The Lap Band
The Lap Band, also known as the adjustable gastric band, involves an inflatable silicone band that is placed around the upper portion of the stomach to achieve weight loss. This occurs by creating a smaller pouch above the band, leaving the rest of the stomach intact below it. Adjustments made to the band will increase or decrease the size of the passageway through the stomach. The purpose is to slow down the passage of food, create a feeling of fullness and enhance better portion control.
The Lap Band surgery became very popular in the early 2000’s as a safer, lesser invasive alternative to the Gastric Bypass surgery and was especially popular with younger patients and lower BMI morbidly obese patients in the 35-45 BMI range. Initial results worldwide looked good for the procedure with a weight loss around 50% of excess body weight with a low rate of early complications
Unfortunately as time went on and as more and more patients had the procedure done worldwide, we began to see an increasing rate of failure with the procedure as well as what looked like an unacceptable rate of long-term complications. There are two problems that cause the Lap Band surgery to be classified as a failure:
- Unsuccessful weight loss- in general this means losing less than 25-30% of your excess body weight.
- Complications – requiring removal of the band.
- Band Intolerance: includes vomiting excessively or feeling uncomfortable most of the time.
- Band Erosion: occurs when the band actually grows into the stomach requiring permanent removal.
- Band Leak: patients often can tell if their gastric banding system has a leak if their feelings of restriction decreases over time (thus increasing hunger) without having fluid removed. To determine whether or not there is a leak somewhere in the system, a leak test can be performed. Surgery is usually required to repair the leak.
- Band Slippage: occurs when the lower part of the stomach “slips” through the band creating a larger pouch above the band. Either removing fluid from the Lap Band or surgical repositioning is required to repair a slippage. Symptoms of a slippage include vomiting, regurgitation and acid reflux. This is diagnosed by an UGI x-ray or upper endoscopy.
- Esophageal Dilation: A dilated esophagus is the enlarging of the lower portion of the esophagus usually as a result of the band being too tight. Most cases this can be handled through deflation of the band system. Gastroesophageal Reflux symptoms and vomiting are common in patients who develop esophageal dilation.
- Pouch Dilation: Refers to enlarging of the stomach pouch above the band. Most of the time this can be treated with deflating the band although surgical repair is sometimes required.
- Hiatal Hernia: A hernia in which the stomach protrudes through the esophageal hiatus (opening) of the diaphragm. Hiatal Hernias can occur after restrictive procedures such as the Lap Band when the food causes the upper, smaller stomach pouch to bulge and push through the diaphragm. It is also common for an obese patient to already have a hernia before surgery.
- Chronic cough: usually nighttime
Lap Band Removal and Lap Band Revision Surgery:
Lap Band Revision Surgery is currently the most commonly performed revisional weight loss procedure. This is now most commonly performed 7-10 years after Lap Band Surgery when problems develop. Lap Band Removal is often indicated to alleviate many of the above complications. By removing the obstruction, esophageal motility recovers and symptoms will resolve.
The Lap Band Revision Surgery can either be done in “one stage” where the band is removed and the patient is immediately converted to a sleeve gastrectomy or in a “two stage” procedure where the patient undergoes outpatient lap band removal followed by the sleeve gastrectomy operation in 2-3 months. Your Bariatric Surgeon will decide which pathway is best for each patient.