Sandy r

sure:

Obes Surg. 2002 Dec;12(6):789-94. Links


Obes Surg. 2003 Jun;13(3):468-9; author reply 469-71.
Sweet eating is not a predictor of outcome after Lap-Band placement. Can we finally bury the myth?

Hudson SM, Dixon JB, O'Brien PE.
Monash University Department of Surgery, Alfred Hospital, Melbourne, Victoria 3181, Australia.

BACKGROUND: It is common belief that sweet eaters will do poorly after gastric restrictive surgery. There is scant evidence for this and significant evidence that sweet eating behavior is not predictive of weight outcome. Preoperative and current sweet eating behavior was assessed in subjects who have had Lap-Band surgery, to find if this influenced weight outcomes. METHOD: 200 unselected patients who had bands inserted for > 1 year completed a questionaire regarding preoperative sweet eating behavior. The last 100 patients also reported current sweet eating behavior. Sweet eating was scored using a standard dietary questionnaire. RESULTS: Mean +/- SD % excess weight loss at 1 year (% EWL1) for the 100 with the highest preoperative sweet eating scores (SES) was 47.1 +/- 16% compared with a loss of 48.2 +/- 16% by those with the lowest SES (P = 0.64). Analysis showed no significant linear or non-linear correlation between the SES and the % EWL. For the highest quintile of SES, the EWL1 was 47.3 +/- 14% and for the lowest was 46.1 +/- 16% (NS). Sweet eaters were younger (r = -0.21, P = 0.003) and had higher fasting insulin concentrations (r = -0.18, P = 0.03). Preoperative SES had no influence on % EWL1 after controlling for factors known to influence weight loss. % EWL at 2 years (n = 130) and 3 years (n = 88) were not different for sweet eaters and non-sweet eaters. Current sweet eating tendency (n = 100) also had no impact on % EWL. CONCLUSION: Sweet eaters do not have less favorable weight outcomes following Lap-Band surgery. Our study confirms the findings of two other major studies. Sweet eating behavior should not be used as a preoperative selection criterion for bariatric surgery.

sure : from a surgeon's site and well-known

"Weight loss surgery patients who have gastric bypass can suffer from what is called dumping syndrome. Dumping syndrome is described as a shock-like state when small, easily absorbed food particles rapidly dump into the digestive system. This results in a very unpleasant feeling with symptoms such as a cold clammy sweat, pallor, butterflies in the stomach and a pounding pulse. These symptoms may be followed by cramps and diarrhea. This state can last for 30-60 minutes and is quite uncomfortable.

Approximately 70-75% of bypass patients exprience dumping, and a percentage of long-term post-operative patients build a tolerance and do not dump on foods that would normally cause dumping syndrome with the malabsorptive gastrointestinal system. However, most patients learn to avoid the foods that cause dumping because it is so unpleasant."

re the port:
The port isn't the least problem for most of us. I chose that over many , many metal sutures that can fail and cause alife-threatening peritonitis.
but w each must research and decide what is bst for us.
sandy

Sandy r

Also, there are just as many patients who go from bypoass to band, from band to bypass, and from band to the sleeve, from band or bypass to DS, etc. it's the patients who do not comply with he WLS needs, which are all almost identical, not the procedure itself that fails.

Sandy r, BSN, MN
band educator
at goal 4.5 yrs

Phoenixfire

I completely disagree with this information and would like to see the research data that proves these assertions.

You'll find people on here who have had the band and were not happy with it or had improper aftercare or had problems with it, and are now trying to get bypass. One has even had severe scarring and internal damage that may eliminate the option of bypass (can't recall the person's name but I hope they see this thread and give you THEIR opinion.)

To the original poster, it is a personal decision based on many factors such as how much weight you have to lose, how long you've been obese and many other things I don't know as I didn't examine the lapband.

Personally, my opinion based on reading here and reading A LOT of band research for two people I know -- who are looking at the band but won't do bypass because they see how little I can eat and don't want to be that restricted -- RNY is a better option with a higher long-term weight loss possibility.

