Dr. Ariel Ortiz? or low BMI options?

There are studies being done in the US with lowewr BMI clients. the problem they are worried about is that the band is made of a certain diameter, and those with much smaller stomachs are possibly going to have a much higher rate of slips and erosions. The smallest band, for instance is the 9.75 cm band and it was designed for people of 40 BMI and over - about 100# overweight or more. When they lost weight to about normal, their sutures holding the band can be very loose. This is one reason the slips and erosions increase after someone is near goal weight.If people start off even lower, when they lose weight, the sutures may not hold the band at all, even though some scar tissue is also there. This can lead to more slips and erosions. Only a very few MX doctors are willing to take this risk for their patients. It is not that the band cannot be placed it cannot be placed safely perhaps.
something to think about.
(Banded for several months now but can't change name it seems)

Hi Bandster Hopeful,


I'm just curious where you've found this information?

The research I've done (and I'm by no means saying I'm right and you're wrong) has pretty much indicated that if there's going to be slippage or erosion, it's most likely to happen early in the process rather than later (like in the first year or two). If you get through that window without major problems, you're actually less likely to encounter those problems later. I can't remember exactly, but I could swear I read two band surgeons who have been quoted as saying this. Did I get some bad info?

Just thinking about it intuitively, wouldn't this mean that there's be a whole lot of people getting slippage and erosion every time anybody got anywhere near a healthy BMI? Seems as though the FDA wouldn't have approved it as a potentially life-long device if it still had these issues.

I do know that in the early days of the band, surgeons did not anchor the band the same way they do now, and there were lots of cases of slippage and erosion. Now, they pull a fold of stomach up and suture it over the band to keep the band from shifting (if I understand the procedure correctly), so that now, over eating, taking nsaids, violent vomiting and such are responsible for the vast majority of slippage and erosion cases, not weight loss.

Also, in terms of the doctors, I suspect it would be difficult to find a US doc who has done anywhere near the number of procedures as the Mexican docs. In fact, the really good ones pioneered this procedure, and have taught many of the American docs how to do it. Having a low bmi myself, I think I'd prefer one of the Mexican Inamed docs to most of the american ones.

Cheers,
LizzyD

Now where's that Doctor that was on here? Can't remember his name. From what he said I think you are correct in that the bands are being attached differently now. It certainly does NOT make sense that they would slip as one got close to their goal. I'll ask Dr. Ortiz about this when I get a fill 8/8 if someone else hasn't gotten a definitive answer before then.

I was banded by Dr O on 6/2 and I think he and Dr Martinez are both excellent surgeons. I feel very comfortable with their knowlege and experience. You might want to take a little Spanish/English dictionary with you for the aftercare. THe nurses there were nice enough but I had a very hard time getting a "washcloth."

My only recommendation to you is to ask for a room facing the pool in the hotel as the other views are pretty bleak. (They changed my room when I requested it.)

I took the train down to SD and it's a really nice train ride if you're coming from somewhere in CA.

__________________
K

There is a lot of questionable information floating around. I don't claim to have all the answers, but I think I can correct a few misconceptions.

Myth #1 The longer you have the band, the greater the chance of it slipping or eroding.

False. If it is going to slip, it will probably do so within the first few years. Erosions are rare these days with current suture techniques.

Myth #2 Lower BMI patients should have Lap Band rather than RNY.

Answer: Nobody knows. There just isn't any data yet. Though this makes sense at a basic level, it may not be true. I am taking care of a few low BMI patients who were banded in Mexico, and I will tell you that some are struggling to lose weight. The fact is that the less overweight you are, the less weight you will lose. The heaviest patients lose the most weight. Looking at it another way, if you eat 4000 calories a day, it's an easier job for me to cut your intake down to 1200 calories by tightening your band. On the other hand, if you aren't very heavy and only eat 1800 calories a day, it's much harder to cut you back only a small amount by tightening the band. I hope that makes sense.

Mark Pleatman MD
www.laparoscopy.com/pleatman

I agree with you that the less weight you have to lose the less you lose. I have lost 20lbs since January 2005. I weighed 195 when I got the band and 175 now. I am 5'7 . I have gone from a size very tight size 16 to a loose 14 and some 12's. The good report is that the weight has been off and stayed off for three months. I have never maintained any weight for that period of time.

I need to loose about 15 more lbs.... I can eat more now and need an adjustment. Some might think I was crazy for getting the band, but I feel so much better and exercise and eat well for the most part. My mother is obese and I was on that road... not to mention the diabetes and high blood pressure in my family.

I would do it again in a heart beat. I appreciate the doc for taking time to post.

I think the point about being "on the road" to much bigger weight problems is a good one - just because your BMI is less than 40 doesnt mean for lots of people that it isnt only a matter of time. Everyone who's 40+ had to move on through the 30's to get there. YOu dont hit 40 and suddenly have different psychological issues that cause you to get fat do you?

I'd say there's plenty of people round in the low 30's that could benefit from a band, whether or not they'd be satisfied with what it achieved is another story. I guess if you had realistic expectations about what it was going to do for you it would be a good thing.

I was banded by Molding Clinic on 4/15/05, and as of today I am down 106 pounds. I have been back for 2 fills and I have nothing but respect and kudos for my hospital. I would do it again if I had to. I will be back for a tummy tuck hopefully this fall.