NOT anti-lapband - but having mine removed. Question about erosion etc.

I am having my lapband out. My severe insulin resistance (IR) just isn't anywhere and sadly I have to have my old friend removed.  I had my band placed in 2005. I am a bit OCD about things and have never thrown up from overeating or eating too big of bites. In fact, other than a little acid reflux (if I forget to take Prilosec I can feel it), I've had no problems. So my Endocrinologist suggestions a malabsorptive procedure instead, as they tend to affect the hormones in the stomach that help with the IR. Plus my health is getting worse so I need to do something. But my question is this. My surgeon is wanting to do an endoscope to make sure there is nothing "weird" going on (as in erosion etc.), to get a little idea of what he's getting into.  Can a person have erosion or something else and not even know it? I have no pain, no vomiting and I still get a bit stuck on certain foods that I normally try to avoid. Any help would be appreciated. Thanks!

Yvonne

Hmm...it seems like there would be some observable symptoms, but I guess you never know. I do think it is reassuring that your surgeon wants to confirm that everything is okay.

Just out of curiosity, did you have good restriction with your lap band and still were not successful in losing weight? What are the certain foods you get a bit stuck on?

(For disclosure purposes - I used to have a lap band and had all kinds of problems, didn't lose weight, and revised, but am super happy with my end results. I don't have any agenda behind my questions, I'm just nosy.)

Best of luck with the removal and new procedure! 

Lindsey

Hi Lindsey - I had a lot of problems getting restriction at first. I had a doctor far away. There are a lot of "armchair doctors" who insist to drive hours and hours to a "good" doctor and I'll tell you. It's not so great to have to drive like we did all the time for fills.  I had them once a month for quite a while.  We went on vacation to Walt Disney World about 4 months out. I was miserable. I would eat something and after 1 or 2 bites, it would sit there stuck.  I'd have to sip on ho****er water it felt like 100+ degrees. So I had a bunch taken out and then we tried again. I finally got to a point where I didn't get stuck all the time, but had good enough restriction to eat smaller meals. I mostly got stuck on even a bite of bread, or dry meat. But for a while, any time I ate before 3:00 in the afternoon or so, it would get jammed up.  I was SO hungry and couldn't eat anything. It was so depressing.

I lost 30lbs the first month because I was simply not hungry at all. I always hate saying this, because there are loads of people who don't believe me, but my obesity was caused from my severe insulin resistance and estrogen dominance.  I truly believe there are thin and heavy people who emotional eat and I think there are both thin and heavy people who don't. I say that because I wasn't eating a lot and still not losing weight.  My Endo actually warned me against the band as he said "I've seen you eat 800 calories a day and not lose anything". I did that for 3 months under his supervision.  So I'm not sure why I lost much (I ended up losing 70lbs - all within the first year) and I saw 212 for a day (I started at 301). My insulin was still sky high. It was so discouraging. So maybe more than you wanted to know. LOL

Thanks for confirming why you were asking. I've had some pretty aggressive responses to me on another board about my future procedure, treating me like I'm pretty stupid, when I'm nothing close to stupid. But I'm an open book, I don't mind sharing at all. 

Yvonne

I have no personal experience but I believe it is possible for there to be erosion into the tissues without any symptoms. If it is severe and eats right into the stomach, there would be pain, possibie bleeding and infection, the latter can show as tenderness, swelling and oain round the port as the infection can travel along the tubing. 

Have you lost weight? Lost and regained? I assume you have some restriction if you occasionally get stuck. Is it that you need to lose more and it just isn't happening? Why does your doctor suspect erosion? 

Edited for typos

My port is always painful when it's pressed on. I have Fibromyalgia so I've always figured that was why, but lately it's been especially painful.  I also have reflux if I don't take daily Prilosec.  I did lose and regain (see above). I'm 5'4" and gained back up to about 250lbs and stayed there for years.  Last year, my blood pressure started mysteriously started climbing.  They put me on a drug in April that spiked my insulin sky high (we didn't know at the time and I normally run high normal). I gained 5-7lbs a month from April until now and I'm still gaining even though they took me off of it in December, my insulin has not come all the way down.  My weight is now higher than it was before my lapband.  I'm taking 4 blood pressure pills and my blood pressure is still high. Not as high as it was, but high.  I feel like I'm living on borrowed time.  I went to a new Endo and she recommended an RNY because of the effect is has on the blood sugar.  I went to a surgeon and he recommended a DS because of my high BMI. 

My doctor doesn't suspect erosion, but wants to look to make sure I don't have it. He wants to be as prepared as he can before he does the actual surgery.

Yvonne

I think you have an awesome doc if he wants to do an endoscopy first, many a surgeon has been shocked at what they find and a 1/2 hr surgery turns into a 3 hr surgery. If you are having any kind of acid it could be a sign of erosion or scar tissue build up. I've known people who had their bands adhere to their livers, stomachs and other organs. An endoscopy won't tell him everything but it will help. Also that little bit of reflux can also cause serious esophageal damage over time. So thank him for being so thorough and knowledgable.

It's funny you say he's so knowledgeable and thorough when on another board they act like he's a crook because he said if the scar tissue is so bad he may need to remove the band first and then go back and do the DS.  I've heard of other surgeons doing that when they get in there and see how bad it is.  It was a bit discouraging and then when I tried to talk to them, it just became something of a ridicule session. So I stopped talking about it. Thanks for being so nice. I appreciate it!

Yvonne

That sounds like a pretty lousy experience on the other board. I've heard several people on the VSG board here say that their revision surgeon was not able to do the removal and revision in one surgery for various reasons. I would imagine it would be even more common with the additional steps associated with the DS procedure. I would also prefer a doctor who would be up front with me about this being a possibility!

Just rereading this post and you say your port area hurts, that could be infected also in fact that is usually where the infection enters when the band gets infected since that is the only spot where the sterile system is entered when filling. That other group sounds nuts! I know a few actual revision surgeons can do band removal and DS in one surgery but regular surgeons tend to do it in 2 stages so as far as I'm concerned there is nothing wrong with 2 surgeries as it gives the stomach time to heal before being traumatized again. Sounds to me like he's pretty darn good.

Good Luck with your band  Removal

as HisLady said whether you and your Surgeon opt to do it in 2 surgeries or in one I the Fact is that Scar tissue buildups with ANY abdominal surgery .

And the Scar tissue that builds up under and around the band needs to be removed to prevent further problems.

IMO I think you'd do well with the DS as it has the best results with Diabetes in general than any other WLS.  As well as best long term WL.

please make sure regardless of the WLS that you Chose you have a True revision surgeon perform the surgery for you :) Even if you have to travel a distance to make it happen.

Erosion isn't always detected with EGD, but it's a good idea to have it done. The literature states that symptoms of an erosion loss of restriction, nonspecific epigastric pain, and port pain/infection.