New Question on LAP-BAND^® vs Realize - Help?

Thread Starter  

Surgery is scheduled for Thursday Sept 11th. (Hope that is a LUCKY day for me) with Dr Carson Liu in Los Angeles.

Like many others, the Dr has given me the choice of bands.

The Dr mentioned that some LAP-BAND^® patients have difficulty eating chicken and turkey. The LAP-BAND^®.com website also mentions "some patients have difficulty eating meat".

Do any of you lap-banders out there have a problem getting chicken or turkey down?

I would love your input in my effort to pick the right band - THANKS!

I have the LAP-BAND^® and eat chicken and turkey all the time. If you cant get food down it's your surgeons fault for not adjusting you correctly not yours. The average weight loss in year 1 with the Realize/Swedish band is 32%, the average for the LAP-BAND^® APS is 62%.

That is complete baloney.

really?

Direct from Ethicons website:

In the multi-center U.S. clinical trial of 276 patients with the REALIZE Band, patients who completed the three-year U.S. clinical trial (n=228) lost an average of 42.8 percent of their excess body weight. (36 months)

Laparoscopic Swedish(Realize) adjustable gastric banding: a five-year prospective study.

Steffen R, Biertho L, Ricklin T, Piec G, Horber FF.
OBEX-Institute, Hirslanden Clinic, Department of Surgery, Zurich and Berne, Switzerland. Rudolf.steffen@bluewin.ch

BACKGROUND: Laparoscopic adjustable gastric banding is a popular bariatric operation in Europe. However, the long-term complication rate and weight loss are still unclear. METHODS: 824 patients underwent a laparoscopic Swedish Adjustable Gastric Banding (SAGB) in a 5-year period. Preoperative data, postoperative weight loss and long-term complications were prospectively obtained for analysis. RESULTS: Mean age of the 824 patients was 43 +/- 1 years, with mean preoperative BMI 43 +/- 1 kg/m(2). No intra- or postoperative death occurred in the first 30 postoperative days. Intraoperative conversion rate was 5.2%. Peri-operative complication rate was 1.2%. 97% of the patients were available for follow-up (maximum 5 years). Long-term complications occurred in 191 patients (23.2%). 135 complications (16.4%) were related to the band, and 56 (6.8%) to the access-port or to the tube. Mean excess weight loss was 30, 41, 49, 55 and 57 % after 1, 2, 3, 4 and 5 years respectively. 82.9% of the patients obtained >50% EWL after initial treatment. CONCLUSIONS: The results of this study suggest that laparoscopic SAGB can achieve an effective weight loss, with an acceptable mortality and morbidity rate.


LAP-BAND^® AP

The LAP-BAND^® AP™ System: The Platform Advances
June 2007
by Paul E. O’Brien, MD


Figure 4
Enhanced weight loss The LAP-BAND^®® APS patients have lost 62 percent of their excess weight at 12 months, and the slope of the line is still steadily upward. The APL patients have 43 percent EWL. The 10cm band patients have 51 percent EWL and the VG band patients have 40 percent EWL at 12 months. If described in absolute terms, the APS patients have lost 27kg and 10.2 BMI units, bringing the mean BMI for the APS patients from 41.6 to 30.4 at 12 months and still progressing. There was an infection at the access port site in a 58-year-old male patient. The access port was removed. He presented at 11 months with erosion of the band into the stomach and had explantation laparoscopically. There have been no other adverse events.

Discussion

The LAP-BAND^®® has been a major addition to our armamentarium in the treatment of obesity and its comorbidities. It has been extraordinarily safe; effective in achieving substantial and durable weight loss, improved health, and quality of life; and gentle in achieving these effects.[12] For a successful outcome, LAP-BAND^®® requires exact and stable positioning and an optimal aftercare program. The deficiencies in the structure of the original band were partly removed by the VG band after 2003 and now appear to be completely removed with the AP series. There should no longer be excess tightness in the early postoperative period. The induction of satiety is retained and possibly augmented by its larger footprint around the upper stomach. Ease of opening and a smooth shape allows for removal and replacement if repositioning is subsequently required.

One study may suggest that - but I asked my doctor and he said he sees his patients having the same loss with the realize and the LAP-BAND^®. I don't personally think the band brand has an impact of weight loss.

From what I have read, the average loss with a LAP-BAND^® is 40% of excess body weight. The 62% number is just too high to be realistic - that is higher than the average RNY number.

