The band is connected by tubing to a port, which
is placed under the skin during surgery. After
surgery, the inner surface of the band is inflated
or deflated with saline solution to provide
restriction. The fill level can be adjusted
through the port access as needed.
Surgeons don’t cut, staple, or bypass any portions
of the stomach or intestines, making the Lap Band
the safest, least invasive and least traumatic of
all weight loss surgeries. The laparoscopic
surgery has the advantage of reduced post-op pain,
shorter hospital stay and quicker recovery.
If for any reason the Lap Band needs to be
removed, the stomach generally returns to its
original form.
The manufacturer of the LAP-BAND® system provides
a very detailed review of the system. |
What is a "Sleeve Gastrectomy"?
The sleeve Gastrectomy is an operation in which
the left side of the stomach is surgically
removed. This results in a new stomach which is
roughly the size and shape of a banana. Since
this operation does not involve any "rerouting"
or reconnecting the intestines, it is a simpler
operation than the gastric bypass or the
duodenal switch. Unlike the Lap-Band ® procedure,
the sleeve Gastrectomy does not require the
implantation of an artificial device inside the
abdomen.
Because the new stomach continues to function
normally there are far fewer restrictions on the
foods which patients can consume after surgery,
however the quantity of food eaten will be
considerably reduced. This is seen by many
patients as being one of the great advantages of
the sleeve Gastrectomy, as is the fact that the
removal of the majority of the stomach also
results in the virtual elimination of hormones
produced within the stomach which stimulate
hunger.
For patients with a body mass index greater than
60, the sleeve gastrectomy may be the first part
of a two-stage operation. Some patients have a
body shape that can make a bariatric surgery
more technically difficult – particularly those
patients who carry their weight in their belly.
If you fall into this category, you may benefit
from a two-stage bariatric surgery. In the
staged approach, a multi-step operation like the
gastric bypass is broken down into two simpler
and safer operations. In the first stage, a
sleeve gastrectomy is performed. This allows a
patient to lose 80 to 100 pounds or more, making
the second part of the operation substantially
safer.
Low BMI individuals who should consider
this procedure include: |
Those who are concerned about the potential long
term side effects of an intestinal bypass such
as intestinal obstruction, ulcers, anemia,
osteoporosis, protein deficiency and vitamin
deficiency.
- Those who are considering a Lap-Band® but are
concerned about a foreign body inside the
abdomen.
- Those who have medical problems that prevent
them from having weight loss surgery such as
anemia, crohn's disease, extensive prior
surgery, and other complex medical conditions.
- People who need to take anti-inflammatory
medications may also want to consider this.
Usually, these medications need to be avoided
after a gastric bypass because the risk of ulcer
is higher.
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| What advantages does it have? |
It
does not require disconnecting or reconnecting
the intestines
It
is a technically simpler operation than the
gastric bypass or the duodenal switch.
There is no foreign body inside your body
It
does not need adjustments or fills
It
may be a safer operation for patients with a
body mass index (BMI) more than 60. It may be
used as the first stage of a 2-stage operation.
Risks and Complications
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| As with any surgery, there can be complications.
This list can include: |
- Deep vein thrombophlebitis 0.5%
- Non-fatal pulmonary embolus 0.5%
- Pneumonia 0.2%
- Acute respiratory distress syndrome 0.25%
- Splenectomy 0.5%
- Gastric leak and fistula 1.0%
- Postoperative bleeding 0.5%
- Small bowel obstruction 0.0%
- Death 0.25% |
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Patients with Lap-Band® complications
If you are a patient with a previous Lap-Band®
procedure and your experiencing problems such as
reflux, esophagiis, band erosion, band slippage,
port site infection you may be a candidate for
"revision" surgery. This means removing the
Lap-band® System and performing a VSG (Gastric
Sleeve) procedure. Patients in this category are
very concerned about regaining their already
lost weight and they will greatly benefit with
the gastric sleeve procedure. At this point the
Gastric Sleeve will not only let them maintain
their weight, but will let them continue losing
more weight.
It might also be a good option if patients have
a problem with their lap band requiring
revision, have already lost a lot of weight and
don't want a full bypass. The weight loss seems
to be a little better and more rapid than the
lap band (60 - 70% EWL) over two years. However
there is still no long term data to support this
claim.