BUT IT IS NOT FOR ME TO SAY WHAT YOU SHOULD CHOOSE, and I encourage you to research (from reputable sources like the Board of Bariatric Surgeons) to find out the information to help you decide. You'll notice the lapband forum is not as full as the RNY forum. I'd look and read over there if you're considering the band.

__________________


Open Roux-en-Y on October, 2002 - 7 year anniversary is right around the corner
Height: 5'8"
Highest weight: 300 lbs. with a BMI of 45.6
Current weight: 140-145 lbs. and a size 6/8 with a BMI of 21.7
Total weight lost after Roux-en-Y gastric bypass: 160 lbs. POUNDS!

Sandy r

Ann Surg. 2007 Jul;246(1):163-4; author reply 164.
Ann Surg. 2008 Jan;247(1):205-6.

Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years.Christou NV, Look D, Maclean LD.
Section of Bariatric Surgery, Division of General Surgery, McGill University Health Center, Montreal, Quebec, Canada. Nicolas.Christou@MUHC.McGill.ca

OBJECTIVE: To complete a long-term (>10 years) follow-up of patients undergoing isolated roux-en-Y gastric bypass for severe obesity. BACKGROUND: Long-term results of gastric bypass in patients followed for longer than 10 years is not reported in the literature. METHODS: Accurate weights were recorded on 228 of 272 (83.8%) of patients at a mean of 11.4 years (range, 4.7-14.9 years) after surgery. Results were documented on an individual basis for both long- and short-limb gastric bypass and compared with results at the nadir BMI and % excess weight loss (%EWL) at 5 years and >10 years post surgery. RESULTS: There was a significant (P < 0.0001) increase in BMI in both morbidly obese (BMI < 50 kg/m) and super obese patients (BMI > 50 kg/m) from the nadir to 5 years and from 5 to 10 years. The super obese lost more rapidly from time zero and gained more rapidly after reaching the lowest weight at approximately 2 years than the morbidly obese patients. There was no difference in results between the long- and short-limb operations. There was a significant increase in failures and decrease in excellent results at 10 years when compared with 5 years. The failure rate when all patients are followed for at least 10 years was 20.4% for morbidly obese patients and 34.9% for super obese patients. CONCLUSIONS: The gastric bypass limb length does not impact long-term weight loss. Significant weight gain occurs continuously in patients after reaching the nadir

Surg Endosc. 2008 Apr;22(4):1019-22. Epub 2007 Oct 18. Links
Gastric banding as a salvage procedure for patients with weight loss failure after Roux-en-Y gastric bypass.Gobble RM, Parikh MS, Greives MR, Ren CJ, Fielding GA.
Department of Surgery, New York University School of Medicine, New Bellevue 15 North 1, 550 First Avenue, New York, New York, 10016, USA gobblr01@med.nyu.edu

BACKGROUND: This study reviews outcomes after laparoscopic adjustable gastric band (LAGB) placement in patients with weight loss failure after Roux-en-Y gastric bypass (RYGBP). METHODS: All data was prospectively collected and entered into an electronic registry. Characteristics evaluated for this study included pre-operative age and body mass index (BMI), gender, conversion rate, operative (OR) time, length of stay (LOS), percentage excess weight loss (EWL), and postoperative complications. RESULTS: 11 patients (seven females, four males) were referred to our program for weight loss failure after RYGBP (six open, five laparoscopic). Mean age and BMI pre-RYGBP were 39.5 years (24-58 years) and 53.2 kg/m(2) (41.2-71 kg/m(2)), respectively. Mean EWL after RYGBP was 38% (19-49%). All patients were referred to us for persistent morbid obesity due to weight loss failure or weight regain. The average time between RYGBP and LAGB was 5.5 years (1.8-20 years). Mean age and BMI pre-LAGB were 46.1 years (29-61 years) and 43.4 kg/m(2) (36-57 kg/m(2)), respectively. Vanguard (VG) bands were placed laparoscopically in most patients. There was one conversion to open. Mean OR time and LOS were 76 minutes and 29 hours, respectively. The 30-day complication rate was 0% and mortality was 0%. There were no band slips or erosions; however, one patient required reoperation for a flipped port. The average follow-up after LAGB was 13 months (2-32 months) with a mean BMI of 37.1 kg/m(2 )(22.7-54.5 kg/m(2)) and an overall mean EWL of 59% (7-96%). Patients undergoing LAGB after failed RYGBP lost an additional 20.8% EWL (6-58%). CONCLUSION: Our experience shows that LAGB is a safe and effective solution to failed RYGBP.


