lapband vs rny

Sue: This topic comes up frequently so I saved a post I sent previously here it is: There is no BEST SURGERY there is only choices and what is BEST for the individual, as Scottie said do not rule out the BPD/DS it has MANY merits as well *to tell you the truth it wasn't one I though of preop as no local surgeon performed and my insurance didn't cover but w/ the past 4 yrs research I highly rec. if an option you look into it! The longterm wt loss is greater not w/o trade-offs though at times for some potentially more metabolic/nutritional risks but depending the the eating habits u desire and your BMI etc think about it! I am happy w my RNY but if I ever need a revision the BPD/DS is my thought!!!*, luckily we have choices! Make an educated and informed one for YOU!!!! this is long! I don't think I added DS links so here are a few! http://www.asbs.org/html/patients/bpds.html http://www.duodenalswitch.com/ http://www.duodenalswitch.com/surgeons/hess_brochure/hess_brochure.html *lots info on risks/longterm issues http://www.dssurgery.com/ http://www.obesityhelp.com/content/wlsurgery.html#DS *************** Deciding to have WLS is a major, life-changing event and shouldn't be made on impulse (I am not saying this is you I am saying this for anyone thinking about it!). I recommend anyone be 110% sure this is what you want to do because it is PERMANENT! Things to think about: · How long have you been researching WLS?**Hopefully at least a good 6 months or so****for many it is years! · Do you understand the procedure, I mean really understand the nitty gritty of what they are going to do to your intestinal system! Not just it will help me lose weight but *for instance w/ the Roux-En-Y gastric bypass* that they are going to cut your stomach in 2,make a small pouch, the old stomach hopefully is transected from pouch by staples and surgically cut in 2! Then the intestines are cut a few feet or so down and rerouted so you lose weight because the tummy is restrictive and bypassing the intestines decreases absorption....Know the risks involved with this!!!***(nutritional/metabolic/physical/psychosocial): ex B12 and vitamin deficiencies/protein deficiency/hernia/adhesions, risk of depression post op related to grief over loss of food and hormonal surge of estrogen/trauma of surgery, marital/relational difficulties/high divorce rate)... · Surgical risks: (not all inclusive.. ~Bleeding, ~Complications due to anesthesia and medications, ~Deep vein thrombosis/clots, ~Wound Dehiscence, ~Infections, ~Pulmonary problems, ~Spleen/Liver injury, ~Stenosis of new connections (stricture), ~Hernia, ~Death. · Depression possibly related to grieving the loss of food, decreased metabolism, and hormonal surges from estrogen being released into the body from rapid wt loss/fat breakdown.... · Gallstones....need for 2nd surgery to remove this. · Long-term osteoporosis (metabolic bone disease), severe vitamin./mineral deficiencies · Hair loss (temporary due to anesthesia, trauma of surgery but will continue if you are protien/vit and mineral deficient!) · Food intolerances (possibly meats, esp. red meat, lactose intolerance, sugar, fats, fried food) · Dumping syndrome (Nausea/vomiting/diarrhea/chestpain/palatations/sweating/tiredness for minutes/hours/days) *when eating highly concentrated fats or sugars (a desired behavioral response that ~ 50% of post-ops geet) · EXCESS SKIN....OK my philosophy is you fit in your skin or you don't...Do say you don't want to feel bad after, ask yourself do you feel bad now? If yes are you healthy now as a MO person? Yeah many insurance companies pay for some plastic surgeries if medically necessary it may be a fight, but you can get some of it removed possibly....If though this will deter you I say the chances are great you will have some amount of excess skin, no one knows how much...Age, gender, prior diet/weight changes, pregnancies all affect this and the best chance on has to control this is (although limited) exercise, water and protein....So if this is a huge issue don't have surgery.......Excess skin may be by far the most distressing side-effect for people as we already come with altered self-esteem/body image!!! · What type of research have you done? (Internet, in-person support group meetings, talking with others who have had surgery, surgeon consult, surgeon seminar, articles, books?????)***Knowledge is power and is the best tool we have for success and happiness afterwards**** · What are your present support systems? Friends, Family, co-workers.....**Although not 100% necessary if others are on board it sure as heck makes the ride all that much easier!!!*** · What are your current stressors? ***WLS is a time when you need to be as stable as possible, going through a divorce, bankruptcy, death of a close relative, job loss...well WLS may be a good option but pick the optimal time as it is stressful enough if everything is good, when you are going through something extra stressful you are hampering your success possibly and not having the old standby of food to rely on can be HELL!***This is not to say there ever is a right time and things can happen post-op but be kind to yourself and do what's best for you, waiting 3 months may make all the difference in the world! After all this is about forever!!! · What is your nutritional/obesity/diet history?