The Laparoscopic Adjustable Band
(Lap-Band)

Introduction to the Laparoscopic Adjustable Band Procedure -
(Lap-Band)

You may have heard of the Laparoscopic adjustable band procedure (referred to as the Lap-Band).  It is now the second most common weight loss surgery procedure performed in the United States. At present it is the least invasive and safest weight loss procedure available – so much so that it is becoming the procedure of choice in the adolescent population. We perform the Lap-Band Laparoscopically, and at present our Weight Loss Surgery Program is the only one in Kansas and several states in the area performing the duodenal switch, biliopancreatic diversion and revision surgery laparoscopically, as well as the Lap-Band and Bypass operation. 

The Lap-Band is a restrictive procedure.  The band is placed around the very top portion of the stomach, inducing weight loss by restricting how much food can be eaten at any one time.  The most appealing feature of the lap-band is the ability to adjust it without additional surgery, allowing a proper fit for every patient.  By adjusting the band the surgeon can adjust the pouch outlet size to increase the degree of restriction felt by the patient.  The smaller the outlet size, the better it will work to control meal portion size, prolong satiety, reduce hunger and cravings, and thus reduce calorie intake.

Unlike other weight loss surgery procedures, placement of the band does not alter the gastrointestinal tract.  No stapling or cutting of the stomach or the intestine reduces potential surgical complications, such as leakage and infection.

The lap-band, like other weight loss surgery procedures, is able to improve and often eliminate the medical disease associated with obesity in more than 80% of cases.  An average 60% of excess weight loss can be expected to be lost with the lap-band.  With good compliance more can be lost, with an 85% chance of maintaining the weight loss long term.

Proceeding with weight loss surgery is a very personal and often difficult decision.  Educating yourself about weight loss surgery is a very important first step.  Although the information presented here may be very helpful, patients have repeatedly told us that attending the weight loss surgery informational seminar helped the most.

For those of you who are not from Kansas, we treat many patients from out-of-state, and from all across the United States.  When contacting the office please inform the staff that you are out-of-state and access our out-of-state link for more information on how we can help you with the preparatory process.

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Am I a Candidate for the Lap-Band Weight Loss Surgery?

To be a candidate for any type of weight loss surgery, the individual must be morbidly obese.  Below are tools you can use to determine if you are morbidly obese and potentially a candidate for the Lap-Band. If you determine you are morbidly obese you are a candidate for the Lap-Band Operation.

Morbid obesity is usually defined as being 100 pounds over the ideal body weight. A better way of defining morbid obesity is by using the Body Mass Index (BMI). BMI is a calculated number that takes weight and height into consideration. A person weighing 300 pounds that is 5ft tall will have a higher BMI than a person weighing 300 pounds but is 6ft tall.  A BMI above 40 indicates that a person is severely obese and therefore a candidate for surgery. Surgery may also be an option for people with a BMI between 35 and 40 who already suffer from cardiopulmonary problems or diabetes.

You are likely morbidly obese if you:

• Are more than 100 lbs. over your ideal body weight, or have a Body Mass Index (BMI) of over 40
• Have a BMI of 35 or greater and are experiencing severe negative health effects of co-morbidities, such as high blood pressure, diabetes, sleep apnea, reflux disease, high cholesterol, etc. related to being severely overweight
• Are unable to achieve a healthy body weight for a sustained period of time, even through medically supervised dieting
• Have physical, psychological, social, or economic problems that could be significantly improved by weight loss

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The Lap-Band Weight Loss Procedure

The Lap-Band is a pure restrictive operation.  The operation is done laparoscopically with 5 small incisions.  Your hospital stay can be as short as 5 hours, or up to 24 hours, and it is possible to return to work in less then 1 week from the time of surgery.  If you do light duty at work, it is possible to go back to work even sooner for some patients.

The Lap-Band is performed laparoscopicaly - with thin and long shafted instruments, the band made of inflatable silicone is placed around the very top portion of the patient's stomach. Like a wristwatch, the band is fastened around the upper stomach to create a new, tiny stomach pouch. This small pouch takes over as your working stomach despite still being connected to the larger, remaining part of your stomach. This small pouch effectively limits and controls the amount of food you can eat at any one meal.

By adjusting the band we can create a very small outlet. The smaller the outlet is, the slower the pouch will empty. As a result, patients experience the sensation of fullness much sooner, with smaller amounts of food. To modify the size of the band, it is inflated or deflated with saline solution. The band is connected by tubing to an access port, which is placed well below the skin during surgery (it is not outside the body). It is usually placed on the right hand side of your abdominal wall. It is placed very deep below the skin over the muscle fascia. After the operation, the surgeon can control the amount of saline in the band by accessing the port with a fine needle through the skin. Adjustments to the band are performed without additional surgery.