Surg Endosc. 2008 Apr;22(4):1019-22. Epub 2007 Oct 18. Links
Gastric banding as a salvage procedure for patients with weight loss failure after Roux-en-Y gastric bypass.Gobble RM, Parikh MS, Greives MR, Ren CJ, Fielding GA.
Department of Surgery, New York University School of Medicine, New Bellevue 15 North 1, 550 First Avenue, New York, New York, 10016, USA gobblr01@med.nyu.edu

BACKGROUND: This study reviews outcomes after laparoscopic adjustable gastric band (LAGB) placement in patients with weight loss failure after Roux-en-Y gastric bypass (RYGBP). METHODS: All data was prospectively collected and entered into an electronic registry. Characteristics evaluated for this study included pre-operative age and body mass index (BMI), gender, conversion rate, operative (OR) time, length of stay (LOS), percentage excess weight loss (EWL), and postoperative complications. RESULTS: 11 patients (seven females, four males) were referred to our program for weight loss failure after RYGBP (six open, five laparoscopic). Mean age and BMI pre-RYGBP were 39.5 years (24-58 years) and 53.2 kg/m(2) (41.2-71 kg/m(2)), respectively. Mean EWL after RYGBP was 38% (19-49%). All patients were referred to us for persistent morbid obesity due to weight loss failure or weight regain. The average time between RYGBP and LAGB was 5.5 years (1.8-20 years). Mean age and BMI pre-LAGB were 46.1 years (29-61 years) and 43.4 kg/m(2) (36-57 kg/m(2)), respectively. Vanguard (VG) bands were placed laparoscopically in most patients. There was one conversion to open. Mean OR time and LOS were 76 minutes and 29 hours, respectively. The 30-day complication rate was 0% and mortality was 0%. There were no band slips or erosions; however, one patient required reoperation for a flipped port. The average follow-up after LAGB was 13 months (2-32 months) with a mean BMI of 37.1 kg/m(2 )(22.7-54.5 kg/m(2)) and an overall mean EWL of 59% (7-96%). Patients undergoing LAGB after failed RYGBP lost an additional 20.8% EWL (6-58%). CONCLUSION: Our experience shows that LAGB is a safe and effective solution to failed RYGBP.

PMID: 17943353 [PubMed - indexed for MEDLINE]


Obes Surg. 2006 Aug;16(8):1032-40. Links
Systematic review of medium-term weight loss after bariatric operations.O'Brien PE, McPhail T, Chaston TB, Dixon JB.
The Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia. paul.obrien@med.monash.edu.au

