Ask Dr. Curry?

Good Morning Dr. Curry,

Simply put, I am just starting this journey  (in pre op phase)  and am deciding on which surgery to have. I originally wanted the sleeve but found out that my BCBS will only cover RNY or Banding. 

Whats the latest in research you have heard regarding long term effects of both? 

I deep down inside want the RNY because it is stated to have the best results, and is the GOLD STANDARD.   I need to loose 120 pounds.  No comorbidities yet, but I do like sweets and I hear if you are a sweet eater then the RNY is for you and the meat eaters need the Banding.   Im predisposed to HBP and Diabetes, and oh yes my cholesterol is high.

 I am at a loss and seeking a second opinion because the first surgeon I talked with quickly talked me out of the RNY and stated the banding is showing better long term effects than the RNY because after 18 months the RNY's start gaining the weight back.  I am trying to do my due diligence, but there is so much conflicting info everywhere , I dont know what to do anymore? 

What are you finding long term?

Thanks and Happy Easter!

I think that, if your BMI is less than 50, your results will likely be similar with either operation.  If your BMI is over 50 then there is some data to suggest that RNY is better.  We have had many patients lose 120 lbs, but it is probably not as easy as it would be with a bypass.  The tradeoff you get, though, is a much lower risk operation.

Hello Dr. Curry,
I just had my 3rd fill on Wednesday of this week.  I had it done early in the morning and was able to drink water and juice and broth with no problems.  Yesterday, day 2 after my fill, I was able to drink water slowly throughout the morning and then some broccoli cheese soup at lunch (very slowly) but as the day went on it got more and more difficult to drink anything.  By last night I wasn't able to drink anything without feeling like it was going to come back up.   I had a very difficulty night, sleeping on and off due to reflux, which i don't normally have, and coughing, etc.  IS this normal after a 3rd fill?  I didn't think the band was too tight because I was able to drink with no problems the first day.  I am thinking that it is swelling that is causing the problems?  Today I have been able to drink water with no problem and am eating some egg drop soup for lunch, also with no problems as I am eating it slowly.  Do you think I need to get some of the fill taken out or should I wait a few days to see how it adjusts?  I have not had any reflux or anything like that today.
Thank you for your help!
Laurie

Laurie,
We frequently find that patients gradually get tighter after a fill for a few days.  This is why we don't ever do them closer than 14 days apart, and prefer to wait 30 days if possible.  Probably just need a small unfill.

Thank you so much for your response, Dr. Curry.  My doctor schedules fills 6 weeks apart.  I have loosened up quite a bit but still have good restriction so I am in pretty good shape now.  Thank you for your time!
Laurie

Dr Curry,

I have still not heard back from my Dr.On results of upper scope,I picked up my own copy,reads as I will copy below,can you tell me if their is in fact something wrong with my band itself?  Thank You again for your time spent on this board.

EBand surgery.Epigastric Pain

Findings:

There is normal appering mucosa and peristalais of the esophagus.There is no evedence of hiatal hernia.Mild reflux was seen durning floroscopy. The visualized portions of the stomach show no definite evidence of ulcer.The duodenal bulb and loops are not visualized.Lap-Band appears somewhat horizontal.

Impressiotatus post Lap-Band surgery with somewhat horizontal positioning of the lap-band.Their is mild gastroesophageal reflux

This doesn't really give me any useful info whatsoever, which is typical for an upper GI report on a band patient.  You have to really see it live to know what's going on.

Dr Curry,
Good Luck to you on your lap-band,nice to know a Dr. that has gone threw this same surgery.Below you will find a copy of my Report,I have not seen my Dr. as of yet as a matter of fact he has not even answerd my calls,so please if you can read this and tell me if this is something serious,he took out all my fills for this test and now after 16 months out I have NO restriction.And could you tell me could he put 5.5 cc back in my band at one time or do we have to start from scratch?

Here is my report
Clinial Esophagram :
Clinical Data,History of Lap- Band surgery.Epigastric Pain

Findings:

There is normal appering mucosa and peristalais of the esophagus.There is no evedence of hiatal hernia.Mild reflux was seen durning floroscopy. The visualized portions of the stomach show no definite evidence of ulcer.The duodenal bulb and loops are not visualized.Lap-Band appears somewhat horizontal.

Impression:

Status post Lap-Band surgery with somewhat horizontal positioning of the lap-band.Their is mild gastroesophageal reflux.
cal Data,HEsophagram :
Clinical Data,History of Lap- Band surgery.Epigastric Pain

Findings:

There is normal appering mucosa and peristalais of the esophagus.There is no evedence of hiatal hernia.Mild reflux was seen durning floroscopy. The visualized portions of the stomach show no definite evidence of ulcer.The duodenal bulb and loops are not visualized.Lap-Band appears somewhat horizontal.

Impression:

Status post Lap-Band surgery with somewhat horizontal positioning of the lap-band.Their is mild gastroesophageal reflux.
istory of Lap- Band surgery.Epigastric Pain

Findings:

There is normal appering mucosa and peristalais of the esophagus.There is no evedence of hiatal hernia.Mild reflux was seen durning floroscopy. The visualized portions of the stomach show no definite evidence of ulcer.The duodenal bulb and loops are not visualized.Lap-Band appears somewhat horizontal.

Impression:

Status post Lap-Band surgery with somewhat horizontal positioning of the lap-band.Their is mild gastroesophageal reflux.



Esophagram :
Clinical Data,History of Lap- Band surgery.Epigastric Pain

Findings:

There is normal appering mucosa and peristalais of the esophagus.There is no evedence of hiatal hernia.Mild reflux was seen durning floroscopy. The visualized portions of the stomach show no definite evidence of ulcer.The duodenal bulb and loops are not visualized.Lap-Band appears somewhat horizontal.

Impression:

Status post Lap-Band surgery with somewhat horizontal positioning of the lap-band.Their is mild gastroesophageal reflux.

I really cannot help you with specific info like this.  You are going to need to talk to your surgeon.

Dr Curry,Thank You for trying to answer my questions,I have seen my Dr. and seems he says nothing bad is going on,the reason for the extra 2.5 cc is he said I was primed at time of surgery,when I asked him this before he told me no ,just the band was put in.Anyway he wants my stomach to rest & see him in 6 weeks.All results came out good on tests he dont know why my Epigastric was inflamed.

My question to you is could the Dr. a Dr. any Dr for that matter put back the whole fill I lost or is it a start all over thing for me now? I am hungrey,and so afraid of gaining back my weight while he might fill me slowly.I need my band filled to feel the restriction I once did.