Adjustable Lap-band Surgery

The adjustable laparoscopic band is the latest and the most safe surgery for weight loss. Currently, only the lap-band (manufactured by Inamed a division of Allergan) is approved in the United States. During the operation the surgeon places an adjustable band around the stomach, creating a small upper pouch. This part of the stomach is where the nerves are that tell the brain that you are satisfied with food. The longer the food stays in this area, the more the brain is convinced that you don't need to eat anymore. The feeling that you are full, or satisfied with less food, leads to less eating -- and thus weight loss. Fewer calories in, more calories burned-- weight loss. The band has a balloon inside that is attached to the tube, so that adjustments can be made that allow food to be kept in the upper part of the stomach longer. The longer food remains in the upper part of the stomach, the longer you stay satisfied. Most individuals need three to five adjustments in their first year, and with those adjustments have very satisfactory weight loss.

The lap-band is widely used in Europe and was approved for use in the United States in June 2001. Ozzy Osbourne’s wife had this type surgery, and she is a clear example of how successful this surgery can be.

Lap-band Video

The surgery takes an hour or so and is done through a laparoscope

The band is placed around the upper part of the stomach, and the inside of the band is a balloon. A small bit of tubing connects the port (reservoir) buried in the skin with the balloon on the band. A surgeon can place saline (saltwater) in the port, which inflates the balloon. By filling the balloon, the band tightens and the opening between the upper and lower stomach (known as a stoma) narrows. The surgeon can add saline, or remove saline, from the band to adjust the opening size quickly and easily right in his office.

Typically, when the band is placed in the patient it is not filled at all. The band is usually placed loosely and is allowed to scar in place for several weeks. Once the band is secure, the surgeon then does a "fill," or inflates the balloon—to narrow the stoma and provide restriction. Patients typically go home the day of surgery, and even though the band is loosely placed, most patients notice that they feel full with a lot less food. Four to six weeks after the band is placed, the surgeon does the first "fill." With this fill, the patient feels restricted and begins weight loss. As they loose weight, they loose some of the fat around the stomach, so further fills are needed to maintain a restriction. Much like needing a belt tightened, the lap band needs fills to keep food in the upper pouch allowing you to feel comfortable with less food.

The Lap-band makes you feel full eating less food

Weight loss occurs because a patient feels full with a small amount of food, which stays in this upper pouch. The stomach becomes like an hourglass, and the food drips into the lower stomach at a rate dependent on the size of the opening and the consistency of the food. Liquids leave the upper pouch quickly, where solid foods take a bit of time to digest and get to a consistency that allows them to go to the lower pouch. Thus, protein, meats, and vegetables -- are the main foods for patients who use this procedure.

Advantages of Adjustable Lap-band Surgery

There are several other advantages of the ALB. It is the least invasive surgical option, there is no intestinal re-routing of the guts, the operative time is an hour or less, and there is less patient pain, hospital stay, and recovery period. Proponents of the ALB also cite fewer peri-operative and post-operative complications. In North America, during tests, one of the largest series had no deaths associated with the lap band.

A good solution for obese teenagers

Some doctors consider this a good solution for obese teenagers since there is no malabsorption of nutrients. It is also recommended for patients who are at very high risk for surgery. Because patients can absorb medications after this type surgery, these surgeries are preferred for transplant patients who are very dependent on absorption of their medicine. There is no dumping syndrome or its related dietary intake restrictions. The bowel is not entered into or cut with the lap-band, so having intestinal leaks is less of a problem than with any other weight loss surgery.

The Lap-band can be adjusted for the nutritional needs of pregnancy

If a woman becomes pregnant, the surgeon can remove the saline from the port, deflating the balloon and opening the stoma. This allows the increased nutritional needs of the fetus to be met. Maria became pregnant two years after her band was placed. The stoma was opened and she had a very healthy boy. Shortly after delivery, the band was re-inflated so she could lose the 90 pounds she gained during pregnancy. All weight loss surgeries are safe for pregnant women with close monitoring by the peri-natologist (fancy ob doctor who watches high-risk pregnancy). As with all weight loss surgeries, we recommend that women wait to become pregnant at least two years after surgery.

