in another band after my first one eroded is a little unnerving.  My surgeon is not pressuring me to do either one.  He wants me to do what I'm comfortable with but he is very excited about the results he has seen with this surgery.

I am 52 and this is more than likely my last chance at getting to be where I want to be.  This is still considered to be investigational and is not covered by insurance but I believe the majority of the costs will be covered by research study funds.

I have complete confidence in my surgeon.  He secondary specialties are liver transplants and pediatric surgery and he is always at the cutting edge (pardon the pun) of the latest and greatest bariatric surgeries.  I just want to do the right thing for me.

My instinct is to let him get in there and take out my band, take a look around and see what kind of damage my band did to my insides.  Then, make a more educated decision about which surgery would be right for me.  As an aside, he completely refuses to do gastric bypass.

What would you do??

I've made my share of, shall I say ill informed decisions, but I hope that I would never subject myself to not one, but two surgeries of questionable value.  Why on earth, with one band failure, would you even consider having another one?  And while not getting cut sounds attractive, have you actually read about the pilcation?  From what I understand, it is not reversable because when you fold the stomach together it forms adhesions so there is no real chance of reversing it.  You are basically turning your stomach into a mass of scar tissue.
The band works in a few cases but it seems that you aren't one of them.  And the pilcation just seems, well, stupid.  At the very least the track record is not there.
Get the band out, find out the damage and then if you want to have a revision, have it to something that may actually assist you in losing your excess weight and keeping it off, because as you said, you are not likely to have a third chance at this.
At the very least, get another opinion.

Please just say NO to plication and get the sleeve.  Surgeons, docs, etc., don't know everything. Don't just go by what they may tell you.  Just because they are docs does NOT mean they have the correct info to give you.  Take that band out and sleeve it up!!!

I'd get the sleeve like I choose.

It avoids the high complication rate that arises from plication.  These are well known and documented and are chiefly why few surgeons perform this surgery.

It avoids the complications that will ultimately arise from a band - you're already dealing with this once, and you're looking to put in another type of band again?  You've already soon you're disposed to erosion.

The removal of 85% is a pro in my book, removing the main source of ghrellin production in the body.  I would hate to have the challenge of have a 2-oz sleeve stomach while still having the crushing hunger pains I had before surgery.

Rather than looking at plication and banding as the best of both worlds, I would argue they are in fact the worse of both worlds, taking the riskiest elements of both procedures and tying them together.  They've gone in you once for the original band.  Then a second time to remove the band.  Then a third time to do banded plication.  Then a potential forth time to fix that in the future as well.

Yes, there can always be complicatoins - it may not be in your best interest to choose the path of highest potential complications.

Also... are you sure your surgeon knows what he's talking about?  He's sounding like a general surgeon rather than a bariatric surgeon.  Liver transplants?  Child surgery?  This is not a guy pouring all his efforts into bariatric surgery.  Just how many banded plicatoins has he performed so far?  And on what basis would he refuse to do a gastric bypass, a clearly successful and standard surgery for thousands of people for many years?  

What would I do?  I'd get away from that surgeon first.

I would also get second and third opinions from other bariatric surgeons.

There are a few people that have posted that had this done, they seemed to be very pleased with it. It is becoming slowly more attractive and more people are getting this done that do not want most of their stomach removed. It seems like the best of both worlds, faster weight loss and then having the comfort and the reassurance of the band keeping you at goal years out. I also hear with the plication erosion is less likely to occur due to the way the stomach is folded.

If something ever happens to my band (which I hope not, I am almost 7 years out and so far so good), this seems like a great alternative that I would look at. Keep us posted on the Lap band forum.

A couple of clarifications...........

This surgeon used to be Chief of Bariatrics at the local hospital which is currently the Center of Excellence in our area. He's not fly by night. He was one of the first surgeons in our area to perform the lapband when it first came out. He does surgery on children at Wolfson Children's Hospital which is one of the best in the country. The reason he is not Chief of Bariatrics at our local COE facility any longer is because he disagrees with the way they are doing things there. Good thing since this "COE" just had a $177m malpratice judgement against them for failure to recognize a leak in a sleeve patient who subsequently almost died and now has brain damage as a result of his complications and there are other malpractice lawsuits pending on this facility due to their poor care of patients.

As of a video he has on YouTube describing the procedure, he has done over 50 of these procedures. If you would like to see the description of the video, just go to YouTube and search for "banded plication Cywes"

I also want to make sure that when we are referring to plication that we are referring the way it is performed now, not "back in the day". He describes this in his video as well.

I hear everyone's concern about putting in another lapband and I share those concerns.

Again, he is not pressuring me to do the new experimental procedure. He just wants me to have all the options available to me because he knows I am anal about researching and because he knows how successful I was a band patient before it failed me.
I have consulted with another surgeon, he did not mention this procedure to me, then again, I didn't ask if there were any other options available. This surgeon operates of of the local COE and has had one sanction against him for leaving a piece of a lapband in a patient. One of the surgeons in his practice was the surgeon who performed the sleeve operation on the malpractice suit I referred to above.

One of the things that struck me most between the two surgeons was when I asked if the liver shrinking diet would be necessary prior to the surgery to remove my lapband. The doctor who operates at the COE said no. The doctor who wants to do the banded plication said absolutely yes since the band has adhered to my liver and since he will need to cut it away, he wants to avoid excessive bleeding. This made absolutely sense to me.

So my decision is not which surgeon I am going to use, it is which procedure I am going to have once I heal from the removal of my band.

Thanks for all the input everyone! I would especially LOVE to hear anyone who has had this procedure specifically.

One more thing, if you would like to read his credentials, go to the surgeon search, type in zip code 32256 and select Dr. Cywes. It's pretty damn impressive if you ask me.

I can't muster up any energy to try and talk you out of this.

This week has left me feeling the same, without the energy to talk someone back from the edge of a cliff. 

This is one of the posts when I miss the veterans who have left.