If you are someone who had gastric band bariatric surgery several years ago and did not lose the amount of weight you had wanted to lose or initially lost weight but then regained it, don't fret...it is quite possible we have a solution for you!
In this podcast Dr. Michael Bilof, founder of Garden State Bariatrics, joins the show to discuss Revisional Bariatric Surgery and what you can expect if you need to have your Gastric Band replaced with one of the newer forms of Bariatrics.
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The Gastric Band Failed … Now What?
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Learn more about Michael Bilof, MD
Michael Bilof, MD
Dr. Michael Bilof began his career as a vascular surgeon where he continuously saw chronically ill patients suffering from type 2 diabetes. Dr. Bilof was frustrated by the overwhelming acceptance of maintaining the comorbidities (e.g., obesity) associated with type 2 diabetes and believed there had to be something more doctors could do to help. In 2003, upon the urging of his wife, Dr. Bilof left his successful vascular practice and retrained in general surgery, specializing in bariatrics. In April 2007, he founded Garden State Bariatrics and began offering lifesaving solutions for individuals with obesity and related diseases.Learn more about Michael Bilof, MD
Transcription:
Bill Klaproth: If you or someone who had bariatric surgery several years ago, either gastric band, vertical banded gastroplasty, and did not lose the amount of weight you had wanted to lose or initially lost weight but then regained it, don't fret. It is quite possible there is a solution for you and here to talk with us about those solutions is Dr. Michael Bilof, a general surgeon specializing in bariatric surgery. He is also the founder of Garden State Bariatrics and Wellness. Always great to have you on. Thank you again for your time. What are some of the reasons bariatric surgery may not work or provide the expected results?
Dr. Michael Bilof: There's any number of reasons, to be honest. When we talk about the band, in particular, there are very few surgeons who are still doing the band. Five or seven years ago, we go to these conferences and probably 30% to 40% of the surgeons were doing a lot of the bandings; now that number is down to less than 10%. It's gone from 30% to 40% of all bariatric surgeries in the United States down to less than 10%. It's really because it's a very ineffective procedure. The band itself is simply a ring that goes around the stomach and it’s very easy to “out eat” the band. There are a small number of patients that the band works for, but honestly, at this point, in my own personal practice, I've stopped doing the band. I haven't done one in several years, and more broadly in the bariatric community in general. Most surgeons are doing few if any of them.
Bill: For someone who has had the band, how do you reevaluate them for bariatric surgery?
Dr. Bilof: If someone comes in and either I've done their band or they’ve had a band with another surgeon, there are several tests that we do to see, one, if there are medical reasons to remove the band because there are some medical complications that develop after the band had been in for any number of years, and typically that'll involve some x-rays and perhaps an endoscopy, and then, depending on the results of those tests, we can submit to the insurance to get the band removed. Following that, most patients will need some other type of bariatric surgery. Obviously, what bariatric surgery they have subsequently depends on their particular situation and what kind of results they're looking for. One thing I would mention is a lot of patients out there have had the band and either never lost enough weight or lost and regained as you mentioned on the intro, one thing I want to say to those patients is they often will feel like they failed – that is the patient feels like they failed – and that’s really not the case in this particular situation. The band, as a device, has really failed. It’s not a very effective weight loss tool and most surgeons at this point have stopped using it because we’ve seen just across the board it just hasn’t worked for the vast majority of patients. When something is not working for 90% of the patients, it’s really not the patients; it’s the device.
Bill: Is that the preferred method then, if the band has failed, to remove the band and then do a bariatric type surgery?
Dr. Bilof: Correct. The band itself is a bariatric procedure, but it’s also one that’s very ineffective. Once the band is out, in my own personal practice, I wait at least eight weeks, some surgeons will wait a little bit longer, before we do the more definite surgery. The good news is if you’ve had a band and if you have a band, once the band is out, we can do any of the other bariatric surgeries. It doesn't mean that you're limited to this or that procedure. The whole spectrum is open and we decide which procedure is best depending on the patient’s goals, preferences, and their medical condition. Just because you’ve had a band, you can really have any of the other procedures once the band is out.