Patients who benefit from Adjustable Lap-band surgery

The following patients might benefit more than others from the Adjustable Laparoscopic Band:

Patients whose serious attempts to lose weight have resulted in only short-term success
Patients who do not have any other disease that may have caused them to be overweight
Patients who are prepared to make major changes in their eating habits and lifestyle
Patients who are willing to continue working with the specialist who is treating them
Patients who do not drink alcohol in excess
Those who have fifty pounds or more weight to lose.

How to beat the benefits of the Lap-band

The lap-band can be overcome by eating "mushy" foods, such as mashed potatoes, milkshakes, breads, and the like. These high carbohydrate foods are easy travel quickly out of the upper pouch, not producing a prolonged sense of "satiety" and contribute to weight gain. These same high carbohydrate foods will cause failure in all weight loss operations. However, if the patient follows the prescribed diet (like those found in Dr. Simpson's books), this surgery is very successful at keeping off excess weight. Eating high protein foods, or low glycemic index carbohydrates leads to more weight loss, as they produce a prolonged feeling of satiety.

The lap band may be the ideal Bariatric Surgery

The surgery is fast, often taking less than an hour. Recovery from the surgery is fast, with most patients going home the following day and returning to work within a week. There is no intestinal re-routing, and therefore no malabsorption, and minimal requirements for vitamins. The adjustable lap band is the most common weight loss surgery in Europe and Australia and may become the major weight loss surgery in the United States.

Band Fills

The band is filled with saline (saltwater) either in the doctors office or in x-ray. The surgeon's fee for a band fill ranges from $100 to $300. If radiology is used, that may cost an additional $300 or more. Every surgeon has a different protocol for band fills, different time schedules and use different procedures. There is no one right way. After the band is filled, you are placed on liquids for the next day or two, and then go to solids—this gives the stomach a chance to get use to its new anatomy.

Our Lap-band Fill Program

Things That Can Go Wrong

In rare cases the band may slip. The band is loosely placed around the upper part of the stomach, but sometimes the band slips down the stomach. This usually occurs after persistent vomiting, and because the band slips down on the stomach, the stomach is totally obstructed-- you cannot even keep water down. When this occurs you will need to go back to the operating room and have the band removed and/or replaced. We believe that this problem is preventable. Most often this occurs when people eat to the point of vomiting, and then continue to vomit. It does not occur when patients get the flu, or have an upset stomach. The band is not meant to be a Hollywood diet-- eat, vomit, eat and vomit. In the most recent data, this happens in less than 2 out of 1000 cases. Sometimes, if caught early, the band can be deflated and the stomach will return to normal. Too tight a band can also lead to a slip. A slip is also known as a "prolapse."

Sometimes the band will erode into the stomach although erosions have happened less in the last few years, as the method that the band is placed has changed dramatically since 2001 -- at least in the United States. Even if everything is done perfectly, erosion of the band into the stomach can still occur. In a recent U.S. study this was reported to occur in 2 out of 1400 cases. When the band erodes the band must be removed. Your surgeon will want to remove your band if it has eroded and allow the stomach to heal before replacing the band. Typically in six months. Again, erosion of the band is becoming increasingly rare, especially with surgeons who perform a lot of bands.

Common problems. The band is a device -- and anything can happen. Tubes can break, ports can flip. These are a nuisance. They require minor surgery to correct, and are reported to be around two per cent or less. Again, the more experience the surgeon has who does the band, the less these problems seem to occur. Although, even in the most experienced hands, remember, the band is a device, and like any device can have problems.

All in all -- band problems are like a fender bender. They may cost you time, they are a pain, but they will not kill you. Other operations, such as the duodenal switch or RNY-gastric bypass, when they have problems it is like an airplane crash -- you may survive a crash, but wouldn't you rather not be in that seat when the oxygen drops?

A Tool for Weight Loss

The adjustable laparoscopic band is one of the newer weight loss systems available. Like all other surgeries, it represents a tool for weight loss, not a total solution. Advocates of the adjustable laparoscopic band have one argument that is difficult to refute—it is easily reversed. Someday obesity will be treated as a chronic disease like diabetes and when it is, we may have drugs that can treat the disease, rendering surgery unnecessary. In that world, it will be nice to have had a surgery that can be easily reversed.

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