Adjustable Gastric Band (Lap-Band)

The adjustable gastric band is the least invasive type of weight loss surgery because it does not alter your body physiology. It's usually, but not always, laparoscopic, and can sometimes be done as an outpatient procedure. This is the only bariatric procedure that is both adjustable and reversible. It's also called:

• Gastric band
• Laparoscopic adjustable gastric band
• Lap-band
• Brand names common in the U.S.: LAP-BAND® System and REALIZE™ Band

When you get the adjustable gastric band, no part of your stomach is removed. Instead, the gastric band goes around the upper portion of your stomach. About 15% of your stomach is above the band. This small stomach pouch can hold only about one-half of a cup (4 ounces) and is called the stoma. The remaining 85% of your stomach is below the band.

When you swallow food, the food goes down your throat and into your stoma. The gastric band prevents it from quickly dropping into the lower 85% of your stomach. That way, you become full when your small stoma fills up. This happens earlier (when you have eaten less) than it happened before you got the gastric band. Before you got the band, you might not have felt full until your entire stomach was filled with food. This may help explain why the gastric band helps you eat less and lose weight.

Bariatric surgeons are now looking at another possible way the band might help you eat less so you lose weight. They explain that the walls of your esophagus (just above the stoma) need to move a little more in order to push food through the gastric band from your stoma into your stomach. The movement is a signal to your brain that you are full.

Once you have eaten, food eventually passes through the band into the lower, large stomach pouch. Then, just like it did before you got the band, it passes into the small intestine for digestion and absorption. The gastric band doesn't change nutrient absorption.

An adjustable gastric band system has three components made of hypoallergenic silicon.

• Gastric band that goes around your stomach to create a small upper stoma that is separated from the lower portion of your stomach
• Access port implanted under the skin under your ribs or near your belly button that allows your surgeon to inject or withdraw saline solution to increase (inflate) or decrease (deflate) band volume
• Connection Tubing that saline solution travels through to get from or to the access port to or from the gastric band with doing a fill or deflation

Advantages and Disadvantages of the LAP-BAND®

Advantages of the Lap-Band

• Quick recovery; can sometimes be performed as an outpatient procedure with no overnight hospital stay
• The only bariatric surgery procedure designed to be adjustable
• Lower risk of nutritional deficiencies
• Reversible if necessary
• Lower risk of serious complications than the other surgeries

Disadvantages of the Lap-Band

• Slower weight loss in the first year than the gastric sleeve and bypass procedures¹
• Higher rates of minor but recurring complications, such as regurgitation and belching, dysphagia (trouble swallowing) and dyspepsia (upset stomach)
• Need to return to your surgeon for fills and adjustments. Your first fill will be four to 6 weeks after surgery, and most patients adjust the fill level five to eight times in the first year. It may take several attempts before you find the fill level that is restrictive enough to help you lose weight but is not so restrictive that you have more complications
• Have foreign objects (the gastric band, the connection tube and the access port) implanted inside your body
• Doesn't prevent you from eating high-sugar, high-calorie foods or from drinking high-calorie beverages that can prevent weight loss
• Always need to be cautious about obstructions and getting food stuck in the band, so may need to avoid certain fried, doughy, sticky and sharp foods for life

Possible Complications/Risks of the LAP-BAND®

• Gastroesophageal reflux disease, or GERD, with severe heartburn
• Band slippage
• Leakage from the thin connection tubing
• Esophageal dilation causing heartburn and requiring band deflation and possibly surgery to have your band repositioned or replaced
• Pouch dilation (stretching of your pouch)
• Gastritis (inflammation of the stomach) or esophagitis (inflammation of the esophagus)

Weight Loss with the LAP-BAND®

These are results of some studies on patients with the lap-band. Note that heavier patients have a greater amount of original excess weight, so even if they lose the same number of pounds as lighter patients, their percent excess weight lost (EWL) is lower.

• 65% of EWL at one year among obese patients (BMI 30 to 40)
• 69% of these patients lost more than 50% of excess body weight (EBW)
• 36% of EWL at three years post-surgery among morbidly obese patients (BMI over 40)
• 22% of these patients lost more than 50% EBW
• 58% of superobese (starting BMI greater than 50) patients lost more than 25% EBW over three years
• 15% of superobese patients lost more than 50% EBW

Restrictive surgery: the lap-band helps you eat less food. The stoma, or small portion of your stomach located above the lap-band, is only the size of one-half cup, or 15% of your original stomach size. This small pouch fills up faster so that you feel full after eating only a small amount of food and don't eat as much at a single meal.

Fills and Adjustments

The gastric band like an inflatable tire, except that instead of inflating it with air, your surgeon inflates, or fills, it with saline solution (a liquid). A fuller band squeezes your stomach more and causes more restriction and faster weight loss. However, it also increases your chances of having regurgitation and night coughing. A band that's not full enough won't restrict your food intake much because your food will pass through the band quickly from the stoma down to your larger stomach pouch. That can slow weight loss.

How Fills Work

You need to visit your surgeon to get a fill or adjustment, but it can be done in a regular appointment; it doesn't require special preparation. Your access port isn't visible to you because it's under your skin, but surgeon will be able to find it by feeling for it or taking an X-ray. Your surgeon will use a needle to prick your skin and inject saline solution into your access port. The fluid travels through the connection tubing and into your gastric band. Never try to perform an adjustment on yourself.

When Will You Get Fills and Adjustments?

When your surgeon inserts the gastric band, it's unfilled or only slightly filled. Keeping the band nearly empty lets your surgery wounds heal faster. About 4 to 6 weeks after surgery, when you're progressing to a semi-solid foods diet, you'll get your first fill. Your surgeon will fill your band to a level that will hopefully help you lose weight without causing more side effects. You'll later need to get an adjustment to increase your fill level if you don't feel restriction and aren't losing weight as fast as you'd hoped; you should get an adjustment to decrease your fill level if you're having trouble eating and/or have symptoms such as pain, vomiting or regurgitation.

Most patients need five to eight adjustments to fill or unfill their bands in their first year after surgery before finding their "green zone," or sweet spot. Each time, you need to visit your surgeon. Your best fill level will probably be somewhere below the maximum fill level rather than at the highest possible level.

Aim for the Green Zone

The LAP-BAND® System uses the idea of the "green zone" to help you figure out if your fill level is right. The "green zone" is the fill volume, or level of fill, that is best for you. If you're not in the “green zone,” you need to get an adjustment.

• Green zone: Your weight loss is about two pounds per week and you're not too hungry between meals. No adjustment is necessary.
• Yellow zone: You don't feel enough restriction, so you're hungry between meals and may eat portions that are too large. Weight loss is slower than your goal. Solution: adjust your fill level to make it larger—add fluid to the band.
• Red zone: You have regurgitation and trouble eating. Solution: adjust your fill level to make it a smaller volume—take fluid out from the band.

When You May Need to Deflate the Gastric Band

An advantage of the lap-band is that it is adjustable. You can make the band tighter (fill it to a higher fill volume) to increase restriction and speed weight loss. Sometimes, a deflation (unfill) is necessary.

• To let your throat (esophagus) heal if you have a complication, such as esophageal dilation with a painful, swollen throat
• When you're ill and are vomiting
• If you get pregnant and need to eat more to provide enough nutrients to your child
• You develop an obstruction that's preventing you from being able to swallow