Lap Band Surgery for Treating Obesity
What is Lap Band Surgery?
The LAP-BAND® adjustable gastric banding system is a surgical device that was FDA approved in June of 2001 for the treatment of morbid obesity.
The LAP-BAND system is a minimally invasive surgical procedure that helps people lose weight by physically reducing the size of the stomach and thereby limiting the amount of food that can be eaten in a single sitting.
An adjustable silicone gastric band is placed around the upper stomach to create a smaller stomach pouch. Unlike other surgical options such as Gastric Bypass, no cutting, stapling, removal of tissue, or intestinal rerouting is required.
What is Obesity Surgery?
Bariatric surgery is a general category of surgical procedures performed on patients who are obese. Bariatric surgery is also known as Weight Loss Surgery and Obesity Surgery. Regardless of the procedure, the overall goal is to help patients lose weight by reducing the size of the stomach. This is accomplished by:
- LAP-BAND Surgery: Implanting a medical device (gastric band)
- Gastrectomy / Gastroplasty: Removal of a portion of the stomach
- Gastric Bypass Surgery: Re-routing the small intestines to a small stomach pouch
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 LAP-BAND 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-BAND Surgery
- 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
- 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.
Self-Pay: If the surgery is not covered by insurance, many patients have opted to pay for the surgeries themselves. In the US, the price range is roughly $15,000 to $20,000. This will usually include all the pre-op consultations, hospital fees, and post-operative follow up care. In addition to domestic surgeons, many patients are opting to travel abroad to take advantage of high-quality and low-cost alternatives that are available in other countries. Mexico is generally a top destination for patients looking for lap band surgery abroad. The costs tend to be very reasonable ($8,000-10,000) and the time and expense of travel is less than other countries. Europe, particularly France, Italy, and Switzerland are also popular destinations. Surgical expenses tend to range in the $10,000 to $15,000 range.