Bariatric & Metabolic Surgery

Lap Band


Why Choose a Lap-Band®

The simple answer to this question is safety.

The Lap-Band® has been in use for more than 30 years and has an unparalleled safety record.
This is why we at Auralia believe the Lap-Band® should be the first-choice procedure for a large portion of those with longstanding weight problems. The Lap-Band® also has many other advantages:

  • Unlike disruptive procedures such as the sleeve gastrectomy and gastric bypass, the Lap-Band® does not require any cutting or stapling, so there is no permanent alteration to the stomach or bowel (which accounts for its remarkable safely profile)
  • The Lap-Band® is completely reversible – unlike the sleeve which involves removing 85% of perfectly healthy stomach
  • The risk of serious surgical complications during Lap-Band® surgery is much lower than that for the sleeve and gastric bypass.
  • Unlike gastric bypass or sleeve, the Lap-Band® is not associated with any significant vitamin and mineral (micronutrient) deficiencies
  • Unlike bypass or sleeve, the Lap-Band® can usually be implanted without the need for an overnight stay in hospital – in other words as a day-case procedure.

Lap-Band® Information

What is a Lap-Band®?

The Lap-Band® is essentially a hollow silicone structure which is fitted around the upper part of the stomach in order to stimulate nerve endings whilst you eat, making you feel satisfied much faster. The Lap-Band® “tightness” around the top of the stomach can be adjusted to suit a patients needs by injecting or removing saline (salt water) through a small access port which is hidden below the surface of the skin.
The idea behind a Lap-Band® is not to prevent a patient from eating, but rather to induce the feeling of satiety whilst eating much earlier on.

Click on the animation below to learn more.

How does it work?

Many people think the Lap-Band® is meant to stop them eating, but this is wrong.

The Lap-Band® actually works by producing satiety (a feeling of fulness), so you feel as though you have had enough even after eating only small amounts.  How does this happen?

It happens because in the stomach wall beneath the Lap-Band® there are specialised nerve fibres (see images below).

When food passes through the Lap-Band®, the nerve fibres are stimulated and send a message to the appetite centre in the brain – which produces a sensation of satiety.  Feeling full after only small amounts of food means you will eat less, resulting in you eating less calories, which is the entire basis for achieving weight loss.

How much weight will I lose with a Lap-Band®?

Overall weight loss

Lap-Band® weight loss results can vary and will depend on how well you follow the Lap-Band® guidelines – which includes eating slowly and choosing low-calorie options with the right texture.

But as a rough guide, you can expect to lose 50-60% of your excess weight over the first 2-years following Lap-Band® surgery, although many patients go on to lose all of their excess weight.

Do remember that this is an average weight loss – some will lose all their excess weight, whilst others may lose less – it depends on how much effort you put in with your Lap-Band®.

5-weeks after surgery

Our experience suggests that at the time of the first Lap-Band® adjustment – usually around 5-weeks after surgery – average weight loss is around 1.5st (about 8% of starting weight).  This is important, because we also know that good initial weight loss – even at this very early stage – predicts long-terms success.

Long-term weight loss

Our clinical advisor (Dr David Ashton) and his colleagues, have published the only major study into Lap-Band® surgery in the private sector, involving 2246 patients over a period of 8-years see here.

This shows that the Lap-Band® procedure is an extremely safe procedure – there were no fatalities and no serious complications – and the Lap-Band® delivered significant and durable weight loss.  Complication rates overall were remarkably low also, proving the exceptional safety of the Lap-Band®.

Another study has carried out a 15-year follow-up on a group of 3,227 Lap-Band® patients.  Average weight loss was 54.2% for these patients, again without any serious complications.

So all the evidence points to the Lap-Band® procedure being an extremely safe and effective weight loss option.

The Operation

The Lap-Band® operation is performed laparoscopically (also known as key-hole surgery) under a general anaesthetic.

