Ask Dr. Curry

There are some patients that just cannot tolerate a band.  We understand very little about why this is.  If this is the case the only option is removal.

     Hi Dr. Curry,    I had a gastric bypass in 1982--lost 120lbs and slowly gained it back.  I am new to the concept of revision and had Stomaphyx on 2/1 with very little restriction.  I met with my MD and my options at this point include Lap Band or Revision.  He (I believe) is somewhat reluctant to do a revision since 1.) he did not do the original surgery and of course does not know what he will find and 2.) he's really not sure of how much success I will have since my pouch is smallish and totally intact.  I had an Upper GI 2 weeks ago which showed an approximately 6cm in diameter pouch and intact stoma (don't know size).  It also seemed to the radiologist that the jejunum was serving as "another  pouch" which allows my pouch to empty too quickly and go into the "reservoir" of the jejunum.  My question is this:  I really didn't speak about the band to my MD too much because we were focused on a revision of the connection (stoma).  Have you seen success with the scenario I just mentioned?  If the pouch is small is the band contraindicated?  Is there a band that will work specifically with a smallish pouch?   Thanks so much for any insight you can provide! Sue

Hi Dr. Curry,   Also, I wanted to ask what the success rate for putting a band over an old bypass is.  Would I be treated just like any other band patient as far as diet etc or would there be other issues that a first time band patient wouldn't necessarily have?  How long are people usually in the hospital and out of work.  I am an RN and work in a state agency for Mental Health and Addiction Services so my job is pretty much office and groups. Thanks Again, Sue

Most of our patients still go home the same day and are back to work in less than a week.  As for success see the previous message.

I don't think there are many surgeons with a tremendous band over bypass experience, but we have done about a dozen with pretty good success.  If your stoma is enlarged but your pouch is normal a band will probably help.  I can't quote you exact numbers on excess weight loss yet, but we have been seeing the scale moving in the right direction for these patients. 

Hi Dr. Curry, I am contemplating getting a Lap-Band.  I originally thought I wanted an RNY, but my husband goes ballistic about the 1 in 99 mortality rate.  The band is safer I assume?  I understand that in the RNY the weight not only comes off because of the smaller stomach, but also just because of the surgery?  This may sound crazy, but I am rarely hungry - I just am an emotional and stress eater.  Would the band help this?  If it helps to make you feel fuller, even if I'm emotionally eating, would it make me not be able to eat very much?  I'm not sure if I'm making sense here - the fills confuse me - do they do these in a doctor's office or hospital?  Is there always a place in the stomach which is open to do these fills? Thanks for your help! Lori - 300 pounds and depressed

Lori, This would be the length of War and Peace for me to answer here, I would recommend that you attend a few different seminars in your area.  1 in 99 is way too high for RNY mortality though.  We have done about 750 RNY's with only one death.  RNY leads to faster weight loss because of less intake due to smaller pouch and also less absorption of calories due to bypassed intestine.  The emotional eating thing is a tough one - with the right team you will get help with this as well but I'm not sure it comes from the band.

Hi Dr. Curry, Thanks so much for answering all our questions! I got another one for you: For the past month I've been having real bad gas pains. I realized that I got real sensitive to anything chocolate flavored (I guess that's a good thing :() and that sets the pains off immediately, but other times I have no idea what it comes from. You said you recommend gas x as much as needed but it's not working as well as it has in the past, or maybe my pains are just getting worse. I overdosed on it this weekend and the results were bad. I got extremely nautious and started heaving as if I was vomiting but there was nothing to vomit. Apparantly the gas x caused a great need to expel gas and there wasn't as much gas there and it caused the heaving to get the non existent gas to get out (I could be totally wrong but I felt a bit better with each burp sorry tmi and it felt like that had to be the explanation). At this point the pain has been keeping my appetite down but sometimes eating makes me feel better and I can definitely eat way too much so I want a fill. However, I'm scared that a fill will make it worse. So for the questions: Do you think this is def band related or should I see my pcp? Is there anything besides gas x that would help the problem? Will the problem last as long as I have my band? And mainly, will a fill make the problem worse and an unfill make it better?  Thanks again for your time in answering all our questions!

It could possibly be a gallbladder problem, but the bottom line is that you have to quit eating chocolate, it's not compatible with success and the Lap Band. I think you're going to have to see your surgeon on this one, I don't think I can figure it out over the net.