THE LAPAROSCOPIC ADJUSTABLE BAND

 

The Institute for Advanced Bariatric Surgery is one of the top centers for Lap-Band surgery in Kansas City and across the country. People come from Lenexa, Kansas City, and surrounding areas because of our advanced research and technology in weight loss surgeries.

 

ABOUT LAP-BAND SURGERY

Lap-Band surgery is a purely restrictive procedure and works by restricting how much food can be eaten at one time (roughly four ounces). The band is placed around the very top portion of the stomach creating a 'new' stomach about the size of a golf ball. The most appealing feature of the Lap-Band is the ability to adjust it without additional surgery, allowing a proper fit for every patient. By adjusting the Lap-Band, the surgeon can adjust the pouch outlet size. The tighter the band, the smaller the portions become, and the longer the patient stays full. The small pouch and the small pouch outlet work together to control meal portion size, prolong satiety/fullness, reduce hunger and cravings, and thus reduce calorie intake.

Unlike other weight loss surgery procedures, placement of the band does not alter the gastrointestinal tract anatomy. There is no stapling or cutting of the stomach or the intestine. Lap-Band surgery requires less invasive surgery and reduces the potential for surgical complications, such as leakage and infection. Since it is considered a safe operation, the Lap-Band is often used as a staging or interim operation. It is used that way when the patient's medical health is prohibitive for a higher risk operation or when the weight is very high combined with poor health. Lap-Band surgery can help the patient lose a hundred or more pounds, and thus improve their medical health and risk to make them a healthier candidate for a more invasive weight loss operation if needed.

Lap-Band surgery, like other weight loss surgery procedures, is able to improve and even eliminate medical disease associated with obesity in more than 50% of cases. On average, 60% of excess weight can be expected to be lost with the Lap-Band. With good compliance, even more weight can be lost, with an 80% chance of maintaining 50% excess weight loss long-term. The Lap-Band takes longer on average to lose weight. The patient is given about two years to lose the 60% of their excess weight.

Making a decision to have Lap-Band surgery (or another weight loss surgery) is a very personal and often difficult decision. Many patients choose the Lap-Band surgery because it is low-risk and it does not alter anatomy permanently. Educating yourself about weight loss and the weight loss surgery programs available is a very important first step. Although the information presented here may be very helpful, patients have repeatedly told us that attending the weight loss surgery seminar was a vital first step to deciding which operation was right for them.

If you are ready to meet with a weight loss surgeon specializing in Lap-Band surgery, you may schedule an appointment by calling 913-322-7401 or request an appointment at the Institute for Advanced Bariatric Surgery via our website. Please inform the staff if you are traveling long distances, so we can provide you with everything you need to help minimize the number of visits that may be required to prepare you for Lap-Band surgery.

 

AM I A CANDIDATE FOR LAP-BAND SURGERY?

To be a candidate for Lap-Band or another type of weight loss surgery, the individual must be severely (BMI > 35) or morbidly (BMI > 40) obese. Morbid obesity is usually defined as being about 100 pounds over your ideal body weight. A better way of defining morbid obesity is by using the Body Mass Index (BMI) definition. BMI is a calculated number that takes weight and height into consideration. A person weighing 300 pounds who is 5 feet tall will have a higher BMI than a person weighing 300 pounds but is 6 feet tall.  The BMI calculator can help determine if you are morbidly obese and a candidate for Lap-Band surgery.

Most insurance companies will have additional criteria to qualify for Lap-Band surgery and other weight loss surgery. Below you will find the basic criteria most insurance companies use:

A Body Mass Index (BMI) > 40, regardless if medical problems or co-morbidities are present or not.

A Body Mass Index (BMI) > 35 and experiencing severe negative health effects or co-morbidities, such as high blood pressure, diabetes, and/or sleep apnea.  

 

THE LAP-BAND PROCEDURE 

Lap-Band surgery is a purely restrictive operation and is done laparoscopically with  five small incisions. Your hospital stay can be as short as five hours, or up to 24 hours, and it is possible to return to work in less than one week from the time of surgery. If you do light duty at work, it is possible to return to work even sooner for some patients.

The Lap-Band is performed laparoscopically with thin and long-shafted instruments. The band is made of silicone and is placed around the very top portion of the patient's stomach. The band is fastened around the upper stomach like a wrist watch to create a new, tiny stomach pouch about the size of a golf ball. This small pouch takes over as you're working stomach despite still being connected to the larger, remaining part of your stomach. This small pouch effectively limits and controls the amount of food you can eat at any one meal.

By adjusting the Lap-Band, we can create a very small outlet or drain. The smaller the outlet is, the slower the pouch will empty and the harder it is to eat. As a result, patients experience the sensation of fullness much sooner, with smaller amounts of food. To modify the size of the band, it is inflated or deflated with saline solution. The band is connected by tubing to an access port, which is placed on top of your muscle during surgery (it is not visible from the outside of the body). It is usually placed on the right-hand side of your abdominal wall. It is placed very deep below the skin on top of the muscle fascia. After the operation, the surgeon can control the amount of saline in the band by accessing the port with a special needle through the skin. 

Lap-Band Fill Function Video (37 sec) 

 

HOW DOES THE LAP-BAND WORK?

