With all the research I have been doing, I am now more than ever sure that the BAND is not right for me, and WILL be getting SLEEVED!!! 


http://www.medscape.com/viewarticle/767489?sssdmh=dm1.803393

Abandon Gastric Banding Bariatric Surgery, Say Experts

Kate Johnson

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July 16, 2012 (San Diego, California) — Bariatric surgeons should abandon gastric banding in favor of sleeve gastrectomy or gastric bypass procedures, several researchers reported here at the American Society for Metabolic and Bariatric Surgery 29th Annual Meeting.

In the United States, the use of gastric banding is still "peaking," but elsewhere in the world it has largely fallen out of favor, said Michel Gagner, MD, in an interview with Medscape Medical News.

Dr. Gagner, from Hôpital du Sacré-Coeur in Montreal, Quebec, Canada, is a world-renowned bariatric surgeon who has established several bariatric surgery centers of excellence in the United States. He said he has virtually abandoned gastric banding, and performs sleeve gastrectomy in 90% of his cases.

His approach matches that of Luigi Angrisani, MD, director of the general and laparoscopic surgery unit at Giovanni Bosco Hospital in Naples, Italy.

Dr. Angrisani presented 10-year follow-up data from a prospective randomized trial comparing gastric bypass with banding, and said the evidence is clearly in favor of bypass.

"There is no point in doing further study comparing bypass with banding at this point," he told meeting attendees. "If you consider the revisions and the failures, only 26% of the banding patients had the band successfully implanted and a successful weight loss," he told Medscape Medical News in an interview. "That is not a nice result."

The study by Dr. Angrisani and colleagues involved 51 patients who were randomized from January to November 2000 to either laparoscopic adjustable gastric banding or laparoscopic Roux-en-Y gastric bypass.

In the banding group, mean age was 33.3 years and mean body mass index (BMI) was 43.4 kg/m²; in the bypass group, mean age was 34.7 years and mean BMI was 43.8 kg/m².

Of the 27 banding patients, 3 had hypertension and 1 had sleep apnea. Of the 24 bypass patients, 2 had hyperlipidemia, 1 had hypertension, and 1 had type 2 diabetes.

Ten years after surgery, 81.4% of the banding group and 87.5% of the bypass group remained in follow-up, reported Dr. Angrisani.

Of the 22 remaining banding patients, 9 (41%) had had their bands removed, leaving 13 for weight-loss evaluation.

The BMI of 6 of these 13 patients exceeded 35 kg/m², so the procedures were considered "failures"; only 7 patients in the banding group were successful in losing weight, he said.

In contrast, of the remaining 21 bypass patients, mean BMI dropped from 43.8 to 30.4 kg/m²; only 20% of the procedures in this group were considered failures.

There were no deaths in the study, and improvement in baseline comorbidities was similar in the 2 groups. However, reoperation rates were higher in the banding group than in the bypass group (41% vs 29%).

In the banding group, reasons for reoperation were pouch dilations (n = 3), band migration (n = 1), unsatisfactory weight loss (n = 4), and untreatable reflux (n = 1).

Reasons for reoperation in the bypass group were potentially life-threatening, said Dr. Angrisani — internal hernia (n = 1), cholecystectomy (n = 4), and incisional hernia (n = 1).

"The complications of bypass are iatrogenic," he told Medscape Medical News. "There is inadvertent bowel injury during manipulation of the bowel. When you do banding, you do not manipulate the bowel."

Like Dr. Gagner, Dr. Angrisani has virtually abandoned gastric banding, reserving it for a select group of smaller patients. An analysis of the Bariatric Outcomes Longitudinal Database (BOLD), presented separately at the meeting (as reported by Medscape Medical News), showed that from 2007 to 2010, banding and bypass surgery were performed in almost equal numbers in 540 hospitals in the United States **** 365 vs 138,222).

Europeans are ahead of the game, having started banding procedures before North America, and therefore detecting problems earlier, said Dr. Angrisani. "This is a very common story. While we as Europeans accept the messages from the US world of surgery, the US community does not accept data coming from Europe. So they are now living the experience we had in the last few years."

"It's a complete disaster, when you think that banding in the United States, based on the BOLD data, is the second-most common procedure," said Dr. Gagner. "Europeans are abandoning banding and the Americans are not getting the message. This abandonment that we see in Europe — we are probably going to see this in the next few years in the United States."

Although there is already a trend toward replacing banding with sleeve gastrectomy, lack of insurance coverage for the sleeve procedure remains a major barrier, he said. In the BOLD analysis, 21% of sleeve procedures were self-paid, compared with 5.7% of band procedures and 1.9% of bypass procedures.

"The European experience is more mature than the US experience with gastric banding," agreed John Morton, MD, from Stanford University in California, *****ported the BOLD data at the meeting.

In an email to Medscape Medical News, Dr. Morton said that "although 6-year data for sleeve gastrectomy indicate that it is safe and effective, the potential long-term complications for the sleeve may not be fully apparent yet, and gastric banding may still be preferred due to it's favorable short-term safety profile."

