You may wonder if I suffer from a little slow-motion Attention Deficit Disorder, as I keep promising that Case Study, and it will come, but not yet. Soon!
After the last post with some new info on our experiences with Sleeve, I thought I'd follow through on an update for the Band as well. Things have changed in a similar but different way for this procedure of late.
As mentioned earlier, our Band numbers have dropped from a high of around 25% of our case load 4 or 5 years ago, to currently less than 5% of new procedures being done. The Sleeve's emergence as a procedure that has Bypass-like legitimate impact on both weight and metabolic disease is likely the biggest reason for that change.
A secondary aspect is the increase in some complications that appear to be related to duration of the how long the Band is in place. This has occurred nationally with other Band programs, as well as internationally in Europe in the past decade. The longer the time, and it is designed to be a lifelong implant, the higher the likelihood of some complications for some folks.
While there still is a significant segment of our Band population that is experiencing good results, "Loves" their Band (and how it helps them eat more appropriately and lose / control their weight), and has had their life changed from having the procedure - some aren't so happy these days.
Unhappiness with their Band is usually in large part from behavioral indiscretion, leading to recurrent emesis, and possible a Band slip (Gastric Prolapse). It may take the form of lack of follow up, insufficient adherence to the quality/quantity of dietary intake to facilitate meaningful weight loss, or lack of consistent exercise as also required to lose weight.
It does seem that time may not be on a patient's side that does not adhere to the above behavioral requirements, as not achieving and maintaining meaningful weight loss is the end result of all these issues that could be cited as truly the biggest complication from unsuccessful Banding-Patient lifestyle.
Resultantly, we have seen an increase in patients needing their Band out due to chronic dysphagia, odynophagia, or lack of substantial weight loss. Occasionally we see esophageal issues with atypical chest pain that needs to be remedied be fluid removal from the Band.
With more frequency now, we have been converting those interested patients that qualify in a revisional procedure such as converting to a Bypass or a Sleeve at the time of Band removal. Moreover, early experience with these Revisional procedures have a substantial weight loss benefit over the more traditional revisional procedure in a patient with weight gain after a Bypass with some mild mechanical issue that may or may not (likely not) be the culprit in the weight regain.
So, the take home message- "Should we even be doing the Band", or, "Should I even refer a patient who wants to have a gastric Band performed?"
Yes, to both.
If a patient is only interested in a Band and needs a weight loss procedure, it still is superior, and worth the 'risk' vs. taking your chances with medical models of weight loss, and the likelihood of success for the majority of patients who try lifestyle modification alone that need to lose more than 10% of their excess weight and keep it off.
Gastric Banding still has its place in our armamentarium, and we will continue both to place Bands and service our Band population with expert after care as we do now.
Having them come in to see us as a potential new patient, after you have referred them with their letter of medical necessity, allows them to come to an orientation first and find out which procedure is best for them.
Their surgeon will then work with them to decide: Band, Bypass or Sleeve?
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