Revisions
The term "revision" is applied when one weight
loss procedure is converted or transformed into
another one. (For example; a Lap-Band® system to
Gastric Bypass or to a Gastric Sleeve.) |
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WHAT IS GASTRIC BYPASS SURGERY?
UNDERSTANDING GASTRIC BYPASS ROUX-EN-Y SURGERY:
According to the American Society for Bariatric Surgery (ASBS) and the National Institutes of Health (NIH), Roux-en-Y Gastric Bypass is the current gold standard procedure for weight loss surgery. It is also one of the most frequently performed weight loss procedures.
Gastric Bypass Roux-en-Y reduces the capacity of the stomach by creating a smaller stomach pouch. The small space holds only one ounce of fluid. The procedure also constructs a tiny stomach outlet, which slows the speed that food leaves your stomach. This allows you to feel full after eating only a small amount and you will stay satisfied for a longer period of time.
Here's How it Works:
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Staples are used to create a small (15 to 20cc) stomach pouch.
- The rest of the stomach is not removed, but is stapled completely shut and divided from the stomach pouch.
- The newly formed pouch empties directly into the lower portion of the intestine – bypassing calorie absorption.
- The small intestine is divided just beyond the duodenum, brought up and connected to the newly formed stomach pouch.
- The other end is connected into the side of the pouch limb of the intestine (creating the "Y" shape that gives the technique its name)
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| Advantages: |
Average excess weight loss is usually higher than with purely restrictive procedures.
One year after surgery, weight loss can average 77% of excess body weight. After 10 to 14 years, some patients have maintained 50-60% of excess body weight loss.
- 96% of certain associated health conditions (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved according to a 2000 study of 500 patients.
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| Risks: |
"Dumping Syndrome". When stomach contents are literally "dumped" rapidly into the small intestine. This is sometimes triggered by too much sugar or large amounts of food at one time. Dumping syndrome doesn't pose a health risk, but its symptoms are not fun: nausea, weakness, sweating, faintness, and diarrhea. Some patients can prevent dumping syndrome by avoiding sweets after surgery.
Up to 20% of patients need follow-up operations to correct problems like hernias.
Up to 30% of patients develop gallstones after losing weight. You can reduce the risk of gallstones by taking bile salts for 6 months following surgery.
Leakage of the connection between the pouch and the intestine. This is very rare, but potentially dangerous.
Diminished effectiveness. The success of the procedure can be reduced if the stomach pouch is stretched and/or left larger than 15-30cc (1/2 to one ounce).
Poor views of internal organs. The bypassed portion of the stomach, duodenum, and segments of the small intestine are difficult to see using x-ray or endoscope. This only becomes a problem if the patient develops ulcers, bleeding, or malignancy. Gastric bypass does not cause cancer.
Nutrient deficiencies. Almost a third of patients develop nutritional deficiencies because the duodenum is bypassed in this procedure. This causes the body to not absorb iron, calcium and other nutrients as efficiently after surgery. Fortunately, these deficiencies can usually be controlled with proper diet and vitamin supplements. Nutrient deficiencies can lead to:
- Iron deficiency anemia. Because the duodenum is bypassed in this procedure, the body doesn't absorb iron and calcium very well after surgery, which can lead to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during menstruation or from bleeding hemorrhoids.
- Osteoporosis. Because the body doesn't absorb calcium properly after surgery, there is a greater risk of developing osteoporosis.
- Metabolic bone disease. Also caused by bypassing the duodenum, some patients experience bone pain, loss of height, humped back and fractures of the ribs and hip bones.
- Chronic anemia. A type of anemia caused by a deficiency of vitamin B12. This can usually be managed with pills or injections.
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Revisions
The term "revision" is applied when one weight
loss procedure is converted or transformed into
another one. (For example; a Lap-Band® system to
Gastric Bypass or to a Gastric Sleeve.) |
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The
patient is first placed under general anesthesia.
The procedure is performed laparoscopically. Five
small incisions are made in the region of the
upper abdomen and special instruments are inserted
in order to perform the procedure and magnify the
internal view of the doctor's movements.
To see a animation video of lap band placement
from INAMED click here. |
1.
The surgical instrument is inserted
behind the stomach. |
2. The end of the Lap Band device is attached
to this surgical instrument. |
3. The tube is gently pulled behind
the stomach. |
4. A diagram showing the Lap Band device
around the stomach in place |
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