BACKGROUND: Although bariatric surgery is known to be effective in the short term, the durability of that effect has not been convincingly demonstrated over the medium term (> 3 years) and the long term (> 10 years). The authors studied the durability of weight loss after bariatric surgery based on a systematic review of the published literature. METHODS: All reports published up to September, 2005 were included if they were full papers in refereed journals published in English, of outcomes after Roux-en-Y gastric bypass (RYGBP), and its hybrid procedures of banded bypass (Banded RYGBP) and longlimb bypass (LL-RYGBP), biliopancreatic diversion with or without duodenal switch (BPD+/-DS) or laparoscopic adjustable gastric banding (LAGB). All reports that had at least 100 patients at commencement, and provided > or = 3 years of follow-up data were included. RESULTS: From a total of 1,703 reports extracted, 43 reports fulfilled the entry criteria (18 RYGBP; 18 LAGB; 7 BPD). Pooled data from all the bariatric operations showed effective and durable weight loss to 10 years. Mean %EWL for standard RYGBP was higher than for LAGB at years 1 and 2 (67 vs 42; 67 vs 53) but not different at 3, 4, 5, 6 or 7 years (62 vs 55; 58 vs 55; 58 vs 55; 53 vs 50; and 55 vs 51). There was 59 %EWL for LAGB at 8 years, and 52 %EWL for RYGBP at 10 years. Both the BPD+/-DS and the Banded RYGBP appeared to show better weight loss than standard RYGBP and LAGB, but with statistically significant differences present at year 5 alone. The LL-RYGBP was not associated with improved %EWL. Important limitations include lack of data on loss to follow-up, failure to identify numbers of patients measured at each data point and lack of data beyond 10 years. CONCLUSIONS: All current bariatric operations lead to major weight loss in the medium term. BPD and Banded RYGBP appear to be more effective than both RYGBP and LAGB which are equal in the medium term.

J Laparoendosc Adv Surg Tech A. 2003 Aug;13(4):265-70. Links
Lap-band: outcomes and results.O'Brien PE, Dixon JB.
Monash University, Department of Surgery, The Alfred Hospital, Melbourne, Victoria, Australia. paul.obrien@med.monash.edu.au

INTRODUCTION: Laparoscopic adjustable gastric banding was first introduced in the early 1990s as a potentially safe, controllable, and reversible method for achieving significant weight loss in the severely obese. The Bioenterics Lap-Band system (Inamed Health, Santa Barbara, California) is the device most commonly used. After 10 years of experience in treating more than 100000 patients with the Lap-Band, it is timely for us to review the outcomes. METHODS: Data for the review are derived from the experience of our unit in the treatment of 1250 patients to date, from an independent systematic review of the published literature up to September 2001, and from major studies published after the date of closure of the systematic review. RESULTS: Lap-Band placement has proved to be a very safe procedure with a mortality rate in the published reports of 1 in 2000, only 10% of the published mortality rate of gastric bypass. The early complication rate has been very low, but late complications of prolapse or erosions have been more frequent, particularly during the early experience. Weight is lost during the first 2 to 3 years after surgery. The systematic review reports 56% excess weight loss (EWL) at 5 years (three reports). In comparison, Roux-en-Y gastric bypass (RYGB) is reported to have achieved 59% EWL at 5 years (four reports). Major improvements in comorbid conditions have been reported in association with weight loss after Lap-Band placement. Most importantly, type 2 diabetes is usually cured, and insulin resistance and reduced pancreatic beta-cell function are reversed. Gastroesophageal reflux, obstructive sleep apnea, and depression are other diseases in which marked improvement is noted. Quality-of-life scores return to normal values. CONCLUSIONS: Lap-Band placement is proving to be safe and effective. In view of the attributes of adjustability, safe laparoscopic placement, and reversibility, it should be considered the optimal initial approach for the control of obesity and its comorbid conditions.


Laparoscopic conversion of failed gastric bypass to duodenal switch: technical considerations and preliminary outcomes.Parikh M, Pomp A, Gagner M.
Laparoscopic and Bariatric Surgery, Department of Surgery, Joan and Sanford I. Weill College of Medicine of Cornell University, New York Presbyterian Hospital, New York, New York 10021, USA.

