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Laparoscopic Adjustable Gastric Band(LapBand)
Definition

This procedure is done to treat obesity . Small incisions are made in the abdomen. An adjustable band is placed around the stomach with the aid of a tiny tool with a camera on it. The tube is called a laparoscope. The surgery causes weight loss by decreasing the amount of food that can pass into your stomach.

Adjustable Gastric Banding


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Reasons for Procedure

This surgery treats severe obesity. Body mass index (BMI) calculations are used to determine how overweight or obese you are. A normal BMI is 18.5-25.

This surgery is a weight loss option for people with:

  • BMI greater than 40
  • BMI 35-39.9 and a life-threatening condition or severe physical limitations that affect employment, movement, and family life

The success of this surgery depends on your commitment and follow-up with your doctor. If lifestyle changes are made and maintained, the benefits of bariatric surgery include:

  • Weight reduction
  • Improvement in obesity-related conditions
  • Improved movement and stamina
  • Enhanced mood, self-esteem, and quality of life
Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Bleeding
  • Infection
  • Blood clots
  • Vomiting
  • Slipping or wearing away of the band
  • Erosion of the band into the stomach, which may require open surgical repair
  • Erosion of gastric wall
  • Port complications
  • Injury to other organs
  • Irritation of the throat due to acid reflux
  • Complications of general anesthesia
  • Death

Long-term complications include vomiting and gallstones.

In some cases, the procedure may not result in weight loss. This may lead to removal of the band or the use of another bariatric procedure.

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications, such as:

What to Expect
Prior to Procedure

Each bariatric surgery program has specific requirements. You may have the following done:

  • Thorough physical exam and review of your medical history
  • Mental health evaluation and counseling
  • Ongoing consultations with a registered dietitian
  • Program to help you lose weight through diet and exercise

Leading up to your procedure:

  • Talk to your doctor about your medications, herbs, and dietary supplements. You may be asked to stop taking some medications up to 1 week before the procedure.
  • Do not start any new medications, herbs, or supplements without talking to your doctor.
  • Arrange for a ride to and from the hospital. Also, arrange for help at home.
  • If advised by your doctor, take antibiotics.
  • The night before, eat a light meal. Do not eat or drink anything after midnight unless told otherwise by your doctor. You may be given laxatives and/or an enema to clear your intestines.
  • Shower or bathe the morning of your surgery.

Anesthesia

General anesthesia will be used. You will be asleep for the surgery.

Description of the Procedure

To prepare you for surgery, an IV will be placed. You may receive fluids and medications through the IV during the procedure. A breathing tube will be placed through your mouth and into your windpipe. This will help you breathe during surgery. You will also have a catheter placed in your bladder to drain urine.

Several small incisions will be made in the abdomen. Gas will be pumped in to inflate your abdomen. This will make it easier for the doctor to see. A laparoscope and surgical tools will be inserted through the incisions. A laparoscope is a thin, lighted tool with a tiny camera. It sends images of your abdominal cavity to a monitor in the operating room. Your doctor will operate while viewing the area on this monitor.

An adjustable round band is placed around the top of the stomach and fastened into place. This creates a smaller stomach area for food. Tubing is placed from the band to an access port in the abdominal wall. The band can later be adjusted with a special saline solution and needle syringe. The incisions will be closed with staples or stitches.

Immediately After Procedure

The breathing tube will be removed. You will be taken to the recovery area while the anesthesia wears off.

How Long Will It Take?

30-60 minutes

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

The usual length of stay is 1-2 days. You may be kept longer if needed.

Post-procedure Care
At the Hospital

While you are recovering at the hospital:

  • Pain medication will be given as needed.
  • On the day after the surgery, x-rays will be taken to make sure the band is in place. If everything looks fine, you will be given fluids, then progress to pureed food.
  • You may be asked to do the following:
    • Use an incentive spirometer to take deep breaths every hour. This is to prevent breathing problems.
    • Wear elastic surgical stockings or boots. This is to promote blood flow in your legs.
    • Get up and walk to circulate blood and promote healing.
Preventing Infection

During your stay, the hospital staff will take steps to reduce your chance of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chance of infection, such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home

Be sure to follow your doctor’s instructions. You will need to practice lifelong healthy eating and exercising habits. Keep in mind after your surgery:

  • It will take 2-4 weeks to fully recover. You may be out of work for several days after surgery.
  • Meet regularly with your healthcare team for monitoring and support.
  • Your doctor may recommend that you meet with a therapist to discuss emotional changes after surgery.

Your new stomach pouch will be the size of a small egg. It will be slow to empty. This will make you feel full quickly. Nutritional guidelines include:

  • Eat very small amounts and eat very slowly. You will begin with 4-6 small meals per day. A meal is two ounces of food.
  • For the first 4-6 weeks, all food must be pureed. After you move to solid foods, food must be well-chewed. When making food choices, ensure that you are getting enough protein.
  • Eating too much or too quickly can cause vomiting or intense pain under your breastbone. Most people quickly learn how much food they can eat.
  • This procedure does not cause nausea and diarrhea if sweet or fatty foods are eaten. In fact, some people gain back weight because they continue to eat high-calorie foods. To promote ongoing weight loss, you will need to eat healthy foods.
  • Follow your doctor’s instructions.
Call Your Doctor

Call your doctor if any of these occur:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision sites
  • Pain that you cannot control with the medications you have been given
  • Blood in the stool
  • Constipation that lasts more than two days
  • Pain, burning, urgency, or frequency of urination, or persistent bleeding in the urine
  • Persistent nausea and/or vomiting
  • Pain and/or swelling in your feet, calves, or legs
  • Persistent cough
  • New or worsening symptoms

Call for emergency medical services right away for:

  • Shortness of breath
  • Chest pain

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

American Gastroenterological Association
http://www.gastro.org

Family Doctor—American Academy of Family Physicians
http://www.familydoctor.org

CANADIAN RESOURCES:

Canadian Association of Gastroenterology
http://www.cag-acg.org

Health Canada
http://www.hc-sc.gc.ca

References:

Bariatric surgery. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 3, 2014. Accessed December 1, 2014.

Gastric band operation. The British United Provident Association website. Available at: http://www.bupa.co.uk/individuals/health-information/directory/g/gastric-band. Accessed December 1, 2014.

LapBand surgery information. Center for the Treatment of Obesity, University of California San Diego Medical Center website. Available at: http://health.ucsd.edu/specialties/surgery/bariatric/weight-loss-surgery/gastric-band/Pages/default.aspx. Accessed December 1, 2014.

Maciejewski ML, Livingston EH, et al. Survival among high-risk patients after bariatric surgery. JAMA. 2011;305(23):2419-2426.

6/24/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Pontiroli AE, Morabito A. Long-term prevention of mortality in morbid obesity through bariatric surgery. a systematic review and meta-analysis of trials performed with gastric banding and gastric bypass. Ann Surg. 2011;253(3):484-487.

1/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Jensen M, Ryan D, et al. 2013 AHA/ACC/TOS Guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. Nov 12 2013.



Last reviewed November 2014 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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