Any input whatsoever...

Hi,.

New here. I have not yet decided between VGS or Lapband.

I thought my  mind was made up, until I started researching more. Did alot of looking on various forums here, too. I took the first step this week, sent in a request. It can take 8-12 months I was told.

I like that the band is not permenant,.If I want or need it out, it can be done, no irreverseable modifications to my body. However, I am not crazy about  a foreign body in me, I'm also thinking frequent visits for fills/unfills, sounds like a pain. There is no LONG term info, as many have been removed.

VGS: It is a drastic permenant FIRST step. Cutting out a piece of my body ...
There is also no long term info on complications , over time. What happens to staples in a body 20 + years. Please, I am sincerely looking for experiences & facts,. Thanks

I would never recommend the band to anyone after living with one for 5 yrs and from what I know it has done to others. It may not be permanent but the damage it so often does isn't reversable. There are people who have had to have their stomachs partially removed because the band can erode into the stomach itself. It can cause irreversable damage to the esophagus. It can also cause irrevesable nerve damage to the vagas nerve. The number of people over 5 yrs out who still have a band that is functional are few and far between.

The VSG is more drastic but that's what ends up happening to many bandsters except they end up with dead stomach tissue that has to be removed and then try to make a sleeve out of. It's much easier to make the sleeve properly if it hasn't been ruined with scar tissue from the band. The VSG has bee around since the 1940's for treating stomach cancer and severe ulcers and has an excellent track record. So there are stats out there for this surgery. Oh and as far as the staples go, they are very tiny ones and scar tissue grows over them and they just become a part of the stomach.

Even the most staunch band supporters who have followed all the rules and lost all their weight have had to revise because of band damage. So to me the only answer is the sleeve. It works the way we were told the band would but it didn't. Keep reading and researching until you are 100 percent sure of your choice.

It all DEPEND on HOW you are getting your band done. If you are going to self pay and go to Mexico BEWARE. If you are going to go a great surgeon here in the US that has a great track record and very low revision rate and has done ideally over 300-500 lap bands and you have a great income or good insurance the lap band may be a great option.

Yes you are very smart by going to various forums inside and outside of this site, there are other boards you may want to read lap band and both Sleeve boards as well as studies on both surgeries.

Regarding foreign object in the body, if your band is done right you will feel nothing, most people don't feel port discomfort, but some do, but again it all depends on on well your surgeon stitch your port to a muscle, I have never had port pain, if you decide on the band just make sure you allow it to heal post op and follow your surgeons healing instructions.

We all KNOW what the band can do long term, all the possible complications are out there in BOLD print, the good news is that MOST complications that can happen are not serious and can be easily fixed, most band complications are reflux, vomiting and heartburn, but guess what? REFLUX, VOMITING AND HEARTBURN IS COMMON IN the SLEEVE, something you CAN'T REVERSE.

Some lap banders will get too tight and cause band slippage and develop horrible reflux and then they say  -- oh I am going to revise to the Sleeve...which has MUCH WORSE REFLUX, including bile reflux when it happens

Never let people here fool you to say you will not get reflux with the Sleeve, it IS VERY COMMON and sometimes requires another surgery or conversion to the Bypass to get rid of it.

Here are the PROS that I see with the Sleeve from my own research: No fills, you have tight restriction right after surgery from the fact that your stomach has been removed, faster weight loss and possible more weight loss overall that most lap banders.

Here are the CONS that I see with the Sleeve from my own research and talking with Sleevers over the years: Very hard recovery post op for most people, cannot be reversed you cannot turn back, once your stomach is gone, it's gone. Reflux both short and long term, requires more vitamins than that lap band, since part of the stomach that absorb vital nutrition such as B12 is removed. Also there are lots of studies that indicate the Sleeve WILL STRETCH out over time, it usually start happening between 2-4 years post op for some much earlier with larger size Sleeves.

Dumping syndrome, many develop hypoglycemia /Dumping like syndrome with the Sleeve long term -- due to rapid stomach emptying caused by removal of the Fundus, but not as bad as Bypass dumping syndrome but bad enough for the Sleeve no longer being considered a "Restrictive only surgery" http://www.ncbi.nlm.nih.gov/pubmed/21647622, also long term many are in trials for long term hypoglycemia --Here are the Clinical Trials Bypass and Sleeve link for both Bypass and Sleeve http://clinicaltrials.gov/show/NCT01581801 also the Sleeve can have long term leaks and staple line breaks http://www.bmilatina.com/index.php/bmi/article/view/8

http://bariatrictimes.com/endoscopic-management-of-persistent-leak-after-laparoscopic- sleeve-gastrectomy-a-case-report/,

 http://www.weightlossia.com/the-truth-about-vertical-sleeve- gastrectomy-long-term-complications

Here are the Pros of the Lap band: Easy recovery for most people , no dumping syndrome, adjustable -- you can always get the band adjusted to help with weight loss and if any adverse symptoms like slippage, erosion,  esophageal motility issues can be reversed when the band is removed.

