LAP-BAND ® Procedure

The Washington University Bariatric Surgery Program at Barnes-Jewish Hospital is designated as an American Society for Bariatric Surgery (ASBS) Bariatric Surgery Center of Excellence.

The LAP-BAND ®* procedure is the least invasive and only adjustable surgical treatment for extreme obesity in the United States. It induces weight loss by reducing the capacity of the stomach, thereby restricting the amount of food that can be consumed at one time.

Operation
The adjustable band is a hollow ring made of silicone elastomer and filled with saline. It is placed around the upper part of the stomach, creating a new small stomach pouch with the large part of the stomach below the band. This way, the food storage area in the stomach is reduced. The pouch above the band can hold only a small amount of food.

The LAP-BAND ® System (shown at right) is placed around the upper part of the stomach. (Illustration and photo courtesy of INAMED Health, Santa Barbara, CA)

The band also controls the stoma (the stomach outlet) between the two parts of the stomach. The size of the opening between the two portions of the stomach controls the flow rate of the food from the upper to lower part of the stomach. This lets you feel full sooner, and the feeling also lasts longer.

To change the size of the stoma, the inner surface of the band can be adjusted by adding or removing saline (a salty solution similar to other fluids in your body). This process is called inflating or deflating. The band is connected through a tube to an access port placed beneath the skin during surgery. Later, the surgeon can control the amount of saline in the band by piercing the access port through the skin with a fine needle. If the band is too loose and weight loss too small, adding more saline can reduce the size of the stoma. If the band is too tight, the surgeon will remove some saline. This, too, can be done without more surgery.

Being able to adjust the band is a unique feature of this system and is a normal part of the follow-up. For a successful outcome with the band, you will need to commit to follow-up every month for the first year and every two months for the second year and may require adjustments at five to 10 of those appointments.

Is this approach right for you?
The LAP-BAND ® System is not right for everyone. You and your surgeon should work together to decide if this is the right procedure for you. Here are some things your surgeon will consider. This approach may be a good option if:

• You are an adult at least 18 years of age.
• Your body mass index (BMI) is 40 or higher, you weigh at least twice your ideal weight, or you weigh at least 100 pounds more than your ideal weight.
• You have been overweight for more than five years.
• Your serious attempts to lose weight have had only short-term success.
• You do not have any other diseases that may have caused you to be overweight.
• You are prepared to make a major change in your eating habits and lifestyle.
• You are willing to continue working with a specialist who is treating you.
• You do not drink alcohol in excess. 

Adjustments
The band can be adjusted to meet your specific needs. This feature allows you and your surgeon to find the right level of restriction just for you.

When first placing the band, your surgeon usually leaves it empty or only partially inflated. This lets you get acquainted with your band during the first few weeks after surgery. It also lets healing occur around the new band site.

These first few weeks are a critical time in which you need to avoid vomiting or putting pressure on your new small stomach above the band. The first time your surgeon adjusts the band is usually four to six weeks after surgery. The exact time will vary. You and your surgeon will decide the right time for your band adjustment, and the adjustment will be made in your surgeon's office. To determine whether you are ready for a band adjustment, your surgeon will consider:

• Your weight loss
• Amount of food you can comfortably eat
• Exercise routine
• How much fluid is already in your band

To get the best results, you will need to follow up monthly for the first year and every two months during the second year. During each adjustment, only a very small amount of saline will be added or removed from the band. The exact amount of fluid required to make the stoma the right size is unique for each person. An ideal “fill” should be just enough to let you gradually lose weight. That means you should still be able to eat enough to get the nutrients you need while reducing the overall amount you can eat.

The band is meant to help you obtain steady and safe weight loss. Do not be in a hurry to have an adjustment before you are ready. To work, the band needs your participation. Your success will depend on you and on the partnership between you and your surgeon.

Your motivation is key
Your surgeon will not perform this operation unless he or she knows you understand the problems caused by your excess weight. In addition, your surgeon will make sure you know your responsibilities. These include new eating patterns and a new lifestyle. If you are ready to take an active part in reducing your weight, your surgeons will consider the treatment. First, though, your surgeon will want to make sure you know about the advantages, disadvantages and risks involved.

• EXERCISE, EXERCISE, EXERCISE! Your success will greatly depend on your commitment to an exercise routine. We strongly recommend that patients participate in the preoperative and postoperative physical rehabilitation program. We encourage patients to take advantage of the dramatic weight loss to increase their exercise capacity and include exercise in their daily routine.
• Medical follow-up. To monitor for long-term complications, such as anemia, it is important to keep scheduled appointments and see your primary care physician regularly

Surgeons who perform this procedure:
J. Christopher Eagon, M.D.

For more information, call 314-454-8877.

More information about bariatric surgery can be found at these web sites:

American Society of Bariatric Surgery 
American Obesity Association 
Weight-control Informational Network (WIN) (informational service of National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK]) 

*LAP-BAND® is a registered trademark of Allergan, Inc.