On December 3rd, an FDA Advisory Panel ruled in favor of indicating the LapBand procedure for patients with a BMI of 35 and greater, and for patients with a BMI of 30-35 with a significant medical comorbidity. This is a significant step in allowing patients access to surgical weight loss who were excluded previously due to BMI limitations. Keep in mind this is only an Advisory Panel decision, and the FDA will make a final ruling in the next few months. In general, the FDA will follow the recommendations they receive from such panels.
How does this impact us? Well, assuming the FDA makes its final decision in favor, some insurance companies may adjust their coverage criteria to match the FDA guidelines. This would probably increase the number of LapBand procedures being performed in the US.
I am in favor of the current ruling because there are plenty of patients (who I have had to turn away) who would benefit form surgical weight loss and fall within the BMI 30-40 class.
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I have had plenty of Band patients express concern for a Band Erosion after they searched the Internet for answers to some of the quirky sensations they may be having. I want to clarify what a Band Erosion is. Basically, for some reason or variety of reasons, the silicone band around the top part of your stomach erodes into the wall of the stomach. We are not always sure what causes an erosion. It could be how the surgeon did the surgery, or the patient’s eating behavior, or their particular biology. For whatever reason, know that an erosion is RARE. Only 1-2% of patients will ever experience an erosion. If it happens, patients can present in a variety of ways. However, the hallmark is a lack of restriction despite successive Band adjustments (it could also be a leak in the system!). Sometimes people can have abdominal pain, fevers, or even Port-site infections. The doctor can diagnose an erosion with an Upper GI Swallow, but the best test is an EGD. If there is indeed an erosion, then an operation is in order for Band removal.
So remember: an erosion is rare, a significant loss of restriction is the hallmark, and an EGD is the way to diagnose it.
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I have had plenty of Band patients express concern for a Band Erosion after they searched the Internet for answers to some of the quirky sensations they may be having. I want to clarify what a Band Erosion is. Basically, for some reason or variety of reasons, the silicone band around the top part of your stomach erodes into the wall of the stomach. We are not always sure what causes an erosion. It could be how the surgeon did the surgery, or the patient’s eating behavior, or their particular biology. For whatever reason, know that an erosion is RARE. Only 1-2% of patients will ever experience an erosion. If it happens, patients can present in a variety of ways. However, the hallmark is a lack of restriction despite successive Band adjustments (it could also be a leak in the system!). Sometimes people can have abdominal pain, fevers, or even Port-site infections. The doctor can diagnose an erosion with an Upper GI Swallow, but the best test is an EGD. If there is indeed an erosion, then an operation is in order for Band removal.
So remember: an erosion is rare, a significant loss of restriction is the hallmark, and an EGD is the way to diagnose it.
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So what is a Hiatal Hernia and why should I care about it?
Hiatal Hernia is a condition where the opening from your chest to your abdominal cavity is abnormally large. The esophagus passes through this opening, or ‘hiatus”, so the most common problem associated with this condition is where part of the stomach gets pushed up into the chest. Hiatal Hernias are often small and asymptomatic. Less than 10% of the population has one, and usually the only thing they notice is acid reflux symptoms. So if you have strong heart burn and have to watch what you eat, there is a possibility that you have this condition.
It is very important for your weight loss surgeon to fix this defect if it is found during the operation. Recent data suggests that an unrepaired Hiatal Hernia during placement of an adjustable Gastric Band is associated with early Band failure… i.e. slippage, pouch dilation, band intollernce, etc. For Bypass and Sleeve patients, the Hiatal Hernia should be fixed to ensure that the gastric pouch size or sleeve creation are the correct size. Repairing a Hiatal Hernia almost always can be done laparoscopically through the same incisions I create, and usually adds just a little extra time to the original procedure.
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By Aloha Surgery (i)
08 Mar, 2012
Adjustable Gastric Band, Bariatric Surgery, Dietary, Food Tips, Gastric Bypass, Post Operative Problems, Vertical Sleeve Gastrectomy, Vitamins, Weight Loss Surgery
Aloha Surgery, Biotin, Dr. Steve Fowler, hair loss, iron, supplements, vitamins, zing
Hair Loss after weight loss surgery can be a big issue for some people. Most of my patients would rather not deal with any hair loss, whatsoever! There is a ton of information available about what is the best thing to do to prevent this, but unfortunately a lot of the literature is poor on scientific facts and liberal on anecdotal marketing! Here’s the facts:
- Hair loss is a response to the stress on the body from a surgical procedure and significant weight loss
- Hair loss is temporary, and usually is most prominent at 6 months after surgery
- If hair loss is still present after one year, this is rare and can be associated with a nutritional deficiency
- Supplements may help, but your body needs to go through its normal response to stress
If you want to take something to try and minimize hair loss, be aware that results are not proven with any product out there. We do know that Iron and Zinc and protein stores should be at their normal levels to minimize hair loss. Taking a multivitamin (and iron if you’ve had a Bypass) should be adequate. Biotin has been a popular supplement, but there is no proof of efficacy.
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