Gastric banding, sometimes known as lap banding, was approved by the FDA in June 2001 and is a highly effective weight loss surgery procedure to help overweight obese people achieve long-term weight loss. It is also the only adjustable and completely reversible surgical treatment for morbid obesity bariatric surgery.
This weigh loss surgery limits the amount of food you can consume by reducing the capacity of the stomach. The labband procedure can be carried out laparoscopically, by keyhole surgery, through five or six small incisions. It can also be carried out as an open operation with one vertical incision in the abdomen.
Weight Loss Surgery Alternative Options
The original alternative to more invasive bariatric gastric bypass surgeries. The Adjustable Gastric Banding system has the experience, technology, and history of proven success to help you reach your weight loss goals for the long-term.
More invasive weight loss surgery are available and include:
Roux-en-Y gastric bypass surgery:
This variant is the most commonly employed gastric bypass technique, and is by far the most commonly performed bariatric procedure in the United States. It is the operation which is least likely to result in nutritional difficulties. The small bowel is divided about 45 cm (18 in) below the lower stomach outlet, and is re-arranged into a Y-configuration, to enable outflow of food from the small upper stomach pouch, via a “Roux limb”. In the proximal version, the Y-intersection is formed near the upper (proximal) end of the small bowel. The Roux limb is constructed with a length of 80 to 150 cm (31 to 59 in), preserving most of the small bowel for absorption of nutrients. The patient experiences very rapid onset of a sense of stomach-fullness, followed by a feeling of growing satiety, or “indifference” to food, shortly after the start of a meal.
Vertical banded gastroplasty:
This operation divides the stomach into two parts — limiting space for food and forcing you to eat less. There is no bypass. Using a surgical stapler, the surgeon divides your stomach into upper and lower sections. The upper pouch is small and empties into the lower pouch — the rest of your stomach. Partly because it doesn’t lead to adequate long-term weight loss, surgeons use it less commonly than gastric bypass.
In this procedure, a portion of your stomach is removed. The remaining pouch is connected directly to your small intestine, but completely bypasses your duodenum and jejunum where most nutrient absorption takes place. This weight-loss surgery offers sustained weight loss, but it presents a greater risk of malnutrition and vitamin deficiencies and requires close monitoring.
Duodenal Switch (DS):
procedure, also known as Biliopancreatic Diversion with Duodenal Switch (BPD-DS) or Gastric Reduction Duodenal Switch (GRDS), is a weight loss surgery procedure that is composed of a restrictive and a malabsorptive aspect.
One of the most effective weight loss procedures for the super obese is the Duodenal Switch. The Duodenal Switch includes a restrictive component but is primarily a malabsorptive weight loss procedure. With Duodenal Switch weight loss surgery, the size of the stomach is reduced to limit food intake and the small intestine is “switched” around to alter the digestion process and limit food (calorie) absorption. This bariatric operation has greatly improved the health and quality of life for many seriously obese individuals by helping them achieve and maintain significant long-term weight loss.
Candidates for Adjustable Lap Band
The LAP-BAND procedure is a safe and effective weight loss solution, and has helped many achieve their weight loss goals. However, this weight loss surgery is not for everyone who is overweight. Whether or not you are a good candidate for lap band weight loss surgery is a decision that you and your doctor will make together. One of the most important measures of eligibility that your doctor will use is your Body Mass Index (BMI), a calculation based on your height and weight. Your BMI classifies you as either overweight, obese, or morbidly obese and determines if you fall in the range to be considered for Lap-Band Surgery.
People who are suitable for this procedure generally need to meet the following criteria:
- Aged 18 years or above
- Have a BMI of 30 or above, or 35+ with obesity-related diseases
- Have been overweight or obese for more than five years
- Not be pregnant at the time of the procedure
- Not drink alcohol excessively
- Have made serious attempts to lose weight before and failed
- Not suffering from an illness that has caused excessive weight gain
- Be prepared to commit to a long-term, significant change in eating habits and lifestyle, including continued monitoring by a specialist.
