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Laparoscopic Adjustable Gastric Banding
A purely gastric restrictive procedure. The Lap-Band is a device designed to produce a small upper gastric pouch, and a narrow opening into the lower stomach. It causes a sense of fullness after only a few bites of food. It helps the patient to choose to reduce food intake, and to lose weight.
The Lap-Band is one of the procedures offered by the Rocky Mountain Weight Loss Surgery Associates.
The Laparoscopic Adjustable polymer Gastric Band (Lap-Band®, Inamed) was approved by the FDA in June 2001, for use in treatment of severe obesity.
 How the Lap-Band procedure is performed
Gastric Banding is a variation on gastroplasty, in which the stomach is
neither opened nor stapled - a band is placed around the outside of the
upper stomach to create an hourglass-shaped stomach, and to produce a small pouch with a narrow outlet. The special device used to accomplish this is made of implantable polymer, and contains an adjustable balloon, which allows us to adjust the function of the band, without re-operation.
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The Appeal of Laparoscopic Adjustable Gastric Banding: the Lap-Band
(Compared to the Gastric Bypass and the malabsorptive procedures.)
- The Lap-Band is the safest weight loss procedure. The mortality (death rate) associated with the Lap-Band procedure is ten times less than with Gastric Bypass and over 20 times less than the malabsorptive procedures. The mortality rate with the Lap-Band is 0.05 % (1/2000), with Gastric Bypass 0.5% (1/200), and with the malabsorptive procedures is 1.1% (>1/100).
- The Lap-Band provides better short term and long-term safety. The Lap-Band generally has fewer complications and the complications overall are less significant.
- The Lap-Band is less “physiologically” disruptive. The recovery is faster and easier. The recovery time is the shortest of all the weight loss procedures.
- The Lap-Band is inserted laparoscopically, without a major incision, with just a short stay - usually overnight. The recovery time is the shortest of all the weight loss procedures and can often allow the patient to take just a few days to return work.
- With the Lap-Band, there is no opening made into the stomach or intestine and no staple lines, so the risk of leakage and infection is profoundly reduced.
- The Lap-Band does not radically reconfigure the intestine or the stomach and food passes through the digestive tract in the natural sequence order.
- With the Lap-Band, problems with vitamin and mineral deficiencies and metabolic problems are virtually non-existent.
- The Lap-Band is reversible, by laparoscopic removal of the band.
- The Lap-Band is potentially convertible to another operation, if the procedure fails to maintain the desired weight loss. A conversion is associated with a higher risk.
- Lap-Band patients continue to get a sense of fullness with very little oral intake.
- The Lap-Band is adjustable. Weight loss can be customized. The band is adjustable in the office setting.
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The lap band is adjustable!
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Risks and Concerns of Laparoscopic Adjustable Gastric Banding
(Compared to the Gastric Bypass and the malabsorptive procedures.)
- Concern: After the Lap-Band is placed; the upper stomach pouch may enlarge in very rare cases, either due to slippage or breakage of the band, or stretching of the wall of the pouch. This may cause poor weight loss, reflux of gastric acid causing heartburn, and can lead to obstruction of the stomach outlet. Stretching of the upper stomach wall can, in rare cases, cause irreversible damage to the upper stomach and the esophagus. In some cases there may be a need to remove the band, and/or convert to a different weight loss procedure. Repeat operations are more risky. Careful follow-up with the surgeon, patient compliance, and careful adjustment of the band can help avoid such problems. A tighter band does not necessarily mean more weight loss.
- Characteristic of the Lap-Band: Weight loss with the Lap-Band is steady and slow. The goal is to lose one to two pounds a week. The dramatic weight loss seen with the Gastric Bypass is not the case, and resolution of medical problems associated with obesity will occur, but at a much slower pace with the Lap-Band. (See chart: Weight Loss: Lap-Band.)
This is a graph that shows three Lap-Band surgeon’s weight loss curve from 2 to 4 years. The weight loss is slow and steady.
- Characteristic of the Lap-Band: At the present time, Insurance companies are somewhat less likely to cover the cost of Lap-Band surgery. However, you may be pleasantly surprised that your insurance company does. More and more are covering the Lap Band every day. If not, many patients choose to finance this procedure and this is a very reasonable thing to do. Please explore the the Lap Band website in this regard. http://www.lapband.com/lapband/costsandinsurance.do The Lap-Band is very affordable. Please do not have another weight loss surgery if Lap-Band seems right for you.
- Overall weight loss. Statistically, the weight loss MAY not be quite as good as other procedures in the short term and in the long term. This claim is strongly argued against by the proponents of the Lap-Band. The studies from Europe and Australia (as well as early studies in the United States) on the Lap-Band demonstrate good weight loss and durable weight loss. The American data is still maturing. It is true that the Lap-Band has not been performed as long as the Gastric Bypass. The Lap-Band proponents believe that there are higher rates of late weight loss failures with the Gastric Bypass, so that in the long term, greater than five years, the weight loss is similar. The Gastric Bypass proponents believe that there are higher rates of late weight loss failures with the Lap-Band. The data is mixed and there is no clear answer, yet. (See chart: Compared Weight Loss Over Time.)
Compared Weight Loss Over Time. This graph shows ONE study that may show that the weight loss over time (5 years) is similar with Gastric Bypass and Lap-Band. Most Gastric Bypass Surgeons think that this is not true and weight loss will be somewhat better (10-15%) over the long term with Gastric Bypass.
- Characteristic of the Lap-Band: At the present time, Insurance companies are less likely to cover the cost of Lap-Band surgery. Therefore most patients will pay out of pocket for this procedure. Please do not have another weight loss surgery if Lap-Band seems right for you. The Lap-Band is very affordable, and less expensive in the grand scheme of life than you might think.
Lap-Band Frequently Asked Questions
Be sure to visit the Inamed Lap-Band site for more information.
In Summary:
Over several years, many thousands of polymer gastric bands have been placed and used with impressive success in most patients. Their safety is well established. As with any weight loss surgery, the anatomic change is a powerful tool that can be used by the patient with great success if they educate themselves and develop good habits over time.
Although the Lap-Band's effects may not be as profound as the Gastric Bypass (and this fact is argued by the surgeons with longer term experience with the Lap-Band and the manufacturers), the risk of the procedure appears to be less, and the recovery time is the shortest.
The Rocky Mountain Weight Loss Surgery Associates recommend and offer laparoscopic short limb Gastric Bypass Roux-en-Y as well as offer the Lap-Band procedure. For most patients, Gastric Bypass Roux-en-Y AND the Lap-Band appears to be the weight loss procedures with excellent ratios of benefits and risks, when compared to other purely gastric restrictive procedures and those procedures with significant malabsorptive components. The Gastric Bypass Roux-en-Y AND the Lap-Band provide excellent short term and long-term weight loss, yet the short term and long term complication rates are low.
- In comparison with Lap-Band, Malabsorptive procedures have more profound concerns about short-term mortality, morbidity as well as long term metabolic and lifestyle issues. See our note about the malabsorptive procedures.
- In comparison with Lap-Band, Laparoscopic Gastric Bypass has a slightly higher mortality, slightly higher risk of metabolic and vitamin associated complications, a slightly longer recovery. Weight loss with Gastric Bypass is dramatic, but there is a debate on if the Lap-Band provides as much and as durable weight loss over time
Lap-Band may be the right decision for you! |
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