Bill: That’s very good to know. Let's talk about insurance on that. Does insurance cover revision bariatric surgery?
Dr. Bilof: It’s hard to answer that in general because every plan is a little different. What I would say is if a patient has insurance that covers bariatric surgery, then most plans will cover the revisional surgery as well. That’s one of the things that we will do for you here and one of the things we do at Garden State is we’ll go through your insurance, call the company and confirm that you have proper benefits for bariatric surgery and, more importantly, revisional bariatric surgery.
Bill: If you do revisional bariatric surgery, same procedure and recovery time and all of those factors remain the same then?
Dr. Bilof: When someone is having revisional surgery, I would say the recovery is a little bit more involved just because the surgery itself is a little more involved. Anytime we do revisional surgery, whether it’s in bariatrics or any type of surgery, it’s always a little harder than in the virgin situation, if you will, and so the surgery is a little more difficult, sometimes a little longer, sometimes a little more challenge. The recovery may be a little bit longer, but it’s typically not anything dramatic. If normally the hospital stay is one day, then usually with the revision procedure, it’s two. If it’s a one-week recovery, maybe it’s two weeks after the revisional surgery. One thing I would mention, and this is a question that we commonly get, is when we do the revisional procedures, can we do them laparoscopically – that is, can we do them through the very small incisions that patients have really come to expect now? The answer, in the vast majority of cases, is yes. We can still do the surgery, even though it’s a revisional procedure and even though it’s technically more complicated and difficult to do, we’re still able to do it laparoscopically through the very small incisions which then leads to quicker recovery times.
Bill: Very good. Generally, then, do people see the expected results after revision bariatric surgery?
Dr. Bilof: Yes, absolutely. Thanks for asking that. Just because the band hasn't worked – which again I know a lot of patients out there are thinking that they failed, but it's really a failure of the device – even though the band itself hasn't worked, that does not have any implications for how they will do a subsequent surgery. If we take the band out and then two or three months later go for the gastric sleeve or gastric bypass, they will have as good a result with their gastric sleeve or gastric bypass as a patient who never had the band. Just because you've had the band and it didn't work out, doesn't mean that these other procedures won't work. That's not true and you can be fairly confident that the other procedures will work just as well as if you never had the band at all.
Bill: You said earlier people think that they failed when you say most of the time that’s not true. Does that keep people from coming in? They think ‘I failed, I'm done, I guess I've lost the battle of obesity, I'm not even going to try again,’ and it sounds like your message is ‘it’s not your fault, come on in, let's evaluate and we can have a plan for you, you have options.’
Dr. Bilof: Correct. That’s absolutely true. I have a patient who comes into the office and they haven't been there for two, three or four years, and I’ll ask what happened and why haven't I seen you, and they just say ‘I feel like I failed, I just didn’t want to come in because I didn’t feel good about myself. My message to patients like that whether I did your surgery or someone else did is you should come in, there are still things we can offer, and particularly if you've had the band, do not think of yourself as a failure; you've unfortunately had a device that's not particulate effective and we now know that we didn't know back in 2007 and 2008 when we were putting a lot of these devices in, but now we do. The good news is there are options and they are very effective options.
Bill: That’s really good to know. I suppose that you have had patients that have come in that had the band and you’ve taken it out and have done subsequent bariatric surgery and it worked and they’ve seen the results they expected and they’ve got the life that they want now because of it.
Dr. Bilof: Yes, absolutely. In my own personal practice, I put in probably 500 to 800 bands over the course of my career. At this point, I personally have taken out half of those bands and I've also taken out bands from patients who've had their surgery with other surgeons. Again, what I would say to patients is any device where half of the devices have to come out because it hasn't worked out clearly is an effective device. If you happen to be one of the patients who fortunately is having good results with the band, that's great, and certainly you should continue with it, but if you're one of the 70% to 80% of patients who have not had success with the band, please come back in and we can evaluate you. Often times, there are things we can do that are still highly effective at helping you lose weight.