Gastric banding is usually not recommended for people with any of the following:
- If the surgery or treatment represents an unreasonable risk to the patient
- Untreated endocrine diseases such as hypothyroidism
- Inflammatory diseases of the gastrointestinal tract such as ulcers, esophagitis or Crohn’s disease.
- Severe cardiopulmonary diseases or other conditions which may make them poor surgical candidates in general.
- An allergic reaction to materials contained in the band or who have exhibited a pain intolerance to implanted devices
- Dependency on alcohol or drugs
- People with severe learning or cognitive disabilities or emotionally unstable people
NOTE: If considering pregnancy, ideally the patient should be in optimum nutritional condition prior to, or immediately following conception; deflation of the band may be required prior to a planned conception. Deflation should also be considered should the patient experience morning sickness. The band may remain deflated during pregnancy and once breast feeding is completed, or if bottle feeding, the band may be gradually re-inflated to aid postpartum weight loss as needed.
What is the Body Mass Index (BMI)?
The Body Mass Index (BMI) is used as a measurement of body fat based on height and weight. The formula for determining your BMI is (weight in pounds) divided by (height in inches squared).
The BMI measurement categorizes weight as follows:
- Healthy Weight: BMI between 19 and 25
- Overweight: BMI between 25 and 30
- Obese: BMI over 30
- Severely (Morbidly) Obese: BMI is 40 or more
Because the BMI does not distinguish between muscle and fat, it is possible for athletes to have a high BMI measurement but not be considered overweight.
Knowing if you meet medical guidelines for bariatric surgery is an early step in your bariatric surgery decision-making process and by submiting a patient form you can quickly determine if our bariatric surgeon will qualify you for surgery.
Preparing for Lap Band Surgery
Surgical candidates go through an extensive screening process. Not everyone who meets the criteria for Lap Banding is psychologically or medically ready for the surgical procedure. A team of professionals, including a physician, dietitian, psychologist and surgeon, evaluate whether the surgery is appropriate for you. This involves identifying which aspects of your health would be expected to improve after surgery and what aspects of your health may increase the risks of surgery. Surgery is recommended when the perceived benefits of surgery outweigh the recognized risks.
Medical Evaluation for Lap Band
A team of health professionals — usually including a doctor, dietitian, psychologist and surgeon — will evaluate whether gastric bypass surgery is appropriate for you. The evaluation essentially determines if the health benefits outweigh the potentially serious risks of this major procedure. Even if you meet the criteria for gastric bypass surgery, you will still need to be evaluated to see if you’re psychologically and medically ready to undergo the procedure.
Your Nutrition and Weight History
The team reviews your weight trends, diet attempts, eating habits, exercise regimen, stress level, time constraints, motivation and other factors.
Your Medical Condition
Some health problems increase the risks associated with having surgery or may be worsened by surgery, such as blood clots, liver disease, heart problems, kidney stones and nutritional deficiencies. The team will evaluate what medications you take, how much alcohol you drink and whether you smoke. You also will have a thorough physical exam and laboratory testing.
Your Psychological Status
Certain mental health conditions may contribute to obesity or make it more difficult for you to maintain the health benefits of gastric bypass surgery. These may include binge-eating disorder, substance abuse, depression, anxiety disorders and issues related to childhood sexual abuse. While these may not prevent you from having gastric bypass surgery, your doctors may want to postpone surgery to ensure that any condition is appropriately treated and managed.
The team will also assess your willingness and ability to follow through with recommendations made by your health care team and to carry out prescribed changes in your diet and exercise routine.
Although there’s no specific age limit for gastric bypass surgery, the risks increase if you’re over age 65. The surgery remains controversial in people under age 18.
