• What is the difference between Laparoscopic Banding (Lap Band) Surgery and Laparoscopic Sleeve Gastrectomy (Gastric Sleeve) Surgery?
• How long does the Lap Band procedure take?
• What is the typical recovery?
• What can I expect to eat after surgery?
• How is the Band adjusted?
• How many adjustments will I need?
• Do I have to be careful with the access port just underneath my skin?

WHAT IS THE DIFFERENCE BETWEEN LAPAROSCOPIC BANDING (LAP BAND) SURGERY AND LAPAROSCOPIC SLEEVE GASTRECTOMY (GASTRIC SLEEVE) SURGERY?

Laparoscopic Adjustable Gastric Banding is a type of weight loss surgery that involves inserting an access port under the skin. The access port is attached to a gastric band that has an inflatable balloon. The lap band is attached around the upper part of the stomach which forms a small gastric pouch. The balloon is filled with saline solution. Using the access port, the surgeon will fill the balloon with saline solution. The filled balloon reduces the size of the stomach. The saline can be withdrawn or filled to modify food intake. The patient will feel full with smaller amounts of food. Lap band surgery is the only reversible weight loss surgery. The entire procedure takes about an hour and is performed as an outpatient procedure. There is very little scarring. Lap band is a minimally invasive weight loss procedure.

Laparoscopic Sleeve Gastrectomy (LSG), gastric sleeve surgery, is a procedure that is normally performed on patients who are too obese to have an other types of weight loss procedures or who do not meet the criteria to have lap band surgery. Gastric sleeve surgery is performed on people so they can reach a safe weight to have a more invasive surgery. The surgeon makes small incisions and inserts a viewing tube that is equipped with a laparoscope (small camera) to see inside the incisions in order to remove part of the stomach. The remaining tube-shaped stomach is closed with staples. It is normally followed by a gastric bypass after the patient has lost a considerable amount of weight. The second surgery normally takes place within 12 to 18 months after the gastric sleeve surgery. A gastric sleeve decreases the size of the stomach by removing 60% to 80% of the stomach. After removal, there is just a thin tube that is remaining. The portion of stomach along the greater curvature is the part that is removed and contains the portion that produces Ghrelin which is the hormone that stimulates hunger. The result is reduced hunger and it limits the amount of food that can be eaten. With a gastric sleeve, there are few food intolerances and a low risk of malnutrition.

HOW LONG DOES THE LAP BAND PROCEDURE TAKE?

The LAP-BAND® system procedure takes about 30 minutes and is done on an outpatient basis. This is done under a general anesthetic, and requires five small incisions.

WHAT IS THE TYPICAL RECOVERY?

If LAP-BAND surgery is performed laparoscopically, patients typically spend less than 24 hours in the hospital. It takes most patients about a week to return to work and a month to six weeks to resume exercising. In the case of open surgery or if there are complications, recovery may take longer.

WHAT CAN I EXPECT TO EAT AFTER SURGERY?

Patients are placed on a liquid diet or as we suggest "anything through a straw" for the first two weeks. The next two weeks incorporate soft food. Four weeks out from surgery patients begin on regular food, being careful to avoid thick meats and breads. It is important to take small bites and to chew food thoroughly. Equally important, one should not drink while eating, to avoid washing all of the food particles that you've taken care to break down, resulting in you being able to eat more. Patients can drink unlimited amounts when they are not eating. Most people take in 800-1200 calories per day.

HOW IS THE BAND ADJUSTED?

An adjustment is an office procedure that takes a few minutes to do. Most people (>90%) state that it doesn't hurt at all. By adjusting the LAP-BAND® Adjustable band, we control how fast the pouch empties. The slower it empties the longer you stay full.

HOW MANY ADJUSTMENTS WILL I NEED?

As you lose weight, the fat around the stomach diminishes and causes the
LAP-BAND® Adjustable band to become looser. This is usually evident by the patient wanting to eat more, and becoming hungry between meals. Additionally, your weight loss curve usually flattens out. Most people require around 3-5 adjustments over the lifetime of the LAP-BAND® System.