The operation takes around 35-40 minutes and patients usually return home on the same day, or the next morning. Generally, 4-5 small incisions are made in the abdominal wall, through which surgical instruments can be passed. The Lap-Band® is then placed around the upper part of the stomach. The procedure does not involve any cutting of the stomach or bowel and only a few sutures (stitches) are applied to keep the Lap-Band® in place. This means that the procedure is fully and relatively easily reversible.

Following Lap-Band® surgery, you should spend the first few days resting at home, but light work is usually possible after that. Whilst some people return to work after a few days, we think it is prudent to take a full week away from work to recover. At the end of this period, it should be quite safe to drive.

Incisions made during surgery are sutured and/or glued and the wounds normally heal within 14 days. The scars will tend to fade gradually, though some patients find it helpful to apply a silicone scar-reduction gel.

It’s important to start working with your Lap-Band® soon after surgery – you can start walking almost immediately. You should also stick closely to the nutritional guidelines with which you will be provided.

Remember – this is the beginning of a new chapter in your life!

Risks of Lap-Band® Surgery

The Lap-Band® has a proven record of being a remarkably safe option for patients considering bariatric surgery, particularly compare to other alternatives.

However, as with any form of surgery, there are potential risks and complications associated with Lap-Band® surgery, they include:

  • Hemorrhage / bleeding (extremely rare)
  • Adverse reactions to anaesthesia and/or medication
  • Blood clots – deep vein thrombosis (legs), pulmonary embolus (lungs)
  • Infection
  • Death (Exceptionally rare)

In the hands of an experienced bariatric team, all of these risks are remarkably low.

Short term post-surgery effects (first 7-days)

Typical side-effects immediately after surgery include:

  • Left-shoulder pain (common after any laparoscopic procedure in which gas is introduced into the abdominal cavity)
  • Minor soreness over the wound areas, with associated mild swelling/bruising
  • Some discomfort taking a deep breath
  • Mild nausea following the anaesthetic (uncommon).

However, most patients do not find the post-operative period difficult and these symptoms are usually short-lived. Pain is easily controlled with light pain relief.

Long-term complications

Several longer-term complications can occur with the Lap-Band®, but fortunately the most frequent of these are the ones which are most easily remedied – often without surgery. They include;

  • Retching / vomiting
  • Band slippage
  • Band erosion
  • Pouch enlargement
  • Access port or tubing leaks

You can read more about long-term band complications here.

Lap-Band® Adjustments

When the Lap-Band® is implanted, it will usually be almost empty with only a small volume of fluid inside it and will only be providing a very small amount of satiety. Approximately 5 weeks after surgery, you can begin the process of having your Lap-Band® adjusted to control hunger, your food consumption and ultimately your weight loss.

A Lap-Band® fill / adjustment is when the level of pressure that the Lap-Band® exerts on the upper stomach is adjusted by injecting (also known as filling / inflating) the Lap-Band® with a sterile saline solution (salt water) to make the Lap-Band® tighter (narrowing the upper stomach and increasing pressure on the nerves when you eat) or by removing existing saline to loosen the Lap-Band® (widening the upper stomach and reducing pressure on the nerves when eating). See the effect of three different fill volumes in the images below.

Lap-Band® adjustments are possible without the need for any additional surgery or anaesthetic because the Lap-Band® is connected via a tube to an access port placed just under the skin during the initial surgery.

Lap-Band® adjustments are made with a special (Huber) needle and syringe. For a skilled and experienced Lap-Band® clinician, the adjustment is generally straightforward and virtually painless. The exception to this is where the patient is very large or where the access port is lying in an awkward position. See my colleague Professor John Dixon performing a Lap-Band® adjustment below:

Optimal Lap-Band® adjustment

The Lap-Band® is optimally adjusted when the patient feels full with small amounts of food and is otherwise well.  Adjusting the Lap-Band® to its optimum aperture size is a skill and is key to achieving good weight loss results. So it’s absolutely essential  that your Lap-Band® provider can offer accurate and timely adjustments. Too little in the Lap-Band® and you will feel hungry and be looking for food – and weight loss will be minimal. Too much and you will be regurgitating food and engaging in “maladaptive eating”. This is where you are eating soft, calorie-rich foods such as cakes, crisps, chocolate (and cheesy wotsits!), because these are the only things you can tolerate.
See the chart below and make sure you are in the Green Zone:

Health Benefits of the Lap-Band®

Lap-Band® surgery has a major, often dramatic, positive impact on a wide variety of obesity associated conditions. Only a surgical intervention can provide such a sustained reduction in health risks, improve quality of life and protect against premature death and disability.