Before Gastric Banding
Before a gastric bypass surgery, patients need to make several changes to their lifestyle. Doctors may recommend smaller meal portions and restrict some foods. Doctors may also encourage smokers to quit or to reduce the number of cigarettes they smoke. Smokers should quit at least two weeks before surgery, but six to eight weeks prior to surgery is ideal. Quitting smoking is important because smokers heal more slowly than nonsmokers, which can result in complications after the surgery, including infection. In addition, smokers are at a higher risk for breathing problems while under anesthesia.
Patients receive antibiotics before the surgery and often up to 24 hours after the surgery in an effort to minimize the chance for infection. A common complication of any hospital patient that is lying in bed for long periods of time is DVT, or deep vein thrombosis. The inactivity of the legs allows blood clots to form, which can then travel throughout the body and possibly result in a stroke or a pulmonary embolism. In order to prevent this, doctors usually prescribe a pre-operation regimen of compression stockings along with a drug that thins the blood and keeps blood clots from forming. As soon as six hours after surgery, a patient should begin walking around in order to prevent DVT.
Types of Gastric Bands
There are two types of adjustable gastric bands have been approved by the FDA: Lap-Band and Realize Band.
The Lap-Band System
The Lap Band System obtained FDA approval in 2001. The device comes in five different sizes and has undergone modification over the years. The latest models, the Lap-Band AP-L and Lap-Band AP-S, feature a standardized injection port sutured into the skin and fill volumes of 14 mL and 10 mL respectively.
The Realize Adjustable Gastric Band
The Realize Adjustable Gastric Band obtained FDA approval in 2007. Realize Band-C has a 14% greater adjustment range than the Realize Band. Both the Realize Band and Realize Band-C, however, are one-size-fits-all. The device differentiates itself from the Lap-Band AP series through its suture-less injection port installation and larger range of isostatic adjustments. The maximum fill volume for the Realize Band is 9mL, while the newer Realize Band-C is less capacity. Both fill volumes fall within a low pressure range to prevent discomfort or strain to the band.
Two other adjustable gastric bands are in use outside of the United States: Heliogast and Midband. Neither band has been approved by the FDA.
The Heliogast band entered the market in 2003. The device features a streamlined band to ease insertion during the operation.
The Midband was the first to market in 2000. In order to preserve the gastric wall in event of rubbing, the device contains no sharp edges or irregularities. It is also opaque to x-rays, making it easy to locate and adjust.
Lap Band Weight Loss
The idea behind the operation is to create a small pouch in the upper part of the stomach with a controlled and adjustable stoma, without stapling, thus limiting food intake.
Lap-Band surgery is usually performed laparoscopically, a modern and minimally invasive method of surgery. General anesthesia is required with laparoscopic surgery.
With laparoscopic surgery, small incisions are made in the abdominal wall, then narrow and hollow tubes are inserted thru the incisions to the surgical area. Specially designed instruments and cameras are inserted thru the tubes to perform the surgery. The camera takes pictures and shows then on a monitor which allows the surgeon to see inside the abdomen.
The surgeon inserts the Lap-Band into the body and positions the gastric band around the stomach to form a ring and then fastens the lock which holds the band in place. The access port, which is connected to the gastric band via tubing, is fastened to the inside of the abdominal wall.
The resulting pouch (or the “new stomach”) dramatically reduces the functional capacity of the stomach. The band has a balloon from the inside that is adjustable and can reduce stoma size, thus prolonging the period of fullness.
The operation is performed under general anesthesia and can last between 30 minutes and 1 hour. The Band is fitted around the uppermost part of the stomach, forming a 15cc small pouch. It is designed so that it can be inflated or deflated at any time after the operation. This helps the patient continually lose weight until they reach their goals. The restriction takes place in the radiology suite and normally takes 15 minutes. This simple procedure is painless. They inject saline into a port placed under the skin in the wall of the stomach. The tube that comes off of the band leads to the port.
Lap Band Surgery Techniques
The gastric band is usually fitted using keyhole (laparoscopic) surgery, but it can also be placed via open surgery. The operation takes 30 minutes to one hour, or more, depending on the technique used.
