Adjustable lap banding surgery or gastric band, is a procedure designed for obese patients with a body mass index (BMI) of 30 or higher who have at least one obesity-related condition such as diabetes. Until now, the requisites were a BMI of 40 or 35 with related obesity conditions, but the FDA has just announced the new guidelines.

In a lap-band surgery, an adjustable gastric band (lap-band) made of silicone is placed around the top portion of the stomach to create a pouch roughly the size of a small egg. As a result, a person will feel full after eating only a very small amount of food.

Lap band or stomach banding surgery procedure

The Lap-Band System was approved by the FDA in 2001 although it has been used in Europe since the 1990s.

In a gastric banding surgery, the surgeon makes several small incisions near the belly button and places a small camera through the incisions into the abdomen. The camera sends a picture of the stomach and abdominal cavity.

The band is made of silicone and Silastic. It has a balloon connected to a tube, which leads to a small port (a small plastic connector about the size of a half-dollar) under the skin, on top of the muscle of the abdominal wall.

Through this port, the surgeon adds or removes saline (salt water) from the balloon during your follow-up visits, making it larger or smaller and thus tighter or looser. This is called a fill.

How the band works

The band creates a small pouch at the top of the stomach. This pouch holds approximately ½ cup of food, whereas the typical stomach holds about 6 cups of food. The pouch fills with food quickly, and the band slows the passage of food from the pouch to the lower part of the stomach. Because the upper part of the stomach registers as full, the message to the brain is that the entire stomach is full, and this sensation helps the person to eat less food.

The band is purely restrictive. Unlike the bypass, the band does not create any changes in the hormones in the gut. There is also no malabsorption. After surgery, the doctor may need to adjust the band to make it tighter or looser if you are having problems getting food down. This type of surgery results in a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures.

What you can expect

Studies show that patients lose between 30 and 50 percent of their excess weight over three to five years.in other words, if you are 100 pounds overweight, you can expect to lose between 30 and 50 pounds; in some studies, participants lost up to 60 percent excess weight loss. This is only true if the band stays on. There are increasing reports of patients needing to have the band removed after several years because of slips or a failure to tolerate it.

The band

It is flexible. The doctor can increase the fill to speed up your weight loss, or decrease it to increase the nutrients you get.
It is reversible. If there is a problem or you don’t tolerate the band, the doctor can remove it. The procedure of removing it is as simple one because no parts of your stomach or intestine has been cut or altered.
There is no dumping syndrome.
Weight loss is slower than if you had a bypass surgery. The band does require persistence and sometimes it can be frustrating.
There are fewer complications with the band surgery because the intestines are not cut although this surgery is not exempt of them.
Lap band complications
Although lap band surgery has fewer complications than some of the other types of bariatric surgery, it is not exempt of them. Most common complications are:

1. Regurgitation of food from the upper pouch
2. Blockage with food of the narrow passage into the larger, lower part of the stomach
3. Ulcer
4. Gastritis
5. Erosion and displacement of the band which requires another operation
6. Internal bleeding
7. Infection
8. Pain at the site of the band
9. Constipation
10. Diarrhea

Adjustments to the band

Lap band surgery requires adjustments to the band for the success of long term weight loss. Adjustments may be performed using an X-ray fluoroscope so that the radiologist can assess if there is any erosion or displacement of the band. Surgery may be required.

Some surgeons adjust the band without the help of X-rays. In these cases doctors assess how much weight the patient has lost or if he/she has regained some of the lost weight. Other symptoms the doctor takes into consideration for the assessment and to decide if an adjustment is needed are heartburn, regurgitation, and chest pain.

Lap banding is not recommended in the following cases:

If the surgery or treatment represents an unreasonable risk to the patient
Hypothyroidism
Ulcers, esophagitis or Crohn’s disease.
Severe heart or lung diseases
An allergic reaction to materials contained in the band
Dependency on alcohol or drugs
People with severe learning or cognitive disabilities
Emotionally unstable people
In this type of surgery, because no parts of the intestinal tract have been removed or bypassed, it is unusual for patients to experience any nutritional deficiencies or malabsorption of micro-nutrients. Calcium supplements and Vitamin B12 injections are not routinely required following gastric banding (as they are with Roux-en-Y gastric bypass or gastric bypass). Gastric dumping syndrome issues also do not occur since intestines are not removed or re-routed.

After lap band surgery

A well-designed bariatric surgery program will include a thorough medical evaluation, consultations with a dietitian, and possibly a counselor or psychologist before and after the procedure, as well as a long term follow up. It should also provide detailed instructions, typically in the form of a manual, outlining what to expect, dietary ground rules, warning signs, etc.

It is important for patients to understand that, in order to maintain their weight reduction, they must carefully follow the guidelines they receive after surgery that relate to diet, exercise, and band maintenance. Not following the plan outlined can lead to regaining part or all the weight lost, even if the loss was achieved through lap-banding or any other type of bariatric surgery.

Chicken meal

Lap band diet

The patient may be prescribed a liquid diet, followed by mushy foods and then solids. This is prescribed for a varied length of time and each surgeon will make different recommendations. A recent study found that patients who did not change their eating habits were 2.2 times more likely to be unsuccessful than those who did, and that patients who had not increased their physical activity were 2.3 times more likely to be unsuccessful than those who did.

The diet for people who go through a lap band surgery should be based on normal healthy food, that is solid in nature and that requires ample chewing. The food should have a paste consistency prior to swallowing to maximize the effect of the band rather than choosing foods such as soups, casseroles and smoothies, which pass through the band quickly and easily.

It is very important to have a medical team with which you can discuss the care you need to have after the surgery. If you have a lap band surgery, make sure you are not included in a group that include patients having different types of bariatric surgery like Roux-en-Y gastric bypass or gastric bypass because although the issues related to obesity are the same, the needs of these patients are different after surgery.

Final word

If you are considering having an adjustable lap band surgery, talk to your doctor and ask as many questions as you can think of. This type of surgery requires that you have counseling for about six months prior to the operation.

Ask your doctor who will be part of the medical team, what type of patients will be in the group with you, how often the group will meet, whether or not you will receive part of the information, especially the one related to your diet, in written form, or any other questions that may be a concern for you.

Author

I am Andy Carpenter and I would start by saying that I have a Bachelor Degree in Nutrition Science conferred by California State University, Los Angeles and that I am certified as a Registered Dietitian.

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