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THINK TWICE ABOUT LAP BAND RE-DO

Today there are 4 main operations to treat obesity worldwide:

  1. The Lap Band or Gastric Banding
  2. The Gastric Sleeve
  3. The Gastric Bypass
  4. The Duodenal Switch

The first two, the Lap Band and the Gastric Sleeve, are purely Restrictive Procedures.

The last 2, the Gastric Bypass and the Duodenal Switch, are a mixture of Restrictive and Malabsorptive Procedures.

There is not an ideal Weight Loss Operation; each of them has different benefits for the patient, different complications and different long term Weight Loss.

Lap Band Re-Do refers to the placing of a new Lap Band in a patient that has already been De-Banded or that needs the Lap Band changed.

Lately there is a new tendency for obese patients and doctors to propose the easiest, simplest and cheapest way to treat obesity.

Sometimes the decision on which procedure is made is based on the fears involved in a major surgery or on the patient’s budget rather than on the medical reasons that suggest the right procedure for that individual in particular.

Last year in the United States 40% of the Bariatric Surgeries where Lap Band Procedures while 3 years ago 85% of all Bariatric Surgeries where Gastric Bypass Procedures.

Besides pointing out the tendency mentioned before, this implies that the doctors’ operative learning curve for placing the Lap Band and for the Follow Up will lead to many De-Banding Procedures due to technique and follow up failures. Furthermore, these patients will have the need of choosing a second Bariatric Procedure. 

There is a big controversy and poor acceptance of the Re-Do Lap Banding Procedure among Doctors, especially the ones whose main surgery is the Gastric Bypass or the Duodenal Switch or those with little experience in Lap Band.

I believe that each patient has to be analyzed individually in order to know if he is a good or poor candidate for a Lap band Re-Do or for the other 3 options left after he has been De-Banded.

Things to be considered before choosing a new procedure for a De-Banded patient are:

  • Was the Operative Technique the one that failed?
  • Was the patient’s behavior the cause of the failure?
  • Where both, the Operative Technique and the patient’s behavior involved in the failure?
  • Was the device the one that failed?

Only after answering these questions can the doctor have the tools to propose a new Bariatric Procedure that fits the patient best.  That way he will minimize the risk for failure observed among patient’s who have a Bariatric Procedure for the second time.

Arturo Rodriguez, MD

     

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