Dr. Angrisani has disclosed no relevant financial relationships. Dr. Gagner reports being a speaker for Covidien, Ethicon, and Gore. Dr. Morton reports being a consultant for Vibrynt and Ethicon.

American Society for Metabolic and Bariatric Surgery (ASMBS) 29th Annual Meeting: Abstract PL 103. Presented June 20, 2012.

 

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I believe it!  

The hospital where I attend support group has only done TWO bands this year.  An overwhelming majority of the newbies that go to our group are getting the sleeve and a few have gotten the RNY. 

Yay for doing your research!  There was so much I didn't know about the band before I got mine in 2009, and I thought I had done research.  I mean I did, but complications and poor EWL were not discussed like they are now.  If I knew then what I know now . . . 

My horrible surgeon is still doing the bands. He advertises like crazy. His mush- mouth face "interviewing" people who are "interested in banding" is something everyone should see. It's like watching a wax mannequin come to life after Satan imbues it with his evil powers.  He's making enough money to be able to afford half hour infomercials that run quite often.

It's been established, however, that this man has no conscience, no ethics, and no humanity. So, of course he'd still be willing. He's making money hand over fist. That's the only reason more studies like this haven't been brought out for public consumption. There's a lotta moolah being made. Funny how that affects what's shared with the public at large, isn't it? Even though we're being damaged left and right... apparently, money does make the world go 'round! 

Hmmm, remember a few months back when the FDA cracked down on those 1-800-GET-THIN or whatever band mills in California?  Sounds like he needs a good dose of that--30 minute infomercials?!?  WTF???

I don't like the thought of clinics advertising WLS on TV.  Yeah, if you wanna buy a snuggie on impulse, cool.  But bariatric surgery is not in the same category.  Unless you're a slimy practitioner who's interested in making money, not about earnestly improving the quality of life for your patients.

GRRRRR.  I can't stand that guy simply for his negligence in your treatment, but knowing that he's still out there hacking away on others sickens me.

On the shiny side, if you didn't get mauled by this jerk, I never would have found you as a dear friend, my schticky Nicci!  There's always a silver lining, even if it's teeny tiny and sometimes makes your butt itch.

He'll be exposed at some point. He's too arrogant and thinks he's untouchable. But it will come out... it always does eventually.

I like that silver lining, Twin!    You're my butt scratcha!  And I guess that means I'm yours! 

I'm so glad they're finally speaking out about this. It's important information that people need to know whether they are thinking about the band, already have the band or had a band removed already. A lot of people have been made to feel as if they've "done something wrong" when their band fails. And it's simply not the truth of the situation.

Back when I had the band done in 2003, I was given a video tape of Ann Wilson from the band, Heart. There was her testimonial about having had the lapband... set to music... and that was the extent of my "research."  Now there's so much more information to take in, thankfully.  Maybe more people can avoid the unfortunate experience that a lot of us had.

I hope they get the word out and Bariatric surgeons start to feel peer pressured to stop doing bands. I had mine in 04, these boards you RARELY saw a complication and weight loss stats were much different than the truth being told today. I did a lot of research and  the choices at the time really were RNY or the band. I still wouldnt have an RNy but in this day I can not imagibe why anyone who did their research would pick a band over VSG.

I also say this as a successful bander, down 115 lbs and "normal" but still I wish VSG was an option in 04.

Hi Heather!!!  

I can't blame the boards for me getting the band, as it was ultimately my decision and I bought into the "less invasive"  and "adjustable" bits promoted by the band companies.  But you're right, even in 2008 when I was researching, there weren't many (any?) threads on complications and stats.

The VSG was just gaining fame as a standalone operation for weightloss when I got my band and that was what I really wanted.  It was still considered experimental at the time and my insurance didn't cover it.   So I chose the lesser of two evils, or so I thought.   

Live and learn, I suppose.  All I know is that I talked a woman out of getting the band at support group and she is extremely pleased with her VSG and I think has lost about 50 pounds.  I told her about my personal issues, she discussed them with her surgeon and they decided VSG was a better choice for her.

Oh--I've met Heather in person a few times and she is a very successful bandster and looks AMAZING!!!

my problem with this study is that it's based on 51 individuals.  NOT enough to really say anything.  seriously, it's a statistically small group.  In accident review (i'm a risk consultant), we like to say we need 100 incidents to actually get somewhere with data, and that is with an employee groups of perhaps 200. 

having said that, i know there are many who have had horrible horrible band experiences-Nic is one...that poor girl has been butchered and that dr should be stripped.  for those who don't lose weight with the band...well, it's a tool, not a cure.

i was banded in october, 2011.  still a newbie.  i'm down 83 lbs.  i have had people, who have never been overweight in their lives say to me "but it only lasts a few years, you'll have to have it removed in 7 years".  wellll......here's my attitude towards that--if that happens, so be it.  at least it will mean 7 years of healthy living for me. 

wls is such an individual thing.  what is good for me, is not good for you, ect.  but a "study" of 51 individuals does not a study make.