The LAP-BAND® System works well for the majority of surgical weight loss patients, but it’s not the appropriate choice for everyone. You and Dr. Simpson need to work together to decide if this is the right treatment for you.
Your motivation is key
Dr. Simpson will not do the operation unless he is certain that you understand the problems your excess weight is causing. Also, Dr. Simpson will make sure you know that you have responsibilities as a patient, before and after surgery. These include changing your eating patterns and a new lifestyle, which includes exercise. If you are ready to take an active part in reducing your weight, Dr. Simpson will consider the LAP-BAND® System treatment. First, though, Dr. Simpson will want to make sure you know about the advantages, disadvantages, and risks involved.
Risks, complications, and adverse events you need to know about
All surgical procedures have risks. When you decide on a procedure, you should know what those risks are. Talk with Dr. Simpson in detail about all the risks and complications that might arise. Then you will have the information you need to make the right decision for you.
What are the general risks?
Using the LAP-BAND® System includes the same risks that come with all major surgeries. There are also added risks in any operation for patients who are seriously overweight. You should know that death is one of the risks. It can occur any time during the operation. It can also occur as a result of the operation. Death can occur despite all the precautions that are taken. There is a risk of gastric perforation (a tear in the stomach wall) during or after the procedure that might lead to the need for another surgery. In the U.S. clinical study this happened in 1% of the patients. There were no deaths during or immediately after surgery in the U.S. study. Your age can increase your risk from surgery. So can excess weight. Certain diseases, whether they were caused by obesity or not, can increase your risk from surgery. There are also risks that come with the medications and the methods used in the surgical procedure. You also have risks that come from how your body responds to any foreign object implanted in it. Published results from past surgeries, however, indicate that LAP-BAND® System surgery may have fewer risks than other surgical treatments for obesity.
Patients can experience complications after surgery. Most complications are not serious but some may require hospitalization and/or re-operation. In the United States clinical study, with 3-year follow-up reported, 88% of the 299 patients had one or more adverse events, ranging from mild, moderate, to severe. Nausea and vomiting (51%), gastroesophageal reflux (regurgitation) (34%), band slippage/pouch dilatation (24%) and stoma obstruction (stomach-band outlet blockage) (14%) were the most common post-operative complications. In the study, 25% of the patients had their band systems removed, two-thirds of which were following adverse events. Esophageal dilatation or dysmotility (poor esophageal function) occurred in 11% of patients, the long-term effects of which are currently unknown. Constipation, diarrhea and dysphagia (difficulty swallowing) occurred in 9% of the patients. In 9% of the patients, a second surgery was needed to fix a problem with the band or initial surgery. In 9% of the patients, there was an additional procedure to fix a leaking or twisted access port. The access port design has been improved. Four out of 299 patients (1.3%) had their bands erode into their stomachs. These bands needed to be removed in a second operation. Surgical techniques have evolved to reduce slippage. Surgeons with more laparoscopic experience and more experience with these procedures report fewer complications.
Adverse events that were considered to be non-serious, and which occurred in less than 1% of the patients, included: esophagitis (inflammation of the esophagus), gastritis (inflammation of the stomach), hiatal hernia (some stomach above thediaphragm), pancreatitis (inflammation of the pancreas), abdominal pain, hernia, incisional hernia, infection, redundant skin, dehydration, diarrhea (frequent semi-solid bowel movements), abnormal stools, constipation, flatulence (gas), dyspepsia (upset stomach), eructation (belching), cardiospasm (an obstruction of passage of food through the bottom of the esophagus), hematemsis (vomiting of blood), asthenia (fatigue), fever, chest pain, incision pain, contact dermatitis (rash), abnormal healing, edema (swelling), paresthesia (abnormal sensation of burning, prickly, or tingling), dysmenorrhea (difficult periods), hypochromic anemia (low oxygen carrying part of blood), band system leak, cholecystitis (gall stones), esophageal ulcer (sore), port displacement, port site pain, spleen injury, and wound infection. Be sure to ask Dr. Simpson about these possible complications and any of these medical terms that you dont understand.
Is there a chance the device will need to be removed?
The LAP-BAND® System is a long-term implant, but it may have to be removed or replaced at any time. For instance, the device may need to be removed to manage any adverse reactions you might have. The device may also need to be removed, repositioned or replaced if you aren’t losing as much weight as you and Dr. Simpson feel you should be losing.
Talk to Dr. Simpson about all of the following risks and complications:
- Gastritis (irritated stomach tissue)
- Gastroesophageal reflux (regurgitation)
- Gas bloat
- Dysphagia (difficulty swallowing)
- Weight regain
Laparoscopic surgery has its own set of possible problems. They include:
- Spleen or liver damage (sometimes requiring spleen removal)
- Damage to major blood vessels
- Lung problems
- Thrombosis (blood clots)
- Rupture of the wound
- Perforation of the stomach or esophagus during surgery
Laparoscopic surgery is not always possible. The surgeon may need to switch to an “open” method due to some of the reasons mentioned here. This happened in about 5% of the cases in the U.S. Clinical Study. There are also problems that can occur that are directly related to the LAP-BAND® System:
- The band can spontaneously deflate because of leakage. That leakage can come from the band, the reservoir, or the tubing that connects them.
- The band can slip.
- There can be stomach slippage.
- The stomach pouch can enlarge.
- The stoma (stomach outlet) can be blocked.
- The band can erode into the stomach.
Obstruction of the stomach can be caused by:
- Improper placement of the band
- The band being over-inflated
- Band or stomach slippage
- Stomach pouch twisting
- Stomach pouch enlargement
There have been some reports that the esophagus has stretched or dilated in some patients. This could be caused by:
- Improper placement of the band
- The band being tightened too much
- Stoma obstruction
- Binge eating
- Excessive vomiting