Laparoscopic Adjustable Gastric Banding

This is a relatively new technique that reduces the capacity of the stomach. With this bariatric surgical procedure, we are placing an adjustable gastric band (LAP-BAND®) or the (REALIZE-Band) around the upper part of the stomach. The band is held in place by stitches and later on, by fibrous tissue formed during the healing process. The band makes a pouch that can hold only a small amount of food.

At the end of the procedure, we place an access port beneath the skin on the right side of the abdomen. The access port is connected to the band on the stomach by tubing. The access port allows us to change the diameter of the band. During office visits the fills are done by injecting saline into the access port.

It is usually done laparoscopically and is 100% reversible.

How much weight will you loose?

Adjustable Gastric Banding (LABG) works as a restrictive device. There is no risk of malabsorption and nutrient deficiency directly related to gastric banding. Excess weight loss with the adjustable gastric band is slightly lower than that with gastric bypass. Weight loss will be less dramatic than with gastric bypass surgery. Official numbers for amount of excess weight loss (EWL) are anywhere between 25-70%. The 25% weight loss was concluded in very first studies using the LAGB. Our current results as well as the Centers of Excellence for Bariatric Surgery reach at least 70% EWL.

Please remember, the LAGB is not filled during your surgery. The LAGB is usually not restrictive immediately after placement. It is OK if you lose some or no weight within the first six weeks. Your first adjustment is scheduled six (6) weeks after surgery.

Pros of gastric banding

No dumping syndrome
No anemia
No malabsorption
Shorter stay in the hospital
Low complication rate
Low mortality rate (around 0.1%)

Cons of gastric banding

Gastric or esophageal perforation
Band slippage
Band erosion into stomach
Incisional hernia
Non-satisfactory weight loss
Infection

What you will experience if hospitalized for this procedure at AGH

On the day of your procedure you will be admitted to the 11th floor
You are prepared for surgery and will be transferred to the holding area to meet your surgeon, your anesthesiologist and OR staff taking care of you. An IV will be put in place at this time
In the OR you will be put to sleep after inhaling oxygen enriched air via face mask
After surgery you will be transferred to the recovery room. If you have a history of sleep apnea you will receive extra monitoring at this time
After you are completely awake you may proceed to the nursing floor or to the intensive care unit (ICU). Placement in the ICU does not mean that there is a surgical complication – it is usually for a patient who needs very close monitoring due to medical conditions that were present before surgery
Pain after surgery is controlled by Patient Controlled Analgesia (PCA). This is a computerized pump, that allows you to request and receive pain medication when ever you might want it. It is very safe and effective in controlling pain
On day 1 after surgery there is an ultrasound exam of your veins in your legs to detect any dangerous blood clots
A swallow test is performed usually the very next day after surgery. You will be asked to drink a small cup of clear liquid x-ray dye. This test helps us to confirm the proper placement of the band
After the swallow study you will be offered sugar free liquids and diet popsicles

Discharge and follow-up

Activity as tolerated
You may shower
Abdominal binder for comfort as desired
May peel off plastic dressings in five to seven days
No heavy lifting or strenuous activity for six weeks
No driving for two weeks and while taking narcotic pain medications
Medications
- Resume pre-surgery home medications as instructed by physician
- Multivitamin twice a day (chewable or liquid)
- Nexium 40mg P.O. (or prescription substitute) to be given to patient
- Roxicet (5/325 mg per ml) five to ten ml PO every four hours PRN (prescription to be given to patient)
Diet
- 3 eight ounce cups of skim milk per day
- Sugar free clear liquids-two quarts per day
- 2 eight ounce broth meals per day (for example: beef/chicken bouillon or strained homemade soup but no creamy soups)
- No straws and/or carbonated beverages
- For dietary questions call 412-359-6574
Scheduling follow-up

Call 412-359-8630 to schedule follow-up appointment in 3-4 weeks
If you are Diabetic and seen by Allegheny Endocrinology Associates, please call their office at 412-359-3426
The second visit in our clinic is usually 6 weeks after surgery
Adjustable Gastric Bands are filled for the first time at the 6 week appointment
Adjustment is done under sterile precautions. It is very well tolerated and one can compare it to any injection shot
You may need several adjustments to help you control the rate of the weight loss

When to Notify Physician

Notify your physician if your temperature exceeds 101 degrees Farenheit
Notify your physician if you experience any signs of infection which include redness, yellow foul smelling drainage from the incision sites, chills, or pain not controlled by pain medications
Notify your physician if you have pain and/or swelling in your leg or calf,chest pain, palpitations or shortness of breath
Additional instructions may be given based on your individual circumstances

If weight loss is not satisfactory or if complication of the adjustable band occurs, another bariatric procedure may be needed. Conversion of a failed LAGB to another bariatric procedure may be technically more difficult and associated with more complications than with a first time RYGB.