Lap-Band Procedure

Laparoscopic adjustable gastric banding

The Lap-band systems adjustable band is a silicone elastomer hollow ring filled with saline and placed around the upper part of the stomach. This creates a new small stomach pouch, with the large part of the stomach below the band. This way, the food storage area in the stomach is reduced. The pouch above the band can hold only a small amount of food. The band also controls the stoma (the stomach outlet) between the two parts of the stomach. The size of the opening between the two sides of the stomach controls the flow rate of the food from the upper to the lower part of the stomach. This lets you feel full sooner the feeling also lasts longer. To change the size of the stoma, the inner surface of the band can be adjusted by adding or removing saline, this process if called inflating or deflating. Saline is a salty solution like other fluids in your body. The band is connected to a tube to an access port placed beneath the skin during surgery. Later, the surgeon can control the amount of saline in the band by piercing the access port through the skin with a fine needle. If the band is too loose and weight loss too small, adding more saline can reduce the size of the stoma. If the band is too tight, the surgeon will remove some saline. This too can be done without more surgery. Being able to adjust the band is a unique feature of the lap-band system and is a normal part of the follow-up. For successful outcome with the band, you will need to be committed to follow up every month for the first year and every two months for the second year and may require adjustments on 5 – 10 of those appointments.

The Lap-band system Indications
The Lap-band system is not right for everyone. You and your surgeons should work together to decide if this is the right treatment for you. Here are some of the things your surgeon will consider.

The Lap-band system may be right for you if:

  • You are an adult at least 18 years of age
  • Your BMI is 30 to 39.9 with one or more obesity related comorbid conditions
  • Your BMI is 40 or higher or you weigh at least twice your ideal weight for you weigh at least 100 pounds (45 kilos more than your ideal weight)
  • You have been overweight for more than five years
  • Your serious attempts to lose weight have had only had short-term success
  • You do not have any other disease that may have caused you to be overweight
  • You are prepared to make a major change in your eating habits and lifestyle
  • You are willing to continue working with a specialist who is treating you
  • You do not drink alcohol in excess

What are the specific risks and possible complications?
Talk to your doctor about all of the following risks and complications:

  • Ulceration
  • Gastritis (irritated stomach tissue)
  • Gastroesophageal reflux (regurgitation)
  • Heartburn
  • Gas/Bloat
  • Dysphagia (difficulty swallowing)
  • Dehydration
  • Constipation
  • Weight gain
  • Death

Laparoscopic surgery has its own set of possible problems, they include:
Spleen or liver damager (sometimes requiring spleen removal)

  • Damage to major blood vessels
  • Lung problems
  • Thrombosis (blood clots)
  • Rupture of the wound
  • Perforation of the stomach or esophagus during surgery

Laparoscopic surgery is not always possible.
The surgeon may need to switch to an “open” method due to some of the reasons mentioned here. This happened in about 5% of the cases in the US clinical study. There are also problems that can occur that are directly related to the Lap-band system. They include:

  • The band can spontaneously deflate because of leakage. That leakage can come from the band, the access port, or the tubing that connects them.
  • The band can slip.
  • There can be stomach slippage.
  • The stomach pouch can enlarge.
  • The stoma (stomach outlet) can be blocked.
  • The band can erode into the stomach.

Obstruction of the stoma can be caused by:

  • Food
  • Swelling
  • Improper placement of the band
  • The band being over-inflated
  • Band or stomach slippage
  • Stomach pouch twisting
  • Stomach pouch enlargement

There have been some reports that the esophagus has stretched or dilated in some patients. This could be caused by:

  • Improper placement of the band
  • The band being tightened too much
  • Stoma obstruction
  • Binge eating
  • Excessive vomiting

Patients who have a weaker esophagus may be more likely to have this problem. A weaker esophagus is one that is not good at pushing food through. Tell your surgeon if you have difficulty swallowing. Then your surgeon can evaluate this.

Weight loss with the Lap-band system is typically slower and more gradual than with some other weight loss surgeries, including gastric bypass. Tightening the band too fast or too much to try to speed up weight loss should be avoided. The stomach pouch and or esophagus can become enlarged as a result. You need to learn how to use your band as a tool that can help you reduce the amount you eat.

