Adjustable Gastric Banding

What is a 'restrictive weight loss' surgery?

Restrictive weight loss surgery is when we put a device in or suture the stomach or the intestine so that it becomes more difficult for food to pass through that area. The example, today the most popular procedure is called the laparoscopic adjustible gastric band. And that is a band. It's made of silastic that goes in around the top of the stomach with a port that is put in just under your skin. We put a needle through your skin into the port, inject saline. It blows up a balloon in the band and decreases the size of the opening, the size of the opening in the stomach so that you can't eat as rapidly as you would normally expect to be able to.

Who should choose to have lap-band surgery?

Patients who choose lap-band surgery have made that decision usually knowing what gastric bypass is vs. the lap-band. Gastric bypass has more complications, higher death rate, higher morbidity rate than the band surgery. The lap-band is a little less successful than the gastric bypass. That is controversial in the surgical literature. The lap-band is a foreign body that is being put into the patient's body and can cause problems. Once a patient has learned all the differences, they make a decision. Are they willing to take the risks of the gastric bypass versus no, would they rather have the band.

What are the advantages and disadvantages of lap-band surgery?

The advantage of lap-band surgery is lesser stay in the hospital, less complication rate and faster return to activity. The downside of the laproscopic band is that you have a foreign body that can erode, get infected, cause various problems and then have to be removed.

Can lap-band surgery be dangerous or fatal?

Lap-band surgery has its complications even though it's a lot less than gastric bypass. Death rate reported in the literature is about 1 in 1000. That's maybe 1/4 of the rate of gastric bypass. There are complications of the band eroding into the stomach and then patients have to have the band removed or the stomach slipping up under the band or the band slipping around causing the stomach to go up and then the band again has to be deflated and repositioned or removed.

How successful is lap-band surgery?

Lap-band surgery is reported to be anywhere from 50, 60, 70% successful, meaning that over a five year period a patient loses 60 to 80% of their excess weight and keeps it off.

How new is lap-band surgery?

The lap-band, I think the first time it was done was '93 or '95. So it's been around for 10 to 12 years. It's been done mostly in Europe. The FDA approved the lap-band in the United States in 2000 or 2001. So it's a relatively new procedure, but thousands upon thousands of them have been done. It's proved to be efficacious and with a low complication rate.

What are the chances of gaining weight back after lap-band surgery?

Chances of gaining weight back after lap-band surgery are probably 50%, 40-50%. Some of those are patients who just don't tolerate the band and we have to keep the fluid out. Some of them are the ones who have had the band removed. And some are, they get around the fact that they have a small restriction. I hate to talk about how you can get around these procedures, but people figure out how to do it because they want to maintain their weight. So they find ways of eating very high calorie, less dense food, not as solid. They can take a lot of that in.