ABC's of Revision III "Banded Blues"

Welcome to new and returning future success stories!

Let's begin with a few words about surgeons. As a child most of us were told, "A poor carpenter blames his/her tools." Based on behaviour, some of us, surgeons, have not yet "grown up." One aspect of this "failure" is that children rarely if ever take responsibility for bad results. This and the purely restrictive nature of the operation place Lap-Banders at jeopardy of an unwarranted verbal assault. If your weight loss has been lagging or you have regained some weight, a "maturity challenged" surgeon may begin by reprimanding you for "eating around" your Band. While a thorough discusiion and review of your nutritional program is a vital part of each follow-up visit; accusations are not.
If your behaviour won't explain the less than stellar weight loss, the next likely "suspect" he/she may blame is the Lap-Band and/or Port. Mechanical failures of the Band/Port do occur, but are EXTREMELY RARE! Diagnosis should initially be pursued without a scalpel. A "Band-o-Gram" should be the first test to demonstrate or exclude the diagnosis of a "leaky" Band or Port. This is an X-Ray study very similar to having your band adjusted under flouroscopy. No diagnostic test is 100% accurate, however this is a very good test.
Now that we have dealt with the Doogey Howser MD's. lets consider more likely causes.
Band Placement.
Was the Band placed in the proper positon (15-30 cc upper stomach)? Has the Band "slipped"?
As a first step, a plain abdominal X-Ray will show if the Band is in high in the left upper abdomen; if it is correctly "tipped" (pointing toward the left shoulder). If further diagnostic tests are needed; an upper endoscopy, upper GI series, and an abdominal CT scan with contrast can all provide valuable information. More than one of these tests may be required.
Band Erosion
If your Band has eroded, slightly more common than hen's teeth, this could explain a weight regain. The best way to make this diagnosis is with an upper endoscopy.
Band Loosening
Just as your trousers/skirt will become loose as you lose weight, so too can your Band. This can be simply determined by a fill.
Band Adjustment
Has your Band ever been tightened to the "Sweet Spot"? If your are able to eat steak (without prior shredding), white bread, sticky rice, etc., you have not had your Band adequately tightened.
Was the Band the correct operation?
I know that this a very "touchy" subject and painful question. No one operation is the correct one for everyone. Although that it's late to be considering this question, but... Beter late than never.

Until next week; Stay Positive!
Never give up!
Keep trying and every day brings you
CLOSER TO SUCCESS

Eric Schlesinger, MD, FACS
AZ Weight Loss Solutions

Dr. I have always been able to eat steak and bread. How rare is this?

Julie,
When a Lap-Band is adjusted to its "sweet spot", it is extremely rare to be able to eat steak (not shredded), soft breads (like white bread), sticky rice, etc.
If your results are good, your ability to eat these foods is not significant. On the other hand, if you are not satisfied with your weight loss, then further investigation is needed. If you would like to discuss the specifics of your situation; contact my office at:

480-419-2280

Eric Schlesinger,MD, FACS
AZ Weight Loss Solutions

call me crazy but is this guy ambulance chasing?

No, he is just trying to help and give the facts.  He is one of the very few Dr.'s out there who will see/answer other patient's questions, other than his.  He's a good guy!

Cool - I had trouble finding him on the list of surgeons (finally did but OH doesn't make it easy). Well in that case - thanks for being here.

Lynn, I understand your question - and the thoughts that may be behind it - "Can I really trust the genuineness of his concern?"  Thought my experience last week might be helpful... I had a stomaphyx with Dr. Schlesinger on Feb. 14.  After the procedure, one of the recovery nurses , when telling me to call my Dr.  if I had any ?'s, said,  "You know, your Dr. is one of the nicest Dr.'s I've ever met!"   That kind of unsolicited comment  (from a nurse, no less!)  bears a lot of weight in my book!  And in my own experience so far, I have found Dr. Schlesinger (and his staff!) to be genuinely caring and trustworthy. ~ Mary

I had a revision from VBG (21 yrs. ago) to a lapband 22 months ago.  I have had nothing but success and base it on an excellent surgeon, excellent aftercare and knowing what to expect emotionally after having had the previous weight loss surgery where I had also lost all my excess weight and then regained it.  The band will only work if you have the patience to keep getting fills till you reach your sweet spot and realize you need to continue with fills as needed.  Being self pay in Canada to the tune of $16,000 didn't hurt my motivation also.

I had an excellent surgeon...one of the most experienced on the planet.  The band was placed correctly.  (The surgeon *****moved it said that the excellent placement made it easier to remove than most.)  I had aftercare by one of the surgeons that the band manufacturer sends their problems to for him to correct.  I had over a dozen adjustments in the first couple of years. And yet...it provided either no restriction (with 0.6cc in a 4cm band) or GERD and reflux (with 0.8ccs in that same band.)  It damaged my esophagus  (dysmotility secondary to gastric banding.)  I had a "gravity operated" esophagus, thanks to my diet with a choke chain.  The scariest thing about the band--the thing you never hear ahead of time--is that at any time in the future a perfectly functioning band can...and often does..become a problem.  So take a group of 100 people who need each need to lose 100 pounds.  Half (according to the more favorable studies) of them will lose less than 50 pounds.  Those are the failed surgeries.  The remaining 50 people will lose between 50 and 100 pounds, making THEM a wls "success."  Some will be happy losing only half of their excess weight, some won't...other will lose it all...but only a very few.   But let's assume that they are all delighted.  Problem is that, over time, erosion occurs, slippage occurs, esophageal problems occur and some of those in that 50% who lost 50 pounds or more end up getting their bands removed.  In other words, for the first year or two or three, the band has a pretty good track record.  (Well, the 50 people in the above example aren't usually too thrilled that they lost less than 50 pounds.)  But after that time period, the positive results DECREASE and the failures INCREASE because of the damage that the band causes to the body. Over time, then, the 50% of the people who didn't lose the 50 pounds and the people who had good results but had a subsequent complication are added together and what we have is an appliance that offers statistically WORSENING results the longer it is in place. Sue