Expert: John Pilcher, MD - 1/21/2009

Question
i am 50 years old, my bmi is 38.  I am on blood thinner, for recurring dvts in the 1990s. I have fibromyalgia and a postive ana.  would I be a able to have the lap band surgery?

Answer
Jane,
Your pertinent questions demonstrate that you have researched this well.  I will break the issues down one at a time:

Age = 50:  no problem

BMI = 38:  most Band surgeons would agree that at this weight, the risk of the Band operation is less than the risk of living with the weight.  In other words, most surgeons (including myself) would consider it proper to offer Band surgery to most people with a BMI of 38.  Most insurance companies do cover Band surgery in the BMI range of 35-40, IF there is an associated medical problem that may be related to the weight.

Recurring DVT's, currently on blood thinner (most likely coumadin/warfarin):  this is probably the stickiest of the issues that you have raised.  The fact is that the number one life-threatening risk factor related to bariatric surgery is DVT leading to Pulmonary Embolus.  A patient who has had a history of DVT has a substantially increased risk of DVT at the time of any subsequent surgical procedure, so this is a real concern.  On the other hand, the weight itself is a risk factor for DVT so it probably makes it worth undergoing surgery for the weight.  You and the surgeon might consider placement of a filter in your vena cava prior to surgery, to stop a blood clot traveling from your legs to your lungs.
Band surgery is not particularly disposed to bleeding, so your blood thinner can be held (stopped) for a few days before the procedure and there should be rather little risk of bleeding.

Fibromyalgia, positive ANA:  there is a theoretical concern about a person who has one type of immune disorder having a reaction to the Band material.  I don't believe this actually happens, though it does deserve discussion with your surgeon.

So in summary, your case is a bit more complex than average, but I believe most surgeons would nevertheless consider you as a valid candidate for Band surgery.

Best of luck!
Dr JP