FAQs about band complications

sleepyjean · January 2, 2006

I thought this was a really great FAQ that answers a few more questions beyond the usual what is a band/how is it adjusted type of question. Also, interestingly, the doctor talks about the causes and repair of erosion, slippage, and pouch dilation. This docter says erosion has to do with the way the band is stitched to your stomach. If that's true, it might explain why erosion is more likely to happen with some surgeons than with others. Just a thought.

liquids. That said, average weight loss is 50% of excess weight at 5 years. But this includes all patients, including those who have lost little or no weight.

How is the Band adjusted?

The Band is tightened by accessing the port with a needle. This is most commonly done in the office. Some surgeons do it at the hospital under x-ray guidance, but this is generally not necessary, and makes the procedure much more expensive. For patients with very thick abdominal walls, it may be more difficult to find the port. In our office we have an ultrasound machine which makes it possible to access most ports without need for x-ray.

Can I adjust my own Band?

In theory, yes. But the answer is NO. NO. NO :confused: (you just know somebody has tried this at home)

Why do I have to take Vitamins?

The LapBand operation is purely restrictive, so technically you don't need to take vitamins if you are eating a healthy diet. On the other hand, by definition you are eating a hypo-caloric diet, one which will cause you to lose weight. Because of this, we worry that you won't get all the vitamins and minerals you need. This is the main reason we ask you to take vitamins after the surgery.

What about the gallbladder?

We don't remove the gallbladder unless you already have gallstones that are causing symptoms. Weight loss is slow and natural, so the risk of gallstones is not sufficiently elevated as to make gallbladder removal worth doing.

Can the Band be rejected by my body?

The Band is made of silicone rubber, and cannot be rejected. Of course it can become infected and require removal, but this is not the same as being rejected like a transplanted organ.

What happens after I lose my weight?

The Band causes you to lose weight by restricting your caloric intake to less than your caloric expenditure. As you lose weight, your calorie requirements diminish. Once intake matches expenditure, you stop losing weight.

How long does the Band stay in?

The Band stays in forever. If it is removed you will regain all the weight you lost.

What is a slipped Band, and what causes it?

There are two types of slippage; anterior and posterior. This refers to whether the front or back side of the stomach slips. There is something else called concentric pouch dilation, but this is not the same as slippage. Slippage or prolapse is when the stomach slides up through the Band, making the pouch bigger. If this happens the Band usually becomes too tight, and patients experience symptoms of reflux (heartburn) as well as nausea and vomiting. This is because the amount of stomach being “squeezed” by the Band is increased, thereby obstructing the Band.

There are several causes. Posterior slippage was more common when the Band was placed by the “perigastric” technique. With this technique the back side of the stomach was free to slide up through the Band. These days most surgeons use the “pars flaccida” technique, which was developed to prevent posterior slippage, and has more or less eliminated the incidence of this problem.

Anterior slippage is when the front of the stomach slips up through the Band. We try to prevent this by suturing the stomach below the Band to the stomach above the Band, “locking” the Band in place in the right spot. In spite of this, slippage still occurs. It can happen because we haven't placed enough stitches, or they haven't been placed in the right place. Slippage can also occur if patients eat too much and vomit frequently.

How is a slipped Band diagnosed?

Fortunately, this is very easy. Often the diagnosis is made based on the history alone. A patient who has been going along fine, with no problems, and then suddenly develops reflux symptoms or symptoms of a too-tight Band will most likely have a slipped Band. The diagnosis is easily confirmed with an x-ray and barium swallow examination. Endoscopy is rarely necessary.

How is a slipped Band fixed?

A slipped Band needs to be fixed with an operation. The Band has to be dissected out, all the sutures removed, and the position of the stomach made right. Some surgeons remove the Band and place it back through a new tunnel. Others just straighten things out and re-suture the stomach over the Band.

What happens if the Band slips again?

That's a tough one. One could certainly try to fix the slip again, but my personal view is that, for whatever reason, the Band is just not working for that particular patient, and ought to be removed.

What is a Band erosion?

This is when the Band actually erodes into the stomach. It is a more serious problem, and generally requires removal of the Band. Band erosion is thought to be related to placing too many sutures (or too tight sutures) at the time of Band implantation. Surprisingly, Band erosion is often unnoticed. Occasionally the port will become infected if bacteria track along the catheter out to the port. Other times patients will stop losing weight. Diagnosis often requires an endoscopy.

What is concentric pouch dilation?

This is technically not the same as slippage. In this case the pouch just seems to be enlarged. Sometimes partial emptying of the Band may help with this.

What is esophageal dilation?

This is when the esophagus enlarges over time, and is probably related to either too tight a Band, or possibly improper placement of the Band around the junction of the esophagus and stomach. This requires loosening or removal of the Band.

What happens if my Band has to be removed because of complications or failure to lose weight?

One option, of course, is to give up on weight loss surgery. Another option is to convert to another procedure such as Roux-en-Y gastric bypass. This can be done at the same time the Band is removed, and is generally done laparoscopically.

If you have questions that have not been answered by this FAQ, please send them to me and I will try to answer them for you.

Mark A Pleatman MD

43494 Woodward Ave. #202

Bloomfield Hills, Michigan 48302

Office Hours: 9:00 AM to 5:00 PM

Phone: (248) 334-5444

Fax: (248) 334-5484

Email: pleatman@laparoscopy.com

NeenBand · January 2, 2006

Good faq from a doc, thanks for posting it.

Kryssa · January 3, 2006

Thanks for the post. I think this is the first Dr that admits complications have more to do with the surgeon than the patient. Interesting...

NJChick · January 3, 2006

How long does the Band stay in?

The Band stays in forever. If it is removed you will regain all the weight you lost.

This is wonderful information. I just have a hard time with this quote. How do they know that everyone will regain ALL the weight. I can see most will, and some will regain some. But to say everyone will regain ALL.

I'd like to see the studies done on this.