What is band slippage|?
What is a "Band slip?" - teaching module, re-post
One of the serious potential problems with a Band is called a "Band
Slip." The latest stats re band slips and erosions are now 3-7%. This
is a worrisome increase from the 1-3% rate it has been since FDA
approval in the US in 2001.
"BAND SLIP" however, is a very misleading term, because it's not the
band that moves at all; it is securely sutured in place. With
a "slip" , the stomach moves up (herniates) thru the band, so it is in
a dangerous position.
There are different kinds of slips, with different symptoms. I often
read on other boards that slips always cause sudden inability to eat
or drink, but this is NOT ALWAYS TRUE at all.
A "small" slip, also called a "concentric slip" or "pouch dilation" ,
occurs when the
pouch stretches out from an overfill or overeating. The symptoms are
SUBTLE
and easily blamed on other things. There can be a bit of new reflux,
finding you can eat more and more over time, ability to eat things
you could not before, etc. As you can see, all these things are
common with NORMAL band weight loss and are NOT clear signs of a
slip. A big clue is if you have EVER had a fill way too tight that
you did not have some removed. These dialations happen mainly after
big overfills that were kept.
This is why periodic fluoros are a very wise thing - maybe every 6
months or so, or whenever there is a concern. I personally do not
believe, and most docs also do not believe, that a fluoro with every
single fill is needed or safe. I got and now get only the yearly
assessment fluoro. I never got a fluoro with any fill.
IMO, Radiation exposure is very good to avoid unless really needed.
While the radiation involved with a fluoro is small, NO radiation is
entirely
safe, especially when the ovaries are right in the radiation field.
My opinion only, after research and discussing with many band
surgeons over the years.
CAUSES of these "small slips", also called pouch dilations:
1.Trying to keep a too-tight fill ! Avoiding too-tight fills means
knowing (being taught) the definition of a too-tight fill and never
keeping one, thinking/praying it will lead to better loss or get
better with time. not only
does it often stall OUT weight loss, it leads to serious problems
sooner or later. It is VERY VERY hard to get out of the mind-set
of "weight loss at ANY cost", but we really must.
2. constently eating more than 1-1.5 cups of food (after we have a
decent fill) whether we "can" or not. This type of concentric slip
(pouch dilation) can often
occur, especially, in those out a couple years, if they are not
careful to
self-limit eating. After a time, it seems the esophagus does not give
reliable "soft stop" signs any longer - or perhaps we have learnd to
ignore them and keep eating. This is a big reason we should work hard
on the emotional eating and lifestyle changes, so we just DON'T
overeat and eat mindlessly any longer. This is the hardest part of
banding, imo. It's not just about weight loss, but changing
lifestyles so we can KEEP the weight off.
3. regular barfing/pb's. IMO, more than 1-2x a month is TOO MUCH,
(after we are thru the initial leanin periods where we all goof) and
we just HAVE to learn the band rules to eat safely. If we are barfing
regularly more than this, I believe we have too much fill for the
level of our band learning, and need some out while we learn better
habits to stay safe.
FIXES: These types of "small" slips , are usually fixed by a complete
unfill and rest period of a few weeks
to 1-2 months. the stomach then often can shrink back into a good,
safe position, and small, gradual refills can begin again. I
believe, after any dilation, that we have to be especially careful to
avoid another to tight fill.
The "big slips" are far more serious. They are usually sudden, and
people have a very major change - usually inability to eat or drink
without pain and/or barfing. These slips can be very urgent, or
occasionally a real emergency, since the stomach can strangulate.
Thankfully, they are not very common (maybe around 2-3%)but require
urgent care. This is why, imo, we must always know where to go and
prepare ahead of time for local care by a very knowledgeable band
practitioner. I believe we must arrange for this before we are
banded, and it should be discussed by he Patient facilitators well
before banding. a few people have needed urgent local care and
sometimes local re-hospitalization within the first few days of
getting
home from surgery. Our family docs must also know ofour plans for
banding, so they can help later in an urgent situation. They can at
least help with finding care or re-admission if needed.
When one is in severe pain and vomitting continually with an urgent
problem, it's not
practical or safe to try to get back on a plane to return to Mexico,
at last-minute plane fares. It's important to know that most ER's and
medical centers will not and cannot help with a band problem, as it
is a VERY specialized area. We must go to a medical center that does
bands, and hope they will accept a Mexican patient. Pathetically,
many will not. However, in a real urgent situation, still go to the
EER of your closest band hospita. they an at least get you re-
hydrted, givepain meds, and you can call dr. kuri for further
directions. Carry your wallet card in your wallet, for this reason!
CAUSES of big slips : almost always, it is from trying to keep a too-
tight fill that results in barfing and food intolerance.
FIXES: Most big slips require an emergency band re-posiioning or
removal. sometimes, a
new band can be placed at the same time of the old must come out. The
new surgery is often
tougher than the first, because there is a lot of scar tissue to
remove and fit the band around. Sometimes, replacement is not
possible at removal, but may be possible after 6 months or so of
healing.
I have added some photos of band slips, dilations, etc into the AAAA
Band photo album here.
As always, PREVENTION of band problems is key to safety and success.
This requires ongoing teaching and ongoing learning to stay safe,
assess problems, and know when to get quick help.
