What is Adjustable Gastric Banding:

The LAP-BAND® Adjustable Gastric Banding System is a simple yet advanced gastric banding system that helps you gradually lose and control your weight by controlling your hunger, allowing you to control your food intake and supporting long term, sustainable weight loss.

How the LAP-BAND® System works:

A silicone band is placed around the upper part of your stomach, like a belt, to create a new smaller stomach pouch. As a result, patients are satisfied with smaller amounts of food. The LAP-BAND® is also adjustable. A small access port is placed below the skin surface. This port allows the surgeon to adjust the opening of the band individualizing it for each patient. By adding or removing fluid from the band the length of time until hunger recurs can be controlled. Adjusting the band is a simple procedure that can be done right in the surgeon’s office.

The effectiveness of the LAP-BAND® System depends on the ability of the patient to change his or her eating behavior and lifestyle. Doctors offering the LAP-BAND® are committed to providing long-term care for their patients, including dietary, behavior-modification, counseling, and support groups with other LAP-BAND® patients. After surgery patients must continue follow-up visits in order to maximize and maintain their weight loss. Patients are encouraged to eat a balanced diet of small meals and to avoid the eating patterns of their pre-surgery lifestyle. Patients are also encouraged to increase physical activity, which is very important to weight loss, good health, and improved quality of life.

The LAP-BAND® System Advantage

 
  • Adjustable
  • Allows for personalized steady, healthy rate of weight loss
  • Minimally invasive surgical approach (small incisions and minimal scarring)
  • No intestinal re-routing, cutting or stapling of the stomach wall or bowel
  • Can be performed on an out-patient basis
  • Reduced post-surgical pain, shorter hospital stay and recovery time
  • Return to work/normal activities typically within one to two weeks
  • Fewer Risks and Side Effects
  • Low risk of post-surgical nutritional deficiencies
  • Reduced risk of hair loss
  • No “dumping syndrome” (food passes through the system too fast resulting in severe cramping, nausea, sweats, diarrhea, etc.)
  • While it is intended to be a long-term treatment, the LAP-BAND® System can be removed at any time, in most cases laparoscopically.
  • Compared to gastric bypass and sleeve gastrectomy, the LAP-BAND® System is the safest, least invasive adjustable obesity surgery option in the U.S.

To further help you understand the LAP-BAND® System Procedure, you may watch the LAP-BAND® System Video.

A gastric sleeve (also known as sleeve gastrectomy, or simply 'the sleeve') decreases the size of the stomach, limiting the amount of food that can be eaten at one time. During this procedure, a thin, long tube of stomach is created using a stapling device, and the rest of the stomach is removed. The sleeve is shaped like a banana. This procedure markedly limits (restricts) the amount of food you can eat and helps you feel full sooner. It allows for normal digestion and absorption. Food consumed passes through the digestive tract in the usual manner, allowing it to be normally absorbed in the body.

The majority of gastric sleeve surgeries performed today are performed using a laparoscopic technique, (minimally invasive). Laparoscopic surgery usually results in a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures. The average hospital stay is 2 to 5 days. Patients usually return to normal activities in 2 weeks and are fully recovered in 3 weeks.

Laparoscopic gastric sleeve can be used as a first step before a gastric bypass or it can be a single procedure for weight loss. If a gastric sleeve is used as part of a two-step procedure, the first step is for the surgeon to create the small stomach “sleeve.” After a period of time determined by the surgeon, another procedure would be done in which the surgeon attaches a section of the small intestine directly to the stomach pouch. This allows food to bypass a portion of the stomach and small intestine. Doing so enables your body to absorb fewer calories, in addition to consuming less food. This two-step procedure may be done because patients may not be able to tolerate both procedures during a single operation.

