Adjustable Gastric Band (Lap-Band)

Adjustable gastric banding surgery, commonly known by the Allergan brand name Lap-Band or Johnson & Johnson’s brand name the Realize Band, is a "restrictive" operation: 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 anywhere between one and five small skin incisions.

An important aspect of the gastric band is that it can be easily adjusted after surgery in the office. As you lose weight, you may feel hungrier and start eating more. This means the band must be tightened, or “adjusted”. 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 into 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.

Advantages:

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

  • Average weight loss is approximately 50 percent of excess body weight which can be maintained for up to 15 years. (O’Brien et al Ann Surg, 2013: 257;87) This equals roughly 50 to 100 lbs, depending on your original weight.

  • 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 or dumping syndrome

  • Patients who have the gastric band feel much less hungry, most likely because a small amount of food stretches 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 gastric 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 is usually performed as an outpatient. 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 4-6 weeks initially. 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.

Disadvantages:

  • 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 gastric band is about 70 percent. Your success depends on your commitment to keeping follow-up visits to your surgeon, every four to six 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 portions, 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.

  • All pills taken afterwards should be small. Large pills may not go through the band and instead start to dissolve in your esophagus and cause ulcers. We advise you to change all your medications to a liquid, powdered or crushable form.

  • Because the gastric 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. The tube may kink or the reservoir may twist, which may require minor surgery. The device may develop a leak which would lead to weight gain.

  • The gastric 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. It is a tool to help you eat less.