Article - Falling-Off the Lap Band Wagon

Posted by: Robert Sewell, MD, FACS on 2/7/2011

Three years ago I published my first book entitled Weight Loss Surgery with the Adjustable Gastric Band – Everything You Need To Know Before And After Surgery To Lose Weight Successfully.”

The title was actually decided on by the publisher and was designed to include every imaginable “keyword” that might be used to search the Internet for a book on gastric banding. I wasn’t exactly enamored with the title but accepted the wisdom of those who are in the business of selling books. I preferred the title I had used when submitting the manuscript, Stepping out of the Shadow of Obesity – A Comprehensive Guide to the Adjustable Gastric Band.” To me, this spoke to what I believe is the heart of the issue of weight loss surgery; individuals taking the initiative to actively “step-out” from under the destructive effects of a lifetime of being over-weight.

At the time I wrote the book I was performing Lap-Band® exclusively for my obese patients, because I believed it to be the safest option available. While I still believe the Lap-Band® has a place in surgical weight management, over the last few years I have witnessed a number of long-term problems with the band. Chief among the complications is displacement or slippage. Over time the band can “slip” down on the stomach causing dilation and partial obstruction of the upper gastric pouch. This can occur despite the fact that the band is sutured in place. The telltale signs are chronic heartburn, chest pain, spontaneous regurgitation, failure to lose weight and even aspiration pneumonia.

When I first encountered the problem of a slipped band, I naturally believed the best treatment was to surgically reposition and re-suture it back in place. The results from these re-do procedures were acceptable, at least for a while, but several patients showed up with a second slip within a few months despite my best efforts. That’s when I decided to try something different, the gastric sleeve.  The sleeve was a very new procedure and involves removing about three quarters of the stomach pouch, but unlike the gastric by-pass there is no re-routing of the intestines. Around 2005 some of my colleagues had started to use the sleeve as a primary obesity operation, but I thought it made more sense as a “rescue procedure” for patients with a slipped Lap-Band®.

I began converting patients with slipped bands to the gastric sleeve about four years ago and the results were truly amazing. Not only did the problems of heartburn, chest pain and regurgitation improve, these patients actually started losing weight again. It’s a well-known fact that most band patients lose about half of their excess weight and then just seem to hit a wall. But after conversion to the sleeve, many of my patients seemed to get back on track, losing up to 75 to 80% of their excess weight. Invariably they would tell me that the biggest difference they noticed was they weren’t hungry any more. The theory is hormones released from the stomach cause us to feel hungry, and since much of the stomach is physically removed during the gastric sleeve procedure, those hormones are also dramatically decreased. Without the constant feeling of hunger, gastric sleeve patients are better able to stick with their weight loss programs. In fact, most of my sleeve patients tell me they have to remind themselves when its time to eat. The sense of hunger does return after about six months, but never to the same degree they’d experienced before. Universally, my conversion patients tell me they wish they’d gone with the sleeve to start with. While hindsight is always 20/20, the fact is the gastric sleeve is still a relatively new option.

As a result of the success I saw in patients converting from the Lap-Band® to the gastric sleeve, in early 2008 I started using the sleeve as the preferred option for most obese patients seeking weight loss surgery. Somewhat ironically this was about the same time my Lap-Band® book came out in print. I’ve learned that writing a book, which takes a year or more to produce, is probably a waste of my time. So, given the fast paced world of Internet communication, I’ve decided to stick to writing this blog, which allows me to make changes “on the fly.” Currently, it is my opinion that the gastric sleeve, combined with a comprehensive weight management program, offers the best option for over-weight individuals interested inStepping Out of the Shadow of Obesity.” Its also the best option for those who have fallen off the Lap Band Wagon. 

 

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