About five small cuts (one to two centimetres long) are made on your abdomen and chest. Your surgeon will insert a tube-like telescopic camera to view the area either by looking directly through this, or at pictures it sends to a video screen. The band is fitted using specially designed instruments passed through the other cuts. Afterwards, the skin cuts are closed with two or three stitches.
A single cut (about 15 to 25 centimetres long) is made on your upper abdomen. Afterwards, the skin cut is closed using stitches and staples.
The size of the pouch needs to be adjusted by adding or removing fluid in the band. This is done through a tube that runs from the band to a “port” in your chest or lower abdomen. The port sits under the skin. The band is adjusted a few weeks after the operation, leaving time for the swelling caused by the surgery to settle down.
Gastric Band Weightloss Results
Everybody is different, so it is difficult to predict exactly how much weight you would lose following weight loss surgery. The amount of weight loss is also dependant on your weight before surgery, your food choices and the amount of exercise that you do following obesity surgery. But you are likely to lose a lot of weight and keep it off.
In addition to dramatic weight loss, gastric bypass surgery may improve or resolve the following conditions associated with obesity:
- Patients can lose up to an average of 27kg of their excess weight in 12 months
- Type 2 diabetes
- High blood cholesterol
- High blood pressure
- Obstructive sleep apnea
- Gastroesophageal reflux disease (GERD)
- Patients have shown maintenance of their weight loss 3-8 years after their surgery
The improvements observed in type 2 diabetes, high blood pressure and high blood cholesterol may significantly decrease the risk of cardiovascular events in individuals who have undergone gastric bypass surgery compared with those treated through other means. Lap Band surgery has also shown to improve mobility and quality of life for people who are severely overweight.
Effective weight loss can lead to either complete control or improvement in obesity related diseases such as diabetes, heart disease, hypertension and obstructive sleep apnoea.
Benefits of Gastric Banding Compared to Other Bariatric Surgeries
- Lower mortality rate (only 1 in 2000 versus 1 in 250 for Roux-en-Y gastric bypass surgery)
- Removable (stomach size returns to normal if the band is removed but does have many adhesions making a revision surgery more dangerous)
- No cutting or stapling of the stomach
- Shorter hospital stay
- Quick recovery
- Adjustable without additional surgery
- No malabsorption issues (because no intestines are bypassed)
- Fewer life threatening complications
Lap Band Recovery
You will have a team of people around you to help you through your weight loss surgery and the following months. They will be there to help you stay healthy and achieve the best weight loss results for you.
Because obesity surgery is just a part of the process, we have put in place a comprehensive aftercare programme to ensure you receive all the care and support you need, long after your surgery for weight loss.
While in hospital:
- Following weight loss surgery your obesity surgeon will usually see you daily to check your condition, discuss your operation and talk through the next stages of your aftercare.
- You will have discussions with your dietician to plan your diet for when you go home. You will be given diet sheets to help you understand what you need to do.
Tips after you have gone home:
- Your weight loss surgeon will see you again a month after surgery then every three months for the first year.
- You will have monthly one to one meetings with your dieticianwho will provide ongoing dietary advice. There are regular patient support group meetings led by the dietician, to help you stay motivated and overcome any difficulties you are having with your new lifestyle.
- You will be able to contact your hospital in case of complication immediately after discharge.
- If you have a lap band, you will need to visit the Outpatient Department of your BMI hospital to have the band adjusted. This usually takes two adjustments to find the right level of restriction, but additional adjustments may be required. The first one is usually six weeks after lap banding surgery.
Gastric Bypass Post Operative Care
Once you have progressed thru your post-op diet of liquids and pureed foods, you will once again be able to eat normal foods.
The biggest change will be in the size of your meals and the new eating behaviors you will have to adopt. The Lap-Banding will help control how much food you can eat, but it will be up to you to make healthy food choices.
