LOL!  I think you must have a HUGE "text support" group out in the world!  I know you have coached me via text a zillion times when I've had personal emergencies!  .....  I'm eating gluten free and loving life thanks to you!

BTW....I found a GF bread here in South Dakota (visiting for a few days) that tastes great and satisifes my "wanter" for the occasional sammy.  Udis! (a word you could say over and over and feel like you've really told someone off!)  calories are still high at 80 per slice so I have to budget into my week....calories & carbs.

Question....Last year I lost a lot of weight in Nov, Dec & Jan ...wasn't trying...then gained over the summer.  Now again....without trying...I'm losing weight big time.  What's up with that?  Does the chill just make me shake those little calories right out of my system?

Hugggzzz,
 

Am J Med. 2008 Oct;121(10):885-93.

Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures.

Tice JA, Karliner L, Walsh J, Petersen AJ, Feldman MD.

Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-1732, USA. [email protected]

Comment in:

• Am J Med. 2009 Jun;122(6):e9; author reply e11.

OBJECTIVE: Bariatric surgical procedures have increased exponentially in the United States. Laparoscopic adjustable gastric banding is now promoted as a safer, potentially reversible and effective alternative to Roux-en-Y gastric bypass, the current standard of care. This study evaluated the balance of patient-oriented clinical outcomes for laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass.

METHODS: The MEDLINE database (1966 to January 2007), Cochrane clinical trials database, Cochrane reviews database, and Database of Abstracts of Reviews of Effects were searched using the key terms gastroplasty, gastric bypass, laparoscopy, Swedish band, and gastric banding. Studies with at least 1 year of follow-up that directly compared laparoscopic adjustable gastric banding with Roux-en-Y gastric bypass were included. Resolution of obesity-related comorbidities, percentage of excess body weight loss, quality of life, perioperative complications, and long-term adverse events were the abstracted outcomes.

RESULTS: The search identified 14 comparative studies (1 randomized trial). Few studies reported outcomes beyond 1 year. Excess body weight loss at 1 year was consistently greater for Roux-en-Y gastric bypass than laparoscopic adjustable gastric banding (median difference, 26%; range, 19%-34%; P < .001). Resolution of comorbidities was greater after Roux-en-Y gastric bypass. In the highest-quality study, excess body weight loss was 76% with Roux-en-Y gastric bypass versus 48% with laparoscopic adjustable gastric banding, and diabetes resolved in 78% versus 50% of cases, respectively. Both operating room time and length of hospitalization were shorter for those undergoing laparoscopic adjustable gastric banding. Adverse events were inconsistently reported. Operative mortality was less than 0.5% for both procedures. Perioperative complications were more common with Roux-en-Y gastric bypass (9% vs 5%), whereas long-term reoperation rates were lower after Roux-en-Y gastric bypass (16% vs 24%). Patient satisfaction favored Roux-en-Y gastric bypass (P=.006).

CONCLUSION: Weight loss outcomes strongly favored Roux-en-Y gastric bypass over laparoscopic adjustable gastric banding. Patients treated with laparoscopic adjustable gastric banding had lower short-term morbidity than those treated with Roux-en-Y gastric bypass, but reoperation rates were higher among patients *****ceived laparoscopic adjustable gastric banding. Gastric bypass should remain the primary bariatric procedure used to treat obesity in the United States.

It is interesting how you sidestep much of what I said, or make strawman arguments – not addressing the points I made, but rather answering a question different from the one I raised but which you prefer to discuss.  You don’t even deny getting kickbacks, but change the conversation to whether DSers have staples – WTF?

Voluntary follow up for DSers is different from necessary follow up with bandsters to get adjustments.  Your band patients HAVE to return to your office for repeated adjustments to their fills.  I suspect your DSers just gave up coming for follow up appointments with you for some other reason having to do with your practice.  I don’t believe PacLap has this problem to nearly the extent you experienced it, because they have a dedicated support system, including Rabkin (who attends MANY support group meetings himself every month, flying all over the west coast, as well as to Chicago and TX to do so), his staff and a loyal and committed patient support system.  Why did this not happen in YOUR practice?

I’m not going to get into a battle of wits with you over your practice – I am interested in promoting FACTUAL information about the DS to pre-ops before they select which surgery they have, not specifically in beating down the lap band – there are plenty of others here who have personal experience with the band and who are fully able to make their own arguments against it.  I personally think the lap band is a CRAP band, that restrictive-only surgeries in general are doomed to fail for a significant percentage if not a majority of morbidly obese patients, and that the VSG is a superior surgery to the CRAP band if one insists on a restrictive-only procedure (though I think it too is doomed to fail for most patients in the long run – but at least it can be easily revised to a DS). 

My specific problem with YOU is your turnaround from your former DS practice to this, and the disinformation on your website.

I also think your statement that all of the surgeries work the same basic way is an out-and-out lie.  Restrictive-only procedures work through caloric restriction – period.  They are enforced diets, and they fail for the same reason that ALL diets fail – AND they will leave the patients worse off than they were before surgery when they do fail.  The DS fixes the metabolic issues at the root of obesity, by correcting the metabolic damage caused by genetics and yo-yo dieting.  And the 10 year stats that demonstrate 94% of DS patients are successful (having lost and maintained a loss of at least 50% of their excess weight – the standard used by most bariatric surgeons) is one that the lapband does not even remotely come close to.  Your statement “outcomes (weight loss over three years or more) are equal -morbidity and mortality is less- and patient satisfaction is higher with the band than with DS." is simply laughably ridiculous.  There is NO published study that I know of showing that weight loss over 3 years is equal between the lap band and the DS – that is PREPOSTEROUS.  And I doubt you can prove the patient satisfaction statement either – certainly there are quite a few unsatisfied lap band customers/victims on this very thread.

As I said, I am most dismayed and personally disappointed in YOU.  I met you in 2003, and you were a dedicated DS surgeon then.  You even said if you needed bariatric surgery, you would have the DS.  Now, it appears to me that you have sold out to the lap band franchise, performing an initially less risky but less effective surgery that requires less of your resources as a surgeon, and which likely provides you with a higher income.  I thought you were one of the good guys – but I was wrong.