Bariatric surgery is a type of weight loss procedure meant for patients with a Body Mass Index higher than 40, or a BMI of 35 and an associated disease, such as high blood pressure, heart disease, diabetes, metabolic disease or sleep apnea. The procedure limits food intake by reducing the stomach’s capacity and size, causing malabsorption of calories, which is an effective approach to weight loss in cases of severe or morbid obesity. Due to improvements and advancements to the procedures, it is now possible for surgeons to perform weight loss surgery using minimally invasive techniques.
The Lap-Band system is placed during a procedure called adjustable gastric banding, during which a rubber ring is implanted around the upper part of the stomach, creating a smaller pouch. By restricting the opening and size of the organ, patients eat less and feel full faster. The Lap-Band is inserted deflated and it is filled and adjusted with saline solution. Additional but more simple procedures may be needed to readjust, reposition or remove the band. The Lap-Band is the only reversible type of bariatric surgery, but it also includes a series of risks that should the considered. The treatment does not begin or end at the surgery, but it is a long-term journey.
Prior to the Lap-Band Placement
Even before deciding to undergo the surgery, patients are analyzed by a medical team, who evaluate overall health, the need for bariatric surgery and eligibility criteria, while patients should get informed about implications like the risks associated with Lap-Band, the potential results and the commitment needed both before and after the surgery. Prior to the surgery, patients will have to conduct lifestyle alterations, including the elimination of bread, rice, pasta and potatoes, crackers, chips, pretzels, or any other high-carbohydrate snack food, cookies, cakes, pies, candy or any sugar-sweetened food, sweetened drinks and full-strength juices, processed, fast, fried, breaded and saucy foods.
In addition, patients are expected to focus on eating protein foods, like very lean cuts of beef, game, lamb, pork, poultry, seafood, eggs and soy foods, fresh vegetables and fruits, and low-fat or fat-free dairy products. However, the medical team will inform the patient about specific requirements months before the surgery. Other recommendations may include planing meals ahead to ensure proper food choices, drink at least 64 ounces of water daily, avoid alcohol, taking a multivitamin and mineral and calcium supplement and initiate a minimum of 10 minutes of daily activity may also be recommended.
This is a long process from first seeing a doctor and actually having the surgery. During this process, patients also need to consider the costs of the all journey, as well as seek for insurance coverage or payment plans. Days before the Lap-Band surgery, the medical team provides specific instructions on the preparation for the day, as well as conduct lab tests and exams, control the medication taken by the patients and ask them to quit smoking. Patients may also need to plan the recovery, home and work arrangements, and ask for the help of family or friends during the first days.
Lap-Band Surgical Procedure
The day before the Lap-Band procedure, patients are demanded to follow the two main guidelines to reduce the possibility of side effects, which are not eating or drinking anything the night before so that the stomach is empty to minimize surgical risks, as well as having someone to be at the hospital and offer both comfort and support. On the scheduled day, the Lap-Band system is inserted surgically during a procedure that can be performed either as open surgery or laparoscopically. Currently it is much more common to be submitted to a laparoscopic adjustable gastric band surgery, which is a much less invasive procedure.
The surgeon makes five to six small incisions in the abdomen to insert the surgical instruments and a small camera, called laparoscope, to increase visibility. Following this first step, the physician uses the transmitted image to place the deflated silicone band around the upper part of the stomach, forming a ring. Attached to the band is a thin tube and an access port, which will remain under the skin and will be used for the adjustments of the band. Patients will need to stay in the hospital for one day or two after the surgery, but Lap-Band is the type of bariatric surgery with fastest recovery.
Compression stockings may be used during the hospital stay and it is important for patients to start moving right after the surgery in order to prevent side effects like blood clots. Other risks associated with the surgery include abdominal and chest pain, dehydration, gallstones, gastrointestinal inflammation or swelling, allergies to the anesthesia or medications, thrombosis, embolism, stroke, heart attack or even death.
Following the Lap-Band Surgery
The recovery to a Lap-Band surgery includes staying at home for about two weeks before getting back to work. In addition, patients will have to commit to dietary changes, starting with a liquid diet to enable the stomach to heal. Patients will gradually transition to pureed and then solid foods, a process that will take months and is accompanied by bariatric vitamins. In addition, part of the recovery includes regular medical visits following the surgery. Physicians will evaluate the healing and recovery and will adjust the band, being he first inflation of the band occurs after the patient recovers from the surgery, usually four to six weeks after.
In order to adjust the band, the physician inserts a needle through the skin into the access port to add or remove saline solution, making the band either tighter or looser depending on the needs of the patient. A Lap-Band system does not provoke weight loss alone, it help patients in the process but needs to be accompanied by an healthy diet and regular physical activity. Patients submitted to a treatment with Lap-Band can expect an average of 40 to 50% percent of excess weight, but some patients fail to lose at least 50% of excess body weight, typically due to a lack of patient compliance to the accompanying weight loss program.
In addition to the complications that can occur right after the surgery, there are also potential long-term side effects. The greatest risk from a Lap-Band is related to its placement, which can result in erosion, slippage or partial displacement. There are also tubing-related complications, which include both port disconnection and tubing. Band leak, esophageal spasm, gastroesophageal reflux disease (GERD), inflammation, infection, regurgitation, nausea, acid reflux, constipation or diarrhea are also potential complications.