Laparoscopic Adjustable Gastric Banding

Laparoscopic Adjustable Gastric Banding, commonly referred to as Lap Band surgery, is a type of minimally invasive weight loss surgery (bariatric surgery) that involves wrapping a band around a part of the stomach to reduce its size and limit the capacity of food intake.

The band used for the surgery is an adjustable, inflatable silicone ring which is placed around the stomach to divide it into 2 parts: a small, upper pouch and a larger, lower pouch. The upper pouch, being smaller, fills up quickly with food giving a feeling of fullness or satiety. This limits excessive intake of food and promotes weight loss. The Lap-Band surgery is a restrictive weight loss surgery and does not involve cutting or stapling of the stomach as do other bariatric surgeries.

Indications

Lap-Band surgery is recommended for obese patients when non-surgical options such as lifestyle modifications and weight loss medication are unsuccessful in reducing weight.

Lap-Band surgery is indicated for obese patients with:

  • Body mass index (BMI) of 40 (or)
  • A BMI of 30 with one or more obesity-associated complications

Contraindications

Lap-Band surgery is contraindicated or not recommended in patients with:

  • Gastrointestinal or inflammatory diseases such as ulcers, oesophagitis and Crohn’s disease
  • Severe heart, lung or liver diseases
  • Hernias (protrusion of a body organ from its cavity)
  • History of auto immune diseases such as scleroderma or systemic lupus erythematous
  • Alcohol or drug addiction
  • Under the age of 18 years
  • Pregnancy
  • Chronic pancreatitis (inflammation of the pancreas)
  • Presence of infection

Surgical procedure

Lap-Band surgery is performed laparoscopically under general anaesthesia. Your surgeon makes a few small incisions in the abdominal wall and inserts a laparoscope, a lighted fibre optic tube with a camera attached to its end, into one incision. Small surgical instruments are inserted through the other incisions. Your surgeon will be able to see the internal structures of the abdomen on a monitor with images sent from the camera.

The band is placed around the upper part of the stomach to divide it into two sections: a smaller, upper pouch and a larger, lower pouch. The band is then secured and fastened with sutures. The band is inflated with sterile saline until it attains the correct diameter to optimally constrict the stomach. In order to adjust the band, an access port connected to the band is placed under the skin of the abdomen. This enables your surgeon to loosen (deflate) or tighten (inflate) the band by injecting or aspirating saline solution as needed. Finally, the incisions are closed.

Post-surgical care

After the surgery, you are required to stay in the hospital for about 2-3 days. You will be given pain medications to keep you comfortable. Your nurse will help you to move at the earliest after the surgery to prevent blood clots, respiratory problems and bedsores. To check if the lap-band is in appropriate position an X-ray of your stomach will be advised a day after the surgery. You will be kept on a liquid diet for the first 2 weeks. Your surgeon or dietician will give you a specific diet plan and instructions to follow after the surgery. It is important to drink plenty of fluids throughout the day to avoid dehydration.

Advantages

Lap band surgery has advantages over other weight loss surgeries including:

  • Safer and less invasive procedure
  • Fewer complications
  • Quicker recovery
  • Shorter hospital stay
  • Ability to adjust the band for customising weight loss
  • Ability to reverse the surgery
  • No stapling or cutting of the stomach or re-routing of intestines

Risks and complications

As with any major surgical procedure, Lap band surgery also carries some risks to the patient.

The common risks and complications associated with lap-band surgery include:

  • Internal bleeding
  • Infection
  • Nausea and vomiting
  • Band slippage or deflation
  • Oesophageal dilation
  • Erosion of stomach
  • Obstruction of stomach
  • Irreversible damage to stomach requiring surgery