My Visit today with Dr Ku, Thank you "Susans_journey"

First I want to thank Susan "Susans_journey", for suggesting to see Dr Ku in PA, you may have saved my lap band.................Because Suzie (my band) was just about to be put on the chopping block.....

Well...after feeling great for about 2 weeks now, and my surgery date for removing my band is getting closer, (November, 16), my husband looked at me and told me, "honey" I really don't think you need to remove your band, especially if you are feeling ok now and if you don't have slippage or erosion.

I told him last week that I had canceled my appointment to see Dr Ku, as I was tired of driving around consulting with other surgeons asking them for their expert opinion on my band. And since the drive would be a little over 2 hours to see Dr Ku, I did not feel it was worth it.

I got a call from Dr Ku's receptionist asking why I canceled my appointment, I told her I was sick and tired of surgeons "selling me the Sleeve" WHILE I WAS STILL IN PAIN from my hernia. So she assured me Dr Ku would look at my test and make a honest assessment and let me know whether or not to remove the band or salvage it.

So I headed out to PA today and met with Dr Ku, very nice and handsome guy, we talked for over an hour about the lap band in general , he was amazed at how knowledgeable I was about the Band and Sleeve. He mentioned that I sure have done my homework on both Band and Sleeve and will do whatever I want that is medically doable.

So he took a look at my the CD of my Upper GI and said every thing looks great and he even mentioned how great my esophagus looked. He mentioned that he has seen some pretty bad looking esophagus' after band placement and for me to have had it over 7 years it said my esophagus looks perfect.

He said based on my endoscopy and Upper GI he would NOT recommend removing the band especially since it has worked for me in the past. Also he says I probably have had this hiatal hernia since I was banded over 7 years ago and he says MOST surgeons were NOT repairing hernia's prior to 2006, and they learned this to be a big problem after band placement. He also mentioned that he was surprised my band has worked as good as it has over the years with hernia.

He mentioned that if a patient has a hiatal hernia it interferes with the patients ability to truly feel "satiety" because the vagus nerve will not be stimulated properly to get that true "full feeling" and instead patients with haital hernia's may request tighter fills to try to make up for not feeling true satiety, which in turn can cause painful eating or reflux and other issues instead of the band working like it is suppose to. Now that was very interesting to learn.

He also said that he can't say how he will repair my haital hernia until he gets in and see what's he is dealing with, he mentioned the band may need to be unbuckled and it may not, depending on where the hernia is situated, and he mentioned that the older 4cc bands surface are a bit harder than the newer bands and may be more a bit more harder to unbuckle but it's definitely doable,

He also mentioned that  the hernia is probably sitting right where the band should be and the bottom of the esophagus in the way, so he will go in and move it back down and stitch it up. He also mentioned that "typically" the band should be replaced with a new band when the hernia is repaired, but he mentioned in my case since my old band has worked great for so many years, it would not make sense to replace it with a new band, if there is no slippage.

He did go on to say that there is a decline in patients wanting the bands, many new weight loss patients are opting for the Sleeve. He also said that the Sleeve is still attractive for many people and not as invasive than the Bypass, it tends to have quicker weight loss than the band and not much maintenance so many newer patients are more attracted to the Sleeve for this reason.

I asked him are there a lot of slippages, and he said NO, not many patients in his practice are getting their bands removed and he has done over 500 bands in his practice since 2006. That's what my previous band surgeon mentioned that although NEW weight loss patients are not requesting the band these days, not many are getting them removed, although sales for the band has declined.

He also said that he believes in the band, and the lap band gets a BAD RAP because of very poor aftercare and the reason for the high complication rate which is not necessary in most of the cases. He mentioned that if he was choosing a weight loss surgery it would be the lap band and not the Sleeve. He mentioned the Sleeve has quicker weight loss in the beginning than most band patients, but not necessarily long term.

Dr Ku did mentioned that although sales have declined for the band there will always be a market for the band because many people will still not want their insides rearranged or stomach removed so each surgical option will still play a role for each individual patient needs.

If I can, I would like to hold on to my band as long as I can, I figure if I can get at least 10 more years out of my band it would be worth it without problems from my hernia, and Dr Ku assured me repairing my hernia would be worth it and it should stay fixed for a long time and at least I can keep my weight under control with my band.

He wants to go ahead in the next week and schedule me for surgery , I told him if he has to remove the band that's ok, but I want my hernia repaired either way.....so we will see what happens next.

that's wonderful news Nana. it's great that you found a doctor that would finally listen to what you wanted instead of shoving the sleeve down your throat. it's funny what he mentioned about the band even with decline that there were still be people who want them because they don't want their insides rearranged or their stomachs cut up. it's certainly why i went with the band and still would choose the band. =) hopefully everything goes well next week!

Thank you! My gut told me to go out to see Dr Ku before getting my band removed and I am glad I did. I think my old surgeons office was trying to get me to revise to the Sleeve because they are moving from a Band ONLY shop to a Sleeve ONLY shop because they are not getting the revenue in for NEW BAND patients like they did before.