DO I HAVE TO BE CAREFUL WITH THE ACCESS PORT JUST UNDERNEATH MY SKIN?

There are no restrictions based on the access port. It is placed under the skin in the abdominal wall, and once the incisions have healed it should not cause discomfort or limit any physical exercise. The only sensation you may experience from the port occurs when you go in for adjustments. If you feel persistent discomfort in the port area, let us know as soon as possible.

1. Can the Band be rejected by my body?

The Band is made of silicone rubber, and cannot be rejected. Of course it can become infected and require removal, but this is not the same as being rejected like a transplanted organ.

1. What is a slipped Band, and what causes it?

There are two types of slippage; anterior and posterior. This refers to whether the front or back side of the stomach slips. There is something else called concentric pouch dilation, but this is not the same as slippage. Slippage or prolapse is when the stomach slides up through the Band, making the pouch bigger. If this happens the Band usually becomes too tight, and patients experience symptoms of reflux (heartburn) as well as nausea and vomiting. This is because the amount of stomach being “squeezed” by the Band is increased, thereby obstructing the Band.
There are several causes. Posterior slippage was more common when the Band was placed by the “perigastric” technique. With this technique the back side of the stomach was free to slide up through the Band. These days most surgeons use the “pars flaccida” technique, which was developed to prevent posterior slippage, and has more or less eliminated the incidence of this problem.
Anterior slippage is when the front of the stomach slips up through the Band. We try to prevent this by suturing the stomach below the Band to the stomach above the Band, “locking” the Band in place in the right spot. In spite of this, slippage still occurs. It can happen because we haven't placed enough stitches, or they haven't been placed in the right place. Slippage can also occur if patients eat too much and vomit frequently.

1. How is a slipped Band diagnosed?

Fortunately, this is very easy. Often the diagnosis is made based on the history alone. A patient who has been going along fine, with no problems, and then suddenly develops reflux symptoms or symptoms of a too-tight Band will most likely have a slipped Band. The diagnosis is easily confirmed with an x-ray and barium swallow examination. Endoscopy is rarely necessary.

1. How is a slipped Band fixed?

A slipped Band needs to be fixed with an operation. The Band has to be dissected out, all the sutures removed, and the position of the stomach made right. Some surgeons remove the Band and place it back through a new tunnel. Others just straighten things out and re-suture the stomach over the Band.

1. Can I have a LAP-BAND® System if I've already had prior stomach surgery?

At this point, if you've had a prior gastric bypass or stomach stapling then you are not a candidate. There are only a few surgeons in the WORLD that attempt that, and we are waiting for long term results to see if it is safe and effective. We also would not place a LAP-BAND® System in someone who has had and anti-reflux procedure such as a nissen fundoplication. There are no problems with patients who've had prior gallbladder surgery, appendectomy or hysterectomy. Patients who have had large ventral hernia repairs with mesh would be on case by case basis.

1. What about becoming pregnant?

Most women of child bearing years find that with weight loss their menstrual cycles become more regular, and that it's easier to become pregnant. There are also less complications with pregnancy and delivery. If a patient who has had a LAP-BAND® System procedure becomes pregnant, we simply deflate the LAP-BAND® Adjustable Gastric band and allow them to consume whatever calories they need for mom and baby to grow. Once they have completed breast feeding we tighten the LAP-BAND® Adjustable Gastric band back up.

1. Can the band be removed?

Although the LAP-BAND System is not meant to be removed, it can be, in some cases laparoscopically. Surgeons report that the stomach generally returns to its original shape once the band is removed. After the removal, though, you may soon go back up to your original weight or even gain more.

1. Will I need plastic surgery for the surplus skin when I have lost a lot of weight?

That is not always the case. As a rule, plastic surgery will not be considered for at least a year or two after the operation, as sometimes the skin will mold itself around the new body tissue. Give the skin the time it needs to adjust before you decide to have more surgery.