These bands are designed completely differently. Please keep in mind the Realize Band IS the Swedish Band with 1996 design, there are no significant changes to the band design. It came out prior to the first generation lapbands in 2001 in Europe.

The Realize band has to be put in empty which means you have zero restriction until your first fill 6-8 weeks following surgery.

The LAP-BAND^® AP is designed to be implanted with the first fill of either 3cc or 4cc, standard or large. It gives you mild restriction and begins working immediately, thus the higher percentage weight loss makes logical sense.

The data you are looking at is with the older generation LapBands, not the Third Generation LAP-BAND^® AP. What I provided the only study on the AP Bands. The Realize band has not been out for a year so it would be impossible for your doctor to have a comparison on the average excess weight without having them tracked for a year each. Does he have data on these patients and has he averaged them out since January on a spreadsheet to compare?

I would consider that if the LAP-BAND^® is filled at surgery, then you would see more weight loss with the LAP, but I did ask my doctor is both bands go in empty and he said yes.

I am not saying that the study you found on the internet is false - I am just saying it is one study. I have touched both bands and I liked the realize better.

No disrespect towards your surgeon be is not using the reccomended priming technique as per the Allergan who makes the band. He has a license to practice medicine as he sees fit but in the study I provided that is how it was done and that is how Allergan instructs the physicians to prep the band before it is implanted for maximum weight loss. I called the company and they sent me some information on it. I met with the nurse prior to my surgery, it is required from my doctor and she he explained why this priming technique is being used and gave me the Obrian guys name to google to do more research. I have the AP and I can assure you it works, I have had restriction since day 1. There was 2.7cc in the band on my first fill then they added a cc. My next fill is Late sept but I really don't even think I need one.I have lost 40.2lbs since the liquid diet week before surgery and the surgery date of June 30th. Trust me it works- The old Lapbands and the Realize bands are implanted empty- The LAP-BAND^® AP is not. Im 100% positive because I have it myself!

I got my LAP-BAND^® with a 4cc prefill at surgery.

There's an excellent article in the July/Aug issue of Obesity Help magazine comparing the 2 bands, you might check their website to see if it's reprinted there: www.obesityhelp.com

One of the biggest differences that I've been able to find is that the pillow on the inside of the bands that is filled with the saline is different. The realize band is one continous chamber and the LAP-BAND^® is several pillows, supposedly that maybe help prevent leaks. However the Realize is supposed to be softer and a lower profile port. One port is stitched in (Lap I think) and one is stapled (Realize I think). I got this info from the article in the magazine. Hope that helps a little. My dr. did both bands and chose the Lap for me.

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That's true-my do says the softer part is the problem-too soft is less restriction

The LAP-BAND^® is also available with a low profile port. Please keep in mind the scar left where the port is left on the Realize Band is about double of the LAP-BAND^® low profile port - its shorter but much, much wider.

Well, I don't have surgery until October 29th, so I am going to give my doctor a call and see what the story is and I may switch the LAP-BAND^®. I like the idea of having restriction at the start.

no offense towards Realizebanders but that's probably a smart move, based on all the info. Also, the reason the old Lap bands can't be used that way is because of the fluid distribution inside the band. Your surgeon is hopefully up to speed on that.

My surgeon's nurse practitioner reported to me that the surgeon instills saline into both bands and on some pts he does not instill. She reported it is an individual case.

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The Realize Band is NOT designed to be implanted with fluid in it and he is not following the instructions in the DFU. Due to the uneven shape and lack of even fluid distribution in the Realize Band it would be very dangerous to fill that band at the time implant until the stomach swelling goes down. Ethicon CLEARLY states in the instructions not to do that. The Allergan AP Band is the only band on the market designed for fluid to be left at the time of implant. I STRONGLY suggest if you go with the Realize Band you tell your surgeon to please put it in empty. Your better off losing weight slowly than having an obstruction or dysphasia right after surgery. In addtion if he has to remove some fat from your stomach during the procedure and fills that band near where the creases are. that puts pressure in the stomach, you can increase your chances of erosion and never be able to have a band again. Its not worth it. Im not trying to diss your surgeon and he can do what he wants but that if the people that make the band say don't do it, it's for a reason. There is not a chance in hell I would go for that.

My surgeon says both bands perform the same in real life. He also says that just because you start off with some fluid in the band, that doesn't mean you'll get to true restriction sooner than someone who doesn't. It's very individual how fast it takes you to get there.

Since his practice sees 10-20% better EWL with the band than stated averages, I think I'll go with what he says.

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