Lap Band / Gastric Band for Weight Loss

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Lap band surgery, once a popular choice for weight loss, has seen a decline in popularity in recent years. In this article, we’ll break down what lap band surgery entails, the procedure and recovery, and why it may not be the go-to option for weight loss surgery anymore.

What is a Lap Band?

A lap band, short for laparoscopic adjustable gastric band, is a surgical procedure where a flexible, adjustable band is placed around the top part of your stomach. This hollow band is connected to a tube and an external port, allowing for the adjustment of tightness or looseness as needed.

The goal is to create a smaller pouch at the top of the stomach, leading to a sense of fullness with less food, ultimately promoting weight loss.

Inserting the Lap Band

The Procedure

The insertion of a lap band is a minimally invasive surgery performed under general anesthesia. The surgeon makes small incisions in the abdomen, using a laparoscope (a tube with a camera) to guide the procedure.

A small pouch is created in the upper stomach, and the lap band, a silicone ring filled with saline solution, is placed around the stomach and secured with sutures. The surgeon adjusts the band’s tightness through a port beneath the skin, allowing for changes over time to support weight loss.

The entire procedure takes about 30-60 minutes, and most patients can go home on the same day.

Adjusting the Lap Band

After surgery, the lap band is initially left empty to allow for healing. Several weeks later, the first fill occurs, where the surgeon adds saline to the band.

Further adjustments are made based on progress. For instance, if weight loss stalls, the band may be tightened, or if nausea occurs, it might be loosened.

Common side effects like heartburn and nausea may arise after each adjustment, but these usually improve over time. If symptoms persist or new issues arise, patients may need to consult their surgeon for further adjustments.

Lap Band Lifespan

The lap band is designed to be a long-term solution, intended as a permanent implant in the body. While it is meant to last for many years, various factors can influence its actual lifespan.

Factors such as your overall health, weight loss progress, and any complications that may arise play a role. In general, most patients can expect to keep their lap band for at least 10 years or more.

Lap Band Removal

Considerations

Before opting for a lap band, it’s crucial to consider the potential need for removal down the line. Some clinics may not include the removal cost in their initial fees, and the timing of removal may not be scheduled.

Since lap bands aren’t meant to stay in the body indefinitely, there may come a time when removal is necessary. If the clinic goes out of business, and you’re left without an alternative for removal, you could find yourself stuck with the lap band longer than expected.

The Removal Process

To remove a lap band, surgeons use laparoscopic tools to carefully extract the band through small cuts in the belly. The tubing and band are cut, and the band is pulled out from around the stomach.

Removal may involve addressing scar tissue and adhesions formed during the initial operation, restoring the stomach’s original anatomy. The subcutaneous port is also removed, and, in some cases, scar tissue around the upper stomach or esophagus is addressed to prevent future complications.

Cost and Weight Regain

The removal process, in some instances, can be as costly as the initial installation. Additionally, lap band removal may result in weight regain for some individuals. In such cases, patients often undergo revision surgery, transitioning to another bariatric procedure like gastric sleeve or bypass.

Many express a desire to have chosen these alternatives initially, regretting the lap band route.

Side effects and complications

Here are some of the common side effects and their approximate frequency:

Short-term side effects:

Pain and discomfort at the surgical site (common)
Nausea and vomiting (common)
Acid reflux (common)
Difficulty swallowing (common)
Infection (rare)

Long-term side effects:

Band slippage or erosion (10-20%)
Esophageal dilation (10-15%)
Gastric prolapse (1-5%)
Port site infection (1-2%)
Band malfunction or failure (1-2%)
Nutritional deficiencies (less than 1%)

It’s important to understand that addressing some of these side effects may require additional surgeries, including the potential removal of the lap band. Additionally, individuals with pre-existing inflammatory stomach issues may not be suitable candidates for a gastric band, and your surgeon will screen for these conditions.

From the experiences of patients, heartburn, reflux, excessive burping, and belching are commonly reported issues. Eating too quickly may lead to nausea and vomiting. To minimize these problems, it’s advised to eat slowly, chew thoroughly, and take small bites and portion sizes.

Frequently asked questions

Is it Reversible?

Yes, lap bands are technically reversible, offering an option to remove them without permanent changes to your stomach. However, it’s essential to note that the longer a band stays in, the greater the risk of permanent alterations and scar tissue formation. This could complicate removal and potentially impact future weight loss surgeries, such as gastric sleeve or bypass.

How Effective Is It?

Lap bands are effective, but they fall slightly behind other weight loss surgeries like gastric sleeve or bypass. While initial weight loss is achievable (around 5-10% of current weight), long-term success depends on building healthy habits.

Some patients experience substantial weight loss, exceeding 100 pounds over a few years. Yet, success varies, especially for those lacking external support.

Regular follow-ups with clinicians and surgeons are crucial to monitor progress and make necessary adjustments for sustained weight loss.

How Much Does It Cost?

In Canada, the cost of having a gastric band inserted is quite high, around $15,000 – $20,000 for the insertion alone. On average, the cost of lap band surgery in the United States can range from $8,000 to $20,000 or more.

Removal fees are not included in the insertion, and in Canada, can run anywhere from $4000 to well over $10,000. In the United States it can range from $5,000 to $10,000 or more.

Should you try it?

Gastric bands serve as a weight loss tool, but they’ve faced scrutiny regarding their potential risks and limited effectiveness compared to other surgical options. Clinicians debate whether the benefits outweigh the drawbacks.

Potential Irreversibility: While gastric bands are marketed as reversible, it’s crucial to note that they may leave lasting changes on your stomach. This includes issues like lifelong heartburn and permanent scar tissue. The damage might impact your eligibility for future weight loss surgeries on your stomach.
Hidden Costs: The total cost of inserting an removing a gastric band is significant, ranging from $20,000 to $30,000. The insertion cost sometimes doesn’t include the removal fee. If you plan to transition to a gastric sleeve or bypass in the future, starting with these options might be more cost-effective than opting for a gastric band first.
Need for Support: Success with a gastric band requires a robust support system. This includes a clinician to guide dietary and lifestyle changes and ongoing follow-ups with the clinic that installed the band for proper adjustments.

The notion of a gastric band effortlessly leading to weight loss and seamlessly disappearing once goals are achieved is optimistic. It’s essential to understand the potential challenges and discuss them thoroughly with your physician before deciding whether to try a lap band.

Ultimately, the decision to try a lap band is personal and should be made in consultation with your healthcare provider. Be informed about the potential outcomes, costs, and the importance of a strong support system to maximize the effectiveness of the gastric band as a weight loss tool.

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Citations

Safety and effectiveness of LAP-BAND AP System: results of Helping Evaluate Reduction in Obesity (HERO) prospective registry study at 1 year https://pubmed.ncbi.nlm.nih.gov/24035447/

Attributions

“Gastric Band Weight Loss Surgery Illustration” by edward.beardsell is licensed with CC BY 2.0. To view a copy of this license, visit https://creativecommons.org/licenses/by/2.0/