ADJUSTABLE GASTRIC BAND or LAP-BAND

The LAP-BAND promotes weight loss by restricting the amount of food that can be consumed at any given time. When the band is properly adjusted the upper stomach pouch will comfortably hold only a couple of ounces of food. If the patient continues to eat the food backs up into the esophagus and results in a very uncomfortable feeling, often relieved only by regurgitating. 

For patients to be successful in losing weight with the band they must first choose high qualty, nutritious foods, particularly those high in protein. They must also learn to eat differently: eating slowly, taking small bites, chewing everything well, and avoiding drinking with meals. This sounds easy enough, but it is anything but easy. Changing a lifetime of eating habits requires commitment and perserverence, as well as regular follow-up by a team of trained professionals.

  
Advantages of the LAP-BAND

The LAP-BAND has become one of the most popular surgical weight loss options because it offers significant advantages over more invasive procedures like Roux-en-Y Gastric Bypass. One obvious advantage is that the LAP-BAND is reversible. However, removal of the LAP-BAND requires another operation to physically remove the device from around the stomach as well as the tubing and injection port.  Generally this is not recommended unless the patient is having a significant problem. If it is working as it should, the band should be left in place permanently. 

Another potential advantage of the LAP-Band is that the weight loss of relatively slow and gradual. This can allow time for the skin to shrink to fit the smaller body.  Unfortunately, this does not always occur, however the likelihood of drooping and saging skin seems to be a bit less than with other procedures that promote more rapid weight loss.

Perhaps the most significant difference between the LAP-BAND and other surgical options, and thus its major attraction, is its adjustability. By adding saline solution to the LAP-BAND system the degree of restriction can be changed to meet the weight loss needs of each patient. 

While many patients enjoy considerable weight loss with the band, sustained weight loss requires a regimen of regular exercise and the development of an overall health lifestyle.


Some Potential LAP-BAND Problems

While the LAP-BAND is widely recognized as the weight loss operation with the lowest surgical risk, there are none-the-less potential problems that may occur weeks, months or even years after the surgery. These are mostly related to the fact that the band is a man-made, foreign object, which is placed around the living tissues of the stomach. 

If the band is adjusted too tightly, over time the result may be dilation of the esophagus. This may cause chest pain, difficulty swallowing and even regurgitation of food or fluid into the lungs. The treatment is simply to remove the fluid from the band to allow the esophagus to return to normal. The fluid can be gradually reinjected later on to re-establish the restriction effect of the band. 


Esophageal Dilation




The band can also "slip" down on the stomach, generally a result of excessive wretching or vomiting, which can break the sutures holding the band in place.  The band can also be pushed down on the stomach over time due to persistent overeating.  In either case, the symptoms may include severe heartburn, chest pain, the ability to eat more food than expected, and failure to lose weight.  These symptoms will likely improve, at least temporarily, by removing some or all of the fluid from the band.  However, in many cases, the problem requires repeat surgery to either reposition the band or remove it entirely.  In many cases the best option is to remove the band and perform a different weight loss procedure, such as the Gastric Sleeve.  


Slipped Band


It is also possible for the band to erode through the wall of the stomach, resulting in an infection of the band and the surrounding area. The symptoms of an erosion generally include back or chest pain, fever, chills, nausea, or painful swallowing. However, sometimes the only symptom is swelling and redness at the port site on the abdominal wall. The diagnosis of an eroded band is confirmed either by an upper GI x-ray or an endoscopic examination of the inside of the stomach.  If an erosion occurs it is mandatory that the band be removed.  Depending on the amount of infection in the area, it may be possible to proceed at that time with a Gastric By-pass or a Gastric Sleeve, but most patients are best managed by simply removing the band.  Then, at a later time, it may be safe to perform another weight loss procedure.

On rare occasions patients may simply be intolerant of the restriction the LAP-BAND creates.  This is not to be confused with some type of allergic reaction. (Allergies are highly unlikely since the LAP-BAND is made out of an extrememly inert substance - Silastic)  In those instances where the patient is unable to adapt to the band, and insists on removal of the band, a second laparoscopic operation can be performed to remove it.  

Finally, it is a well recognized fact that some patients fail to lose the amount of weight the anticipate with the band. Despite repeted adjustments and dietary counseling they remain significantly overweight. In such cases it may be advisable to remove the band and convert to a Gastric Sleeve or Gastric Bypass procedure. This option should only be considered when all reasonable efforts have failed. 


Summary

It is extremely important for any potential patient to recognize that obesity is a complex disease and the LAP-BAND alone will not cure this problem. The procedure should be veiwed merely as a tool that is most effective when combined with a comprehensive weight management program.  Only by combining weight loss surgery with dietary counseling, behavior modification training and regular exercise is it possible to acheive optimal success. 



The LAP-BAND was FDA approved in June 2001, but prior to that it enjoyed excellent results in Australia and Europe as a proven solution to the obesity epidemic. Optimally, LAP-BAND patients can expect to lose 50 to 70% of their extra body weight over the course of 12 to 18 months after the surgery. However, results vary dramatically from individual to individual.