Here are the Cons of the Lap band: There is a possibility that fills can be a nightmare, make sure you research your surgeon. It can take months to get to a good fill level, fills can get costly for those with limited incomes or no insurance. Most fills costs average from free with co-pay to over $1,200 without insurance, so make sure you ask your surgeon about fill costs and aftercare. If you don't have good insurance and have a limited income the lap band is probably NOT a good choice.

Here are more on lap band risk: http://www.obesityhelp.com/forums/lapband/lapband_risk_in

Also fills are no exact science this is where you would have to work with your surgeon about honesty in how much you can eat and your hunger level, your surgeon WILL NEVER KNOW HOW TIGHT YOUR BAND IS, you have to be honest in how much you can eat after lap banding where your surgeon can determine and measure in how much saline will be added for each subsequent fill adjustment

If your band gets too tight, it is up to YOU to go back to get some saline removed. Your surgeon should have a fill chart of what is considered the yellow zone, green zone and red zone, red zone is where you do not want to be and green zone is where you want to stay for optimal weight loss and less problems with the band.

Some people report they never reached the green zone, happy medium of the sweet spot, this is where you must have a GOOD surgeon to fill your band properly, and yes some surgeons DO NOT fill the band properly, they either fill the band too tight (to cause complications), or the patient can eat too much to be successful, the green zone does exist, you just have to know how to tweak the band and work with surgeon, once you start to feel restriction with the band the next fills should be smaller and smaller until you reach the sweet spot.

For me personally, I chose the band because I did not want my insides rearranged or stomach removed, and if something ever happens I can get the band removed, I lost over 130 pounds with my first band went from a size 28 to size 10 and kept that weight down for 6 years, then I started having issues with reflux, turns out, it was a hiatal hernia, and fro getting bad fills from my previous surgeon over the years, .....I've had a band inside my body almost 8 years, had a hiatal hernia repair last year, old 4cc band removed due to it being more prone to issues long term, and new AP band installed, I don't know what the future may hold, but in the meantime I will enjoy my new band help me lose weight, by restricting my portions with no sickness or side effects. For ME, it was the lap band or nothing.

Edited to Add: Regarding long term issues with the staples in the Sleeve, my sister had stomach stapling surgery years ago, in the 1980's, that is similar to the Sleeve, she also had some of her stomach removed due to ulcers, some of her staples did not come out until about 10 years later, she had a revision surgery in 2006 that like to killed her, she did not lose weight with the revision, but she is doing ok now, but she complained about stomach pain for years and vomited daily. She is older than I am and on disability, due to stomach issues and back pain.

She lost all of her weight and kept it off for about 3-4 years and then she eventually regained ALL of her weight over the years and she also has dumping syndrome, ALL weight loss surgeries that staple or remove the stomach, most patients will develop dumping like syndrome, RNY have worse dumping since their plyoric valve is removed, but overall she is doing well, she still can't eat a whole lot, but she can eat WAY more than I can when my band is restricted and if she wants to lose weight she has to diet.

Good luck

A little Unknown FACT about Mexico and the Surgeons
It was the MX surgeons that perfected the band and the surgical technique as best they could. It was approved for use in MX 10 years prior to being approved in the US. It was the MX surgeons that proctored the US surgeons in bands. Due to that Allergan cut them a deal, MX surgeons got the band for $2K each but US surgeons had to pay $4k per band. (Yes, that is COST!) Well, then they came out with the mega band and they wanted people staying in the US for surgery because they made double the money so they refused to sell the mega bands to MX surgeons to try and force people to stay in the US and pay double for their stupid bands. That one kind of back fired on them because the mega bands turned out to be no better than the smaller bands. Matter of fact, Canadian surgeons actually have a choice between the old band and the mega band. They prefer the smaller bands, people have a better shot at actually getting restriction. US surgeons have no choice, they can only buy the mega bands.

So that FACT seems to negate the the issue about going to Mexico 

And your correct the band is NOT permanent, and if you have problems Allergan has seen to it you have no legal recourse as it states in their information all the potential problems that can occur THUS releasing them from liability.

Special Notice

The manufacturer of the LAP-BAND AP® Adjustable Gastric 
Banding System has designed, tested and manufactured it to be
reasonably fit for its intended use. However, the LAP-BAND AP®
System is not a lifetime product and it may break or fail, in whole
or in part, at any time after implantation and notwithstanding 
the absence of any defect. Causes of partial or complete failure 
include, without limitation, expected or unexpected bodily 
reactions to the presence and position of the implanted device, 
rare or atypical medical complications, component failure 
and normal wear and tear. In addition, the LAP-BAND AP®
System may be easily damaged by improper handling or use. 
Please refer to the adverse events section in this document 
and to the Information for Patients booklet for a presentation 
of the warnings, precautions, and the possible adverse events 
associated with the use of the LAP-BAND AP® Adjustable Gastric 
Banding System.