The LAP-BAND procedure works best with solid foods to decrease hunger. Solid foods stay in the stomach pouch longer, so you should feel full after eating only a few ounces of food.
In order for your body to remain healthy and function properly, it will be important to choose foods are high in protein and nutritional content. Your diet will ideally include:
- low-fat proteins (select meats, fish, skinless poultry, eggs)
- fruits and vegetables
- healthy breads and cereals
- dairy products (good source of calcium, but choose non-fat or low-fat)
- heart-healthy fats
Your doctor will work with you in developing a new diet plan. Some of the important guidelines for eating with the LAP-BAND are:
- Eat only three small meals a day – this is all you need. Do not snack between meals.
- Eat only solid foods at mealtime – this is how the LAP-BAND® works to restrict food.
- Eat slowly and chew your food thoroughly, about 15-20 times a bite, until it reaches a liquid consistency – this will help to create the feeling of fullness and make it less likely for food to get stuck in the LAP-BAND® pouch.
- Stop eating when you feel full – eating too much can result in pain, nausea and vomiting. It can also stretch the LAP-BAND® pouch.
- Choose healthy foods – make sure you are getting enough protein and nutrients.
- Do not drink while you eat – this will wash down the food and you will not reach the feeling of fullness, defeating the purpose of the LAP-BAND®. Do not drink for 30 to 45 minutes before or after meals.
It is important to drink plenty of fluids during the day in order to stay hydrated and replace the fluid that is lost due to weight loss. If you become dehydrated you may experience a loss of energy, lightheadedness, dry skin, and nausea. You should choose low-calorie liquids and try to drink about 6 – 8 cups of fluid a day Water is a good choice, but other drink options include low-calorie, non-carbonated liquids, such as artificially flavored drinks, broth, tea, and black coffee (without sugar). Avoid drinking fluids with meals as they move food thru your LAP-BAND pouch too quickly.
Possible Gastric Bypass Risks
Most people get through their weight loss operation with few problems, but as with all surgeries there are risks and complications – even though rare – are a possibility. Serious complications but rare complications include heart attack or a blood clot, but these potentials can be identified before surgery during your health evaluation.
To reduce your risk of complications you may be asked to lose weight before surgery, or to go on a special milk and yoghurt diet. This will shrink the fat around your liver, and allow easier access to your stomach during the operation.
A commonly reported occurrence for banded patients is regurgitation of non-acidic swallowed food from the upper pouch, commonly known as Productive Burping (PBing). Productive Burping is not to be considered normal. The patient should consider eating less, eating more slowly and chewing their food more thoroughly. Occasionally, the narrow passage into the larger, lower part of the stomach might also become blocked by a large portion of unchewed or unsuitable food.
Other complications include:
- Gastritis (irritated stomach tissue)
- Erosion: The band may slowly migrate through the stomach wall. This will result in the band moving from the outside of the stomach to the inside. This may occur silently but can cause severe problems. Urgent treatment may be required if there is any internal leak of gastric contents or bleeding.
- Slippage: An unusual occurrence in which the lower part of the stomach may prolapse through the band causing an enlarged upper pouch. In severe instances this can cause an obstruction and require an urgent operation to fix.
- Malposition of the band: This can cause a kink in the stomach, or (rarely) the band may not encircle the stomach at all, giving no restriction to the passage of food.
- Band was not placed on the stomach: (very rare – especially with an experienced bariatric surgeon.) However, in two asymptomatic patients, the band had not enclosed the stomach but only perigastric fat.
- Problems with the port and/or the tube connecting port and band: The port can “flip over” so that the membrane can no longer be accessed with a needle from the outside (this often goes hand in hand with a tube kink, and may require repositioning as a minor surgical procedure under local anaesthesia); the port may get disconnected from the tube or the tube may be perforated in the course of a port access attempt (both would result in loss of fill fluid and restriction, and likewise require a minor operation).
- Internal bleeding