Lap-Band
Restrictive Procedures (Lap-Band)
Laparoscopic adjustable gastric banding, or lap-band, is the second most commonly performed operation for weight loss in the United States. This operation has been popular in Europe, Australia and many Latin American countries for more than a decade. In many European countries, it is the most common weight loss operation. Lap-band was approved by the FDA in June 2001 and has been shown to help patients lose weight with lower risk of serious complications.
This operation creates a small stomach pouch in the upper part of the stomach. No staplers are used to staple or cut the stomach. Instead, a silicon band is placed around the upper part of the stomach, creating a small upper gastric pouch. The size of the stomach pouch is similar to the size of the pouch after gastric bypass surgery. The band has a balloon on the inner surface that is connected to a reservoir through tubing. The band is placed around the stomach with a minimal amount of fluid.
The patient returns to the office a few weeks after surgery. At that point, the surgeon starts gradually filling the band with saline solution. A small amount of saline is added to the band every few weeks. The “filling procedure” is usually performed in the office. In a small number of patients, the port cannot be felt through the skin and filling may need to be performed in the radiology department. The procedure takes 10 to 15 minutes and involves very little pain. Each filling narrows the opening of the stomach pouch. This helps the patient feel full with smaller amounts of food. Most patients reach an adequate filling volume within 12 months and do not need any more fillings.
Benefits and Risks of Lap-Band Surgery
Benefits
There are several reasons why patients choose a lap-band procedure:
- It is less invasive than most other weight loss operations including gastric bypass surgery.
- It is almost always performed using a laparoscopic approach, which means smaller scars, less pain and faster recovery.
- Most patients stay in the hospital overnight and go back to work or to their preoperative activities in one to two weeks.
- It is a reversible procedure. If the weight loss is not satisfactory or the procedure leads to complications the band can be removed any time and converted to gastric bypass.
- The weight loss with lap-band can be fine-tuned by filling the band.
- The band is designed to stay in the patient forever and help with weight loss.
The lap-band procedure does not disconnect the stomach pouch from the remnant stomach. As a result, if a disease develops in the remnant stomach or first part of the small bowel (the parts which are bypassed during gastric bypass), it is still possible to diagnose and treat those problems using upper endoscopy (EGD). Upper endoscopy is usually not possible after other weight loss operations including gastric bypass surgery without performing an abdominal operation.
Risks
Lap-band is not free of complications. The risks of complications are low, and they are different from the complications of gastric bypass. Here is a list of lap-band complications:
- Slippage: The band can slip down the body of the stomach. The risk is highest during the first three weeks. It is absolutely important to avoid solid food. If the band slips, it can be diagnosed with an upper GI series or EGD. Most of the time, a slipped band can be repositioned with a laparoscopic procedure similar to the original procedure. The band has to be removed and replaced with a new band.
- Erosion: The band can erode into the stomach. This usually happens slowly over a long period of time. The usual presentation is a patient who initially did well and lost a good amount of weight but then started to gain it again. An EGD can confirm the erosion. In the case of erosion, the band needs to be removed, and removal can usually be performed using a laparoscopic technique. The band site is allowed to heal throughout the next few weeks. After that, a new band can be placed, or the procedure can be converted to gastric bypass.
- Infection: The port site can become infected. Most infections can be treated with antibiotics. However, if antibiotics cannot eradicate the infection, the port may need to be removed and allowed to heal over several weeks. At that point, a new port can be placed.
- Other: Other complications include but are not limited to bleeding, damage to surrounding structures and esophageal dilatation. The risk of complications has decreased throughout the last five to 10 years
- Death: The risk of dying from lap-band is 10 times less than gastric bypass or most other weight loss operations. The risk of a leak from the stomach is extremely low, and complications related to the bypass are non-existent.
It is also important to understand that weight loss after lap-band is slower than gastric bypass. Patients usually lose one to three pounds per week.
The rate of weight loss is roughly half the rate of gastric bypass. However, a slower weight loss is not necessarily bad. Some studies have also shown that weight loss after lap-band continues up to five years as opposed to 18 months after gastric bypass. On the average, patients can expect to lose 30 to 60 percent of excess weight over a period of five years after lap-band. Individual results vary.
