Lap Band History - in case anyone is interested

[NCIS 0]

I hope this is helpful for others..it's on wikipedia. Just in case anyone is interested..I was not aware of a lot of the info. Does everyone already know all of this? Good luck to all!

Adjustable gastric band

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Jump to: sleep apnea, food each meal. This pouch fills with food quickly and the band slows the passage of food from the pouch to the lower part of the stomach. As the upper part of the stomach registers as full, the message to the Calcium supplements and Vitamin B12 injections are not generally required following gastric banding (as they are with RNY, for example). Fluid and restriction, and likewise require a minor operation).

Internal bleeding

Infection

The band lifetime combined incidence of all complications is of the order of 10%.

The psychological effects of any weight loss procedure also must not be ignored, as a proportion of patients fail to lose weight (often because they subconsciously develop strategies to defeat the band and maintain their status quo which they have become psychologically habituated to). Continued counselling, dietary advice and interaction with WLS support groups - locally and/or on the web - is widely seen as being of considerable help to patients, and can make the difference between success and failure. Many patients perceive themselves as having previously failed at every other weight loss strategy, and consequently their trigger threshold for giving up on WLS is often low, even after substantial financial commitment.

[liquid that contains a radio-opaque fluid similar to barium—clear or white. When swallowed, the fluid is clearly shown on X–ray and is watched as it travels down the esophagus and through the restriction caused by the band. The radiologist is then able to see the level of restriction in the band and to assess if there are potential or developing issues of concern. These may include dilation of the esophagus, an enlarged pouch, prolapsed stomach (when part of the stomach moves into the band where it does not belong), erosion or migration. Reflux type symptoms may indicate too great a restriction and further investigation may be required. In some circumstances fluid is removed from the band prior to further investigation and re-evaluation. In some cases further surgery may be required (e.g. removal of the band) should gastric erosion or similar be detected.

Some health practitioners adjust the band without the use of X-ray control (fluoroscopy). For example, this is standard practice in the main bariatric surgery clinic in Melbourne, Australia, where AGB placement has been performed for more than ten years. Some UK services, such as Bristol, also do non-fluoroscopic adjustments. In these cases, patients visiting for a regular fill adjustment will typically find they will spend more time talking about the adjustment and their progress than the actual fill itself, which generally will only take about one to two minutes..

For some patients this type of fill is not possible, due to issues such as partial rotation of the port, or excess tissue above the port making it difficult to determine its precise location. In these cases, a fluoroscope will generally be used.

No accurate number of adjustments required can be given. However, an average may be estimated to be between three and five fills (where saline/isotonic solution is inserted into the band via the subcutaneous port) for a person to reach the optimal restriction for weight loss. The amount of saline/isotonic solution needed in the band varies from patient to patient. There are a small number of people who find they do not need a fill at all and have sufficient restriction immediately following surgery. Others may need significant adjustments to the maximum the band is able to hold. Bands come in several diameters and sizes and can hold a total of between 4 cc (ml) to 12 cc (ml) of fill fluid depending on the design. Band size is usually determined by personal preference of the surgeon who places the band together with what s/he is either able to use (e.g., specific bands approved in country of surgery) or what s/he believes to be the most appropriate. In Europe, for example, it is possible for the surgeon to use many designs. The size of the band used is determined by the surgeon during surgery based on the size and thickness of the patient's stomach.

It is more common practice for the band not to be filled at surgery—although some surgeons choose to place a small amount in the band at the time of surgery. The stomach tends to swell following surgery and it is possible that too great a restriction would be achieved if filled at that time. Clearly, this is undesirable.

