LAP Band Surgery

What is LAP Band Surgery?

Laparoscopic Adjustable Gastric Banding (LAP-Band Surgery), also known as Gastric Band Surgery, is a minimally invasive surgical procedure designed to aid weight loss in obese individuals. During this procedure, a flexible and adjustable band is placed around the upper part of the stomach, creating a small pouch that limits the amount of food the stomach can hold. This leads to a feeling of fullness with smaller food portions, ultimately promoting weight loss.

Who is Suitable for Gastric Band Surgery?

Gastric band surgery is generally recommended for individuals who:

Have a BMI of 30 or higher, indicating obesity, or a BMI of 40 or higher, indicating severe obesity. Individuals with a BMI of 35-39.9 may also be considered if they have significant obesity-related health issues.
Have a history of trying and failing to achieve significant and sustained weight loss through conventional methods such as diet and exercise.
Have obesity-related health conditions like type 2 diabetes, hypertension (high blood pressure), sleep apnea, or joint problems may be suitable candidates. Gastric band surgery can help improve or resolve some of these health issues.
Are willing to undergo a psychological evaluation to assess their readiness for the emotional and lifestyle changes associated with weight loss surgery.
Are willing to adhere to post-operative dietary guidelines, attend follow-up appointments, and engage in healthy habits.
Will undergo medical evaluation to ensure that the candidate is generally healthy enough for surgery and that no contraindications or significant risks are involved.
Are adults, although adolescents with severe obesity may be considered for weight loss surgery on a case-by-case basis.

Benefits of Gastric Band Surgery

Reduces Food Capacity: Limits the amount of food the stomach can hold.
Weight Loss: Induces significant excess weight loss, typically 40-50%.
Minimal Invasion: No cutting of the stomach or rerouting of intestines.
Safety: Has the lowest rate of early postoperative complications and mortality among approved bariatric procedures.
Low Risk: Poses the lowest risk for vitamin/mineral deficiencies.

Disadvantages of Gastric Band Surgery

Slower Weight Loss: Weight loss can be slower than other surgical methods.
Success Rates: More patients may not achieve a 50% excess body weight loss.
Device Required: Involves a foreign device that remains in the body.
Potential Complications: Rare occurrences include band slippage, erosion, or mechanical issues.
Dilation Risk: Overeating may lead to oesophageal dilation.
Strict Post-Op Regimen: Requires adherence to a postoperative diet and follow-up visits.
Higher Re-operation Rate: Has the highest rate of re-operation among bariatric procedures.

What are the Types of Gastric Bands?

Several types of gastric bands are available, each with unique features. The most common types include:

Adjustable Gastric Band with Port: Consists of a silicone ring and an access port connected by a tube. The port is placed beneath the skin, allowing for easy adjustment of the band's tightness.
Realise Band: This is another adjustable gastric band that works similarly to the lap band. It offers customisation and adjustability for individual needs.
Orbera Intragastric Balloon: Although not a traditional gastric band, an intragastric balloon is a non-surgical option that involves placing a silicone balloon inside the stomach to reduce its capacity temporarily.

Preparations Before Gastric Band Surgery

Before undergoing Gastric Band Surgery, it's essential to take several preparatory steps to ensure a safe and successful procedure. Here's a checklist of things to do before Gastric Band Surgery:

Schedule an initial consultation with a qualified bariatric surgeon. This is the first step to assess your suitability for the procedure and discuss your weight loss goals.
Complete a thorough medical evaluation, which may include blood tests, imaging studies, and other diagnostic tests. This helps identify any underlying health issues and ensures you are physically prepared for surgery.
Follow your surgeon's dietary guidelines in the weeks leading up to surgery. Some surgeons may recommend a pre-operative diet to reduce liver size, making the surgery technically easier.
Maintain or increase physical activity levels within your capabilities. Regular exercise can help improve your overall fitness and prepare your body for surgery.
If you smoke, consider quitting or reducing smoking as much as possible. Smoking can increase the risk of complications during and after surgery.
Begin adopting the lifestyle changes required post-surgery, including dietary modifications, portion control, and increased physical activity.
Be mentally prepared for the emotional and psychological aspects of weight loss surgery. Consider seeking counselling or support from a therapist or support group to help you cope with the changes.
Attend nutrition counselling or educational sessions to learn about the specific dietary requirements after surgery. You must understand how to make healthy food choices and manage portion sizes.
Review all medications you are currently taking with your surgeon. Some medications may need to be adjusted or temporarily discontinued before and after surgery.
Follow the fasting instructions provided by your surgical team, which usually involve refraining from eating or drinking for a specific period before the surgery.
Ensure you have a support system, including family or friends, who can assist you during recovery.
Complete any pre-operative tests or assessments your surgeon requires, such as cardiac evaluations or respiratory assessments.
Fully understand the Gastric Band Surgery procedure, including its risks and benefits. Ask your surgeon any questions you may have to address any concerns or uncertainties.
Have a final consultation with your surgeon to review your progress and ensure you are fully prepared for the surgery.
Arrange for transportation to and from the hospital on the day of the procedure. Ensure you have a comfortable and supportive recovery environment at home.
Adhere to all pre-operative instructions provided by your surgical team, including guidelines on when to stop eating and drinking before surgery.

Gastric Band Surgery Procedure

Lap Band surgery is performed laparoscopically under general anaesthesia, minimising discomfort and scarring. It involves:

Making four small incisions in the abdominal wall.
Inserting a laparoscope with a camera for visualisation.
Placing the band around the upper stomach, creating a small upper pouch.
Securing and adjusting the band with sutures.
Inflating the band with saline through an access port for optimal restriction.
Closing the incisions.

What to Expect After Gastric Band Surgery?

You will be taken to a recovery area to wake up from anaesthesia, and medical staff will monitor your vital signs.

Once fully awake and stable, you will be discharged from the hospital on the same or the following day, depending on your surgeon's recommendations.

Gastric Band Surgery Recovery Plan

Recovery from Gastric Band Surgery is a gradual process that involves specific steps and guidelines to ensure a safe and successful outcome. Here is a recovery plan to help you navigate the postoperative period:

Immediately After Surgery (Hospital Stay)

Pain Management: Your surgical team will provide pain relief medication to manage discomfort or pain. Take these medications as prescribed.
Liquid Diet: You will start with a clear liquid diet immediately after surgery. Sip small amounts of clear liquids like water, broth, and sugar-free gelatin to stay hydrated.
Hospital Stay: Most patients are discharged on the same day as the surgery. However, some may require an overnight hospital stay for observation.

Weeks 1-2: Transition to Full Liquids and Rest at Home

Full Liquid Diet: Gradually progress to a full liquid diet, including protein shakes, pureed soups, and yoghurt.
Hydration: Continue to prioritise hydration by sipping water between meals. Avoid drinking with meals to prevent discomfort.
Rest: Rest and avoid strenuous activities during this period. Focus on healing and allowing your body to adjust to the changes.

Weeks 3-4: Transition to Soft Foods and Light Activity

Soft Food Diet: Introduce soft, easily digestible foods such as mashed potatoes, scrambled eggs, and well-cooked vegetables.
Protein Intake: Ensure you meet your protein intake goals to support healing and maintain muscle mass.
Slow and Frequent Meals: Eat small, frequent meals to accommodate your reduced stomach capacity.
Light Activity: As your healthcare team recommends, begin light physical activity, such as short walks. Avoid strenuous exercise at this stage.

