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Laparoscopic Adjustable Gastric Banding

For patients in the St. Louis and outlying regions

 

Educational/promotional video on the LAP-BAND® System provided by Allergan, Inc., for the purpose of patient education.

The laparoscopic gastric banding procedure is the least invasive and only adjustable surgical treatment for extreme obesity in the United States. During the procedure, surgeons wrap a band around the upper part of the stomach, dividing it into two parts: a small upper pouch and the remainder of the stomach. It induces weight loss by reducing the capacity of the stomach, thereby restricting the amount of food that can be consumed at one time. The size of the opening between the two portions of the stomach is adjustable and controls the flow rate of the food from the upper to lower part of the stomach. Laparoscopic banding recipients feel full sooner, and that feeling lasts longer.

 

 LAP BAND  REALIZE Band
Laparoscopic adjustable gastric banding: LAP-BAND® System (left) and REALIZE® Band (right).
 

The Adjustable Band
The adjustable band is a hollow ring made of biocompatible materials (so the body adapts to it without being harmed) and is filled with saline, a salty solution similar to other fluids in the body. The band controls the size of the opening between the two parts of the stomach.

Surgeons can adjust the size of the opening between the upper pouch and rest of the stomach by adding or removing saline from the ring. This process is called inflating or deflating. The band is connected through a tube to an access port placed beneath the skin during surgery. Later, the surgeon can control the amount of saline in the band by piercing the access port through the skin with a fine needle. If the band is too loose and weight loss too small, adding more saline can reduce the size of the opening. If the band is too tight, the surgeon will remove some saline. This, too, can be done without more surgery.

The Operation
In most cases, the surgeon uses a laparoscopic (minimally invasive) approach to implant the adjustable band. To gain access to the abdominal cavity, he or she makes small incisions in the abdomen. Surgeons insert surgical instruments  through ports, which are placed into the incisions. A video camera called a laparoscope provides a view of the abdomen during the procedure.

Laparoscopic procedures typically result in less pain and scarring and a shorter recovery time for the patient than open surgical procedures.

Are You a Candidate?
Laparoscopic adjustable gastric banding is not right for everyone. You and your surgeon should work together to decide whether this is the right procedure for you. This approach may be a good option if:

  • You are an adult 18-70 years of age or an adolescent 13-17 years old
  • Your body mass index (BMI) is 40 or higher, you weigh at least twice your ideal weight, or your BMI is 30 to 39.9 with 1 or more obesity-related co-morbid conditions (diabetes, sleep apnea, heart disease or high blood pressure)
  • You have been overweight for more than five years.
  • Your serious attempts to lose weight have had only short-term success.
  • You do not have any other diseases that may have caused you to be overweight.
  • You are prepared to make a major change in your eating habits and lifestyle.
  • You are willing to continue working with a specialist who is treating you.
  • You do not drink alcohol in excess.

Your motivation is key
Your surgeon will not perform this operation unless he or she knows you understand the problems caused by your excess weight. In addition, your surgeon will make sure you know your responsibilities. These include new eating patterns and a new lifestyle. If you are ready to take an active part in reducing your weight, your surgeons will consider the treatment. First, though, your surgeon will want to make sure you know about the advantages, disadvantages and risks involved.

  • EXERCISE, EXERCISE, EXERCISE! Your success will greatly depend on your commitment to an exercise routine. We strongly recommend that patients participate in the preoperative and postoperative physical rehabilitation program. We encourage patients to take advantage of the dramatic weight loss to increase their exercise capacity and include exercise in their daily routine.
  • Medical follow-up. To monitor for long-term complications, such as anemia, it is important to keep scheduled appointments and see your primary care physician regularly.

Risks
Generally, laparoscopic adjustable gastric banding is a safe surgical procedure, which carries a 0.1 percent risk of death; however, about 5-10 percent of patients have major or minor postoperative complications.

Risks include:

  • Band erosion into the stomach
  • Slippage of the band
  • Port and tubing problems requiring reoperation
  • Esophageal dilation and reflux

Post-Surgery Diet and Weight Loss
Most patients start on a liquid diet and begin walking the day of surgery. Generally, patients are ready to go home the morning after surgery and in some cases on the same day. Patients typically stay on a liquid diet for a week and then advance to a soft diet for two weeks and then progress to a regular diet. It is critical that laparoscopic adjustable gastric band patients follow up with their surgeon monthly the first year and every other month the second year to get their adjustments or they will not get good weight loss. Weight loss and resolution of diabetes and other obesity-related diseases such as sleep apnea, high blood pressure and arthritis occur gradually over the months after surgery. Patients lose an average of 40 percent of their excess body weight during the first year after surgery and then their weight stabilizes.

Surgeons who perform this procedure:
J. Christopher Eagon, MD 

For more information, call 314.454.7224.

More information about bariatric surgery can be found at these web sites:

American Society of Bariatric Surgery 
The Obesity Society
Weight-control Informational Network (WIN) (informational service of National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK])

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