Long term results for the Band

 

So what?  I respect the republican party yet.... hear of the GANG OF 8?  Everyone screws up, including this time.

Your comment makes no sense. Science should never be replaced with anecdotes and scientists are a fair bit ahead of politicians -

Respected among people who do science and do surgery for a living. It is read by them and while any can argue the merits of a study it is a good study with remarkable conclusions

For some reason I thought that - but our interactions have not been all positive. Plus, politics for me is like spiders for my wife- and any mention of politicians makes me immediately nauseated. 

You can ask anything you wish- although I would prefer we keep on topic with long term results. 

 

I am clearly not getting the hang of this posting thing.  My posts keep getting removed.  I am undecided on OH, while I do believe they have over moderated this entire forum to its ultimate death, I actually do appreciate that they are allowing you to post to your own career death.  The real irony here is that you don't even see what you are doing.

Dr. Simpson, shall we just cut to the chase?  Can we just get down and dirty honest?  I have no hope of this being the case but the hopeful side of me is going to give it a shot anyway.

Why are you here?  You quite obviously have nothing of value to band vets, you don't comprehend band issues, you are totally oblivious of band problems.  Lap Bands are a dying breed, nobody wants them anymore.  Anyone who does 20 minutes of sincere research using peer reviewed journal articles wouldn't even consider such a surgery type.  So why are you here?  You are participating on an old old old forum full of band vets that you can't manipulate and taunt.  Oh, you try but from what I am reading, you are failing in a miserable manner.

You want to know the truth?  *I* am the bariatric nurse I have referred to previously.  My employer has removed a slew of your bands just like he has removed a slew of other surgeon's bands.  Science has been trying to get bands right for 40 years, they have failed.  Yeah, those patients that YOU taught to use their bands came to us suffering and dying from band complications.  We stood up and we did the job, we did what you decline to do.

I was speaking to a (non employer) bariatric surgeon about you yesterday.  I laughed when I repeated your words, you have only removed 20 bands.  Know what he said?  He said he believes that number to be true!  He also reminded me why we must remove bands you place as well as other surgeons.  You merely don't tell the whole story.  Let's be clear about this.

Wanna get even more down and dirty honest?  You think you know who I am, you do not.  I can damn well assure you I am NO ex girlfriend.  (GAG)  However, if I tell you my history I am comfortable that you will remember me.  I am the person that could have filed formal complaints with HIPAA due to Joyce's actions.  But YOU didn't do the dirty deed, Joyce did.  She left your place of employment and I knew full well YOU did not commit the moral crime, your employee did.  Thus, I didn't turn in your sorry butt.  In retrospect, I should have.  You remain responsible for the actions of those you willingly choose to hire.

My employer does not do bands.  He believes it is unethical as he knows full well he will get the patient back for a revision to a safer surgery type.  Amazing yet true, some surgeons still have ethics!  How crazy is that??

Let us be clear about one more issue.  There is NOTHING you can throw at me that I cannot refute.  NOTHING!  I know the topic of WLS inside and out, it is my passion.  I know your game, I think I know your motives.  But I damn well know WLS, stats, statistics, and reality.  You want my phone number?  You want the phone number of my surgeon?  You PM me and ask for it.  But I will tell you that we will not break HIPAA laws to satisfy your desires.  You want to know about our patients?  Your previous patients?  You have each and every one of them sign a release of info.  That is what the law dictates and WE follow laws and morality.

PM me and I will consider your request should you desire.

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Yes, revisions rates changed with surgical technique.  However, as you well know, the huge mega bands had only been out for 2 years post this study.  Not nearly enough time to know what we know now, they are currently removed at the same rate as the tiny bands.

Your study is silly, but it does our side a world of good.  Bands are dangerous, your study proves this.  More surgeries to unlock the band, relock the band, reposition the band, unlock it again.

It keeps YOU in the surgery business, right?  The other surgery types typically have one surgery and they are done.  But YOU keep your patients in the OR unlocking/relocking/repositioning the band.

'nuff said.

Sad to reduce this to motives. Remember in Australia they are not paid by surgery. It is universal health care. They get a paycheck - no incentives.

And let's look one step further, after taking into account all the flaws in their "study", at what they call their good results with lap band. Their carefully selected, most favorable patients, maintained a weight loss of 47% of their excess weight.

 

Now, at least here in the USA (I don't know about Australia), the definition of "success" for bariatric surgery is maintaining a weight loss of at least 50% of your excess weight. This is the standard accepted definition of success in the bariatric surgery community. While that compares favorably to how the MO fare without surgery, it's still a pretty loose definition of success. But in this study, even the selected "successful" patients were, on average, bariatric surgery failures.

I don't doubt that there were some patients who did succeed. But clearly, the majority of these band patients did not,and that's even after you filter out the ones least likely to succeed and leave in only the most favorable patients.

In the real world, we are seeing more and more patients having lap bands removed either because of complications, or intolerance, or losing insufficient weight or even no weight loss at all. In the USA, there are others who would like to revise to other, more effective operations but their insurers won't pay for a second operation. Some are at least able to get the bands removed, some not even that. It is sad to see any bariatric surgeon citing this "study" as support for the use of lap bands.

Larra

When the FDA advisory panel was looking they defined success as 30% EWL at five years. 

Not certain what you mean by "the real world." 

When compared to the study on sleeves- this study showed better resolution, longer follow up and good results. 

The AMSBS uses the 50% excess weight loss definition for success. I doubt that 200,000 or so patients in the USA would be having bariatric surgery every year if they were told that if they lost just 30% of there excess weight they should consider that "successful", or the results they should expect.

The real world is one in which an operation that falls below the threshold for success in the majority of its patients (and remember they excluded their less favorable patients) would not be considered successful.

Band having longer follow-up than sleeve. Sure! The sleeve as a stand-alone has only been in general use for a few years. However, gastric bypass and DS have been around far longer and longterm results are available. So comparing band only to the sleeve is disingeneous at best.

 

Larra