Even though you will probably NEVER see this information you still have to sign a release form from your surgeon.

I'd personally go to the VSG Forum and  read/talk to others there that have had the sleeve done

Good Luck no matter what you decide.

No ONE mentioned that Mexican surgeons were not skilled, that's NOT the problem, the PROBLEM IS AFTERCARE. It will be very hard for someone with limited income to jump on a plane, slimming, and vomiting and can't get food down if their bands get too tight.

When lap band problems occur or if someone's band gets too tight...they must be taken care of immediately...and WE ALL KNOW MOST US surgeons will not touch someone with a ten foot pole if they got their bands placed in Mexico...

Please don't get a band.  It requires so much follow up and your success is impacted by so many factors.  Surgeon skill, fills, diet, unresolved food issues, etc.  

testing preop should include:

cardiac evaluation 

esophageal mmanometry

barium swallow

Nutrition ccounseling

psych evaluation 

sleep study

You need the manometry if you're considering vsg or band.  I had my band 3 years...I had zero % esophageal motility pre removal. Even on a full liquid diet, I can feel the difference.  Liquids don't get stuck in my esophagus.

find the best bariatric surgeon you can to do your procedure...

steph

Bands have far more complications than bypass, when someone proves to me that 50% of bypass folks have to reverse their surgery at the 6 year point like bands do, I will believe bands have fewer complications.

The portion of your stomach that is removed during surgery has two functions.  One is to stretch to hold more food.  It can hold 16-19 cups of food.  How is that working for you today?  The other function is that it over produces a hormone called Ghrelin, ghrelin is what tells your brain you are hungry.  Studies show our population over produces this hormone so we really are always hungry.  How is that working for you today?  What do you need these two functions for?

The fundus of my stomach made me fat and ill.  It is no different from a sick appendix.  Would you fret equally as much over having that removed if it was harming you?  What about your gallbladder?  Would you worry you would need a sick gallbladder back?

Who says there is no long term info on complications for sleeves?  Sleeves (partial gastrectomies) are the oldest surgery type of bands, sleeves, bypass, and DS.  They have been doing partial gastrectomies for over 100 years just not for weight loss but stomach cancer and ulcers instead.  We know FULL well long term complications of sleeves.  Seriously, where are you getting your info because even for WL stats we have long term data.  As for the staples in your body for 20 years, they have been around for 20 years and so far noooo problem.

The band is not permanent but the severe damage it does is.  You worry about losing part of your stomach, how do you feel about the risk of losing esophageal function?  I'm not trying to be snitty, I am trying to put this in its proper perspective.

Maybe stop thinking about how to undo WLS so you have the opportunity to regain and revise to a safer surgery type.  Start looking at permanent solutions.  You don't want to regain, you want permanent.  Right?

Could you direct me to info re: sleeve complications, longterm? This is precisely why I am on the forum, to get info. Lots of it. I've been reading for awhile, but jumped in , to discuss.  :-) Thanks

I can.  For US stats I would Google Paul Cirangle, he is a surgeon in CA.  He has the longest term stats on sleeves in the US.  Keep in mind, when these stats first started they were using a larger bougie and regain was indeed an issue.  So they made the sleeves smaller using a smaller bougie and while weight loss was about the same regain was greatly reduced.  The stats used to (maybe they don't anymore, I am not sure) combine both bougie sizes.

Most of the risk is surgical and even that is just a fraction higher than banding surgery.  Long term the sleeve is the safest surgery we have of the main four.  Bands, sleeves, bypass, DS.  There just isn't a lot that CAN go wrong long term.  Depending on surgical technique there is a small part of the fundus that produces Intrinsic Factor, you need IF to absorb B12.  If your surgeon uses a technique that removes that then you will need to supplement for life with B12.  If your surgeon does not use that technique you stand less than 1% risk of needing to supplement B12.

There is a person on this board that revised from a band to sleeve and she complains a great deal about dumping.  Truth is, what she is describing is not dumping.  It is overeating.  She was eating the same quantity or more than I do several years post op and she was 3 months post op.  At three months you just can't eat that quantity.  There is no room.  Of course you are going to experience pain if you eat double the quantity that your sleeve holds.  That's a given.

The thing is, bands do not last long term in the vast majority of people.  Of the old timers here most have already had to have bands replaced, leaks fixed, etc.  It all means another surgery.  That is not a minor issue, that is major.  You WILL end up revising in the future anyway, isn't it better to get the right surgery type the first time around?

Reflux is another complication.   The stats I have read show it happens in less than 1% of the sleeved population.  I don't believe that stat.  I believe it is higher.  We know full well sleeves need a PPI for a few months post op, but the stats refer to after the first few months.  I still don't believe that, I do believe it is higher but I can't prove it.  My unscientific guess is that it is closer to 10%.  Maybe even 15.  But again, that is a guess based on what I read on the boards.

Thanks for the info & detailed response. I haven't been able to get on , the last few days, and have a lot of reading to do. Appreciated  :-)