Often times patients will come in because their Lap-band feels too tight. They find more difficulty with some foods, and are uncomfortable. They ask me “does stress cause the device to tighten?” The answer is, yes, it does.

The biology of stress is this: when you have stress, be it physical stress (like an illness) or mental stress (like your mother-in-law coming by for a short two week visit)…the body reacts by retaining fluid. You may notice that wedding rings are tighter, and there is more swelling in the legs at night.

The balloon of the adjustable Lap-band is a semi-permeable membrane, meaning it is osmotically active. In plain English: the more water you retain,  some is transmitted to the device, so it swells.

If a patient has 5.5 cc in their Lap-band (we measure it) and they come in and it feels tighter, we find they have 6 cc in the device. Where did the ½ cc come from? That is from the extra water the body is carrying. Since the balloon on the device is semi-permeable it will retain more water also.

This is the same reason that most people find the Lap-band to be tighter in the morning. In the evening you may notice you have some swelling of your ankles – by gravity your body water has gone down to the legs.  In the morning that swelling is gone, and the water has gone back to the central compartment of the body where the Lap-band is. If we measure the device in the morning it can have 0.25 to 0.5 cc more in it (which can make a difference).

This is also why we don’t like the Lap-band being too tight. People need room for stress – of all kinds. Leaving room in the device to allow for this, means that patients will have fewer difficulties.

Gallbladder and the Lap-band

What is the gallbladder? The gallbladder is a storage organ for bile. Bile is what helps you digest fat and fatty foods. When the gallbladder does not work well, or empties poorly, gallstones can develop.

There are different types of gallstones, but most of the time gallstones are made because the gallbladder does not function well. If the gallbladder does not work well, then the bile become concentrated, super saturated, and the stones will crystallize out.

Gallstones can simply form and cause no symptoms. However, at any time a gallstone can migrate and cause severe symptoms.

Typical symptoms of a gallbladder that has problems include severe pain in the middle of the abdomen going to the back, or to the right side or the right shoulder. It can cause nausea and vomiting. Typically eating foods that are high in fat can cause symptoms to be worse.

Risk factors for gallstones to develop include obesity, genetics, and women who are in their 40’s. Certain diets can increase the risk of gallstones also. The Lap-band has never been shown to be an independent risk factor for gallstones- but the gastric bypass is.

The only treatment for symptomatic gallstone disease is to remove the gallbladder. For silent gallstones- they can be watched, but removal for patients who have other medical issues is advised. Please consult your surgeon.

Patients who have a LAP-BAND and develop gallstones should have their gallbladder removed

– electively. It is easier to remove a gallbladder that is not infected, that has minimal risk of contamination of the device.  While general surgeons can safely remove gallbladders, there is a risk to the Lap-band system of surgical injury, and having someone familiar with the system would be important. Some surgeons would choose to place a patient on antibiotics until the symptoms calm down and remove the gallbladder electively.

Some patients have their gallbladder removed at the time of their Lap-band and this has proven safe, but there is a small risk of contamination.

Should you develop gallstones and have a Lap-band, please know that your surgeon is the safest one to remove your gallbladder and evaluate your Lap-band at the same time.