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LAP-BAND® System

LAP-BAND® System

This is the simplest and the least invasive of all of the bariatric procedures. It works by imposing portion size restrictions on the patient by placing an adjustable band, like a belt, around the top part of the stomach. The tightness of the band is adjusted by injecting saline water into a reservoir placed under the skin under the left rib cage.

This procedure is viewed as the most “patient friendly” approach as our patients can determine how fast or how much weight they desire to lose on an on-going basis. During conditions where our patient would need to eat more (for example, during a pregnancy, or after an unforeseeable surgical procedure or illness) the band can be deflated and the restriction for food intake can be suspended.

The Installation Procedure:

The Lap-Band procedure is performed under general anesthesia where 5 small incisions are made in the upper abdomen above the umbilicus. The largest one is about 1 inch wide for the placement of the port. We also place an average of 6 anchoring sutures to prevent the development of slippage.

This minimally invasive procedure takes about one hour to perform, and most patients are ready to go home the same day or within 24 hours after admission. They are offered clear fluids for oral consumption after surgery and are encouraged to walk the same day as tolerated. Pain medications are given intravenously or orally and most patients usually recover after a few days to 2 weeks and can return to work.

The One Month Post-Surgery Inflation Procedure:

The band is not filled until 1 month after surgery. Adjustments are performed in our offices, where the skin is cleansed and a local anesthetic is administered. A special needle is inserted through the port and saline water is injected into the reservoir. We ask our patients to drink small amounts of water after each adjustment to make sure that the reservoir is not filled too tightly. Occasionally, if the port is difficult to locate, an ultrasound or X-ray may be needed to aid in locating the port.

When patients lose weight, everything gets looser. So does the band around the stomach. Thus it’s necessary for the patient to return for the adjustments to tighten the band. If they do not return for the adjustments, the Lap-Band may not achieve it’s desired function. Once the patient has reached the desired weight loss, the need of adjustment becomes very infrequent. With the passage of time, the band can still get looser. Follow-up with the health care provider is the key to a successful journey with the Lap-Band procedure.

Advantages & Disadvantages:

With this procedure, since food will pass through the natural route, and the Lap-Band will not interfere with the natural absorption of nutrients and vitamins from food, blood tests are performed less frequently and vitamin supplements are not as important and not mandatory. However, multivitamin, Vitamin D3, and fish oil supplements are still recommended to enjoy a healthier life.

Generally, the Lap-Band procedure will require the most post-surgery follow-up relative to the other bariatric procedures.

Potential Complications from the Lap-Band Procedure can include:

  • Port and tubing related problems: Leaks, flips, kinks, and infections.
  • (These problems are usually corrected under local anesthetic and on an outpatient basis.)

  • Band related problems: Slippage, leaks, erosion, reflux and infections.

Slippage means that the portion of the stomach below the band slides upwards into the band and enlarges the top part of the stomach or the “pouch”. This slow and gradual process can cause a blockage where the patient will experience food and liquid intolerance. This can be corrected laparoscopically by moving the band higher and re-suturing the stomach around the band.

The occurrence of slippage in our practice is currently about 2.2%.

Other Complications:

Other clinics have reported erosions and infections in their practices, but we have not seen these issues in our practice after performing over 650 Lap-Band procedures. Band intolerance, including reflux and pains, can also occur, and may require removal of the band.

Corrections:

In our study of 600 patients, approximately 13% of our patients required surgical intervention. More than half of these corrections were performed under local anesthesia, and the remainder were performed under general anesthesia.

Lifestyle Choices:

Although this procedure usually produces satisfactory results, unsatisfactory weight loss is still a possible outcome when patients choose to regularly eat inappropriate foods, continually take in too many calories on a daily basis, and restrict their lifestyles to an inadequate level of physical activities.

The Lap-Band procedure is not a miracle cure — it does require some level of patient cooperation for a successful outcome.