Roux-en-Y gastric bypass (RYGB) provides a combination of restriction and malabsorption to cause weight loss. A small (15-30 cc) gastric pouch is created to restrict food intake and the lower part of the small intestine is rerouted to empty this pouch and bypass the stomach and first part of the small intestine. The procedure is usually performed laparoscopically using minimally invasive surgical techniques.

The gastric bypass has a more rapid initial weight loss, requires fewer follow up visits, does not require adjustments (not adjustable), and does not require a long term medical device to be placed.

Disadvantages of Roux-en-Y gastric bypass include the potential for anastomotic (reconnection) leaks and strictures (narrowing), nutritional deficiencies, ulceration, severe dumping syndrome symptoms, distention of the bypassed stomach and internal hernias, and is permanent.

Revisions After LAP BAND Surgery

The revision rate for the LAP BAND is approximately 10% during the first two years due to either device-related problems or unsatisfactory weight loss. A complication specific to this type of procedure is slippage of the gastric band, which requires a follow-up procedure to fix the problem. While some patients will have the band replaced, others choose to revise to another procedure.

Revisions After Gastric Bypass Surgery

A gastric bypass revision is necessary in approximately 5 to 10% of patients over 5 years due to complications, unsatisfactory weight loss, or weight regain. Complications that may occur after gastric bypass surgery, such as ulcers, chronic vomiting, hernia, staple line failure, can often be improved through revisional bariatric surgery.

If gastric bypass fails a patient has several options, including:

 
  • If the problem is lack of weight loss or weight regain, non-surgical approach includes examining eating habits and exercise routines and participating in nutritional counseling, exercise program, behavior modification therapy, psychological counseling, and support groups
  • If the problem is lack of weight loss or weight regain, surgical options include placement of an adjustable gastric band on the stomach pouch, conversion to distal gastric bypass, and conversion to duodenal switch
  • If stomach pouch or stomach opening has enlarged, a LAP BAND may be added to reduce amount of food that can be eaten and slow the movement of food from the stomach to the small intestine
  • If stomach pouch or stomach opening has enlarged, the bariatric surgeon can try and fix the problem by re-operating to either remove more stomach and re-stapling the stomach line or stitching up the stomach opening to make it smaller, although it may only be a temporary fix and happen again
  • If surgical complication, such as popped staple line, ulcers, or hernia, the bariatric surgeon will need to surgically repair the problem
  • StomaphyX, a non-surgical revision for gastric bypass surgery, that treats the stretched stomach pouch or enlarged stomach outlet

Patient Criteria for Revisional Bariatric Surgery

Before a revisional bariatric procedure is performed, the patient will be examined by the bariatric surgeon to determine the cause of failure and to evaluate for the appropriate treatment options. Bariatric surgery is a very specialized and complicated treatment process that doctors approach carefully. Great care is given to maximizing weight loss success while minimizing risks and complications. The bariatric surgeon will need to determine if post operative weight loss failure is due to a problem with the original surgery or the patient’s inability to follow the necessary lifestyle changes. The doctor will want to discuss the options and what a patient should expect with the bariatric revision.

Results with a Bariatric Revision

Although the results can vary widely depending on the original procedure and the reason for the revision, bariatric surgery revisions are usually successful in resolving the associated problems and promoting further weight loss. Weight loss following a revision is usually not as dramatic as the initial bariatric procedure, but it can be substantial over time. As revision surgery can be more complex and involve more risks than general bariatric surgery, it is important to choose a bariatric surgeon that is experienced and skilled in performing revision bariatric surgery and that the operation is performed as a medical facility that is designated as a Bariatric Surgery Center of Excellence.

As with all bariatric procedures, the best weight loss results are achieved by patients who are able to comply with the diet and exercise recommendations of their bariatric surgeon. The post-bariatric process can be a struggle and patients will benefit in their weight loss efforts by attending support groups, talking to a nutritionist for dietary advice, working out with a bariatric exercise program, and if needed talking to a psychologist to help deal with emotional aspect of obesity and weight loss surgery.

Begin your journey today!