Laparoscopic adjustable gastric band or lap band surgery is a restrictive weight loss surgery or a type of bariatric surgery to treat obesity.
It is also known by the following names.
- Stomach Banding
- Stomach banding Surgery
- Gastric Banding
- Gastric Band
- Laparoscopic Adjustable Gastric Band
- Lap Band
What is gastric band surgery (Lap-Band)?
The adjustable gastric band is a surgically implanted silicone device to help obese people lose weight. It’s a type of bariatric surgery that restricts the amount of food you can eat at one time.
The adjustable gastric band reduces the size of your stomach. This is not permanent and the lap band can be removed at any time when indicated.
The “Lap-Band” is the only brand of gastric band that is currently available in the U.S. It was approved by the FDA in 2001.
There are two types of stomach bands that are approved by the FDA and used in the United States:-
- LAP-BAND. This is the trademark for the FDA-approved laparoscopic adjustable gastric banding device manufactured and marketed by Allergan, Inc.
- REALIZE BAND. This is the trademark for the FDA-approved laparoscopic adjustable gastric banding device manufactured by Ethicon Endo-Surgery, which is a division of Johnson and Johnson.
Aim of Gastric Banding | Why It Is Done
Stomach Banding or Lap Band is done to achieve three goals.
- It helps to bring about a significant reduction in obesity.
- It reduces the health risks associated with obesity like high blood pressure, sleep apnea, diabetes, GERD, etc.
- It brings down the early mortality risk associated with obesity.
Eligibility for Stomach Banding or Lap Band
Not everybody can undergo lap band surgery. Certain criteria prevail that make you eligible or rule you out for this procedure. The eligibility criteria for the lap band are explained below.
- Age between 18 years and 55 years
- A history of obesity of up to 5 years
- You are morbidly obese. That is you have a BMI of 40 or more. Alternatively, your excess weight is 100 lbs more than what your weight should be in men and 80 lbs more in women.
- You do not consume excess alcohol.
- You have a BMI between 30 to 40 along with anyone obesity health risks such as diabetes, high cholesterol, high blood pressure, sleep apnea, etc.
- Have religiously tried to lose weight by following the weight loss diet and exercising regularly without satisfactory results.
- Have understood and are ready to accept the risks associated with bariatric surgery.
- Are ready to follow the lifelong dietary requirements for long-term success.
- You are judged too risky for the more invasive gastric bypass surgery due to some underlying health problems.
Contraindications for Gastric Band
- Any existing inflammatory disease of the gastrointestinal tract makes you ineligible. Such conditions are ulcers, gastritis, esophagitis, and inflammatory disease of the intestine (Crohn’s disease).
- Any severe heart disease or severe lung disease makes you ineligible for any surgery due to the risk from the surgical procedure.
- Any congenital anatomical defect in the gastrointestinal tract such as a structurally different esophagus or a stomach or intestines
- Untreated hypothyroidism
- Alcohol abuse or drug addiction
- Mentally challenged people
- During pregnancy. The gastric band is contraindicated during pregnancy. However, pregnancy is not contraindicated if you are already having the gastric band. In such a case, the gastric band is deflated once pregnancy is confirmed or if morning sickness presents itself. The lap band can be reinflated once breastfeeding is completed.
Lap Band Surgery Procedure
Duration of procedure: About one hour.
Duration of hospital admission: About 4 to 5 hours.
Anesthesia: Usually performed under general anesthesia.
It is carried out using a laparoscope with a video attachment. Three to five small incisions are made by the lap band surgeon on the abdomen above and near the umbilicus. In the case of an open gastric band surgery, one single large incision is made above the navel.
The laparoscope is first inserted into the abdomen so that the surgeon can view the contents inside the abdomen in a magnified fashion.
The other incisions are meant for certain other instruments with long handles, which are used for wrapping the gastric band around the stomach. The area around the stomach, where the gastric band is to be placed, is cleared.
The lap band surgeon wraps an inflatable silicon band around the stomach to squeeze the stomach into two pouches, the smaller upper pouch and a larger lower pouch connected by a very narrow passage, which is about an inch in diameter.
This restricts the amount of food you can eat at one time and slows down the passage of food through the stomach. The upper pouch will have a capacity of about half to one cup and can hold up to an ounce of food.
The band contains saline and has an opening or port which is placed just below the skin. The saline can be withdrawn or added to adjust the tightness of the band. This is to facilitate the right amount of tightness of the band around the stomach.
How much weight can you lose with Lap-Band?
There are variations in post-operative success stories of gastric banding, but there can be a loss of about 40% of the excess weight over two years. That means if you were 100 lbs. overweight, you’d lose 40 lbs.
On average, about half to one kilogram of weight is lost per week on a consistent basis. This slows down after a year or a year and a half. In the second year, you will lose about 55% of excess weight.
For this weight loss to occur, you must follow religiously follow strict dietary guidelines, regular physical activity and a disciplined lifestyle.
Advantages and benefits of Gastric Band over other weight loss surgeries
- Gastric banding is the least invasive and considered the safest weight loss surgery.
- Low rate of complications.
- The gastric band is removable and therefore stomach size comes to normal after its removal. Changes made after lap band are therefore reversible which is not so in other bariatric surgeries such as gastric bypass.
- Mortality of this surgical procedure is very low: one in 2000 as compared to one in 250 in 2000 of gastric bypass.
- There is no stapling or surgical excision or removal of any part of the gastrointestinal tract.
- Hospital admission is short and post-operative recovery is fast.
- The gastric band, if required, is adjustable by just removing or adding saline. No extra surgery is required.
- There is no malabsorption as the gastrointestinal tract is intact and not bypassed. Nutritional deficiency is therefore rare, unlike gastric bypass.
- Gastric banding can help treat obesity-related health conditions such as high cholesterol, high blood pressure, heart problems, type 2 diabetes, sleep apnea, and nonalcoholic fatty liver.
Complications and Risks of Lap Band Surgery
- Nausea and vomiting. This can be reduced by adjusting the tightness of the gastric band.
- Swallowing difficulty
- Blockage of the passage opening in the stomach
- Rarely the band may migrate from outside to inside the stomach.
- Infection due to surgery
- Slippage of the band leads to enlargement of the upper pouch of the stomach
- Wrong placement of the band
- Leakage of the saline
Life after Lap Band | Post Operative Care
Certain dietary habits can help you achieve more success in losing weight and avoid some complications. It is important that you discuss your post-operative diet and exercise plan with your lap band surgeon and follow it religiously.
The upper pouch of the stomach after the lap band is small and the passage for the food is narrow. Dietary habits, therefore, revolve around this anatomical picture.
- Drink about 8 to 10 cups of water every day but only between meals.
- For the first 3 to 4 days, your doctor will recommend only a liquid diet to avoid erosion or slippage of the band.
- Do not drink caffeinated beverages such as coffee or tea for the first three months.
- Avoid carbonated drinks permanently as they will cause gas, bloating, and an increase in stomach size.
- Your doctor will recommend a modified liquid diet, with nutrition in mind for the first six weeks.
- In the following six weeks, you can eat shredded food.
- The diet should be high in proteins (about 60 grams daily) to prevent protein deficiency complications such as hair loss, fatigue, muscle weakness, anxiety, depression, etc.
- Eat normal healthy food.
- Chew your food well into a paste before swallowing.
- Eat small meals.
- Do not overeat. Stop eating when you feel full.
- Do your prescribed physical activity regularly.