What really upsets me is what if I have worse GERD if I revised over to the Sleeve...then what do I do? You can't do much of anything if you don't have enough stomach left to repair a hernia. And that is the biggest compliant of the Sleeve horrible GERD, which HAS BEEN MY MAIN COMPLAINT for 2 months when my hernia was inflamed which caused gastritis and esophagitis.

 But honestly I don't think some surgeons care if the patient are in misery all they want to see is weight loss and numbers at any means necessary.

I wonder what is going to happen when the Sleeve matures and the excitement is gone and all LONG TERM ISSUES of weight regain, and other issues rear their UGLY HEAD....because ALL WEIGHT LOSS SURGERIES have a "POPULAR HIGH" LIKE THE BYPASS, BAND ...and NOW THE Sleeve is the 'cat's meow"...lol...this is the very reason I am not quick to jump on the Sleeve "high"....I'd like to see more long term studies/side effects and complications and regain stats before I opt to chop off most of my stomach.... and right now it's just not enough for me.

Okay, I assumed you actually knew what a hernia was.  You realize that a hiatal hernia is when the top portion of the stomach slips upward through a gaping hole in the diaphragm into the chest cavity. Your stomach or stomach size really doesn't have anything to do with fixing a hernia or not. The hernia is the area of the diaphragm that gapes. The hernia didn't "cause gastritis"... your body might have REACTED adversely.  

You could have a large hernia, resulting in more of the stomach protruding into the chest cavity, causing heartburn, chest pain and difficulty swallowing. The smaller ones usually don't have as many symptoms associated with them. I take medication to treat the symptoms of the hernia I developed while banded. But having the band around the top portion of the stomach and getting stuck can certainly help the hernia get larger and larger over time.

Like this:

You see the fundus in this diagram? That's what's removed during sleeve surgery.

Nic, thanks for your diagram...but my hernia DID cause gastritis and esophagitis and yes I DO know what a haital hernia is no need for a diagram, I trust my surgeons judgment they are professionals that deal with hernias and lap bands all day long. I am thankful that I am no longer inflamed and no longer on medication, but I DO NEED my hernia repaired to prevent this from occurring in the future and the hernia just so happen to get in the way of allowing my band to be effective. If hernias did not interfere with the band, surgeons would not repair them these days.

As explained in laymen terms below:

http://www.ehow.com/facts_5858348_medications-used-gastritis-hiatal-hernia.html

Gastritis, or gastro-esophageal reflux disease, is a condition that affects the lower sphincter muscle of the esophagus. Gastritis can sometimes be caused by a hiatal hernia where part of the upper stomach extrudes into the chest through a person's diaphragm. Most people do not feel the hiatal hernia itself, just the symptoms of gastritis pain, flatulence or mild to severe heart burn.

I also explained my symptoms to a top surgeon that does hiatal repairs -- and he mentioned that the back and chest pain WAS CAUSED BY MY HIATAL HERNIA, I also had shortness of breath which are CLASSIC hiatal hernia symptoms, you can google that.... and my ONLY symptom now is mid  back burning in the center of my back and that now is minimal and only occurs after eating, these are all caused by the hernia, my esophagus is no longer inflamed since I no longer have painful eating.

I am hopeful that my surgery next week will take care of all my symptoms.

Thank you so much for sharing all this with us, Naomi. It sounds like you've found a winner in Dr. Ku. I agree with him that the band gets a bad rep because of poor aftercare.

Yep, I think I found a winner, I had to drive out of state to find a winner...lol....it was very interesting how he mentioned that a haital hernia can interfere with how a patient not able to get a "full feeling" this may be the answer as to why so many obese people have hiatal hernias....who knows hiatal hernias may cause obesity even in those that don't have weight loss surgery, I would think that may interfere with the ability to feel full regardless which wls or even no wls.

i found that to be an interesting point as well. have to do more research before i'd buy that one completely. i doubt my hernia (which was repaired before the band surgery) made me eat enough for a small family from mcdonalds :)

My ex-PCP told me years ago that hiatal hernias are very common in obese people and told me that weight loss would reduce my symptoms (at the time, a sort of grabbing pain in my upper abdomen). Weight loss did do that (no thanks to him, though, as he's the one who told me I didn't need something as "drastic" as WLS). I hadn't heard that a hiatal hernia can affect a person's experience of satiety (feeling "full"). I suppose that's possible based on my completely inexpert understanding of hernias and the role of the vagus nerve in satiety...if the stomach oozing up through the hernia interferes with vagal function...hmmm.

Well, I respectfully request more detailed reports of your conversations with Dr. Ku. He sounds like a very interesting person, and that rarity - a surgeon with a good bedside manner.

Jean, I've heard that many obese people have hiatal hernia too, I think what this surgeon was suggesting was that especially patients with a lap band, the hernia interferes with ability to feel true satiety because the hernia is in the way and tends to be in the spot there the vagus nerve gets stimulated to sends the signal to the brain that you are full. I was just wondering if this happens in those people that don't have a lap band since most people with a hiatal hernia are in fact obese.