Sandy r, BSN, MN
band educator
at gioal > 5 yrs
One of the serious potential problems with a Band is called a "Band
Slip." The latest stats re band slips and erosions are now 3-7%. This
is a worrisome increase from the 1-3% rate it has been since FDA
approval in the US in 2001.
"BAND SLIP" however, is a very misleading term, because it's not the
band that moves at all; it is securely sutured in place. With
a "slip" , the stomach moves up (herniates) thru the band, so it is in
a dangerous position.
There are different kinds of slips, with different symptoms. I often
read on other boards that slips always cause sudden inability to eat
or drink, but this is NOT ALWAYS TRUE at all.
A "small" slip, also called a "concentric slip" or "pouch dilation" ,
occurs when the
pouch stretches out from an overfill or overeating. The symptoms are
SUBTLE
and easily blamed on other things. There can be a bit of new reflux,
finding you can eat more and more over time, ability to eat things
you could not before, etc. As you can see, all these things are
common with NORMAL band weight loss and are NOT clear signs of a
slip. A big clue is if you have EVER had a fill way too tight that
you did not have some removed. These dialations happen mainly after
big overfills that were kept.
This is why periodic fluoros are a very wise thing - maybe every 6
months or so, or whenever there is a concern. I personally do not
believe, and most docs also do not believe, that a fluoro with every
single fill is needed or safe. I got and now get only the yearly
assessment fluoro. I never got a fluoro with any fill.
IMO, Radiation exposure is very good to avoid unless really needed.
While the radiation involved with a fluoro is small, NO radiation is
entirely
safe, especially when the ovaries are right in the radiation field.
My opinion only, after research and discussing with many band
surgeons over the years.
CAUSES of these "small slips", also called pouch dilations:
1.Trying to keep a too-tight fill ! Avoiding too-tight fills means
knowing (being taught) the definition of a too-tight fill and never
keeping one, thinking/praying it will lead to better loss or get
better with time. not only
does it often stall OUT weight loss, it leads to serious problems
sooner or later. It is VERY VERY hard to get out of the mind-set
of "weight loss at ANY cost", but we really must.
2. constently eating more than 1-1.5 cups of food (after we have a
decent fill) whether we "can" or not. This type of concentric slip
(pouch dilation) can often
occur, especially, in those out a couple years, if they are not
careful to
self-limit eating. After a time, it seems the esophagus does not give
reliable "soft stop" signs any longer - or perhaps we have learnd to
ignore them and keep eating. This is a big reason we should work hard
on the emotional eating and lifestyle changes, so we just DON'T
overeat and eat mindlessly any longer. This is the hardest part of
banding, imo. It's not just about weight loss, but changing
lifestyles so we can KEEP the weight off.
3. regular barfing/pb's. IMO, more than 1-2x a month is TOO MUCH,
(after we are thru the initial leanin periods where we all goof) and
we just HAVE to learn the band rules to eat safely. If we are barfing
regularly more than this, I believe we have too much fill for the
level of our band learning, and need some out while we learn better
habits to stay safe.
FIXES: These types of "small" slips , are usually fixed by a complete
unfill and rest period of a few weeks
to 1-2 months. the stomach then often can shrink back into a good,
safe position, and small, gradual refills can begin again. I
believe, after any dilation, that we have to be especially careful to
avoid another to tight fill.
The "big slips" are far more serious. They are usually sudden, and
people have a very major change - usually inability to eat or drink
without pain and/or barfing. These slips can be very urgent, or
occasionally a real emergency, since the stomach can strangulate.
Thankfully, they are not very common (maybe around 2-3%)but require
urgent care. This is why, imo, we must always know where to go and
prepare ahead of time for local care by a very knowledgeable band
practitioner. I believe we must arrange for this before we are
banded, and it should be discussed by he Patient facilitators well
before banding. a few people have needed urgent local care and
sometimes local re-hospitalization within the first few days of
getting
home from surgery. Our family docs must also know ofour plans for
banding, so they can help later in an urgent situation. They can at
least help with finding care or re-admission if needed.
When one is in severe pain and vomitting continually with an urgent
problem, it's not
practical or safe to try to get back on a plane to return to Mexico,
at last-minute plane fares. It's important to know that most ER's and
medical centers will not and cannot help with a band problem, as it
is a VERY specialized area. We must go to a medical center that does
bands, and hope they will accept a Mexican patient. Pathetically,
many will not. However, in a real urgent situation, still go to the
EER of your closest band hospita. they an at least get you re-
hydrted, givepain meds, and you can call dr. kuri for further
directions. Carry your wallet card in your wallet, for this reason!
CAUSES of big slips : almost always, it is from trying to keep a too-
tight fill that results in barfing and food intolerance.
FIXES: Most big slips require an emergency band re-posiioning or
removal. sometimes, a
new band can be placed at the same time of the old must come out. The
new surgery is often
tougher than the first, because there is a lot of scar tissue to
remove and fit the band around. Sometimes, replacement is not
possible at removal, but may be possible after 6 months or so of
healing.
I have added some photos of band slips, dilations, etc into the AAAA
Band photo album here.
As always, PREVENTION of band problems is key to safety and success.
This requires ongoing teaching and ongoing learning to stay safe,
assess problems, and know when to get quick help.
Sandy r, BSN, MN
band educator
at gioal > 5 yrs
. 
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