Lap-Band Fill Function Video (37 sec)

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How Does the Lap-Band Work?

The band divides the stomach into two parts. The smaller, upper stomach takes over as the dominant functioning stomach. As food is swallowed, it enters the new stomach first. The band is adjusted till the correct outlet size for your pouch is reached. The size of the pouch limits how much food you can eat, while the size of the outlet controls how quickly it can empty. The tighter the outlet the longer it will take for food to leave the pouch. The longer the pouch is full the longer you experience satiety and no hunger.

The small pouch and small outlet produce early satiety, that in a cooperative, compliant patient induces behavioral changes leading to less caloric intake, and therefore, weight loss. Inadequate chewing can result in pain, or reflux. Patients must eat slowly, reduce meal and bite size, and avoid overeating or drinking fluids with calories. Failure to follow these guidelines can defeat the purpose of the surgery. The amount of weight that you will lose will depend on the band as well as on your motivation and compliance.

The Lap-band Diet Guide is available for more information about the lap-band diet after surgery.

Animated Lap-Band Video (44 sec)

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Advantages of the Lap-Band Weight Loss Surgery

The medical and emotional benefits of the Lap-Band procedure begin within a few months after surgery, and the cosmetic benefits follow in their wake. Over time the benefits of Lap-Band surgery may include:

• significant sustained weight loss
• blood sugar levels that become completely normal within 1 year of surgery
• lower or normal blood pressure
• lower or normal cholesterol levels
• relief from sleep apnea, acid reflux, and urinary stress incontinence
• less arthritis pain and improved mobility
• increased energy and ability to exercise
• improved mood and self-esteem
• arrested progression of heart disease
• improvement of many lung conditions
• exercise endurance

The benefits of the Lap-Band are similar to other obesity surgery procedures. It continues to be the least invasive weight loss surgery operation available.  If performed by our doctors you do not need to stay in the hospital over night.  You will be fully recovered within a weeks time up to 2 weeks.  A 60% excess weight loss can be expected with the Lap-Band. 80% to 90% of patients are able to maintain their weight loss long-term. Weight loss with the lap-band is similar, but slower compared to other weight loss surgery procedures.

For more detail please review Risks and Benefits of Surgery

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Risks of the Lap-Band Weight Loss Surgery

Complications can occur as with any type of surgery – please review Risks and Benefits of Surgery. Below is a list of the specific complications that are unique to the Lap-Band procedure.

• Infection requiring band removal (rare)
• Stomach prolapse/slippage - requiring possible re-operation (3-4%)
• Gastric pouch outlet obstruction/swelling (rare)
• Band erosion (rare)
• Port/tubing mechanical failure (rare)
• It is necessary to take nutritional supplements after the operation. These include:
  • Multivitamin (one per day)
  • Calcium (usually twice per day) 

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Deciding on the Lap-Band Weight Loss Surgery

The decision about which operation is best for you is a complicated and very personal decision. Although the information presented here may be helpful, you will be able to learn substantially more about the benefits and risks of the Lap-Band operation during your consultation with the bariatric surgeon or at our free weight loss surgery seminars.

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The Weight Loss Surgery Program at IABS, Kansas City

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The Next Step after Your Weight Loss Surgery

Proceeding with weight loss surgery is a very personal and often difficult decision.  Educating yourself about weight loss surgery informational seminars is a very important first step.  Although the information presented here may be very helpful, patients have repeatedly told us, that attending the weight loss surgery helped them the most.  At the seminar, you will be able to separate fact from fiction, meet the surgeons, ask questions, and hear testimonials from patients who have already undergone weight loss surgery. The patient testimonials are often the highlight of the seminar.  Individuals considering weight loss surgery enjoy talking to patients and getting first hand accounts of how the operations have worked for them and how it has changed their lives. 

The next step is to meet in consultation with the surgeon.  The visit has multiple purposes:  determine your health and operative risk, discuss which operation may be best for you, answer your specific questions and concerns, and start the preparatory process toward getting insurance pre-approval and scheduling your surgery.  You can save about 45 minutes of your time at the doctor’s office by filling out the New Patient Forms prior to coming for your doctor consultation.

While waiting for your insurance approval or obtaining your medical work-up, start reading the Preparatory Guide and the Lap-Band Diet Guide.  These will prepare you for your surgery as well as what to expect after your operation.  For further questions do not hesitate to contact the office at (913) 322-7401.

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