***WLS is not for everyone, it is for the Morbidly obese (BMI above 40 or 35 with major comorbdities such as sleep apnea, Coronary disease, Diabetes....)This should be no ones first attempt at dieting (*I know this is not yours again just general guidelines)...Anyone who says this is the easy way out, KNOWS NOTHING about the surgery or the struggles you will endure and lifestyle changes necessary post-op for success! They are usually ignorant, jealous or both! Again your education and knowledge here goes a long way...Everyone seems to know someone who 'died' or had a 'terrible experience' with WLS...BUT no one seems to have a name or number to call that person!!! It is again based on hearsay alot of the time and their own fears and insecurities...You are doing this for you remember that, it is nice to have support, so educate friends and family, bring them to a support group!!! It can only help! Many programs require wt loss preop...I know many people disagree with this or don't understand why..IMHO I think it is a generally good idea to start instilling dietary, exercise and overall lifestyle changes preop, there is nothing magical about the surgery that makes u wake up and think like a thin person (*I WISH!!!!) So making small changes are helpful pre-op...EXERCISE is one of the biggest keys to success (IMHO again) and anything you can do preop will help you keep up with this and be healthier for surgery!! (and a better surgical risk!)...Start eating smaller portions, it is hard if you go from eating super sized fast food today to clear liquids for 2 weeks (*this is my equivalent of psychological hell/torture!!!) Start slowing down when you eat, put that fork down in-between bites, cut up your food to small pieces, stop drinking and eating at the same time (cant do it or shouldn't postop so start now!) Start taking in 64 ounces of fluid a day if u aren't already, will need to postop! Cut out carbonation, caffeine, sugar, alcohol and chocolate (these are 5 recommended things to avoid postop for many esp. in the first year) again make postop life easier on yourself not harder start ahead!!!!Try on new coping skills for size, they wont miraculously appear postop! Stock the house with clear liquids, crystal lite, diet kool-aid, broth, diet jello etc so u are ready when u get home!!!!Try and avoid the 'last supper syndrome' you will eat most everything again eventually, perhaps in smaller quantities, so don't have a feast each night of things u think u will never have again! · Ask yourself: What is my ability to make lifestyle changes? Be compliant with post-op recommendations??? This is only a tool....(*sorry can't say that enough!).... a. Need to exercise nearly daily for health/wt loss and help with excess skin b. Need to supplement with B12, multivitamin, folate, Iron, Zinc, Calcium citrate, protein shakes possibly give or take things. c. Need for LIFELONG FOLLOW UP!!!! If you're not taking care of self now you MUST postop or you may trade far worse illnesses for the Morbid obesity you have now malnutrition and vit/mineral def can be permanent and irreversible! · Know that extended release medications may not be as effective or absorbed well (**esp. birth control pills in woman of childbearing age use alternative form of BC) I could probably ramble on all day about this..I hope some of this helps you! Any specific ? email us or me offline! Take care and good luck it is an awesome journey!! *not perfect and a positive attitude helps! DO this for you and only you!!!!Start journaling now www.obesityhelp.com is a great site, start your own profile there! Also if you haven't seen this document (pouch rules) print and read! A good basic guide to things that will help you use the tool and be successful as possible (*for most of us!!!) http://www.digitalhorsewoman.com/pouchrules.htm The Bypass as well as the lapband have all of the risks that come with having an operation, the lapband may involve shorter OR time and no rerouting of intestines. Both can lead to gallstones & excess skin r/t wt loss, Neither is "SAFE" BOTH need to be considered carefully and not taken lightly...it must be an informed decision and used only as a last resort for people who are 100lbs overweight or have a BMI of 40 or greater, unless their BMI is 35 and they have comorbidities (DM, HTN, sleep apnea...) The surgeon really should be going over all the risk/benefits with the patient, whichever procedure they the PERSON chooses. I would though encourage anyone who is contemplating this to educate him or her to make the best-informed decision possible. Weight loss surgery is not for everyone. I am glad there are different options, because not everyone can have a bypass...and the band is an option for those that cannot/do not (want to) have their GI system altered. I promote weightloss surgery (band or gastric bypass) to those that are informed and understand the risks/benefits and have weighed them heavily!. The bypass is what I know most about and have had. WHY? There is more research on this surgery (IN THE US), it has been around longer, perfected, esp. in regards to weight loss (depending what research you look at the band may only give the person a 38% wt. loss vs. 78% wt loss is a standard for GBP), The band has only been used in this country since June/July 2001 (In Europe 10-15 years). and long-term complications still are not all known, Can the band stay in forever? Who knows, many do opt to get a bypass after ineffective wt. loss with the band, (So why go thru 2 operations if the bypass will be your final destination? IF your insurance will pay for a SECOND operation?!), many see the band the same in