WHAT IS A BAND EROSION?

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WHAT IS A BAND EROSION?

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. There is

a very sobering picture of a band erosion in the AAAA Band photos

file here, so you know what we are talking about. Courtesy of Dr.

Trace Curry, Cincinnati, Ohio.

It sounds like an emergency, but it very rarely is. This is why it is

deceptive. Erosions occur slowly,

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

and are only VERY rarely dramatic or " send us to the ER " as some have

thought.

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.

RARELY, 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, a few 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. Banding is NOT " easily reversible " , as the ads

claim. Band Removal is much more difficult than the original band

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

HOW OFTEN DO EROSIONS OCCUR ??

the slip and erosion rate is now 3-7%,

per the 2007 ASBMS (American Society of Bariatric and metabolic

surgeons) meetings/reports. It is INcreasing over the earlier 1-3%

stats. Erosions are the lower end of this 3-7%

range, with slips much more common.

The new Inamed AP bands were specifically designd to address and

reduce the increasing rate of slipos and erosion, and the early

reports show they are doing just that. There are a number of design

changes over the old, earlier inamed bands.

Unfortunately, these new AP (Advanced Performance) Bands are not

available in Mexico. Most of the US docs and those in oter countries

use only these bands now, feeling thy are far superior.

WHAT CAUSES EROSIONS?

These are the things felt to play a part:

1. Inexact band placement.

2. too tight fills that are not relieved

3. excessive vomiting

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. This is why many docs

restrict use of NSAIDs to a 2-3 days only, unless absolutely

necessary. When someone MUST take NSAIDs longer, they need to follow

other safety measures too.

5. Banding someone with certain 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 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 clear reason - they are just not well-

understood

6. At the 2008 Seattle Bash, one of the experienced, and up-to-

date Band surgeons gave presentation/ study that felt that placing

more than 1 suture into the

diaphragm increases erosion risk. Some docs place 2-3 sutures. I have

seen no studies at all on this yet, but some of other docs agreed.

WHAT ARE THE SYMPTOMS OF AN EROSION??

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, and 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

restrciton is USUALLY from other, simpler causes.

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

peritonitis.

3. generally, no big symptoms at all.

4. ANY ongoing stomach opain in a bandster must always be thoroughly

investigated by a GI specialist of Band doc.

HOW ARE EROSIONS DIAGNOSED??

1. symptoms may be suspicious and a barium swallow is done. This

provides other clues.

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

tiny camera in it is placed down the throat and into the stomach,

while the patient is under sedation.

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

partially inside the stomach. some surgeons want a yearly endoscopy,

to try to pick up problem early.

WHT CAN BE DONE??

1. With an erosions, the band ALWAYS must be removed and the stomach

wall repaired. a few surgeons will consider replacing a new band

after 6 months of healing time,

but the rate of a second erosion is much higher.

One should consider other forms of weight loss surgery, if desired.

HOW CAN I DECREASE MY CHANCES 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.

2. If one is being banded now, choose 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. (Taken directly from a surgeon's website)

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.

Sadly, few surgeons send us home after a fill with any info at all

about too tight fills.

4. Avoid vomiting! very important!! every vomit risks a slip right

then, and increases risks for future slips and erosions. No one

knows " how many " vomits will produce a slip or erosion. A FEW are

unlikely to. NONE is best, but we all goof sometimes.

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

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

completely thru

the stomach wall.

We just MUST NOT be vomiting often. To me, more than 1-2x a month is

just begging for

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

vomiting. If we vomit often, something is wrong, so please ask for

help and we can help you.

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 about 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.

Our bands are literally saving our lives - treat them and your

stomach well.

Sandy r

patient educator