Bill: So good to know. Thank you for your time as always. For more information, please visit the Garden State Bariatrics and Wellness Center website at gsbwc.com. That’s gsbwc.com. This is Winning Through Losing: A Weight Loss Surgery Podcast with Garden State Bariatrics. I'm Bill Klaproth. Thanks for listening.
Bill Klaproth: If you or someone who had bariatric surgery several years ago, either gastric band, vertical banded gastroplasty, and did not lose the amount of weight you had wanted to lose or initially lost weight but then regained it, don't fret. It is quite possible there is a solution for you and here to talk with us about those solutions is Dr. Michael Bilof, a general surgeon specializing in bariatric surgery. He is also the founder of Garden State Bariatrics and Wellness. Always great to have you on. Thank you again for your time. What are some of the reasons bariatric surgery may not work or provide the expected results?
Dr. Michael Bilof: There's any number of reasons, to be honest. When we talk about the band, in particular, there are very few surgeons who are still doing the band. Five or seven years ago, we go to these conferences and probably 30% to 40% of the surgeons were doing a lot of the bandings; now that number is down to less than 10%. It's gone from 30% to 40% of all bariatric surgeries in the United States down to less than 10%. It's really because it's a very ineffective procedure. The band itself is simply a ring that goes around the stomach and it’s very easy to “out eat” the band. There are a small number of patients that the band works for, but honestly, at this point, in my own personal practice, I've stopped doing the band. I haven't done one in several years, and more broadly in the bariatric community in general. Most surgeons are doing few if any of them.
Bill: For someone who has had the band, how do you reevaluate them for bariatric surgery?
Dr. Bilof: If someone comes in and either I've done their band or they’ve had a band with another surgeon, there are several tests that we do to see, one, if there are medical reasons to remove the band because there are some medical complications that develop after the band had been in for any number of years, and typically that'll involve some x-rays and perhaps an endoscopy, and then, depending on the results of those tests, we can submit to the insurance to get the band removed. Following that, most patients will need some other type of bariatric surgery. Obviously, what bariatric surgery they have subsequently depends on their particular situation and what kind of results they're looking for. One thing I would mention is a lot of patients out there have had the band and either never lost enough weight or lost and regained as you mentioned on the intro, one thing I want to say to those patients is they often will feel like they failed – that is the patient feels like they failed – and that’s really not the case in this particular situation. The band, as a device, has really failed. It’s not a very effective weight loss tool and most surgeons at this point have stopped using it because we’ve seen just across the board it just hasn’t worked for the vast majority of patients. When something is not working for 90% of the patients, it’s really not the patients; it’s the device.
Bill: Is that the preferred method then, if the band has failed, to remove the band and then do a bariatric type surgery?
Dr. Bilof: Correct. The band itself is a bariatric procedure, but it’s also one that’s very ineffective. Once the band is out, in my own personal practice, I wait at least eight weeks, some surgeons will wait a little bit longer, before we do the more definite surgery. The good news is if you’ve had a band and if you have a band, once the band is out, we can do any of the other bariatric surgeries. It doesn't mean that you're limited to this or that procedure. The whole spectrum is open and we decide which procedure is best depending on the patient’s goals, preferences, and their medical condition. Just because you’ve had a band, you can really have any of the other procedures once the band is out.
Bill: That’s very good to know. Let's talk about insurance on that. Does insurance cover revision bariatric surgery?
Dr. Bilof: It’s hard to answer that in general because every plan is a little different. What I would say is if a patient has insurance that covers bariatric surgery, then most plans will cover the revisional surgery as well. That’s one of the things that we will do for you here and one of the things we do at Garden State is we’ll go through your insurance, call the company and confirm that you have proper benefits for bariatric surgery and, more importantly, revisional bariatric surgery.
