Adjustable Gastric Banding
The LAP-BAND® System is an adjustable silicone gastric band designed to help you lose excess body weight, improve weight-related health conditions and enhance quality of life. It reduces the stomach capacity and restricts the amount of food that can be consumed at one time. The LAP-BAND® System procedure does not require stomach cutting and stapling or gastrointestinal re-routing to bypass normal digestion. The LAP-BAND® System is the only adjustable and reversible weight-loss surgery available in the United States and the only weight-loss surgery approved for use by the Food and Drug Administration (FDA).
The name “LAP-BAND” comes from the surgical technique used, laparoscopic, and the name of the implanted medical device, gastric band. The LAP-BAND® System is a silicone ring designed to be placed around the upper part of the stomach and filled with saline on its inner surface. This creates a new, smaller stomach pouch that can hold only a small amount of food, so the food storage area in the stomach is reduced. The band also controls the stoma (stomach outlet) between the new upper pouch and the lower part of the stomach. When the stomach is smaller, you feel full faster, while the food moves more slowly between your upper and lower stomach as it is digested. As a result, you eat less and lose weight. The success of this process, however, also depends on how motivated you are and how committed you are to your goal of long lasting weight loss.
Adjustable Weight Loss
Once placed around the stomach, tubing connects the LAP-BAND® to an access port fixed beneath the skin of your abdomen. This allows the surgeon to change the stoma (stomach outlet) size by adding or subtracting water, inside the inner balloon through the access port. This adjustment process helps determine the rate of weight loss. If the band is too loose and weight loss is inadequate, adding more saline can reduce the size of the stoma to further restrict the amount of food that can move through it. If the band is too tight, the surgeon will remove some saline to loosen the band and reduce the amount of restriction.
The diameter of the band can be modified to meet your individual needs, which can change as you lose weight. For example, pregnant patients can expand their band to accommodate a growing fetus, while patients who aren’t experiencing significant weight loss can have their bands tightened.
There are many advantages with banding surgery, including these:
- Least invasive surgical option
- No intestinal re-routing
- No cutting or stapling of the stomach wall or bowel
- Small incisions and minimal scarring
- Reduced patient pain, and recovery when compared to gastric bypass
- Very low risk of nutritional deficiencies associated with gastric bypass
- No “dumping syndrome” related to stomach division
- Adjustments performed without additional surgery
- Removable at any time
The Band can erode through the wall of the stomach. This happens in about one percent of patients. Patients usually discover erosion when they get a wound infection at the port site more than six weeks after surgery or they find that adjustments of the band are not working despite filling the band with large volumes of normal saline. Erosions rarely results in a sudden life-threatening situation for the patient. Erosion of the Band requires at least temporary removal of the Band.
Band slippage or shifting
The Band must remain in the correct position on the upper stomach in order to function properly. If it slips out of place or twists, it is likely to cause obstruction of the stomach, requiring fairly urgent re-operation to reposition the Band.
The function of the Band as a partial blockage against outflow from the stomach pouch may cause the esophagus (which normally pushes food down in a very coordinated way) to become fatigued or damaged and to fail its normal swallowing function. Patients with a weaker esophagus may be more likely to have this problem. A weaker esophagus is one that is not good at pushing food through to your stomach. Tell your surgeon if you have difficulty swallowing. The first step is generally to remove all the fluid from the band, let your stomach recover, and then, gradually fill the band back up. If the problem returns or your start to get reflux disease, you may need your band evaluated by an upper GI series.
The Band, the port, and the connection tubing are designed to last for life. In fact, the Band itself is almost never reported to break or leak. However, the tubing and the port definitely can become twisted, kinked, or broken. Such events require re-operations (usually minor) for repair or repositioning of the problem spot. The usual first symptoms include the inability to feel full despite having multiple fills.
Injury to stomach or other nearby organs during surgery
Even in capable hands, the maneuvers involved in placing the Band may sometimes create injury to the stomach, esophagus, spleen, liver, or to other tissue. Sometimes these injuries can be addressed at the time of surgery and the Band can still be placed. Sometimes the nature of the injury means it is most reasonable to abandon the operation.
Wound infections can occur after all types of surgery. When independent evaluators look at surgical wounds they find about 5% of patients get wound infections. These can be minor or major. Major infections often include fever, hot skin around a wound site, leakage from the wound and redness of the area. These infections may require antibiotics or further surgery. It is important to tell your doctor whenever you think you have an infection. The most common site for an infection after laparoscopic Roux en Y gastric bypass is the biggest incision on the left side.
Bleeding can occur, but thankfully this is very rare. Use of blood thinners, to prevent venous thromboembolic disease, may actually increase the risk of hemorrhage slightly. Transfusions may be needed, and re-operation is sometimes necessary.
Infection can occur after surgery. Effective short-term use of antibiotics, diligent respiratory therapy, and encouragement of activity within a few hours after surgery, can reduce the risks of infections.
Abdominal surgery always results in some scarring of the bowel, called adhesions. No matter what surgery you have on the bowel there is a one to two percent lifetime risk of adhesions forming and blocking the bowel. When a patient’s bowels become blocked, the patient generally has severe abdominal pain and eventually vomiting. Vomiting is always abnormal after surgery. The treatment for bowel obstruction is surgery.
Any injury, such as a surgical operation, causes the body to increase the coagulation of the blood. There is an increased probability of formation of clots in the veins of the legs, or sometimes the pelvis, in the morbidly obese patient. A clot which breaks free and floats to the lungs is called a pulmonary embolism, a very dangerous occurrence. Commonly, blood thinners are administered before surgery, to reduce the probability of this type of complication. The best way to prevent this life threatening complication is to walk after surgery.
Stomach injury is a rare but known complication of lap band surgery. Usually this results from the process of dissection of the band around the stomach. Sometimes injury can be treated with antibiotics, and sometimes it will require immediate re-operation.
Almost any of the above complications can result in death. The best way to avoid the most common causes of death after gastric bypass surgery is to walk frequently and to report any problems to your surgeon.