Lap vs RNY(lap)
Dirk -
I appreciate your passion on this, but you are wrong when you indicate that RNY's don't work on portion sizes or water, etc. This is just untrue. Some do, some don't - just like those with the band. This is based on personal effort which is completely subjective. I know you gave your disclaimer before these comments, but you went right in to lump it all together. It's not different for us in that aspect. You get what you give when dealing with these surgeries....regardless of the type of surgery.
As for rate of loss, you yourself indicated your quick rate of loss which surpasses my rate of loss. So I suspect your skin is hanging more than mine? Rate of loss really doesn't have anything to do with how much hanging skin you have as much as it has to do with how long you were overweight, how old you are, how overweight you were (100 lbs to lose fares much better in the skin dept than 200 or 300) and how many stretch marks you have.
Even for those who have lost an enormous amount very quickly, their skin can and does catch up if they live with it for awhile. They will end up in the same spot a year after they've lost all their weight regardless of speed of loss. It just means waiting it out a little longer to get the most benefit later.
As for reversal of the RNY, it can be done, it just isn't often done.
Dina
Hi Robbin-
- I'd much rather supply info to back up statements, so Click on these links for more info:
http://www.myagb.homestead.com/differ_rny.html
http://clos.net/complications/complications.htm
http://www.asbs.org/html/story/further.html
http://www.asbs.org/html/story/chapter5.html
http://www.asbs.org/html/story/chapter4.html
Just to let you know - some of these sites were last updated in 2002 - Many patients have proved these findings wrong, by now. These are scientific findings, but outdated.
Good Luck in making YOUR choice.
BTW - I agree with everything Granny LaLa said.
Dana
Robin, There probably is good and bad in all of the surgeries. Do you homework, read the profiles and decide for yourself. Personally I had seen so many people posting frantically looking for places to get fills that it turned me off from getting banded. As I say everyone can tell you that they had the best surgery but you decide for you.
http://www.obesityhelp.com/morbidobesity/showcomplarticle.phtml?ID=1047462681
A memorial board to OH members. Nearly all are for those that died from complications from RNY, none from Lapband. A few others from their illnesses caused by being obese and not having WLS in time and from accidents. Very sad.
Oooh - hot topic!!! LOL.
I hope we can balance each other out - everyone has their favorite for their reasons. I think trying to disparage the lap band or rny either way is just not nice, so I'm going to try to be dispassionate but provide my thoughts.
First, I would have probably had the lap band had I: 1) had insurance that paid or 2) did not have a hiatal hernia. One should not seek out the band if they have a hiatal hernia. Although the nurse for the doctor local to me at the time said it could possibly be done, a consult with the surgeon said no way - even if the hiatal hernia were repaired. I guess it's just too much of a risk with the pressure on it. If you do not know if you have a hiatal hernia, a few indicators are that you have acid reflux, especially at night. My hiatal hernia did not cause a lot of problems for me when I ate light or low carb.
So, I hope that gives a little background into where my thoughts were. I too think that it is generally a safer surgery, but there are risks involved, just as with everything. The issue with the band, according to the surgeon I spoke with (who does most his business in bands) is that there can be slippage with repeated vomiting. This does happen sometimes, so it's not without risk, although I think the risk is less than with RNY.
Also per the surgeon I saw about this, when I went to his seminar in February of this year, he drew a graph of weight loss expectations over time with Duodenal switch, rny and the band. Duodenal switch gave the best results long term with both a lower final weight and less change of regain. The RNY was next best in success and is always referred to as "the Gold Standard." It gave a better rate of loss than the band and also, per Dr. Mirande in Klamath Falls, OR, even with the 15-20 lb regain most had, proved to be a better long term choice for losing and keeping the weight off. The band was not far behind the RNY but was still not quite as favored for weight loss.
Generally, the way he put it was that the greater the risk the better the results. The DS has a greater risk of complication than the RNY but gives a better result. It also has a greater amount of malabsorption than the RNY. So you go in steps. It is all based on how you feel you will want to conduct yourself in the future.
One of the things I considered when I was trying to decide on what to have was first and foremost my determination. I knew it would take effort on my part regardless of which method I chose. It is not a free ride, even if you have the DS. I knew from my years and years of dieting that I had strong will power, but I just wasn't able to lose. I felt if I could restrict my intake it would have been sufficient, as I lived an Atkins lifestyle for years - but I just out-ate it. So for me, I felt I could do the lap band without feeling deprived at all. I knew I would not be trying to drink sugary drinks full of empty calories, or eating things I shouldn't have even though I wouldn't dump. I think for those that are considering lap band it is important that they have their heads screwed on right. If you have emotional eating issues, I think it could be harder to deal with this. You can out-eat any surgery if you choose to. And I have seen people speak of their experiences on all fronts where it would seem to me they are intentionally sabotaging themselves. I just felt that with my dieting history that I would be stable if I had the band. My main concerns with the band were slippage, but that wasn't a major concern for me.
So when I heard the news that the band wasn't going to be an option for me I didn't rush to rny actually but considered the DS. I thought it might be easier for me since I was used to doing Atkins which is high fat. I thought it might be easier to follow that and not compromise my cream cheese! 
