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What Is Lap Band Weight Loss Surgery?

Lap Band Surgery Explained

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Updated February 11, 2011

What Is Lap Band Weight Loss Surgery?

Lap-band surgery diagram

Photo © A.D.A.M.

Lap Band surgery, or adjustable gastric banding surgery, is a restrictive weight loss surgery that works by decreasing the amount of food that is able to be consumed before feeling full. During gastric banding surgery, a firm silicone band with an inner inflatable ring is placed around the stomach to slow the passage of food from the upper portion of the stomach to the lower portion. What makes the procedure unique is the ability to adjust the fit of the band, unlike other procedures where the band size is fixed and cannot be changed.

The inflatable ring acts like an inner tube, which can be inflated or deflated as necessary to achieve weight loss results by restricting the expansion of the stomach. Ideally, the band will make the patient feel full with less food, slow the digestion of food and increase the length of time the feeling of fullness lasts after a meal. If the band allows food to pass too quickly or allows too much food to be eaten at a meal, it can be tightened by adding saline to the band. If the patient experiences vomiting or difficulty swallowing with meals, the band may be too tight and saline can be released.

A port connects to the band, allowing the band to be adjusted through the skin with a syringe, adding or releasing saline. The port is permanent, and because it is rests just below the skin, there are no concerns with swimming or bathing after surgery.

The Lap Band Procedure

The surgery is typically performed in a hospital or a surgery center, using general anesthesia. Most surgeries are performed laparoscopically, which allows the surgeon to work using long instruments placed in the body via incisions a few centimeters long. In rare cases, the surgery will be performed “open,” with the larger traditional incision, or a surgery that begins laparoscopically may be converted to the open procedure when the surgeon determines it is necessary.

The surgery begins with multiple half-inch long incisions in the area of the stomach. The instruments are inserted through these incisions and the surgeon begins by positioning the band around the stomach. Once in place, the band is inflated with saline, adjusted for the proper fit and placement, and closed around the stomach

Once the band is in place, a port that rests just below the skin is placed. The port is injected with saline to insure that it works properly, inflating and deflating the cuff without leaks. Once the surgeon determines that the both the port and the band work properly and that both are in place, the instruments are withdrawn and the incisions are closed, typically with absorbable sutures and sterile tape.

After Lap Band Surgery

This procedure is popular with both surgeons and patients for a variety of reasons. The surgery is the least invasive of all the weight loss surgeries, requires the least amount of recovery time and poses no risk of malnutrition when properly adjusted. Some patients return to work within days and resume their normal activity level in a week or two, on average, patients take a week to return to work and a month to return to full exercise.

The adjustable nature of the band allows for steady weight loss of one to two pounds per week, a slower rate than with many surgeries, that helps prevent some side effects like gallstones and skin that hangs from the abdomen as the area shrinks. The band is typically empty of saline, or has minimal inflation, in the first six weeks after surgery.

Once healing is complete, the adjustments begin, working to restrict the flow of food without completely obstructing the movement of food through the digestive tract. These adjustments may continue for over a year after the procedure in order to optimize the effects of the band. The adjustments are done by the surgeon and typically take place in an x-ray suite, so the filling can be observed. An overly tight band can rub and cause erosion of stomach tissue.

The adjustment capability also allows the band to be completely emptied in times of need, such as pregnancy or serious illness, allowing the stomach to return to its full capacity when the patient needs more nutrition, and reinflated later.

In the rare event that there is a problem with the band, it can be replaced laparoscopically. There is a risk that the band will slip, or move out of position, especially when the saline level in the band is being altered.

Lap band weight loss surgery requires significant behavior modification by the patient. A patient who does not drastically alter his eating habits will not have the weight loss that other patients experience after this procedure. The stomach can stretch, allowing larger quantities of food, if the patient does not adhere to the surgeon’s instructions regarding meal size.

In addition, exercise remains an important component of weight loss and contributes greatly to long-term success. When working properly, the band poses no additional risk of malnutrition, and there is no risk of dumping syndrome as in other surgeries.

In the first year after surgery, patients can lose as much as two to three pounds per week, with higher BMI patients losing more pounds per week than lower BMI patients. After the first year, the average rate of loss slows to a pound per week. Weight loss usually moves into the maintenance phase 18 to 24 months after surgery. Long-term maintenance of significant weight loss is not as successful as with combination procedures such as roux-en-y gastric bypass and biliopancreatic diversion surgeries.

Sources:

Bariatric Surgery For Severe Obesity. Consumer Information Sheet. National Institute of Diabetes and Digestive and Kidney Diseases. March 2008. http://win.niddk.nih.gov/publications/gastric.htm

Jones,Nicolas V. Christou, MD, PhD, Didier Look, MD, and Lloyd D. MacLean, MD, PhD. " Weight Gain After Short- and Long-Limb Gastric Bypass in Patients Followed for Longer Than 10 Years." Annals of Surgery 2006 November; 244(5): 734–740.

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