Months 1-6: Adapt to Dietary Changes and Regular Follow-Up

Dietary Progression: Gradually reintroduce solid foods, beginning with well-cooked and easily chewable options. Focus on balanced, nutrient-dense meals.
Port Adjustments (Fills): Visit your surgeon for band adjustments (fills) as needed to achieve the right level of restriction. These adjustments are crucial for weight loss success.
Regular Follow-Up: Continue with regular follow-up appointments with your bariatric surgeon or healthcare team to monitor your progress and address any concerns.
Lifestyle Changes: Embrace and maintain the changes required for successful weight loss. This includes portion control, healthy eating habits, and regular exercise.
Hydration: Stay well-hydrated by sipping water throughout the day. Avoid carbonated beverages, which can cause discomfort.

Months 6 and Beyond: Ongoing Maintenance and Support

Long-Term Diet: Follow a well-balanced, nutrient-rich diet and portion control. Focus on protein intake and nutrient supplementation as recommended by your healthcare team.
Exercise Routine: Gradually increase your physical activity levels and incorporate regular exercise. Exercise is essential for maintaining weight loss and overall health.
Support and Counseling: Consider participating in support groups or seeking counselling to help with weight loss and the emotional and psychological aspects of surgery.
Monitor Health: Regularly monitor your overall health and well-being. Pay attention to changes in your body, such as weight fluctuations or signs of nutritional deficiencies.
Pregnancy Planning: Discuss this with your surgeon if you plan to become pregnant. Adjustments to the band may be necessary during pregnancy.

Prognosis of Gastric Band Surgery

Various factors, including individual adherence to post-operative guidelines, can influence the prognosis after Gastric Band Surgery. Here are key points to consider:

Weight Loss: Gastric band surgery often leads to gradual and significant weight loss, reducing excess body weight.
Health Improvements: Many individuals experience better health outcomes, particularly in obesity-related conditions like type 2 diabetes, hypertension, and sleep apnea.
Lifestyle Changes: The long-term outlook depends on maintaining critical lifestyle changes, such as portion control, healthy eating habits, regular exercise, and adherence to post-surgery dietary recommendations.
Adjustments (Fills): Regular band adjustments (fills) visits are crucial for fine-tuning the band's restriction and achieving the desired weight loss.
Potential Complications: Although uncommon, there are risks like band slippage, erosion, or mechanical issues with the band, tube, or port, which can impact the prognosis and require additional medical attention.
Psychological Support: Emotional and psychological aspects of weight loss and surgery are significant. Support groups and counselling can be valuable for addressing these factors.
Individual Variation: Remember that the prognosis varies from person to person, influenced by factors such as dedication to lifestyle changes, adherence to medical advice, and overall health.

Risks Associated with Gastric Band Surgery

While Gastric Band Surgery is generally safe, it's essential to be aware of potential risks and complications. Here are common risks and concerns associated with the procedure:

Infection: Risk of infection at incision sites or around the access port.
Band Slippage: The band may shift position, requiring repositioning or further surgical intervention.
Band Erosion: This is a rare occurrence where the band erodes into the stomach wall, necessitating surgical correction.
Mechanical Problems: Issues with the band, tube, or access port may arise and require surgical intervention.
Adjustment Complications: Overfilling or underfilling the band can lead to discomfort or inadequate weight loss.
Oesophageal Dilation: Overeating or consuming large meals may cause oesophageal dilation.
Nausea and Vomiting: Some patients may experience these symptoms, often linked to rapid eating or dietary choices.
Band Removal: In certain cases, band removal may be necessary due to complications or insufficient weight loss.
Scarring: Minor scarring is typical after surgery, with laparoscopic scars being less conspicuous than open surgery scars.
Blood Clots: A slight risk of blood clots exists, particularly if post-operative mobility is limited.

FAQs About Gastric Band Surgery

Q: Is Gastric Banding always performed laparoscopically?

A: Yes, open surgery is rare. Laparoscopic surgery offers quicker recovery, less discomfort, and reduced scarring.

Q: Does the Gastric Band limit physical activity?

A: No, patients can engage in any physical activity they choose after recovery.

Q: How is the Band adjusted?

A: Adjustments are performed by doctors and surgeons, usually without pain or discomfort. They can be done anytime, but most are needed in the first 18 months.

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