But I didn't consider it too long as I decided the RNY sounded right for me.
And in all seriousness, I was prayerful about this and was actually led to Dr. Aguirre. Some may not be religious and I understand and respect that, but for me, it was the answer I was given every which way I turned.
As for going to Mexico, I would not get the lap band going to Mexico. The only reason why is that it has proven extremely difficult to get an American doctor to give you a fill when you have had surgery in Mexico. I wonder if they would balk so much if you just told them you just moved to the area and had your surgeon 3000 miles away on the other coast of the US. But then they would probably want medical records. Still - I find no good reason why American doctors are so resistant to this. Certainly this isn't the part that carries a huge risk, but yet they still resist. I know there is a holistic doctor in Portland, OR that is doing fills for Mexico patients. Thank goodness she is one bright shining spot in Oregon for band post ops!!!
The one thing about getting the band in Mexico that would make me reconsider is if I built the cost of getting a fill in Mexico into my budget. That would mean airfare/travel expenses each time. I *think* - not knowing the band that well - that it doesn't take a huge amount of tweaking, but the chances are still there that there might be.
Anyway, I have to say that I am thrilled with my open rny that I had. I would do it again in a heartbeat. The band was not for me, but I do feel it is a great alternative for many people. I don't see the RNY in the same negative light that many banded people do, but I think their negativity is borne out of fear of what they don't know on a personal basis. The risks are real for both surgeries, but so are the benefits.
If you are a motivated person, I have no reservations that the band would enable you to take off all your weight to goal. But there are some people who even with the RNY are weight loss resistant. I'm a slow loser even with the RNY. Mine is likely due to my PCOS/endocrine disorder. I know now if I had the band it would be even slower and require even more effort on my part. I would still have been fine with that though.
Oh - and one thing I wanted to say. I know we have all heard horror stories, but I'd like to throw out some things that dispute some of the things said about RNY here. I am not trying to say that people haven't done their research, but I do know that some of the stuff purported here is not accurate. One thing is that the pouch can get stretched out and you can regain with the RNY. I have read up a lot on this and the pouch cannot stretch back to the point where your stomach was before. Your pouch is actually pretty much what it will always be after about a year. The thing that can get stretched is the stoma, and generally it's not usually caused from overstuffing (but I suspect can). It's one of those things that happens sometimes. Some people get strictures, while others have enlarged stomas that do not allow the pouch to hold onto food. Why they use the band on those with RNY is in order to cause a restriction on the stoma - not the pouch. It is being experimented with in order to allow for the restriction they should have had in the first place. From the surgeon's accounts I have read it sounds to me like it is just an unfortunate occurance. But still, if it is caused by overeating, it is again, likely an emotional issue and if you want to out-eat it you can...and you can with the band as well.
As for rebounding on the weight loss, that is typical of an rny, but it is also that way with the band. It's pretty natural regardless of surgery type. Those that don't rebound are generally careful and responsible and putting in their effort to be successful. Not that those who do have regain aren't trying, but some put in more effort than others. The simple fact of the matter is that with the RNY you do have a slight malabsorptive effect going on (more malabsorptive for distal procedures though), so you do not absorb all the calories. With the band you absorb all the calories (and nutrients!). Logic prevails that if you relax your eating standards you can regain with both, but the chance of regain is likely going to be less with the rny.
Oh - and snacking - that is one way you can cause regain regardless of the procedure. This is one thing that if you are a snacker now, you should learn how to kiss that goodbye if you want to be successful later. Not that having a snack on occasion will be a problem, but if you do it all the time, it will be.
Hope that helped somewhat. I support anyone who has wls, regardless of the type. They all have their benefits, risks and complications. It is what you decide to do that is best for you. Take the facts, leave the passion behind and make the decision for yourself, and if you are religous, then prayer is certainly in order!
Dina
But I didn't consider it too long as I decided the RNY sounded right for me.
And in all seriousness, I was prayerful about this and was actually led to Dr. Aguirre. Some may not be religious and I understand and respect that, but for me, it was the answer I was given every which way I turned.
As for going to Mexico, I would not get the lap band going to Mexico. The only reason why is that it has proven extremely difficult to get an American doctor to give you a fill when you have had surgery in Mexico. I wonder if they would balk so much if you just told them you just moved to the area and had your surgeon 3000 miles away on the other coast of the US. But then they would probably want medical records. Still - I find no good reason why American doctors are so resistant to this. Certainly this isn't the part that carries a huge risk, but yet they still resist. I know there is a holistic doctor in Portland, OR that is doing fills for Mexico patients. Thank goodness she is one bright shining spot in Oregon for band post ops!!!
The one thing about getting the band in Mexico that would make me reconsider is if I built the cost of getting a fill in Mexico into my budget. That would mean airfare/travel expenses each time. I *think* - not knowing the band that well - that it doesn't take a huge amount of tweaking, but the chances are still there that there might be.
