What is a Lap-band slip?
The Lap-band is forced down the stomach – it really doesn’t slip. This typically happens when the upper pouch (the stomach above the band) is dilated.
As you eat too fast or get things stuck the upper pouch dilates. The band goes from pointing to the heart to a horizontal position. This is either an acute slip- or a chronic one.
At this point the Lap-band has slipped. It may need surgical repair.
To repair the slip we place the band above the slip. Then the dilated stomach is tacked up so it drains well. Sometimes we have to remove the band - sometimes unbuckle the band.
Three Types of Lap-band Slips – all different:
There are three types of band slips – and all are treated differently:
The most common band slip is a chronic Lap-band slip - where the upper pouch is dilated slowly over time and forces the band down. This is also called a Type 1 slip – it requires one of three types of repair (reposition the band, remove the band, or unbuckle the band- see below).
An acute Lap-band slip, Type 2 slip – happens when something gets stuck - as a result the upper pouch acutely dilates, forcing the band down and obstructing it. This repair, if gotten to quickly, is fairly simple – all one has to do is open the band, pull down the stomach and close the band. Often will require some suturing. Sometimes this can be fixed by letting fluid out of the band and allowing the stomach to slip back to normal.
An acute on chronic Lap-band slip – Type 3 slip – is a chronic slip that gets an acute component to them – there is a chronic dilation of the pouch, then something happens that acutely dilates the upper pouch (something gets stuck). These require removal, repositioning, or unbuckling of the band.
What causes a Lap-band to slip?
Eating too fast is the primary cause. By eating too fast the food is not given time to go past the band. So the upper stomach begins to dilate above the Lap-band. Once the stomach begins to dilate, it s easier and easier to dilate (think of blowing up a balloon, it is easier to blow it up the larger the balloon becomes).
Getting food stuck can also cause the band to slip. When food gets stuck some people try to force it down with water or soda – and this causes a dilation of the upper stomach. Your body produces a lot of “slime” to try to lubricate the stuck food. Typical foods that have caused slips include: goldfish crackers, white bread, rubbery eggs (they need to be cooked properly), and dry chicken.
Can a Lap-band slip be fixed?
If we take the pressure off the band - remove the fluid, and you can tolerate liquids sometimes the band will return to normal size. This happens a lot if we can get to the band early.
If we don’t get there early then we try “conservative” measures in the hospital – if the person cannot drink. IV fluids, steroids to reduce swelling, and keeping the person without food or drink will resolve some.
If that doesn’t work then an operation is needed. The band will either need to be removed, repositioned, or unbuckled for a bit. Sometimes we leave the band unbuckled - remove adhesions, and leave the band unbuckled for a few months. This is an option for when the stomach is too dilated to allow operative reposition of the band. But it does require another operation to go in and re-buckle the band.
Can this be dangerous?
If the upper pouch is too stretched out sometimes we cannot replace the band, and have to remove it for a while. We cannot always just “unbuckle” the band - especially in some of the older bands – or in the act of unbuckling the band the balloon is injured and we must remove the band.
Re-do surgery is always at an increased risk above just placing a band.
What are the signs of a Lap-band surgery slip?
Typically patients develop heartburn, nighttime cough, or reflux of food at night. These are not normal with patients who have the band. If you have these you at least need to have fluid removed from the band, but need to get an evaluation by the surgeon. Sometimes we catch things in time that it can correct itself- but then the real correction will be the person learning to eat better.
How do you fix the slip?
From the last two illustrations above – we place the band above the slip – then tack the dilated stomach so that it will easily drain into the stomach. The surgery takes about an hour or less to do.
If I get my Lap-band surgery repaired how can I avoid this in the future?
The band works great for weight loss- but it does mean you have to change some things. Usually patients have the slip long before they know it, and have changed things- so it isn’t an issue. Finishing a meal in 20 minutes instead of five minutes- and avoiding foods that get stuck in the band are the two biggest contributors to this.
The other is when you get in trouble; call your surgeon earlier rather than later. Know that heartburn and reflux are not normal with the band. They are an early warning signal that the band is too tight. Sometimes this resolves with removing fluid from the band - but if it does not then your surgeon will want to have an x-ray with you swallowing barium