Adjustable Gastric Band (Lap-Band)

Adjustable gastric band, or Lap-Band, surgery is a "restrictive" operation, meaning that it limits food intake and does not interfere with the normal digestive process. In this procedure, a silicone band is wrapped around the upper part of the stomach, creating a small stomach pouch. The lower, larger part of the stomach sits below the band. The two parts of the stomach remain connected through a narrowing created by the band. The band thus restricts the amount of food you can consume at a single meal. Food can still pass from the upper to the lower stomach regions, however, it moves through the new opening slowly, so that you feel full longer. The procedure is performed laparoscopically, using 5 small skin incisions.

An important aspect of the Lap-Band is that it can be easily adjusted after surgery. The inner lining of the band contains a balloon that can be inflated with saline (salt-solution), allowing the surgeon to narrow or widen the opening and thus control how much food can pass through to the lower portion of the stomach (imagine a small blood pressure cuff wrapped around the upper portion of your stomach). This is accomplished by using a fine needle to gain access to a small reservoir that is positioned well under the skin and fat of the abdomen at the time of surgery. The reservoir, in turn, is connected by a thin tube to the saline-filled sac. The reservoir is not visible; it can be felt only when you push on your abdomen.

• Gastric banding is the safest form of bariatric surgery, with a rapid recovery time.

• Weight loss ranges from 50 to 65 percent of excess body weight over the first two years and is maintained for up to five years. (The Lap-Band was approved by the FDA in 2001, so studies have yet to assess longer-term results of the procedure.) This equals roughly 50 to 100 lbs, depending on your original weight. (The observed weight loss was actually lower in the FDA clinical trials, resulting in only 35 percent excess weight loss. However, Lap-Band surgical techniques have changed significantly since those trials.)

• It is the least invasive operation of all the weight loss surgeries available. Since there is no cutting or re-connecting of stomach or intestines, there is no risk of intestinal leak, dumping syndrome, or food intolerance.

• Patients who have the Lap-Band do not feel hungry, most likely because a small amount of food stretches of the uppermost part of the stomach, signaling a sense of fullness.

• There is no malabsorption of medication or protein, meaning that you absorb every nutrient that you eat. This is particularly important in young women who want to get pregnant. Although Lap-Band patients do not need any vitamin or mineral supplements, we recommend a multivitamin once a day.

• The majority of existing obesity-related health problems are improved, or even cured, such as diabetes, high blood pressure, sleep apnea, and high cholesterol.

• Since the band is an implantable device, its effect can be completely reversed just by taking it out.

• The surgery takes approximately one hour to perform and requires only an overnight hospital stay. Patients can return to work in three to five days.

• It is adjustable - without the need for more surgery, just a ten minute visit to the surgeon's office. The band needs to be tightened as the patient loses weight - roughly every six to eight weeks. Therefore, one must be committed to see his or her surgeon frequently for the first year and then annually. In some circumstances (e.g., pregnancy and certain illnesses), the patient may need to eat more, in which cases the band can be loosened, done in the office.

• You must re-learn how to eat. Think of a six-lane highway of cars narrowing down to one-lane because of construction. It takes the car longer to get past the construction site, but once past, it's back to six lanes and smooth sailing. So the more cars there are - the more food you take in - the greater the back-up before you reach the narrowing. Therefore, if you eat too fast or too much, or if you don't chew your food enough, you will vomit. Some foods - such as steak, white meat chicken, and doughy bread - will not pass through the opening.

• The chances of losing a substantial amount of weight after the Lap-Band is about 70 percent. Your success depends on your commitment to keeping follow-up visits to your surgeon, every six to eight weeks for at least the first year and perhaps longer, to have your band adjusted. Band adjustments are made in response to the amount of weight you lose, your appetite, your eating habits, and the symptoms you experience. This is the only way to assure significant long-term weight loss. If you do not follow-up with your surgeon, you will not lose weight.

• Because the Lap-Band is an implantable device, it does carry a small risk of slippage (causing complete blockage of the gastric pouch) or erosion into the stomach (causing weight loss to stop). In either case, another laparoscopic surgery would be required to re-position or remove the band.

• Other technical problems can arise. In a few cases, the tube may kink or the reservoir may twist, which may require minor surgery.

• The Lap-Band is not a perfect solution, and it will not result in weight loss if you start eating an excess amount of chocolate or high-calorie drinks, such as ice cream, milk shakes and soda.