Bill: If you do revisional bariatric surgery, same procedure and recovery time and all of those factors remain the same then?
Dr. Bilof: When someone is having revisional surgery, I would say the recovery is a little bit more involved just because the surgery itself is a little more involved. Anytime we do revisional surgery, whether it’s in bariatrics or any type of surgery, it’s always a little harder than in the virgin situation, if you will, and so the surgery is a little more difficult, sometimes a little longer, sometimes a little more challenge. The recovery may be a little bit longer, but it’s typically not anything dramatic. If normally the hospital stay is one day, then usually with the revision procedure, it’s two. If it’s a one-week recovery, maybe it’s two weeks after the revisional surgery. One thing I would mention, and this is a question that we commonly get, is when we do the revisional procedures, can we do them laparoscopically – that is, can we do them through the very small incisions that patients have really come to expect now? The answer, in the vast majority of cases, is yes. We can still do the surgery, even though it’s a revisional procedure and even though it’s technically more complicated and difficult to do, we’re still able to do it laparoscopically through the very small incisions which then leads to quicker recovery times.
Bill: Very good. Generally, then, do people see the expected results after revision bariatric surgery?
Dr. Bilof: Yes, absolutely. Thanks for asking that. Just because the band hasn't worked – which again I know a lot of patients out there are thinking that they failed, but it's really a failure of the device – even though the band itself hasn't worked, that does not have any implications for how they will do a subsequent surgery. If we take the band out and then two or three months later go for the gastric sleeve or gastric bypass, they will have as good a result with their gastric sleeve or gastric bypass as a patient who never had the band. Just because you've had the band and it didn't work out, doesn't mean that these other procedures won't work. That's not true and you can be fairly confident that the other procedures will work just as well as if you never had the band at all.
Bill: You said earlier people think that they failed when you say most of the time that’s not true. Does that keep people from coming in? They think ‘I failed, I'm done, I guess I've lost the battle of obesity, I'm not even going to try again,’ and it sounds like your message is ‘it’s not your fault, come on in, let's evaluate and we can have a plan for you, you have options.’
Dr. Bilof: Correct. That’s absolutely true. I have a patient who comes into the office and they haven't been there for two, three or four years, and I’ll ask what happened and why haven't I seen you, and they just say ‘I feel like I failed, I just didn’t want to come in because I didn’t feel good about myself. My message to patients like that whether I did your surgery or someone else did is you should come in, there are still things we can offer, and particularly if you've had the band, do not think of yourself as a failure; you've unfortunately had a device that's not particulate effective and we now know that we didn't know back in 2007 and 2008 when we were putting a lot of these devices in, but now we do. The good news is there are options and they are very effective options.
Bill: That’s really good to know. I suppose that you have had patients that have come in that had the band and you’ve taken it out and have done subsequent bariatric surgery and it worked and they’ve seen the results they expected and they’ve got the life that they want now because of it.
Dr. Bilof: Yes, absolutely. In my own personal practice, I put in probably 500 to 800 bands over the course of my career. At this point, I personally have taken out half of those bands and I've also taken out bands from patients who've had their surgery with other surgeons. Again, what I would say to patients is any device where half of the devices have to come out because it hasn't worked out clearly is an effective device. If you happen to be one of the patients who fortunately is having good results with the band, that's great, and certainly you should continue with it, but if you're one of the 70% to 80% of patients who have not had success with the band, please come back in and we can evaluate you. Often times, there are things we can do that are still highly effective at helping you lose weight.
Bill: So good to know. Thank you for your time as always. For more information, please visit the Garden State Bariatrics and Wellness Center website at gsbwc.com. That’s gsbwc.com. This is Winning Through Losing: A Weight Loss Surgery Podcast with Garden State Bariatrics. I'm Bill Klaproth. Thanks for listening.