Anyway, I have to say that I am thrilled with my open rny that I had. I would do it again in a heartbeat. The band was not for me, but I do feel it is a great alternative for many people. I don't see the RNY in the same negative light that many banded people do, but I think their negativity is borne out of fear of what they don't know on a personal basis. The risks are real for both surgeries, but so are the benefits.
If you are a motivated person, I have no reservations that the band would enable you to take off all your weight to goal. But there are some people who even with the RNY are weight loss resistant. I'm a slow loser even with the RNY. Mine is likely due to my PCOS/endocrine disorder. I know now if I had the band it would be even slower and require even more effort on my part. I would still have been fine with that though.
Oh - and one thing I wanted to say. I know we have all heard horror stories, but I'd like to throw out some things that dispute some of the things said about RNY here. I am not trying to say that people haven't done their research, but I do know that some of the stuff purported here is not accurate. One thing is that the pouch can get stretched out and you can regain with the RNY. I have read up a lot on this and the pouch cannot stretch back to the point where your stomach was before. Your pouch is actually pretty much what it will always be after about a year. The thing that can get stretched is the stoma, and generally it's not usually caused from overstuffing (but I suspect can). It's one of those things that happens sometimes. Some people get strictures, while others have enlarged stomas that do not allow the pouch to hold onto food. Why they use the band on those with RNY is in order to cause a restriction on the stoma - not the pouch. It is being experimented with in order to allow for the restriction they should have had in the first place. From the surgeon's accounts I have read it sounds to me like it is just an unfortunate occurance. But still, if it is caused by overeating, it is again, likely an emotional issue and if you want to out-eat it you can...and you can with the band as well.
As for rebounding on the weight loss, that is typical of an rny, but it is also that way with the band. It's pretty natural regardless of surgery type. Those that don't rebound are generally careful and responsible and putting in their effort to be successful. Not that those who do have regain aren't trying, but some put in more effort than others. The simple fact of the matter is that with the RNY you do have a slight malabsorptive effect going on (more malabsorptive for distal procedures though), so you do not absorb all the calories. With the band you absorb all the calories (and nutrients!). Logic prevails that if you relax your eating standards you can regain with both, but the chance of regain is likely going to be less with the rny.
Oh - and snacking - that is one way you can cause regain regardless of the procedure. This is one thing that if you are a snacker now, you should learn how to kiss that goodbye if you want to be successful later. Not that having a snack on occasion will be a problem, but if you do it all the time, it will be.
Hope that helped somewhat. I support anyone who has wls, regardless of the type. They all have their benefits, risks and complications. It is what you decide to do that is best for you. Take the facts, leave the passion behind and make the decision for yourself, and if you are religous, then prayer is certainly in order!
Dina One other thing I thought I would like to say though.....
I appreciate the passion many of these folks have for the band, but I really feel it is unrepresentative of those who have had surgery in Mexico because many of these fine folks had surgery in the US. There are more challenges present for those who choose to go to Mexico for the band than in the US....mainly in getting fills done.
So please research it well and make an informed decision. If you choose to go lap band, please prepare for more trips to Mexico for fills, or research it out and find someone locally who will do that for you BEFORE you go down there. Don't assume they will do it for you....most people have a horrible time getting their fills in the US.
Dina
Just a question: you mention that people that have the lapband in Mexico have a problem finding doctors to do their fills. What about RNYers that have had surgery in Mexico that end up with their staples infected or staples haven't held? When they have strictures? Don't they have an even harder time finding doctors for the emergency surgery? Usually when something like this happens, it's extremely serious and life threatening and they have to find someone pronto to take care of it. Fills can be scheduled and time can be found when looking for fill doctors. I haven't had WLS yet and still watching everything. So far the band looks to be the best for me.
Well, considering that from what I have known of other folks in Oregon who have had the band, they have needed at least 2 adjustments. That can put a dent in the wallet if you can't find anyone locally to do the work. Just check out the past posts here on the South of the Border forum and on the Oregon board. They are full of folks who are having a hard time getting fills. One woman from Oregon had her lap band done in October of last year and lost 15 lbs. She went back to Mexico for a fill and it wasn't effective. She finally found the holistic doc in Portland that would do it for her but only after turning over every stone to find her.
My comments are not meant to be non-support of folks who want to get a band in Mexico. Rather it is a warning to those who contemplate it that they should research who will be willing to do their fills before they leave.
As for the RNY the same thing applies to a degree, but I found an internist who said he would take me on as a patient. He can handle things like strictures and such, but major surgery would have to happen on an emergency basis as any other emergency surgery. They would not be able to refuse you as an emergency patient if you entered the ER for liability reasons. The issue then becomes if you can pay for it. These are all risks we weigh and take. By far I have seen more lap banders who have had more problems with aftercare than those with the RNY. That is not an opinion - just an observation. Doesn't mean it's good or bad or anything....just means that we are ALL best to be prepared when we go outside the country for our surgeries...regardless of which one. My only words of caution for any of these procedures is to be like a Boy Scout and BE PREPARED. Get your ducks in a row before you venture outside the country and the chance you will encounter these problems will be diminished greatly.
Dina
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