Infection is possible. Also, the band can erode into the stomach. This can happen right after surgery or years later, although this rarely happens.

Complications can cause and reduce weight loss. They can also cause weight gain. Other complications can result that require more surgery to remove, reposition, or replace the band.

Some patients have more nausea and vomiting than others. You should see your physician at once if vomiting persists.

Rapid weight loss may lead to symptoms of:

  • Malnutrition
  • Anemia
  • Related complications

There have been some reports that the esophagus has stretched or dilated in some patients.This could be caused by:

  • Improper placement of the band
  • The band being tightened too much
  • Stoma obstruction
  • Binge eating
  • Excessive vomiting

Patients who have a weaker esophagus may be more likely to have this problem. A weaker esophagus is one that is not good at pushing food through. Tell your surgeon if you have difficulty swallowing. Then your surgeon can evaluate this.

Weight loss with the Lap-band system is typically slower and more gradual than with some other weight loss surgeries, including gastric bypass. Tightening the band too fast or too much to try to speed up weight loss should be avoided. The stomach pouch and or esophagus can become enlarged as a result. You need to learn how to use your band as a tool that can help you reduce the amount you eat.

Infection is possible. Also, the band can erode into the stomach. This can happen right after surgery or years later, although this rarely happens.

Complications can cause and reduce weight loss. They can also cause weight gain. Other complications can result that require more surgery to remove, reposition, or replace the band.

Some patients have more nausea and vomiting than others. You should see your physician at once if vomiting persists.

Rapid weight loss may lead to symptoms of:

  • Malnutrition
  • Anemia
  • Related complications

It is possible you may not lose much weight or any weight at all. You can also have complications related to obesity.

Lap-band Adjustments
With the Lap-band system, the band can be adjusted to meet your specific needs. This is one of its more attractive aspects. The feature allows you and your surgeon to find the right level of restriction just for you.

When first placing it, your surgeon usually leaves the band empty or only partially inflated this lets you get acquainted with your band during the first few weeks after surgery. It also let’s healing occur around the new band site.

These first few weeks are a critical time. You need to avoid vomiting. You also need to avoid putting pressure on your new small stomach above the band. The first time the band is adjusted is usually four to six weeks after your surgery. The exact time will vary. You and your surgeon will decide when the right time is for your band adjustment. Adjustments are made by your surgeon in the office. To determine how ready you are for a band adjustment, your surgeon will consider:

  • Weight loss
  • Amount of food you can comfortably eat
  • Exercise routine
  • How much fluid is already in your band

To get the best results, you will need to follow-up monthly for the first year and every two months during the second year. During each adjustment, only a very small amount of saline will be added to or removed from the band. The exact amount of fluid required to make the stoma the right size is unique for each person. An ideal “fill” should be just right enough to let you gradually lose weight. That means, you should still be able to eat enough to get the nutrients that you need while still reducing the overall amount you can eat.

The Lap-band system is meant to offer you a way to obtain steady and safe weight loss. Do not be in a hurry to have an adjustment before you are ready. To work, the band needs your participation. You success will depend on you and on the partnership between you and your surgeon.

Your motivation is key
Your surgeon will not do the operation unless he or she knows you understand the problems your excess weight is causing. Also, your surgeon will make sure you know you have responsibilities. These include new eating patterns and a new lifestyle. If you are ready to take an active part in reducing your weight, your surgeon will consider the treatment. First, though, your surgeon will want to make sure you know about the advantages, disadvantages and risks involved.

  • EXERCISE, EXERCISE, EXERCISE! Your success will greatly depend on your commitment to an exercise routine. We strongly recommend that patients participate in the preoperative and postoperative physical rehabilitation program. We encourage patients to take advantage of the dramatic weight loss to increase their exercise capacity and to include exercise in their daily routine.
  • Medical follow-up. In order to monitor for potential long-term complications, such as anemia, it is important to keep scheduled appointments and see your primary care physician regularly.