Get informed

As a surgeon, one of my duties is to discuss Informed Consent. There are two components to this: One aspect of this is the consent part. This is where discussion of risks, benefits, and complications takes place. It is also where options are discussed. A patient cannot give a consent if it is not informed and this is the second component. A consent is not informed if the patient was not provided with all the options and details.

In my clinical practice, I routinely discuss all the surgical options with a prospective patient. It is my duty to explain in great detail what the surgical alternatives are, what their relative risks are when compared to each other, and what are the pros and cons of each procedure. Once this information is presented, I would then discuss the rationale as to why certain procedures are superior in certain clinical conditions. It ultimately is the patient that makes the decision as to what procedure to have for treatment of their morbid obesity. In some cases, however,if I do not think that the procedure that the patient has decided to have will serve the patients' long or short term health needs I will ask that the patient seek another surgeon.

One of the most common examples of a scenario like this is when patients are seen in my office for surgical treatment of morbid obesity, and are inquiring about Lap Band®. They have seen an advertisement in television, radio, or even on a bill board. There are even those patients that are told by the primary care physicians that they should ONLY have the Lap Band®  done because it will solve all their problems. The promotional marketing material is only a small portion of a large body of information that is made available to patients and their primary care physicians. To most patients, Adjustable Gastric Banding (Lap Band®, Realize Band®) are “drive thru” procedures.  They have been advertised as a procedure where a patient goes to a surgeons’ office, gets examined, and operated on and looses weight, happy ever after. This is untrue on a number of fronts, and far from the way it works for overwhelming number of patients that get the Lap Band® done. I am not against the adjustable gastric banding procedures. I only advocate that the expectations be set for the patients appropriately

First of all the Lap Band® is not for every one. The scientific information on this matter is overwhelming. The educational booklet that is available, and published by Allergan (the manufacturer of the band) has a list of conditions in which the band should not be used. Then there is the relative efficacy of the banding procedure compared to the Duodenal Switch and the Gastric Bypass operation. The question a patient and a primary care physician should ask:

1. Are the treatment options as good in treating, and resolving, certain conditions of a patient.
2. What are the chances that a patient with diabetes, high cholesterol or high blood pressure, will have cure of those conditions if they had the Gastric bypass, Duodenal Switch or the Lap Band done.

The reality is that, in my opinion most patients that are having the Lap band done have not been educated and provided with the information to make an informed consent. When you consider how little most patient will loose with Lap Band, then one has to realize that the risks, as little as they may be compared to the other procedures are not worth taking.