Weight Loss Articles
Learning about "Lapbands"
January 1, 2008
It’s a shame that the terms weight-loss and surgery are so often equated with gastric bypass, or even liposuction. It’s a shame, because like many cases of the household name versus the alternative, the alternative is probably the better choice.
Adjustable gastric banding (known by various aliases: laparoscopic banding, lap band surgery, or just the LAP-BAND) is the latest of the weight loss surgeries, and, thanks to its safety, efficacy, and sustainability, it’s enjoying an explosion in popularity.
The bariatric family of surgeries also include gastric bypass, gastrectomy, and gastro-plasty, and those three are all occasionally associated with the familiar term, “stomach-stapling”. It’s not an unfair description - in all of the mentioned procedures, surgical staples are frequently used, to close off sections of a split stomach.
The lap band’s unique in that there are no staples involved.
Here’s how it works: a lap band - a small, plastic, ring-shaped implant with an inflatable balloon inside, filled with saline solution - is placed around the stomach, making a pouch of the uppermost section. This “new stomach” is significantly smaller than the whole stomach; it can fit about 15cc of material, meaning the patient will feel full much faster. As the food breaks down in the upper pouch, it drops through the lap band to the lower stomach, and proceeds through the whole of the digestive system. This means that the procedure’s classified as restrictive rather than malabsorptive. A port is placed under the skin, with a length of tube attached to the balloon inside the lap band - this allows the surgeon to “fill” or “de-fill” the band, adjusting it for comfort. The goal is to find a “sweet spot” where the patient feels full when an ideal amount of food is consumed. After the initial surgery, patients return to the surgeon a few times a year to get adjustments done, until the lap band is sitting exactly the way they want it.
The surgery’s done laparoscopically, meaning a very small, “keyhole” incision is made; cameras and special instruments are used to perform the procedure. The whole procedure takes 30 minutes to an hour, and recovery time in the hospital is usually less than 48 hours. Most patients return to normal activity within a week.
Complications are rare, but they may include band slippage, band erosion, or access port problems. In the event of complication, discomfort, or lack of function, lap-banding is one of the only bariatric procedures that can be fully reversed.
More invasive weight loss surgeries - gastric bypass, for instance - are reserved for morbidly obese persons; they’re used as a final tool in the event that other forms of weight loss fail. The lap band works as a life-saving measure as well; studies show a sustainable 50-70% excess weight loss in successful cases. However, because it’s adjustable, a lap band can be used to lose as little as twenty pounds.
Ultimately, adjustable gastric banding is considerably safer than its cousin surgeries: it has the lowest mortality rate (0% in Canada) and the lowest occurrence of complications (around 9%). It’s even technically cheaper, although it’s not covered by OHIP. Many of the centres that provide the surgery also provide financing options for their patients to alleviate some of the cost.
Some of these centres (at least, in Canada) use bands from several manufacturers; the variety ensures that the right band will be used for the right patient.
The trick, of course, to any of the bariatric surgeries, is to remember that they’re tools and not solutions. The gastric banding procedure won’t make excess weight vanish, but, if approached right, it’ll be a huge help. Thankfully, the centres that offer the procedure have thought of that. Before surgery, patients are given an evaluation and coaching to make sure that they're ready to change their nutritional and physical habits to suit their new lifestyle. After the surgery, many centres provide support groups, seminars, and consultations with therapists to make sure patients lose the weight and keep it off.
So: safety, efficacy, sustainability. Maybe the alternative should be the household name.
There are many centres that perform adjustable gastric banding in Toronto, but you’ll need to do some research to find the right one. A few things to remember: you’ll want an experienced surgeon, a selection of bands, the possibility of financing, and a detailed support strategy.
Adjustable gastric banding (known by various aliases: laparoscopic banding, lap band surgery, or just the LAP-BAND) is the latest of the weight loss surgeries, and, thanks to its safety, efficacy, and sustainability, it’s enjoying an explosion in popularity.
The bariatric family of surgeries also include gastric bypass, gastrectomy, and gastro-plasty, and those three are all occasionally associated with the familiar term, “stomach-stapling”. It’s not an unfair description - in all of the mentioned procedures, surgical staples are frequently used, to close off sections of a split stomach.
The lap band’s unique in that there are no staples involved.
Here’s how it works: a lap band - a small, plastic, ring-shaped implant with an inflatable balloon inside, filled with saline solution - is placed around the stomach, making a pouch of the uppermost section. This “new stomach” is significantly smaller than the whole stomach; it can fit about 15cc of material, meaning the patient will feel full much faster. As the food breaks down in the upper pouch, it drops through the lap band to the lower stomach, and proceeds through the whole of the digestive system. This means that the procedure’s classified as restrictive rather than malabsorptive. A port is placed under the skin, with a length of tube attached to the balloon inside the lap band - this allows the surgeon to “fill” or “de-fill” the band, adjusting it for comfort. The goal is to find a “sweet spot” where the patient feels full when an ideal amount of food is consumed. After the initial surgery, patients return to the surgeon a few times a year to get adjustments done, until the lap band is sitting exactly the way they want it.
The surgery’s done laparoscopically, meaning a very small, “keyhole” incision is made; cameras and special instruments are used to perform the procedure. The whole procedure takes 30 minutes to an hour, and recovery time in the hospital is usually less than 48 hours. Most patients return to normal activity within a week.
Complications are rare, but they may include band slippage, band erosion, or access port problems. In the event of complication, discomfort, or lack of function, lap-banding is one of the only bariatric procedures that can be fully reversed.
More invasive weight loss surgeries - gastric bypass, for instance - are reserved for morbidly obese persons; they’re used as a final tool in the event that other forms of weight loss fail. The lap band works as a life-saving measure as well; studies show a sustainable 50-70% excess weight loss in successful cases. However, because it’s adjustable, a lap band can be used to lose as little as twenty pounds.
Ultimately, adjustable gastric banding is considerably safer than its cousin surgeries: it has the lowest mortality rate (0% in Canada) and the lowest occurrence of complications (around 9%). It’s even technically cheaper, although it’s not covered by OHIP. Many of the centres that provide the surgery also provide financing options for their patients to alleviate some of the cost.
Some of these centres (at least, in Canada) use bands from several manufacturers; the variety ensures that the right band will be used for the right patient.
The trick, of course, to any of the bariatric surgeries, is to remember that they’re tools and not solutions. The gastric banding procedure won’t make excess weight vanish, but, if approached right, it’ll be a huge help. Thankfully, the centres that offer the procedure have thought of that. Before surgery, patients are given an evaluation and coaching to make sure that they're ready to change their nutritional and physical habits to suit their new lifestyle. After the surgery, many centres provide support groups, seminars, and consultations with therapists to make sure patients lose the weight and keep it off.
So: safety, efficacy, sustainability. Maybe the alternative should be the household name.
There are many centres that perform adjustable gastric banding in Toronto, but you’ll need to do some research to find the right one. A few things to remember: you’ll want an experienced surgeon, a selection of bands, the possibility of financing, and a detailed support strategy.