Lap Band Surgery for Treating Obesity

What is Lap Band Surgery?

The band is inflated with saline through an access port placed under the skin, which is connected to the band by tubing. The degree of inflation can be adjusted, with a more inflated band leading to a narrower opening and therefore slower passage of food between the pouch and the rest of the stomach. The Lap Band is currently the only FDA approved adjustable & reversible obesity surgery that does not require cutting and stapling of the stomach or gastrointestinal re-routing to bypass normal digestion. The name Lap Band comes from the surgical technique used (laparoscopic) and the name of the implanted medical device (gastric band).

How does a Lap Band work?

The lap band creates a small pouch in the upper part of the stomach without trauma associated with others methods (e.g. stomach stapling). The smaller gastric pouch not only limits the amount of food that can be consumed at one time, but also slows the rate at which the stomach empties of food. The patient will end up feeling comfortably full with less food, and will continue to fell full for several hours afterwards due to the slower pace at which the stomach empties.

How much weight will I lose with Lap Band Surgery?

The amount of weight loss varies from patient to patient and is dependent on the patient’s profile and the degree of commitment the patient has in making lifestyle changes. That being said, the reported range for weight loss varies from 1 to 3 lbs/week of fat loss during the first year after the surgery. Weight loss continues afterwards, but at a slower pace. While the lap band is removable, it is generally left in place permanently unless there are complications.

Who is a candidate for Lap Band surgery?

The system is used for weight loss in  clinically obese adults who have been obese for at least five years and for whom non-surgical weight loss methods have not been successful. They must be willing to make major changes in their eating habits and lifestyle.

The American Society of Bariatric Surgery recommends the following indications for any surgical treatment of obesity:

• BMI* (Body Mass Index) above 40, or 100 lbs above ideal weight, or BMI between 30 to 40 in the presence of other associated diseases that may improve with weight loss (high blood pressure, diabetes, sleep apnea, and painful joint condition arthritis proven by x-ray)
• Age between 18 and 55 years
• Stable obesity for more than five years
• Failure of dietary or weight-loss drug therapy for more than one year
• Absence of glandular diseases such as hypothyroidism
• Comprehension of the procedure and compliance by the patient
• No dependency on alcohol or drugs
• Acceptable operative risk

There are several contradictions which will disqualify you from lap band surgery. Your doctor will work with you in understanding your unique situation and make an appropriate recommendation.

What does the Surgery Involve?

The lap band is inserted via laparoscopy, a procedure less invasive than some other forms of obesity surgery. Instead of one large incision, the surgeon makes several small 1cm incisions through which fiber optic video equipment and slender surgical instruments are passed. This means less trauma to tissues and a faster recovery time for the patient.

The procedure itself is performed under general anesthesia and lasts between 30 minutes to an hour. The gastric band is placed around the upper part of the stomach and saline is injected into an access port placed under the skin in the wall of the stomach. The pressure from the saline inflates the gastric band and creates a small 15cc gastric pouch. Part of the lower stomach will then be sutured over the band. The rest of the lower stomach will stay in its normal position.

How long does it take to recover from lap band surgery?

Normal lap band surgeries typically require a hospital stay of less than 24 hours. Most patients return to work within 1-2 weeks, and 4 to 6 weeks before resuming strenuous exercise. Following surgery, you should expect to have regular checkups with your doctor. Many doctors will see their patients weekly or bi-weekly following the surgery for the first month of post-operative care, and then monthly to quarterly checkups for the remainder of the first year. Adjustments to the gastric band pressure, if needed, will be performed at these checkups.

During the recovery period after surgery, it is important for you to follow your doctor’s dietary recommendations. You will need to give time for your new stomach structure to heal completely. During the first 6 weeks after surgery, you will be restricted to liquids and soft foods. You will progress from clear liquids up to creamier and more solid foods over time.

What are the risks for Lap Band surgery?

Like any complex gastric operation, there are risks associated with lap band surgery. Be sure you review the risks associated with lap band surgery with your surgeon. Risks specific to this surgery include: infection, spleen bleeding or injury, gastric perforation (a tear in the stomach wall), and access port leakage. There are risks also associated with general anesthesia, including death (rare). There were no deaths during or immediately after surgery in the FDA clinical trials. Beyond surgical risks, most patients experienced at least one side effect during recovery. Common side effects include nausea and vomiting, heartburn, abdominal pain, and slippage of the band. 

Advantages and Disadvantages of Lap Bad Surgery

Advantages:

• Least invasive surgical procedure – only several small (1 cm) incisions needed
• Least traumatic procedure - no stapling or cutting of the stomach
• Shorter hospitalization than other procedures
• Fully adjustable to each patient’s individual changing needs
• Fully reversible – just remove the band

Disadvantages:

• Slower initial weight loss than gastric bypass
• Requires implanted medical device
• Possibility of band slippage or port leakage

What does Lap Band Surgery cost?

Insurance. Lap band surgery is approved in the US and many insurance companies will cover the expense when indicated to treat clinical morbid obesity. You will need to consult your insurance policy to see if the procedure is covered. Look for statements mentioning obesity or gastric/ bariatric surgery.