Lap bands – the good, the bad and the ugly

Lap band surgery is also called laparoscopic adjustable gastric banding, gastric banding, or the LAP-BAND system, it’s all one and the same thing.

Laparoscopic Adjustable Gastric Banding involves placing an inflatable silicone ring around the upper part of the stomach via laparoscopic (keyhole) surgery.

So how does it work?

The constant, gentle pressure that the Lap Band applies to the top of the stomach increases the feeling of fullness with a smaller amount of food. Patients therefore consume less food and lose weight steadily over time.

The Lap Band is attached to an access port which sits beneath the abdominal skin, this allows the Lap Band to be adjusted to the patients’ individual needs

THE GOOD

• It is a minimally invasive procedure
• Laparoscopic surgery
• Low mortality rate
• Rapid recovery from surgery
• It is completely reversible
• It is fully adjustable, so the tightness can be modified to suit the individual patient
• Adjustments are usually very straight forward and are easily performed by a bariatric surgeon or a Re:You GPs with a special interest in bariatric medicine in their consulting rooms
• It can be very effective at assisting people to reduce their portion size, especially when they already have a good meal structure
• Patients can lose 20-25% of their total body weight

THE BAD

• People can develop ‘band intolerance’, we as medical professionals can’t tell who will potentially develop this problem. It means that no matter how compliant they are and how well adjusted the band is, they are still having issues with intolerance of food and frequent vomiting and regurgitation.
• It’s like the body, in particular the oesophagus, just gets tired of the band. At the end of the day it is a ‘foreign body’. Sometimes deflating the band can help, but often removal of the band is needed to resolve the issue.
• Pouch dilatation often occurs if the band has been too tight for too long and there has been recurrent vomiting and regurgitation of food. Patients can have variable tolerance of food, so one day a particular meal will pass through perfectly and the next day they will have issues with the same food eaten in the same way. This can be very frustrating! Removing some fluid from the band can often resolve this issue.
• Band slippage - Some patients may not notice any symptoms when this complication occurs while others may experience heartburn, acid reflux symptoms or significant pain. The Lap Band will usually need to be removed.
• Band leak – now this is fairly obvious. Suddenly the feeling of restriction will reduce without deflation of the band. A special xray can be done to check for this complication and it can be fixed.
• Band erosion – this is where the band actually grows in to the stomach and unfortunately the only solution for this is permanent removal of the band

THE UGLY

Research shows that the greatest cause for removal of Lap Bands is the lack of patient compliance with the device.

We see this as ‘ugly’ because it either means:

• that we are not adequately preparing and educating our patients before they have a band inserted
• or they are not committing to the lifestyle alterations needed to assure safety and effectiveness of the Lap Band

People can either work with their band and be very successful, or work against their band because they do not really understand how it works. At the end of the day it is still only a ‘tool’, and a healthy diet and regular physical activity are still important.

The band has had a bad wrap over recent years because there are lots of blogs and support sites focusing on the negative stories. Some of these could be corrected with proper band adjustment and band education. We feel that sometimes bands are being removed prematurely, and other times patients persist with a very dysfunctional band for way too long.

At the end of the day we think there are lots of patients out there suffering in silence with their band because they are either too embarrassed to go back to their bariatric clinic as they feel like a failure, or they just don’t know that there is support out there.

Whilst we know that many Lap Bands genuinely need to be removed, we think there should be a ‘back on track with your band’ movement that encourages people to get their band checked.

Let stop ‘ugly’ bands, because they can still be very successful tools.