Weight Loss Surgery Explained: The Lap Band

The dramatic surge in weight in this country has led to a parallel surge in the numbers of people who turn to surgery to solve their weight problem.  These procedures are very serious undertakings that should be understood and certainly not taken lightly.  The mechanisms by which they work speak volumes about the true mechanisms behind weight gain and the difficult road to weight loss.  The next few posts are taken out of the Weight Loss Counter Revolution book (which can be purchased by clicking here). The purpose is to give you an overview of the most common procedures and an understanding of how they are successful.  As always, I will use research studies that evaluate the risks and benefits of the surgeries as my sources.  I thought I’d start with the lap band procedure in honor of my state’s governor, Chris Christie, who recently underwent the procedure.

The Laparoscopic Adjustable Gastric Band Procedure (LAGB)

Laparoscopic surgery is a type of minimally invasive surgery.  Before this technique was developed, a surgeon would have no choice but to make a large incision and spread apart the abdominal muscles to get to the area on which he or she was operating.  Traditional “open” surgery leads to a larger scar, more pain, and longer rehabilitation times.  Laparoscopic surgery, on the other hand, involves making multiple small incisions, inserting a camera into the abdomen, and using specialized tools to operate inside the abdomen.  Laparoscopic surgery creates smaller holes, less pain, and shorter hospital stays.  For the lap band procedure, a soft silicone ring is placed around the stomach.  This is connected to an infusion port just under the skin.  Injecting and removing water from this port will tighten or loosen the band and adjust the stomach to the desired size.

The band works via a simple mechanism.  It makes the stomach fill faster.  The restriction of stretching the stomach will create an earlier full signal to the brain and thus limit caloric intake.  Notice that the only thing the band does is decrease calorie intake by making it uncomfortable to eat too much.  This is not magic.  If a person would restrict the calorie intake on their own they would have the same results.

With that said, the procedure is successful at inducing weight loss.  Studies have shown that estimated weight loss at three months is between 15 and 20 percent, at one year between 40 to 53 percent, with eventual increases of up to 45 to 75 percent estimated weight loss after year two. Long-term results showed an average of 43 percent of excess weight lost after 12 years.

Sounds great, huh?  Just a few days in the hospital a few scars on the belly and you can drop half your excess weight and keep it off.  These are good numbers, but there is a catch.   Although gastric banding is effective, there are many potential complications.  Long-term results showed that almost 40 percent of patients experienced one of the major complications, 22 percent had minor complications, and almost half of the patients had to be operated on again with a whole new set of risks and complications.  The major complications were complete blockage of the stomach, band infections, stomach rupture, serious bleeding, pneumonias, blood clots in the lungs, problems with emptying of the stomach, and erosion of the band into the stomach.  Minor complications included incisional hernias and infections of the port or port tubing.  So obviously, this is a surgery that is not to be taken lightly.

The bottom line is that the lap band surgery should be approached the same way you would approach any other procedure.  If the risk related to the condition is greater than the risk of the procedure than go for it.  If someone is so obese that they are at great risk for its many associated complications than this is a reasonable option.  With that said, if you can lose the weight without surgery, you would get all the benefits with none of the risk. Unfortunately, it requires more work and patience but you know it’s worth it.

Sources:

• Ren C, Horgan S, Ponce J. US experience with the LAP-BAND system. Am J Surg 2002;184:46S
• Fox S, Fox K, Srikanth M, Rumbaut R. The Lap-Band system in a North American population. Obes Surg 2003;13:275.
• Himpens J, Cadiere G, Vouche M, Dapri G. Long-term outcomes of laparoscopic adjustable gastric banding. Arch Surg 2011;146:802.