terms of wt. loss as the VGB (vertical gastric band, which has almost been abandoned or revised to bypasses in this country r/t ineffective wt loss (no malabsorption). With the band, there are risks such as: stomach perforation, pouch enlargement r/t band placement/slippage, band slippage, erosion of the band, erosion of band into the stomach, body rejects foreign object (the band), access port problems (flipping etc), saline evaporating from port requiring more f/up fills, more follow-up is needed for the fills.....Also the lapband is not done everywhere yet in this country, insurance companies are still reluctant to pay for it, insurance companies are paying for the bypass, without much issue. These are the reasons I chose what I chose... I am not implying Bypass is not without risks, It has many risks...more serious? Depends which side-effect/complication you get, depends who you talk to....I had a complication, but came through it fine, I had adhesions and scarring that caused a stricture on my small bowel, this could of happened if I had the lap band, our bodies make adhesions, it is a risk of abdominal surgery...mine were in the wrong place and caused a problem! Malabsorption...which in essence means lifelong follow-up with a clinical nutritionist, for labs... and supplements of: calcium, iron (maybe), B12, folate (maybe) and a multivitamin for life. Protein also needs to be a focus of the bypass persons diet, and sometimes supplementation is needed. Hair thinning at 3 months, r/t protein deficiency, but it grows back in full after a few months (not baldness mind you thinning) Dumping syndrome...now some say this is a benefit, sort of the ultimate behavior modification..if you eat sugar/fat you feel awful, tired, nausea, diarrhea..so you don't eat that food again! What is agreed on is careful screening medically, surgically, nutritionally as well as emotionally/psychologically. Eating disorders need to be looked at, esp. compulsive eating. A good aftercare plan is key, having a multidisciplinary team to follow you (Good PCP, Surgeon, Nutritionist, therapist, support group) are all factors shown in research to lead a person to the best outcome/wt. loss possible. THERE REALLY IS NO WAY TO OUTLINE EVERYTHING THAT IS GOOD/BAD/UGLY WITH EITHER PROCEDURE. FOR ME BYPASS WAS THE ANSWER, FOR SOMEONE ELSE IT MAY BE THE BAND. GOOD LUCK! Here are some other great LAP BAND sites to get you started! the group: Members: 5048 http://health.groups.yahoo.com/group/Bandsters/ We've been the primary AGB (Adjustable Gastric Banding) online support group since 1998. We have members in every stage of Banding, using both Lap-Band® and SAGB (Swedish Adjustable Gastric Band) bands the world over. We're a supportive forum where members learn about Banding, discuss their experiences and support each other while making new friends.We're also an AGB information center -- with a fair deal of documentation, stories and links available at Yahoogroups, and our webpage -- http://www.thebandsters.com. Finally, we actively direct members to other AGB lists to help them meet their specialized needs. or: http://health.groups.yahoo.com/group/bandsters-nyc/ Members: 262 This group is an offshoot of the main Bandsters group and was created solely for the purpose of having a community of NYC bandsters. The group will be used for coordination of social activities in NYC and as a forum for discussion about surgical programs in NYC.search criteria: bandster, bandsters, agb, lap-band, lapband, lap band http://www.obesity-online.com/Pat_and_docs_info/index.html (*read all the links on the left) http://www.inamed.com/products/obesity/us/clinician/lapband/prodinfo.html http://www.inamed.com/products/obesity/us/patient/lapband/information.html http://www.inamed.com/products/obesity/us/clinician/internet.html http://www.drchampion.com/lapband.htm http://www.lapbandinformation.com/ http://www.lap-band.com/ http://www.obesitylapbandsurgery.com/adjmain.html http://www.asbs.org/html/story/chapter5.html http://www.sabariatric.com/lap_band.php (nutrition info even for banded people!) http://www.sabariatric.com/outline2.html http://www.sabariatric.com/assets/forms/AGB_Diet_000.pdf http://www.obesityhelp.com/morbidobesity/surgtype-forums/LapBand/ http://www.lapbandinformation.com/RECOMMENDED_FOOD_PLAN.pdf food plan Take Care, Jamie Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King http://www.obesityhelp.com/morbidobesity/members/profile.php?N=c1132518510 "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"

Hi Sue, I knew from the moment I heard about the lap band that it was for me. RNY was too drastic for me. You really have to weigh the pros and cons for yourself. I have seen wonderful success with all of them, really. For me, the lap band seemed to be a more permanent weight loss tool because I feel like I have better control. I've lost 119 pounds now and I don't feel like I have the same chance of putting it back on than when I did in 2003. I had lost 95 pounds, and I put it right back on. Now I have a tool that I can fall back on. If I feel I can eat a lot, I could go for a fill. I was talking with my sister who is on WW again, she was telling me she never feels full. Well I sure do. Pre band, I never did. As long as my band wants to stay in me(no erosion, no complications) I have a lifetime friend Kristine

kristine ,yoou look great.. thats exactly the same way i feel about rny. maybe cause i've only had my tonsils out 30 yrs ago. thanks for the response.....sue