BACKGROUND: Weight loss failure after Roux-en-Y gastric bypass (RYGB) is a challenging problem facing bariatric surgeons today. Conversion from RYGB to biliopancreatic diversion with duodenal switch (BPD-DS) might provide the most durable weight loss of all revision procedures currently available. Revision to BPD-DS can be done laparoscopically in 1 or 2 stages and involves 4 anastomoses: gastrogastrostomy, duodenoileostomy, ileoileostomy, and jejunojejunostomy (to reconnect the old Roux limb). This study reports on our early outcomes after laparoscopic conversion from RYGB to BPD-DS. METHODS: The data from all patients undergoing conversion from failed RYGB to BPD-DS were retrospectively reviewed. The data analyzed included age, body mass index, excess weight loss, method of gastrogastrostomy, and morbidity/mortality. RESULTS: Twelve patients were identified for analysis. The mean age and body mass index before conversion was 41 years and 41 kg/m(2), respectively. Of these 12 patients, 4 (33%) had undergone revision surgery (lengthening of the Roux limb, resizing the gastric pouch, adjustable band on pouch, or distal gastric bypass) before conversion; 8 (66%) had obesity-related co-morbidities; 7 (58%) underwent conversion to BPD-DS in 1 stage. Most gastrogastrostomies were performed using the 25-mm circular stapler. No patient died and no leaks developed. One patient required laparotomy, and 4 developed stricture at the gastrogastrostomy. The patients lost a dramatic amount of weight after conversion to BPD-DS, with a mean body mass index and excess weight loss of 31 kg/m(2) and 63%, respectively, at 11 months postoperatively. All co-morbidities resolved completely with the weight loss. CONCLUSION: Our preliminary results indicate that laparoscopic conversion to BPD-DS from failed RYGB is highly effective with an acceptable morbidity. Using a linear stapler to construct the gastrogastrostomy might reduce the stricture rate.


Surg Endosc. 2005 Dec;19(12):1631-5. Epub 2005 Oct 17. Links
U.S. experience with 749 laparoscopic adjustable gastric bands: intermediate outcomes.Parikh MS, Fielding GA, Ren CJ.
Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite 10S, New York, NY 10016, USA. parikm01@popmail.med.nya.edu

BACKGROUND: Laparoscopic adjustable gastric band (LAGB) has consistently been shown to be a safe and effective treatment for morbid obesity, especially in Europe and Australia. Data from the U.S. regarding the LAGB has been insufficient. This study reveals our experience with 749 primary LAGB over a 3-year period in a U.S. university teaching hospital. METHODS: All data was prospectively collected and entered into an electronic registry. Characteristics evaluated for this study include preoperative age, BMI, gender, race, conversion rate, operative time, hospital stay, percent excess weight loss (%EWL) and postoperative complications. Annual esophagrams were performed RESULTS: From July 2001 through September 2004, 749 patients (531 females, 218 males) underwent LAGB for the treatment of morbid obesity. There were 630 Caucasians, 61 African-Americans, and 49 Latin Americans, with a mean age of 42.3 (range 18, 72 years) and mean BMI of 46.0 +/- 7.0 (range 35, 91.5 kg/m(2)). There was one conversion to open (0.1%). Median operative time and hospital stay were 60 minutes and 23 hours, respectively. The mean %EWL at 1 year, 2 years, and 3 years was 44.4 (+/-17.8), 51.8 (+/-20.9), and 52.0 (+/-19.6), respectively. There were no mortalities. Postoperative complications occurred in 12.8% of patients: 1.5% acute postoperative band obstruction, 0.9% wound infection, 2.9% gastric prolapse ("slip"), 2.0% concentric pouch dilatation (without slip), 0.8% aspiration pneumonia, 2.4% port/tubing problems, 0.3% severe esophageal dilatation/dysmotility (reversible), and 1.5% overall band removal. CONCLUSION: These American results substantiate the data from abroad that LAGB is a safe and effective treatment for morbid obesity.

Obes Surg. 2008 May 2. [Epub ahead of print] Links
One-year Readmission Rates at a High Volume Bariatric Surgery Center: Laparoscopic Adjustable Gastric Banding, Laparoscopic Gastric Bypass, and Vertical Banded Gastroplasty-Roux-en-Y Gastric Bypass.Saunders J, Ballantyne GH, Belsley S, Stephens DJ, Trivedi A, Ewing DR, Iannace VA, Capella RF, Wasileweski A, Moran S, Schmidt HJ.
Surgery, New York University, Manhattan VA, 423 East 23rd St., New York City, NY, 10010, USA, jokensa@yahoo.com.

