All about LAP BAND SURGERY

What Is a Lap-Band?

"Lap-Band System" is the brand name of the FDA-approved, adjustable gastric band used in the procedure. Most simply, a Lap-Band is a silicone belt that goes around the top of the stomach. This results in the ability to control your hunger and achieve a "feeling of fullness," or satiety. Ultimately, you eat much less and should feel full sooner.

A key component of the Lap-Band System is its adjustability. The band is connected to a port, which enables the device to be inflated over time to expedite the weight loss.

Who Are Candidates for the Lap-Band System?

The NIH (National Institutes of Health) requirements for Lap-Band surgery are the same as for any other weight loss surgery. These criteria were originally set in the early 1990s and have not changed. If your BMI, or body mass index, is between 35 and 39, then you must also have associated severe medical problems, or co-morbid conditions, in order to be a candidate for the Lap-Band. These conditions usually include diabetes, hypertension, or high cholesterol. But if your BMI is greater than 40, then it is not required that there be any associated medical problems.

Most insurance companies also require a history of previous attempts at weight loss. How stringent these requirements are can differ from one insurance company to another.

Many people do not meet the NIH requirements or do not have the insurance benefit for weight loss surgery, but they may still be able to pursue the procedure by paying for it themselves.

How the Lap-Band Is Placed in the Body

After performing a series of small incisions, your surgeon would use a small camera, called a laparoscope, to visualize placement of the Lap-Band. The Lap-Band is placed around the top of the stomach and secured in place with sutures. The port is then placed underneath the skin on the top part of the abdomen. Surgery should take only about an hour, and an overnight stay in the hospital may or may not be required.

How the Port Works

Injecting saline into the port inflates the band, making the passage to the lower part of the stomach smaller, which further restricts food intake. Fluid can easily be removed in the doctor's office if it is too tight.

After Lap-Band Surgery: Recovery and Aftercare

Following surgery, you should be able to return to work within a week, with minimal discomfort. You will need to follow a nutrition plan (which may include vitamin supplements) prescribed by your surgeon and/or nutritionist. The nutrition plan will likely include a liquid diet for a few weeks, until you can tolerate soft foods, and later solid foods. A specific exercise program, as well as behavioral-modification therapy, may also be recommended.

Frequent office visits are mandatory to adjust the band. Your surgeon or his assistant will be able to inject the port in the office. On average, patients require six to eight adjustments of the band during the first 18 months following Lap-Band surgery.

Patients typically lose 50% to 60% of their excess body weight within two years after the procedure. Additional plastic surgery may be indicated, depending on how much weight is lost.

Lap-Band System Complications

As with any surgical procedure, there are known risks. Besides the standard risks of most procedures, including bleeding and infection, there are complications specific to Lap-Band surgery. Slippage of the band can occur as you lose weight and the stomach goes above the band, causing heartburn or vomiting. This can usually be fixed laparoscopically. Rarely, the band may erode into the inside of the stomach.

Laparoscopic surgery is not always possible. Your surgeon may need to use an "open" method. This happened in about 5% of the cases in the U.S. clinical study. Other problems can occur that are directly related to the Lap-Band System:

• The band can spontaneously deflate because of leakage. That leakage can come from the band, the reservoir, or the tubing that connects them.
• The stomach pouch can enlarge.
• The stoma (stomach outlet) can be blocked.

For Lap-Band Surgery, Consult a Qualified Surgeon

Using a qualified surgeon will be critical to your success as a Lap-Band patient. Not only will this reduce your risk of complications, but also it will ensure that you lose as much weight as you can. Be sure to verify the number of procedures your surgeon has done, and find out about his office support for Lap-Band patients.

Cost of Lap-Band Surgery

The cost of Lap-Band surgery varies from about $17,000 to $30,000, depending on where you live. In the past, insurance companies did not cover this procedure, but increasingly they are paying for all or part of it if medical necessity is established by your doctor and if you meet the NIH requirements described above.

Gastric bypass

Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine. You will feel full more quickly than when your stomach was its original size, which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed. This leads to weight loss.

The most common gastric bypass surgery is a Roux-en-Y gastric bypass.

In normal digestion, food passes through the stomach and enters the small intestine, where most of the nutrients and calories are absorbed. It then passes into the large intestine (colon), and the remaining waste is eventually excreted.

In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum).

This procedure can be done by making a large incision in the abdomen (an open procedure) or by making a small incision and using small instruments and a camera to guide the surgery (laparoscopic approach).

See a picture of a Roux-en-Y gastric bypass.

What To Expect After Surgery

This surgery usually involves a 4- to 6-day hospital stay (2 to 3 days for a laparoscopic approach). Most people can return to their normal activities within 3 to 5 weeks.

Gastric bypass surgeries may cause dumping syndrome. This occurs when food moves too quickly through the stomach and intestines. It causes nausea, weakness, sweating, faintness, and possibly diarrhea soon after eating. These symptoms are made worse by eating highly refined, high-calorie foods (like sweets). In some cases you may become so weak that you have to lie down until the symptoms pass.

Why It Is Done

Although guidelines vary, surgery is generally considered when your body mass index is 40 or higher or you have a life-threatening or disabling condition related to your weight.

Your doctor may only consider doing gastric bypass surgery if you have not been able to lose weight with other treatments.

The following conditions may also be required or are at least considered:

• You have been obese for at least 5 years.
• You do not have an ongoing problem with alcohol.
• You do not have untreated depression or another major psychiatric disorder.
• You are between 18 and 65 years of age.

All surgeries have risk, and it is important for you and your health professional to discuss your treatment options to decide what is best for your situation.

How Well It Works

Most people who have gastric bypass surgery quickly begin to lose weight and continue to lose weight for up to 12 months. One study noted that people lost about one-third of their excess weight (the weight above what is considered healthy) in 1 to 4 years. Some of the lost weight may be regained.

The laparoscopic approach showed similar results, with 69% to 82% of excess weight lost over 12 to 54 months.

Risks

Risks common to all surgeries for weight loss include an infection in the incision, a leak from the stomach into the abdominal cavity or where the intestine is connected (resulting in an infection called peritonitis), and a blood clot in the lung (pulmonary embolism). About one-third of all people having surgery for obesity develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis.

Fewer than 3 in 200 (1.5%) people die after surgery for weight loss.

After a Roux-en-Y gastric bypass:

• An iron and vitamin B12 deficiency occurs more than 30% of the time. About 50% of those with an iron deficiency develop anemia.
• The connection between the stomach and the intestines narrows (stomal stenosis) 5% to 15% of the time, leading to nausea and vomiting after eating.
• Ulcers develop 5% to 15% of the time.
• The staples may pull loose.
• Hernia may develop.
• The bypassed stomach may enlarge, resulting in hiccups and bloating.

What To Think About

In a gastric bypass, the part of the intestine where many minerals and vitamins are most easily absorbed is bypassed. Because of this, you may have a deficiency in iron, calcium, magnesium, or vitamins. This can lead to long-term problems, such as osteoporosis. To prevent vitamin and mineral deficiencies, you may need to work with a dietitian to plan meals, and you may need to take extra vitamin B12 as pills, shots, or nasal spray.

There is also a possibility that you may develop gallstones after gastric bypass. Sometimes the gallbladder is removed as part of the surgery. But if your gallbladder is not removed, then you may need to take medicine to prevent gallstones.

Early studies of the laparoscopic approach to surgery for obesity suggest that it reduces recovery time and postsurgery complications.