The Lap-Band surgery divides the stomach into two parts. The smaller golf ball size stomach takes over as the dominant functioning stomach. As food is swallowed, it enters the new stomach first. The small new stomach controls how much food can be eaten at one time if the band is adjusted correctly. The band is adjusted till the correct outlet size or 'sweet spot' for your pouch is reached. The size of the pouch limits how much food you can eat, while the size of the outlet controls how quickly it can empty. The tighter the outlet, the longer it will take for food to leave the pouch and the harder it makes it to eat. The longer the pouch is full, the longer you experience satiety and no hunger.

The small pouch and small outlet produce early satiety, that in a cooperative, compliant patient induces behavioral changes leading to less caloric intake, and therefore weight loss. Inadequate chewing can result in pain or reflux. Patients must eat very slowly, reduce bite size, and avoid overeating or drinking with meals. The success of Lap-Band surgery and keeping the weight off strongly relies on patient education and compliance with the rules. Failure to follow these guidelines can defeat the purpose of the band. The amount of weight you will lose will depend on how well the patient is using the band (or following the rules). The rules are the key to success with all weight loss operations. 

Lap-Band surgery alone without permanent lifestyle and eating habit changes will not ensure long-term success. Proper education and compliance with the rules are key to any patient's success. The operation to a significant degree will force many patients to change their eating habits for life but we do not want patients to rely on that solely. The band is only a tool - probably the best thing a weight loss patient has ever tried, but it is only something to help patients with the necessary work to reach their health and weight loss goals.

 

Animated Lap-Band Video (44 sec) 

 

WHAT CAN I EXPECT FROM THE LAP-BAND WEIGHT LOSS OPERATION?

The medical and emotional benefits of the Lap-Band procedure begin within several months after surgery, and the cosmetic benefits follow in their wake. Over time, the benefits of Lap-Band surgery may include:

  • Significant sustained weight loss

  • Blood sugar levels that are easier to manage and/or become normal within one year of surgery

  • Lower or normal blood pressure

  • Lower or normal cholesterol levels

  • Relief from sleep apnea, acid reflux, and urinary stress incontinence

  • Less arthritis pain and improved mobility

  • Increased energy and ability to exercise

  • Improved mood and self-esteem

  • Arrested progression of heart disease

  • Improvement of many lung conditions

  • Exercise endurance

 

The benefits of the Lap-Band are similar to other obesity surgery procedures with successful weight loss. It continues to be the least invasive and safest weight loss surgery operation available at this time.  A 60% excess weight loss can be expected with the Lap-Band. 70% of patients are able to maintain their weight loss long-term. Weight loss with the Lap-Band is slower compared to other weight loss surgery procedures.

With Lap-Band surgery, patients lose around 60% of their excess weight within two years and 70% of that weight is lost in the first year of lap band surgery.

Example: Patient X weight is 300 lbs, patient X ideal weight is 100 lbs which means patient X has 200 lbs of excess weight.  If patient X chooses the Lap-Band that patient will lose a total of 120 lbs (60% x 200 = 120), 80 lbs of which the patient will likely lose in the first year.  

 

RISKS OF THE LAP-BAND

As with all surgery, there are risks. Patients considering surgery must weigh the risks and benefits of surgery against the severity of their obesity. The decision to proceed is based on the premise that the treatment should be less harmful than the disease being treated. Please also read the section of our website under the obesity link to learn about the disease, risks, and benefits weight loss surgery can offer to morbidly obese patients.  

Below is a list of some specific complications that are unique to the Lap-Band procedure:

  • Infection requiring band removal (rare)

  • Stomach prolapse/slippage - requiring removal (6%)

  • Temporary Gastric pouch outlet obstruction/swelling (infrequent)

  • Band erosion (rare)

  • Port/tubing mechanical failure (rare)

  • Port flippage (infrequent)

  • Esophageal dilatation/dysfunction (infrequent)

  • intolerance of the band (infrequent)

Operative mortality and morbidity:  Operative (30-day) mortality for laparoscopic adjustable gastric banding when performed by skilled surgeons should be less than 0.1%. Operative morbidity is about 5%.

Long-term complications: There are unique long-term complications with the laparoscopic adjustable gastric band, which include slippage with or without obstruction, esophageal dysfunction and/or dilatation, band erosion and access port problems. Experience has markedly reduced the incidence of these complications. Use of a prosthetic device introduces additional potential problems of malfunction and infection.

Reversal and revision:  intolerance, slippage, and erosion are the most common reasons for band removal. A Lap-Band operation can be converted or revised to any of the other remaining weight loss operation, if necessary, or desired by the patient. Often when a slippage or erosion occurs the band will no longer work as well as it did in the past. The recommendation is to remove the band. The patient then has the option of no weight loss surgery, placing another band, or revising the band to a different weight loss operation. The most common revision operation chosen by an existing Lap-Band patient is the Sleeve Gastrectomy.

  

DECIDING ON THE LAP-BAND WEIGHT LOSS OPERATION

The decision about which operation is best for you is a complicated one. The decision to proceed is based on the premise that the treatment should be less harmful than the disease being treated. Although the information presented throughout our website may be helpful, you will learn substantially more about the benefits and risks of the Lap-Band operation during your visit with the bariatric surgeon at our free weight loss surgery information seminar.