BACKGROUND: An increasing importance has been placed on a bariatric program's readmission rates. Despite the importance of such data, there have been few studies that document 1-year readmission rates. There have been even fewer studies that delineate the causes of readmission. The objective of this study is to delineate the rates and causes of readmissions within 1 year of bariatric operations performed in a high-volume center. METHODS: Records for all patients undergoing bariatric operations during a 31-month period were harvested from the hospital electronic medical database. Readmissions for these patients were then identified within the hospital database for the year following the index operation. The electronic medical records of all readmitted patients were reviewed. RESULTS: The overall 1-year readmission rate for 1,939 consecutive bariatric operations was 18.8%. The laparoscopic adjustable gastric band (LAGB) had the lowest readmission rate of 12.69%. Next was the vertical banded gastroplasty-Roux-en-Y gastric bypass (VBG-RYGB) with a rate of 15.4%. The laparoscopic Roux-en-Y gastric bypass (LRYGB) had the highest readmission rate of 24.2%. Leading causes of readmission were abdominal pain with normal radiographic studies and elective operations. Independent factors predicting readmission were found to be LOS > 3 days (odds ratio 1.69 p = 0.004) and having a LRYGB (odds ratio of 1.49 p = 0.003). The previously reported reoperation rate for bowel obstruction of 9.7% had decreased to 3.7% due to changes in operative technique. CONCLUSION: Rates of readmissions for patients undergoing bariatric surgery center at our high-volume center decreased over time and are comparable to other major abdominal operations.

all these are easily found with a net search of medical research.

sandy r, BSN, MN
band educator
at goal for 4.5 yrs

mistymee

hmmmmmm....

__________________

Phoenixfire

Hey Sandy, thank you for posting the data you've gathered on this, and I'm sure the original poster will be glad to have that in order to make a well-informed decision. Good deal, and great stuff. You may want to put it in the lapband forum if it's not there already, because many read the two forums to learn about both the benefits and risks. Just a thought, as it will help others as they come along

__________________


Open Roux-en-Y on October, 2002 - 7 year anniversary is right around the corner
Height: 5'8"
Highest weight: 300 lbs. with a BMI of 45.6
Current weight: 140-145 lbs. and a size 6/8 with a BMI of 21.7
Total weight lost after Roux-en-Y gastric bypass: 160 lbs. POUNDS!

Josephine

my honest advice is to spend about a month on lapbandtalk.com and then about a month here observing and joining in the discussions and meeting people that have had both and then decide for yourself which is right for your circumstances.

__________________

Sandy r

I'm personally not a fan of lapbandtalk. I find ObesityHelp.com much more balanced and objective, with forums for each of the different WLS. . But I surley agree that much research is needed and that we should consult several surgeons - both bypass and band specialistas. the band docs should not be bypass docs who happen to do a few bands, or general bariatric surgeons who may know nothing about bands - but docs who do mostly or exclusively bands.
sandy r

pmenjivar

I believe that the best thing you can do is talk to your surgeon about what your options are and which is best for YOU. There is success with both procedures and each person must make the decision based on their weight, eating habits and health issues. For me personally, I NEEDED to have LAP RNY because I NEEDED to have results fast because of several health issues that needed to be reversed fast. I also was almost 350 pounds which was another factor on why I chose the surgery I did. But I did so much research and talked it all over with my family doctor before I even approached my surgeon.

We all have our own opinions and will defend the choices that we made for ourselves. But please make the decision that is best for YOU!

Good luck to you!

__________________
Pam
LAP RNY 7/13/04
342/218/195
Day of Surgery/Current/Goal

A Subby's Wife

__________________
~ Toi ~

Highest/Surgery/Current/My Goal
303 / 284 / 220 / 165

Lap - RNY
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