Expert: John Pilcher, MD - 3/3/2010

Question
I'm writing to ask about band slippage.  A year ago I had the band revised due to a posterior slip.  Once again it has slipped.  My doctor took out all the fluid in hopes that it would reset itself.  It hasn't.  He now wants to remove the band.  My questions are:  Do the doctors generally not revise the band a second time?  I was hoping that would be a possibility. Is there another type of band that might work better? I know that the sleeve is another option but it seems sort of new and stapling the stomach concerns me. Any information or opinions you might have on a recurring slip would be greatly appreciated.

Answer
Alyson,
I certainly regret your trouble.  The short answer is that I agree with your surgeon - once a Band has slipped a second time the percentage of repeat slip is so high that it is not usually medically proper to try again.

My understanding of the surgical literature about Band slip is that in the whole population of patients who have a Band there is about a 3-5% chance of a slip.  In almost all cases a surgical repair can be accomplished, but those who have had one slip have a significantly higher chance of another slip, in the range of 10-12%.  I don't think there is clear consensus on the chance of a third slip, but most of us who do this regularly believe that the chance of a third slip is more than 50%.

You have asked a good question about a different type of Band and lower chance of slip - there is some data suggesting that more flexible and broader Bands have a lower chance of slip but I think this possible advantage is overwhelmed by your personal experience of two slips.

I know what you mean when you express concern about the stomach stapling part of a sleeve operation.  However, I will let you know that conversion to a sleeve is a choice that I consider completely valid when a Band has failed, and almost all patients I have converted from a Band to a Sleeve are very happy with the change.

Best wishes,
Dr JP