Do you still have a Lap Band?

In the early 2000’s the Lap Band procedure became a very popular surgery for weight loss.  At the time, it was the only minimally invasive, restrictive only bariatric operation for weight loss.  The other option was the gastric bypass which created malabsorption.  So at the time, the Lap Band surgery offered a surgical option for weight loss without malabsorption that was very attractive to younger patients.  Many younger patients that were obese and didn’t have medical comorbidities such as diabetes chose the Lap Band surgery.  It was also quite popular with younger, obese women who hadn’t had children and wanted to become pregnant.  It was an effective surgery and patients typically lost around 50% of their excess body weight.

Unfortunately as the years went by, we saw a higher than desired amount of long term complications in Lap Band patients.  The procedure involved implanting an artificial device which included the band component around the upper portion of the stomach, the adjustment port implanted on the abdominal wall muscle under the skin and a length of plastic tubing to connect the two.  Most complications we see in Lap Band patients involve problems with the device itself including broken tubing, slippage of the band component, infection of the device or erosion of the band component into the stomach.  In the past we could repair or replace portions of the Lap Band system but this is no longer done.

In 2007 I performed the first sleeve gastrectomy surgery in St. Louis.  As I predicted at the time, this procedure rapidly became the most popular bariatric surgery and quickly replaced the Lap Band surgery.  We now had a minimally invasive, restrictive only weight loss operation that did not require an artificially implanted device.  Instead of using a band device to make a small stomach pouch above the band, we would use a stapler to make the entire stomach smaller.  This turned out to be a better procedure with a higher, total average weight loss of 60-70% excess body weight and none of the long term complications of the Lap Band procedure.

 So if a patient still has a Lap Band, what are their options?  Some patients have no issues or abnormal symptoms with their Lap Band and still feel it is effective in helping them maintain their weight loss.  We still follow these patients, regardless of who did their surgery, and give them dietary counseling and do Lap Band adjustments in the office when appropriate.  When we see patients that are having complications or abnormal symptoms with their Lap Band device, we recommend removing it.  This can be done as an outpatient with a brief laparoscopic procedure.  With these patients I can simply remove the Lap Band system laparoscopically and send them home within 2-3 hours or I can laparoscopically remove the Lap Band and in the same operation convert them to another weight loss procedure such as a sleeve gastrectomy.  This is called a “Band to Sleeve revision”.  These patients typically go home the same day as well.