The patient may be prescribed a liquid-only diet, followed by mushy foods and then solids. This is prescribed for a varied length of time and each surgeon and manufacturer varies. Some may find that before their first fill that they are still able to eat fairly large portions. This is not surprising since before the fill there is little or no restriction and this is why a proper post-op diet and a good after-care plan is essential to success. Many health practitioners make the first adjustment between 6 – 8 weeks post operatively to allow the stomach time to heal. After that, fills are performed as needed. Some practitioners may be more aggressive than others, but most appear to require a 2 – 4 week wait between fills. It is very important to discuss post-surgical care and diet plans with your weight loss team if you are considering this surgery. Recommendations can vary dramatically from team to team and it is important to find a weight loss team with a good post-surgical plan. Some teams offer support groups, but unfortunately many of them mix RNY and gastric bypass patients with gastric banding patients. Some gastric band patients have criticized this approach because while many of the underlying issues related to obesity are the same, the needs and challenges of the two groups are very different, as are their early rates of weight loss. Some gastric band recipients feel the procedure is a failure when they see that RNY patients generally lose weight faster.

[edit] Effectiveness

The average gastric banding patient loses 500 grams to a kilogram (1-2 pounds) per week consistently, but heavier patients often lose faster in the beginning.[citation needed] This comes to roughly 22 to 45 kilograms the first year for most band patients. It is important to keep in mind that while most of the RNY patients drop the weight faster in the beginning, some studies have found that LAGB patients will have the same percentage of excess weight loss and comparable ability to keep it off after only a couple of years. Gastric banding patients may have to work a little harder in the first couple of years, but the procedure tends to encourage better eating habits which, in turn, helps in producing long term weight stability. However, with greater experience and longer patient follow up, multiple series are now being reported that have found suboptimal weight loss and high complication rates for the gastric band, particularly when used in younger patients.[citation needed]

A systematic review concluded "LAGB has been shown to produce a significant loss of excess weight while maintaining low rates of short-term complications and reducing obesity-related comorbidities. LAGB may not result in the most weight loss but it may be an option for bariatric patients who prefer or who are better suited to undergo less invasive and reversible surgery with lower perioperative complication rates. One caution with LAGB is the uncertainty about whether the low complication rate extends past three years, given a possibility of increased band-related complications (e.g., erosion, slippage) requiring re-operation".[24]

The Royal College of Surgeons of England held a national consensus meeting on the status of bariatric surgery in the UK on 21st January 2010, in the course of which the President, John Black, drew attention to the inequality of access to WLS across the nation (in many strategic health authority areas the NICE thresholds for surgery are being ignored as bariatric service provision is geographically patchy and financial commitment is inadequate).

[edit] Single Incision Laparoscopic Surgery (SILS)

Single Incision Laparoscopic Surgery (SILS) is an advanced, minimally invasive (keyhole) procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient’s umbulicus (navel). Special articulating instruments and access ports obviate the need to place trochars externally for triangulation, thus allowing the creation of a small, solitary portal of entry into the abdomen. SILS has been used for several common surgical procedures including hernia repair [25], cholecystectomy [26] and nephrectomy [27]. The SILS technique has also been used in weight-loss surgery for both sleeve gastrectomy [28] and – more recently – for laparoscopic adjustable gastric banding (LAGB) [29].

[edit] The LAP-BAND in Australia

According to an August 2006 article in The Medical Journal of Australia [1], over 90% of weight loss surgeries in Australia are installations of the laparoscopic adjustable gastric band. Some of the more interesting findings in the study are these:

Our group has treated more than 2700 severely obese patients with the LAGB procedure since 1994 without a single perioperative death. In contrast, mortality from RYGB is reported at between 0 and 5%, with the ASERNIP-S systematic review showing a mean short-term mortality rate of 0.5% — ten times the risk of LAGB. [...]

All bariatric procedures have been able to achieve loss of more than 50% of excess weight. The ASERNIP-S systematic review showed greater weight loss after RYGB than LAGB during the first 2 years after the procedure, but the difference in weight loss was not significant at 3 and 4 years. In a recent review, we extended the data of the ASERNIP-S review by including all studies that included at least 50 patients, reported up to March 2004. This showed a substantial weight loss after both procedures, with an initial greater weight loss after RYGB but similar effectiveness for both procedures at 4, 5 and 6 years.