What is a Band Erosion ? re-post

[Guest guest]

An erosion is the most serious of the routine band problems, and

always requires band removal.

the term " BAND EROSION " , like the term " band slip " , is misleading.

The

band does not erode - it is nearly indestructible. It is the stomach

tissue that erodes, until the band actually works it's way thru the

stomach wall and part of it the band is INSIDE the stomach.

It sounds like an emergency, but it rarely is. Erosions occur slowly,

over months, from one of the common problems leading to erosions,

and are only very rarely dramatic.

There are rarely any big symptoms, as it is such a gradual process.

As the band slowly eats it's way thru the stomach wall, the tissues

usually seal themselves around the band and close up any hole.

Occasionally,

though, the erosion prduces an unsealed hole in the stomach wall that

allows stomach acid and stomach contents to leak into the abdominal

cavity.

This can cause severe pain, high fever, and a life-threatening

peritionitis. Sadly, some Bandsters have died from erosion-caused

peritonitis or the surgery to remove the band and repair the stomach.

Removing a band can be very tough, as there is a lot of scar tissue to

get thru and remove. It's much more difficlut than the original band

placement surgery, more painful, and requires a longer recovery time.

How often does this happen? the slip and erosion rate is now 3-7%,

per the last American Bariatric Society meetings/reports in 2007, and

is

increasing over earlier stats. Erosions are the lower end of this

range,(3%) with slips much more common.

What causes erosions?

These are the things felt to play a part:

1. Inexact band placement by an inexpereinced surgeon.

2. too tight fills

3. excessive barfing

4. NSAID use is felt to posibly play a role, as it weakens the

stomach wall ,

causes ulcers, harms the protective stomach mucous, and makes the

stomach less able to resist band pressure.

5. Banding someone with certain known GI problems, or with some of

the auto-immune problems. these people may have a higher risk of an

erosion, and should consult several experienced surgeons before

deciding they wish to take the ossibly-increased risk of getting

banded. Just because one doc or another will DO the surgery, this

does not mean it is necessarily wise or safe to do it.

5. some erosions occur for no known reason - they are just not well-

understood. The bandster did NOTHING to cause them at all.

6. At the recent Seattle Bash, one of the experienced, and up-to-

date Band surgeons felt that placing more than 1 suture into the

diaphragm

increases erosion risk. Some docs place 2-3 sutures. I have seen no

studies on this yet, but some of other docs agreed.

What are the symptoms?

1. After a period of good restriction and loss, and more and more

fill, there is a sudden total loss of all restriction . THis is

becuase the

band has eaten thru the stomach wall. More and more fill does

nothing at all, since the band is no longer on the outside of the

stomach, compressing it. It's important to know that sudden loss of

restriction is USALLY from otheer, simpler and safe causes.

2. Rarely, it is a real emergency, with severe pain, high fever,

peritonitis.

3. generally, no big symptoms at all. sometimes general stomach pain

and low fever, which must always be investigated very thoroughly.

How are erosions diagnosed?

1. symptoms may be suspicious and a barium swallow (fluoro) is done.

This provides other clues.

2. an endoscopy is the test that shows for sure. a thin tube with a

tiny camera on it is placed down the throat and into the stomach.

Then, the band can actually be seen coming thru the stomach wall and

partially inside the stomach. There is a picture of a band erosion

from this endoscopy camera inside the stomach - in the " AAAA Band "

album on the photos section.

What can be done?

1. the band always must be removed and the stomach wall repaired. a

few surgeons will replace a new band after 6 months of healing time,

but the rate of a second erosion is much higher.

How can i decrease my risk of suffering an erosion ?

1. choose only a highly-experienced band surgeon who will place the

band precisely. Any surgeon who has done more than a few hundred

bands is considered very experienced by Inamed, the LapBand

manufacturer. Check mout the doc you choose carefully. even some of

the " experienced " surgeons have a higher than usual erosion rate.

2. IMO, choose if being banded now, to get the newest AP bands ,

designed specifically to lower erosion risk, as well as lower risks

of slips and other

problems. They are also felt to improve weight loss, per the

literature (but i don't understand how) .

3. avoid too tight fills ! very important!! this means knowing the

definition of a good fill, and getting an overfill removed quickly.

Even if a fill " looks ok " on a fluoro, or the surgeon thinks it is a

good amount, it still can turn out to be an overfill. YOU are

responsible for knowing

what a good fill is, and never keeping one that is too tight.

4. Avoid barfing ! very important!! every barf risks a slip right

then, and increases risks for future slips and erosions.

With too-tight fills and barfing, the band rubs back and forth on

the stomach and wears the tissue away, allowing the band to eat thru

the stomach wall. This is another major reason we just MUST NOT be

barfing often. To me, more than 1-2x a month is just begging for

trouble. Learn and follow the rules, and eat mindfully, to avoid

barfing.

5. Take part in local and online teaching/support forums, to keep

learning more and more about care and safety of your medical implant.

New things are learned and becoming understood abiut the band and

obesity all the time, new improved bands

being designed and released, and you should know of new developments.

I try to keep up and share new reports and articles here often.

As with ALL band problems, PREVENTION is the key. It's much easier

and wiser to learn how to prevent problems, than to try to pick up

pieces when problems have already occurred.

Sandy r