1. Will I feel hungry or deprived with the LAP-BAND?

The LAP-BAND makes you eat less and feel full in two ways – first by reducing the capacity of your stomach and second by increasing the time it takes food to get through the digestive system. After a small meal, the amount of which varies from person to person, you should feel full. If you follow the nutrition guidelines when you choose your food and then chew it well, you should not feel hungry or deprived. Remember that the LAP-BAND is a tool to help you change your eating habits.

1. How much weight can I expect to lose?

Most patients lose 1-2 pounds per week for the first year and a half. Most recent studies show that the average weight loss at 5 years is comparable to that of gastric bypass. Typical weight loss is 60-65% of your excess body weight. This is calculated by subtracting your ideal body weight from your current weight and then multiplying that number by .65.

1. What are the risks?

The LAP-BAND® system procedure has been shown to be 10 times safer than gastric bypass. Complications such as slip (2-10% reported in the literature) and erosions (1% reported in the literature) can occur. Both can be repaired laparoscopically.
Temporary gastric obstruction occurs immediately after surgery and has a frequency of 2-5%. This is usually treated with IV fluids and observation. Once the swelling goes down patients do fine. The final complication specific to the LAP-BAND® System is problems that can arise from the port. Rarely, the port can flip over or develop a leak, which requires a simple outpatient procedure to resecure or replace the port. The risk of death from a LAP-BAND® System is the same as someone undergoing a general anesthetic (around 0.05%).

1. What will happen if I become ill?

One of the major advantages of the LAP-BAND System is that it can be adjusted. If your illness requires you to eat more, the band can be loosened by removing saline from it. When you have recovered from your illness and want to lose weight again, the band can be tightened by increasing the amount of saline. If the band cannot be loosened enough, it may have to be removed.

1. Will I need to take vitamin supplements?

You may. It’s possible to not get enough vitamins from three small meals a day. At your regular check-ups, your specialist will evaluate whether you are getting enough vitamin B 12, folic acid, and iron. [insert your recommendations]

1. What about other medication?

You should be able to take prescribed medication though you may need to use capsules, break big tablets in half or dissolve them in water so they do not get stuck in the stoma and make you sick. You should always ask the doctor who prescribes the drugs about this. [insert your recommendations]

1. What if I go out to eat?

Order only a small amount of food, such as an appetizer. Eat slowly. Finish at the same time as your table companions. You might want to let your host or hostess know in advance that you cannot eat very much.

1. What about alcohol?

Alcohol has a high number of calories and breaks down vitamins. An occasional glass of wine or other alcoholic beverage, though, is not considered harmful to weight loss.

1. Can I eat anything in moderation?

 After your stomach has healed, you may eat most foods that don’t cause you discomfort. However, because you can only eat a little it is important to include foods full of important vitamins and nutrients such as those advised by your dietitian. If you eat foods that contain lots of sugar and fat or drink liquids full of “empty” calories, such as milkshakes, the effect of the LAP-BAND may be greatly reduced or cancelled.

1. Will I suffer from constipation?

There may be some reduction in the volume of your stools, which is normal after a decrease in food intake because you eat less fiber. This should not cause you severe problems. If difficulties do arise, let us know as soon as possible. And remember to drink at least 6-8 glasses of water a day.

1. How Do I Get Started?

First, our patients call and make an appointment to attend one of our free
LAP-BAND® System seminars. After attending the seminar a history form is filled out by the patient and reviewed by us. We then see the patients in our office for their first visit. Next a letter of medical necessity is submitted to their insurance company and once approved the patients are notified. We then have a designated day where patients come in for their preoperative testing as well as nutritional and exercise counseling. The patient then sees the surgeon the following week for the second visit and their surgery will be the following week.

1. What if my insurance company doesn't approve this?

We have developed a cash-pay program with many of the facilities we utilize. It is all inclusive and covers all office visits and adjustments for up to one year. We also can help you set up financing with CareCredit if necessary.