LAP-BAND Surgery Procedure, Advantages, and Results

• Laparoscopic Adjustable Gastric Band (LAGB) Surgery
• The Minimally Invasive Procedure
• Adjustable Weight Loss
• Advantages at a Glance
• Your motivation is Key
• Eating Meals and Diet after Weight Loss Surgery
• How to choose a LAGB surgeon?

Laparoscopic Adjustable Gastric Band (LAGB) Surgery

The LAGB surgery was approved by the FDA in June 2001. This has been the number one weight loss operation performed in Europe and Australia for many years prior to that.

Over 300,000 bands have been placed world-wide since 1993. Multiple long-term studies have shown average excess weight loss to be greater than 55% in the majority of patients. The initial experience with the band showed less weight loss, but current studies have shown that the band is a highly effective operation with the lowest risk.

LAGB surgery involves implanting an adjustable gastric band designed to help you lose excess body weight, improve weight-related health conditions and enhance quality of life. It reduces the stomach capacity and restricts the amount of food that can be consumed at one time. The LAGB procedure does not require stomach cutting and stapling or gastrointestinal re-routing to bypass normal digestion.  The band is a silicone ring designed to be placed around the upper part of the stomach and filled with saline on its inner surface. This creates a new, smaller stomach pouch that can hold only a small amount of food, so the food storage area in the stomach is reduced. The band also controls the stoma (stomach outlet) between the new upper pouch and the lower part of the stomach. When the stomach is smaller, you feel full faster, while the food moves more slowly between your upper and lower stomach as it is digested. As a result, you eat less and lose weight.

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The Minimally Invasive Procedure

During the procedure, surgeons usually use laparoscopic techniques (making tiny incisions rather than a large incision and inserting long-shafted instruments through “ports”), to wrap the LAGB around the patient’s stomach. A narrow camera is passed through a port so the surgeon can view the operative site on a nearby video monitor. Like a wristwatch, the band is fastened around the upper stomach to create the new stomach pouch that limits and controls the amount of food you eat. The band is then locked securely in a ring around the stomach.  Since there is no stomach cutting, stapling, or gastrointestinal re-routing involved in the LAGB procedure, it is considered the safest, least invasive, and least traumatic of all weight-loss surgeries. The laparoscopic approach to the surgery also has the advantages of reduced post-operative pain, shortened hospital stay, and quicker recovery. If for any reason the LAGB device needs to be removed, the stomach generally returns to its original form.

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Adjustable Weight Loss

Once placed around the stomach, tubing connects the LAGB to an access port fixed beneath the skin of your abdomen. This allows the surgeon to change the stoma (stomach outlet) size by adding or subtracting saline or salt water, inside the inner balloon through the access port. This adjustment process helps determine the rate of weight loss. If the band is too loose and weight loss is inadequate, adding more saline can reduce the size of the stoma to further restrict the amount of food that can move through it. If the band is too tight, the surgeon will remove some saline to loosen the band and reduce the amount of restriction.

The diameter of the band can be modified to meet your individual needs, which can change as you lose weight. For example, pregnant patients can expand their band to accommodate a growing fetus, while patients who aren’t experiencing significant weight loss can have their bands tightened.

The LAGB procedure is the only adjustable weight-loss surgery available in the United States to help maintain restriction and keep the weight off long-term.

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Advantages at a Glance

Minimal Trauma

• Least invasive surgical option
• No intestinal re-routing
• No cutting or stapling of the stomach wall or bowel
• Small incisions and minimal scarring
• Reduced patient pain, length of hospital stay and recovery period

Fewer Risks and Side Effects

• 10 times less operative and short-term mortality than gastric bypass¹
• Low risk of nutritional deficiencies associated with gastric bypass
• Reduced risk of hair loss
• No “dumping syndrome” related to dietary intake restrictions

Adjustable

• Allows individualized degree of restriction for ideal rate of weight-loss
• Adjustments performed without additional surgery
• Supports pregnancy by allowing stomach outlet size to be opened to accommodate increased nutritional needs
• Only surgical option designed to help maintain long-term weight loss

Reversible

• Removable at any time
• Stomach and other anatomy are generally restored to their original forms and functions

Effective Long-Term Weight Loss

• More than 300,000 LAGB devices placed worldwide
• Standard of care for hundreds of surgeons around the world
• #1 selling adjustable gastric band for weight loss
• Academic publications with up to 10 years of follow-up

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Your motivation is Key

Your surgeon will educate you on your responsibilities as a weight loss surgery patient. These include new eating patterns and a new lifestyle. If you are ready to take an active part in reducing your weight, you may be ready for Laparoscopic Adjustable Gastric Band (LAGB) Surgery 

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Eating Meals and Diet after Weight Loss Surgery

Weight loss gives you more energy, makes you feel better about yourself and motivates you to continue the changes that have made you successful. The success of any weight loss operation must begin with realistic goals. Once you establish your goal weight, your motivation will ultimately determine the amount of weight you lose.

