Adjustable LapBand^® Gastric Banding

The laparoscopic adjustable gastric band or LapBand® has been used in other countries since 1993 and was approved for use in the United States in 2001. This procedure is considered by some to be the least invasive and safest operation for the treatment of morbid obesity. More than 100,000 procedures have been performed world-wide, and it is rapidly gaining in popularity.

The most appealing feature of the LapBand is the ability to adjust it, allowing a proper fit for every patient. A fitted band is the key to successful weight loss. The band, which is placed around the top portion of the stomach, induces weight loss by creating a smaller stomach, which restricts the amount of food that can be consumed. By adjusting the band, the surgeon can adjust the size of the pouch outlet for each patient. The more accurate the outlet size, the better it will work to: reduce meal size, induce longer food retention and thus prolong satiety and reduce hunger.

The benefits of the LapBand include the reversibility of the procedure, the short hospital stay (23 hour overnight stay or less) and the low risk profile for surgery. The LapBand can also be ideal for circumstances such as pregnancy, when weight loss can be adjusted or eliminated for a period of time. There are virtually no nutritional deficits associated with this procedure, though vitamin and calcium supplements are encouraged.

The procedure:

In a LAP-BAND procedure, there is no stapling in the abdomen and no division of the intestinal tract. This minimally invasive approach involves laparoscopic entrance into the abdomen, after which the area behind the stomach in dissected for placement of the band.

The band is placed about one centimeter below the gastroesophageal junction and closed underneath a balloon, which creates a smaller stomach pouch. A port is placed under the skin to connect to the inside of the band and allow for the opening to be tightened. This port is secured with four stitches which hold it in place.

After a LAP-BAND procedure, the patient stays in the hospital for 10 to 23 hours. Either later the same day after they have surgery or the morning after surgery, they have a gastrografin swallow (x-ray) procedure, which indicates the initial position of the band and confirms that there are no leaks in the stomach. The patient is then discharged to go home with specific LapBand diet instructions for the next 7-8 weeks, gradually making the transition from full liquids to solid foods. The initial filling of the band is done at about 4-5 weeks, once the swelling from surgery has subsided and healing has begun. “Fills” or “adjustments” are accomplished in the office with minimal time and discomfort involved. They are required approximately every 4 to 6 weeks for the first year, until the patient has reached a point of consistent weight loss with good tolerance of most foods.

Why the Procedure Works

The LAP-BAND system includes a silicone band that is surgically placed around the stomach and can be adjusted to limit food intake. This procedure is usually performed laparoscopically, making it much less invasive than other 'open' surgeries.

There is no cutting or stapling involved in the LAP-BAND procedure, because the band creates a 'pouch' in the upper stomach, dividing it from the lower stomach. This limits how much your stomach can hold. The band also controls the outlet, or stoma, between the two parts of the stomach. The size of the opening regulates the flow rate of food from the pouch to the lower part of the stomach. This allows you to feel full sooner and the feeling of fullness after eating lasts longer.

The LAP-BAND system is adjustable, allowing for changes in the size of the stomach through the addition or removal of saline. Saline is a salty solution similar to fluids found naturally in your body. After surgery and recovery, your surgeon can later control the amount of saline in the band by piercing the reservoir through the skin with a fine needle. In this way, your rate of weight loss can potentially be adjusted without additional surgery.

Possible Risks and Complications

The risk profile for the LAP-BAND procedure is lower that that for any other type of bariatric surgery. In addition to general surgical risks, there are a few risks unique to the LAP-BAND procedure. Removal of the band or conversion to another type of weight loss procedure occurs in about 3% of patients.

• Access Port Infections
  Access port infections occur in 10% of patients. The port may have to be removed and replaced. These infections may also be a sign of band erosion.

• Reservoir/Tubing Problems
  Complications with the reservoir/tubing occur in 5.8% of patients.

• Band Erosion
  Erosion of the band into the stomach 'flap' occurs in less than 1% of patients. The figure was higher in earlier studies due to improper placement of the 'buckle' on the band.

• Prolapse of the Stomach
  Prolapse or slippage of the stomach underneath the band occurs in 1-2% of patients due to the use of the Pars Flaccida technique. The Bariatric Center uses this technique, in which the band is 'fixed' in place higher on the stomach and part of the stomach is sewn over the band. This technique drastically reduces the incidence of stomach prolapse.

• Re-Operations
  Re-operations occur in approximately 5% of patients, according to comprehensive worldwide studies. Re-operating may be required due to any of the complications above, or because the patient does not tolerate the band or does not lose an adequate amount of weight.

• Open Procedures
  Conversion to an 'open' (non-laparoscopic) procedure occurs in 1.3% of patients. They occur when the band cannot be placed laparoscopically because of a very large liver or multiple adhesions from previous surgery.

• Mortality
  Death occurs in 0.05% of patients (1 in 2000) who have a LapBand®, usually from a perforation of the stomach during placement of the band. Other early complications that can potentially lead to death include perforation of another part of the intestine or bleeding. Our program has not experienced any mortalities.