Weight loss surgery – Gastric banding

The Lap band is a device which has been inserted for the purpose of weight loss for over 20 years.  Because it was the first weight loss procedure to be performed with keyhole surgery it soon became popular amongst both surgeons and patients alike.  It is the lowest operative risk of all bariatric operations, involves usually just an overnight stay in hospital and most patients can return to work in one week.  Apart from the general risks of any surgery, the only operative risk of Lap band surgery is the very small risk of gastric or oesophageal perforation (less than 1 per 1000).

The band works by making the patient feel full after eating a small amount of food.  This is achieved because the band delays the transit of food through the upper part of the stomach which stimulates stretch receptors in the stomach wall in that area.  These stimulated receptors send a signal to the satiety (fullness) center in the hypothalamus part of the brain and the patient feels full.

Following the surgery, the patient is required to attend for band adjustments to achieve the correct level of satiety (green zone) and be happy with their food intake.  The adjustments are performed via a port which is connected to the band and sits under the skin on the abdominal wall.  This is just an “in-office” procedure.  Long term, on average, patients achieve around 50-55% of excess weight loss.  The procedure is fully reversible.

Advantage:

The major advantage of the procedure is its low risk and this is still attractive to some patients.

Disadvantage:

The major disadvantage of the band however, is the high rate of secondary (revisional) surgery required because of the development of complications related to the band over time.  These problems are:

1. Band slippage which may be acute or chronic
2. Pouch and/or oesophageal dilatation above the band
3. Band Erosion into the stomach
4. Band infection
5. Port problems (flipping, infection, pain)
6. Band intolerance where the patient finds it difficult to cope with the dietary restrictions of the band

Overall up to 30% of band patients require revisional surgery, band removal or port revision over time, and many need more than one revisional procedure

The lap band can work extremely well if the patient learns how to eat correctly with it, but there are many patients who find it difficult.  There are some surgeons who no longer perform the procedure because of the intense follow up required and the high revision rate.

VBSC still offers the procedure in selected patients and for those who request it because of its safety.

This document must be read in conjunction with the Royal Australasian College of Surgeons booklet on obesity surgery.  Particular note needs to be taken of post-operative symptoms that if they occur, you should contact your surgeon or go to the nearest Emergency Department. 

Please note the after-hours number for the VSC and your particular surgeon.