Weight loss surgery simply creates a situation where a small amount of food makes you full and less hungry. If you take advantage of this situation, you will lose weight. Weight loss operations are effective at reducing the number of calories eaten in a day.

Exercise adds to this by increasing the number of calories burned. When you exercise, you build muscle, which increases your metabolic rate, which burns more calories. We strongly encourage the addition of exercise to weight loss surgery because the combination of eating fewer calories and burning more calories is very powerful for successful weight loss.

There are patients who go through the trouble of having weight loss surgery and do not lose much weight. That's because instead of using the tool effectively, they sabotage the operation. Becoming a thinner person requires change. You must be more active and make wise food choices. An example of sabotaging is a patient who eats a large quantity of high-calorie liquids such as milkshakes or sugary sweets. Sugar is an unnecessary source of calories that you must burn off with exercise. We strongly recommend not eating sweets after weight loss surgery (unless it’s your birthday). A better choice would be sugar-free foods. Other patients will sabotage their success by grazing or emotional eating -- eating small amounts of food throughout the day. After weight loss surgery, if you avoid sugar, high-calorie liquids and emotional grazing, you will increase your success rate. Exercise also increases your success. The best way to lose weight is to eat less and exercise more. 

We have many successful patients, but it is incorrect to think that you do not have to put any effort into losing weight. Northwest Weight Loss Surgery has developed a comprehensive after care program to better prepare you for the lifelong changes after surgery. We encourage you to attend our monthly support groups where we discuss many topics relating to the weight loss journey. 

It is important for you to understand that weight loss surgery is not magic and does require effort by the patient. It does not work by itself. Weight loss surgery is a tool to help you lose weight. It works by making you feel full on a small amount of food and helping to control background hunger. It is a powerful tool and for most, the only tool that helped them regain control of their weight. But like all tools, it works best if you use it correctly. A comprehensive program that provides extensive education and support will maximize the results of weight loss surgery. We are committed to providing you with education and support to assist you on the way.

With obesity affecting 67 percent of our population, the United States is the most overweight nation in the world. Once you get to be severely overweight, diet and exercise programs have dismal long-term results. Many people lose weight in the short term, but they gain it all back -- and then some. For those patients, weight loss surgery is the only effective long-term solution. The main problem with remaining overweight is that you have a higher chance for early death and are at risk for many medical problems associated with obesity. Most patients who have had weight loss surgery found it to be the only thing that allowed them to keep the weight off long-term. We hear people say things like ‘weight loss surgery gave me my life back” and “I wish I would have done this sooner”. 

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How to choose a LAGB surgeon?

Once you have decided that weight loss surgery is right for you, you will then need to select a facility and surgeon. Don’t be afraid to ask questions before choosing a surgeon. The following list provides a good starting point for questions we would encourage you to ask of any surgeon you are considering.

• Are you a LAGB specialist, or do you perform other types of surgery?
• How many LAGB procedures have you done?
• How long have you been doing LAGB surgery?
• How do you determine who is a good candidate for this surgery?
• How do you screen patients?
• Do you have LAGB patients working in your office?
• Is there a Patient Support Line I can call to talk with other banded patients?
• Do you have an online support group that is monitored by the medical staff?
• Do you ever attend the patient support groups? Is there a program fee for support group?
• How many papers have you published on LAGB surgery?
• What is the charge for band adjustments?
• Who will be doing the adjustments?
• What is your past experience with laparoscopic surgery?
• What is your complication rate?
• Who will take care of me if I have a complication? What is the cost if a second surgery is required?
• What is your conversion rate to an open incision?
• What do I need to do in order to see success with this program?
• What is included in the cost? (Look for hidden fees, band adjustments, fluoroscopy, anesthesia, program fees for support groups, etc.)
• May I attend one of your support groups prior to surgery?
• Do you have Insurance coordinators available to help me with insurance questions?
• Is a seminar required or can you provide me with the information I need privately?

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1. Executive summary: Laparoscopic adjustable gastric banding for the treatment of obesity (Update and Re-appraisal). The Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIPS) 2002; 1. (Laparoscopic adjustable gastric banding surgery, like the LAGB surgery, is associated with a mean short-term mortality rate of around 0.05% compared to 0.50% for Gastric Bypass and 0.31% for Vertical Banded Gastroplasty.)
Disclaimer:
As with any surgery, there are specific risks and possible complications associated with the LAGB surgery. Talk to your doctor to determine if you are a candidate for the LAGB procedure.
M898-10 06/07