Overweight, obesity and morbid obesity are serious health conditions that are adversely affecting quality of life and lifespan in an increasingly large proportion of the population. Lap-Band surgery is a surgical weight loss procedure approved by the US Food and Drug Administration (FDA) and it is among the most common types of surgeries used to address the problem of obesity.

Weight loss or bariatric surgery may be an option for patients who previously tried and failed to lose weight with other medically supervised weight loss programs, including behavioral alterations, pre-packed meals and pharmacotherapy. Patients need to have a Body Mass Index (BMI) higher than 40 or higher than 35 and suffer from a comorbidity, such as high blood pressure, diabetes or heart disease,[1] in order to be eligible for Lap-Band surgery.

The surgery consists of the placement of a silicone band around the upper part of the stomach, causing a reduction in the organ’s size. The second step is to connect the inflatable inner surface of the band to an access port through a thin tube. The Lap-Band does not cause weight loss in and of itself, but the patient will feel full faster and with smaller amounts of food, since it limits food intake based on the tightness of the band, which can be adjusted by regulating the amount of fluid injected into the band by a physician.

Patients often express concerns about the safety and health dangers of weight loss surgery. Despite the fact that weight loss surgery may be the last option to lose weight, research[2] has consistently demonstrated that Lap-Band surgery, as well as other bariatric procedures, are both safe and effective.[3] To make the best health decision, patients need, however, to consult with their doctors and be aware of the dangers associated with the procedure.

Lap-Band Dangers: Possible Risks

While proven to be a safe procedure, there are risks associated with the Lap-Band surgery, and potential complications that may occur. The percentage of patients who suffer unexpected side effects from the surgery vary slightly, depending on the research, but one study[4]  conducted in 2007 that confirmed that it occurs in 26% of the cases. The registered side effects of a Lap-Band surgery include:

  • band problems
  • blood clots
  • bowel function changes
  • bowel perforations
  • esophageal dilation
  • food trapping
  • gallstones
  • Gastroesophageal Reflux Disease (GERD)
  • hiatal hernia
  • indigestion (Dyspepsia)
  • food intolerance, nausea
  • vomiting
  • pneumonia
  • port problems
  • pouch dilation

The most common adverse events registered as a result of the Lap-Band is vomiting, which occurs in 28.9% of the cases, followed by indigestion (22.1%), acid reflux (14.8%), and nausea (5.4%[5]. These most common side-effects of the Lap-Band, however, are frequently associated with a lack of patient compliance and not a malfunction of the band itself. There are methods to reduce the probability of suffering from these side-effects and complications, particularly by adhering to the best practices of the device. In a consumer update entitled, “FDA Targets Gastric Band Weight-Loss Claims” issued by the FDA in 2001, public health officials warned of the critical importance of adhering to the Lap-Band’s indications:

Gastric banding requires a drastic diet change—you need to eat small portions frequently to prevent complications and ensure weight loss, says Lerner. “If you eat or drink more than your stomach pouch can hold, the pouch will stretch and food may back up into the esophagus. You may have nausea and vomiting, and require an adjustment of the band.”

And if patients eat a lot of fattening foods or drink milkshakes or other high-calorie liquids, they may not lose a lot of weight.

The dangers associated with the Lap-Band can also be mitigates by both physician intervention and patient compliance, which is why the Lap-Band is an overall safe treatment.

Lap-Band Dangers: How To Avoid Them

There are numerous accounts of “Lap-Band Horror Stories” on the internet, typically posted on blogs and social media by gastric band surgery patients who give anecdotal accounts of their own experiences with the Lap-Band. While any surgical procedure always poses risks to the patient, the evolution of bariatric surgery has greatly reduced these risks. The Lap-Band is currently placed in the patient’s body through a minimally invasive laparoscopic surgery, which means that the surgeon only makes small incisions in the abdomen to introduce the surgical instruments and a small camera called a laparoscope.

This method is used instead of open surgery, which reduces the risks of surgical complication. Overall, the proven safety record of the procedure is demonstrated by its very low mortality rate of 0.1%[8]. In addition to the surgical method, seeking out an experienced bariatric surgery professional also helps reduce the risks. By the time the FDA approved the Lap-Band in 2001, the company that currently commercializes it, Apollo Endosurgery, presented extensive results of safety and efficacy clinical trials for the device as well as the procedure. Apollo Endosurgery continues to test and evaluate the product through “FDA post approval studies.”

The Lap-Band continues to be a preferred option for obese patients since it is minimally invasive and not permanent, as the gastric band can be removed at any time, unlike other weight loss surgeries, such as sleeve gastrectomy, which permanently change the digestive tract. In addition, several clinical trials have demonstrated the effectiveness of the Lap-Band, which is able to help patients achieve their weight loss goals, as well as improve comorbidities, such as type 2 diabetes[6].

Lap-Band Dangers: Patient Influence

While a small percentage of gastric band patients have suffered serious adverse medical events, the high-profile accounts of so-called Lap-Band dangers are not generally supported by science. In the 2007 study cited above, both the safety of effectiveness of the Lap-Band were evaluated in 135 women (90.6%) and 14 men (9.4%) submitted to the surgery. Only 7 participants, or 4.7% of the study needed a reoperation, of whom four were submitted to an explantation (removal of the band) due to a serious adverse event, two were submitted to “port revisions” (repositioning of the port so that the band can be filled with saline), and one repositioning of band due to slippage.[4]

The behavior and compliance of patients after the surgery is crucial aspect of the treatment being a success. Not only does patient compliance directly determine the success of the treatment, but it also helps reduce the risk of complications. An increasing number of people are having the band removed, making for an increase in anecdotal stories suggesting that the device isn’t safe. However, research revealed that the greatest cause for explantation of the lack of patient compliance with the device.

This means that a segment of gastric band patients are not committing to the lifestyle alterations needed to assure safety and effectiveness of the Lap-Band, as well as avoid potential dangers. A healthy diet and regular physical activity are important and should be discussed with a physician. In the same way, patients need to be willing to give up alcohol and drug addictions. Ultimately, the Lap-Band is indicated as a long-term weight loss treatment and additional surgeries may be needed to enhance the results, correct potential problems and ensure the safety of the patient.

The system is not recommended for patients younger than 18 years old, patients with conditions that may make them poor surgical candidates or increase the risk of poor results, including inflammatory or cardiopulmonary diseases, gastrointestinal conditions, symptoms or family history of autoimmune disease, and cirrhosis. Pregnant women are also not candidates for the Lap-Band surgery.

References:

[1] FDA Approval for Lap-Band, February, 2011.

[2] “The Sleeve Bypass Trial: a multicentre randomized controlled trial comparing the long term outcome of laparoscopic sleeve gastrectomy and gastric bypass for morbid obesity in terms of excess BMI loss percentage and quality of life,” August, 2015. “Bariatric Surgery: Three Surgical Techniques, Patient Care, Risks, and Outcomes,” August, 2015. “Laparoscopic sleeve gastrectomy in obese Korean patients: up to 4-year follow-up in a single center,” May, 2015.

[3] “Is Laparoscopic Bariatric Surgery a Safe Option in Extremely High-Risk Morbidly Obese Patients?” August, 2015.

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