Questions about the Lap Band

Hello,

I was introduced to this forum and I have some questions or perhaps more importantly insight from people who have already embarked on this journey.   I saw a doctor in Fort Worth about either the VSG or the Lap Band.  He suggested the Lap Band because I use smokeless tobacco ( I know horrible habit, but one battle at a time) and he said that males generally have good results with the Lap Band.  After reading on this forum I keep seeing about "failures" with the band.  Is this common?  I understand that this is just a tool to help me in my weight loss journey, and I also understand that there are ways to "self-sabotage" the band.  What advice would you have about this decision?   I am going into this with the knowledge that I need to change my behavior that allowed me to get so big in the first place.  Does anyone have any suggestions about which direction to turn for assistance with the "mental/overeating" part of the journey?  

I am sorry for being so "needy" but  I want to make an informed decision about what I am undertaking.  Any tips or suggestions or advice are greatly appreciated.  I have begun the Insurance portion, but it requires 3 months before I can submit the paperwork so I do have a bit of time.

Thank you in advance for you answers.

Tyler

Welcome, Tyler.

I can't think of why the band would be better than the sleeve for a user of smokeless tobacco.

We don't have a lot of male forum members because more bariatric surgery patients are female than male. I can think of a very successful male member, Tom Bilcze, whose blog is at beariatric.com.

As for the frequency of band failure posts on this forum, keep in mind that people post more often when they're struggling and need more information, assistance, support, sympathy, etc. A lot of happy bandsters don't post here any more because they've lost their weight and are out there somewhere living their dreams.

I think it's possible to self-sabotage following any type of bariatric surgery, mainly because of the mental/emotional/behavioral issues that helped make us obese in the first place. I've found the most help in dealing with that part from counseling with a therapist who's experienced with eating disorder and WLS patients.

I don't put much store in statistics (because figures can lie, and liars can figure), but it does seem that the band has the lowest weight loss rate compared to the other procedures available. That doesn't mean it's a bad surgery. It's worked very well for me - I lost 100 of my excess weight (90 lbs) in a year.

An important thing to consider when deciding whether or not to have band surgery is aftercare. The band requires more medical aftercare because most band patients need numerous fills (and sometimes unfills) to achieve a fill level that will yield optimal weight loss. Depending on your insurance coverage, the aftercare could eat up a lot of time and money. I'm lucky that I pay only a $5 copay for fills, but since seeing my surgeon requires a 5-6 hour drive round trip, I have to take a whole day off work. My last fill was 8 months ago and I don't think I'll need another one very soon, but in my first year post-op I saw my surgeon about once a month.

Jean

Hi Tyler,

Since you are in the DFW area, there are LOTS of bariatric surgeons there.. I'd suggest talking to more than one.

You may also want to start seeing a behavior modification therapist to help with eating behaviors.  You will most likely have to have a psychological evaluation before any WLS anyhow, so you may as well start now.

I've found Judith Beck's book "The Beck Diet Solution" and the accompanying workbook to be helpful.  It is NOT a diet book, but a book on how to slowly change your thinking about food and eating.  

I'd also suggest that you join the yahoo group DFWBandsters to talk to some other bandsters in your area.  And a few of the people on that group were banded and moved to a sleeve for various reasons.  They can give you their views of both surgeries.  I also very much like the yahoo group SmartBandsters.  Both of these groups have members that have been successfully banded 10 or more years.

I personally did not want a malabsorptive surgery.  I know they work well for many, but it just wasn't for me.  I've had very little problems with my band and those that I have had, have been operator error (ie, I ate too much or too fast or the wrong thing, etc. etc.).   Some people do have just plain bad luck with the band.. and some abuse it.  I don't know if there's any way to predict if you will be one of those who can't tolerate the band.. but you can certainly work on controlling how you use or misuse it.  :) 

I understand the "one addiction at a time" theory.. but if you could cut back on the smokeless tobacco, that would be very helpful.

Glad you're reaching out for information and support.   Congratulations on making steps to improve your health!!

Hi Tyler,

I have had the lap band and the VSG and for me, the VSG is the hands down winner. I love my sleeve and you can sort through some of my recent posts or PM me if you want to know about my experiences with either.

I think that problems with the band are pretty common. Some studies have it higher and others lower, but I would guess that about 35-40% of most band patients have some type of complication within 5-10 years. I think it is fairly common to require further surgeries for repair, replacement, or removal/revision.

Here are some interesting studies so you don't have to just go by my guess-timates:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2698858/?tool=pu bmed
"The placement of a gastric band appears to be a disservice to many morbidly obese patients and therefore, in the current culture of evidence based medicine, the prevalent use of laparoscopic gastric banding can no longer be justified."

http://www.ncbi.nlm.nih.gov/pubmed/21422330
"However, because nearly 1 out of 3 patients experienced band erosion, and nearly 50% of the patients required removal of their bands (contributing to a reoperation rate of 60%), LAGB appears to result in relatively poor long-term outcomes."

http://www.ncbi.nlm.nih.gov/pubmed/21188545
"LAGB can achieve an acceptable weight loss in some patients, but the failure in one out of four patients does not allow proposing it as a first-line option for the treatment of obesity."

http://www.ncbi.nlm.nih.gov/pubmed/20496124
"Of the study population, 146 (52.9%) patients had at least one complication requiring reoperation. Presently, only 148 (53.6%) patients still have their original band, 49 (17.8%) had their original band replaced with a new one, and 79 (28.6%) had their band removed."

http://www.ncbi.nlm.nih.gov/pubmed/19730234
"The percent of excess weight loss at 4 years was higher in the gastric bypass group (68 ± 19% vs. 45 ± 28%, respectively, P < 0.05)."


The lap band does work for some people and there are some great examples of that on this board, but the problem is that it is unpredictable. It's hard to know what side of the fence you will land on once you have the band placed. I know some people don't like to put too much stock into stats and want to go into the procedure with faith that they will be the success stories (I was pretty much one of those people! oops!), but with more and more insurance companies instilling a "one WLS per lifetime" rule, it is really important to give yourself the best odds of success.

Best of luck to you in your decision! Spend the next 3 months researching and you'll be sure to become well-informed and find peace with your decision.

Lindsey

With regard to smokeless tobacco - do you chew it then?

This might be why the band was recommended. Chewing tobacco (and smoking it) can be implicated in gastric cancer, and the doctors are not going to want to sleeve a person who might then need every ounce of their stomach later on if they got gastric cancer.

Cat.

Cat, that makes sense.   I was discussing the sleeve with a doctor friend the other day (who is not a bariatric surgeon)  and wondering about barrett's esophagus (spelling?) and wondering what would a bariatric surgeon decide to do if a person who wanted a sleeve had Barrett's. 

Thanks for enlightening us.  :)

There is a band group on Yahoo from your area that may be able to help you with a surgeon. It is DFWbandsters at Yahoo, alot of bariatric nurses and Drs are on that message board.