LAPAROSCOPIC ADJUSTABLE GASTRIC BAND (LAP-BAND)
Laparoscopic Adjustable Gastric Band (LAGB or lap-band) is a device which is placed laparoscopically around the stomach and is usually same day surgery. The Lap-Band was originally introduced in the United States in 2001 and was upgraded in 2007. The Apollo Lap-Band is currently the state of the art Adjustable Gastric Band in the United States and is the one we currently use in our practice.
In this procedure a silicone band with an inner balloon that can be inflated and deflated is placed laparoscopically and secured around the upper portion of the stomach, so that there is a small amount of stomach above the band with the rest of the stomach below. There is no cutting or removal of the stomach during this procedure. The band is fixed by wrapping and stitching part of the stomach around the band so that the band can heal in a fixed position where it is placed. The band is attached by tubing to a port that can accept a needle. This port is sewn on to the anterior muscle wall, below the skin and fatty tissue, and once healed it cannot generally be felt by the patient. The port can be accessed by those trained to do port access in the office setting.
Weight loss is achieved by accessing the port and inflating the band around the stomach so that the stomach is narrowed in an hourglass like fashion, to a very small amount of stomach above the band, and the rest of the normal stomach below. Food will stop for a short period of time above the band and give the patient an early full signal, so that they can eat a very small portion and feel full. Food passes through the banded area, into the normal stomach, and then through normal digestion. With band adjustments the amount of food, the type of food, and the amount of hunger the patient experiences can all be manipulated by the amount of saline injected into the band.
With the Lap-Band patients lose up to 60% of their excess weight over a one to two year period and are able to keep about 40% to 50% of the excess weight off long term. This is true for about 60% to 80% of lap-band patients.
Advantages of the Lap Band:
- It is least invasive weight loss procedure. There is no rerouting or cutting of the stomach or intestine.
- It has the lowest mortality (death) rate (1/10,000).
- It is reversible.
- It is versatile, as those patients with the band can always have the fluid adjusted (for medical treatments, pregnancies, vacations, etc).
- Greater than fifty percent of patients have been able to keep of 40% or greater of their weight off up to ten years.
- 25% to 35% of patients have complete remission of comorbidities greater than ten years.
Disadvantages of the Lap Band that may lead to band removal and/ or revision:
- Chronic reflux, heartburn, vomiting.
- Failure to lose weight.
- Weight regain.
- Band migration, slippages or rarely erosion into the stomach.
- Port complications.
Robert V. McKeen, M.D.