Gastric Band Surgery for Weight Loss (Lap Band)

Why should I consider Lap-Band Surgery for weight loss?

Patients suffering from Severe or Morbid Obesity should consider surgery when diet and exercise regimens have been unsuccessful. It has been shown in multiple studies that patients with a BMI over 35 have difficulty successfully maintaining significant weight loss, with significant defined as losing 10% of ones total body weight.(30lb weight loss in a 300lb person) There is a prevailing theory called the “Set Point Theory” which is based on the premise that the brain has a “set point” as to the number of calories the body needs. In patients who are obese and begin to diet the caloric intake drops below this set point and the brain interprets that as starvation. The body then attempts to protect itself by increasing hunger making it difficult to maintain the diet necessary to lose weight. Surgery seems to “reset” that point at much fewer calories thereby controlling hunger and making it possible to maintain a diet long term.

 

What are the long term risks and benefits of weight loss surgery?

The benefits of weight loss surgery far outweigh the risks. Studies published in the New England Journal of Medicine have compared patients with a BMI over 35 who have had surgery vs those who have not. The surgery group’s risk of early death decreased by 30-40%. Surgery has tremendous benefits in decreasing severity or even putting into remision diseases like Diabetes, High Blood Pressure, Sleep Apnea, Arthritic Pain, GERD, and Urinary Incontinence. It has also been shown to decrease the risk of developing certain cancers such as Ovarian, Breast, Uterine and Colon Cancer. Additionally, in our practice, we have seen patients’ nutritional status improve after bariatric surgery.

What is Lap-Band Surgery?

This is considered a purely “restrictive” procedure meaning weight loss occurs by decreasing the amount of food a person can eat. The Lap-Band is a silicone based device with an inner balloon that completely encircles the upper portion of the stomach creating a small pouch. The emptying of the pouch may be adjusted after surgery by accessing a port under the skin to add or remove fluid from the band. This allows your surgeon to provide more or less restriction according to yourweight loss. This procedure is generally performed using a laparoscopic technique which most often results in a shorter recovery period.

What is the Greater Curve Plication?

The Greater Curve Plication is a newer technique for placing the Lap-Band that offers patients many advantages over the traditional Lap-Band. It involves using sutures to plicate or imbricate the greater curve or left side of the stomach. Essentially this acts to create a pleat in the stomach which significantly decreases the volume of the stomach below the band. Advantages include faster initial weight loss, fewer adjustments of the Lap-Band (translating into fewer return office visits), and decreased risks of slippage of the Lap-Band which would require additional surgery to repair. It is able to do this while maintaining full reversibility because no portion of the stomach is removed.

What can I expect after surgery?

By performing the surgery laparoscopically most patients can go home the day of surgery or the day after. The post operative diet is essentially the same for all bariatric surgery with a weekly progression of liquids to pureed to solid foods. This is to allow for healing of the stomach and to prevent vomiting while the swelling of the stomach resolves. Weight loss tends to be a little slower with the Lap-Band, unless the greater curve plication is added, but weight loss continues to occur for a longer time. The total weight loss may be a little less than with other options, but this is not significant from a medical nor cosmetic standpoint. There may also be some additional soreness under the patients left ribcage where the Lap-Band access port is attached to the muscle of the abdominal wall.

What do you mean by adjustments?

The Lap-Band acts by creating a small upper pouch of stomach above the band. When this pouch fills with food it causes the pouch to stretch sending a signal to the brain that the stomach is full and thereby decreasing hunger. The size of the pouch allows for smaller portions than before the Lap-Band to create this sensation. The objective is to maintain this satiety or fullness for longer periods of time which decreases the urge to come off the diet. If hunger returns within 1-2 hours after eating then the Lap-Band is tightened or adjusted by inflating the inner balloon. This slows the emptying of the pouch which keeps the stretch on the stomach for longer periods thereby decreasing hunger. If hunger can be controlled then dieting becomes more successful.

Why do some people not loose sufficient weight after Lap-Band surgery?

This phenomenon can occur after any bariatric surgery. All operations are meant to be tools to help you loose weight. It is still dependent on you to eat the right types of food as well as the correct amounts. Avoiding bad habits such as sugars and sweets and persistent grazing will increase the success after Lap-Band surgery. This operation will make it difficult to eat too much at one time, and will help with appetite control, but it will not prevent you from eating sugar especially in the liquid form. One should only consider weight loss surgery of any kind when committed to making a lifestyle change and using surgery to help maintain that change.

What is the next step to be considered for Lap-Band surgery?

If you have tried dieting without success and are interested in an option with a proven record of success, come to a free seminar to learn more about surgical options for weight loss. At this seminar you will meet one of our surgeons as well as other members of our weight loss team. The medical, social and psychologic aspects of obesity will be discussed as will your surgical options. The intent is to give the patient sufficient knowledge to know if surgery is right for them, and if so, an understanding of the surgical options to pick which is right for you. You can sign up for a seminar by clicking here.

 

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