Some of the health benefits of Lap-Band® associated weight loss are:

  • Cardiovascular disease – reduced risk of heart attack and stroke (due to lower blood pressure and cholesterol levels)
  • Type 2 diabetes – complete resolution or major improvement in the majority of Type 2 diabetics
  • Sleep apnoea – resolution or marked improvement in snoring, daytime sleepiness and fatigue
  • Reflux (heartburn) – the Lap-Band® is an effective anti-reflux device in most patients
  • Back and joint pain – most Lap-Band® patients experience dramatic reductions in back and joint pain and markedly improved mobility
  • Stress incontinence – Very common in female patients struggling with obesity. Lap-Band® patients can expect a significant improvement or complete resolution of symptoms
  • Infertility and PCOS – most patients with polycystic ovarian syndrome (PCOS) experience correction or improvement of underlying hormonal problems and restored fertility
  • Asthma – asthmatic patients see marked improvement in symptoms and a reduction in asthma medication
  • Fatty liver – 80% of patients will have complete resolution of obesity-associated fatty liver disease
  • Psychological wellbeing – reduced depressive symptoms and anxiety, improved social interaction and overall quality of life

The above list is not exhaustive, but it accounts for the fact that Lap-Band® patients have – on average – a 60-70% lower risk of premature death when compared with their obese (non-banded) peers.

In summary, the Lap-Band® improves or resolves a range of obesity-associated weight problems, enhances social and psychological functioning and reduces the risk of premature death and disability. Not many procedures anywhere in medicine can offer such a remarkable list of benefits!

Advantages and disadvantages of the Lap-Band®

Let’s summarize the advantages and disadvantages of the Lap-Band®:

Advantages Disadvantages
Very low risk Requires relatively regular attendance at clinic for adjustments
Fully reversible (preserves stomach and bowel) Unlike sleeve or bypass the Lap-Band® does not reduce appetite hormones
Day-case procedure (usually) Complications (though usually very minor) are a little more common than other surgeries.
Significant and durable weight loss Health benefits are entirely dependent on weight-reduction
Major reductions in obesity-associated health risks Can sometimes be a problem for those who do a lot of overseas travel
Low risk of vitamin and mineral deficiency Experience of the surgeon directly related to the risk of long-term complications

Enduring Lap-Band® Myths

There are a lot of rumours and myths about the Lap-Band® – here we dispel some of the myths surrounding them.

No Fizzy Drinks with a Lap-Band®

The myth here is that you can’t have fizzy drinks after a Lap-Band® because it will cause bloating and may “stretch” the stomach. You can find advice of this kind even on NHS websites. In fact, as long as they don’t cause any discomfort, zero calorie fizzy drinks are perfectly safe to drink. I have lots of successful Lap-Band® patients who enjoy diet coke (as do I) and other zero calorie drinks without any difficulty.

Sweet eaters don’t do well with a Lap-Band®

This is a remarkably durable myth, which even some bariatric surgeons seem to believe. But the evidence is quite clear – sweet eaters who have Lap-Band® surgery do just as well as those who don’t generally eat sweets. In fact, there is even a study which showed that NOT eating sweets increased the risk of failure with the Lap-Band®. Of course, trying to define a “sweet eater” is not always easy. Clearly, if you have a Lap-Band® and you eat 1kg of chocolate every day, you’ll fail – but you will fail with any procedure. There is nothing specific about the Lap-Band® – or about sweets – that spells failure. If you have a Lap-Band® and all you eat is a bar of your favourite chocolate every day, you will lose weight. We don’t recommend that, but in the end, what matters is calories rather than specific food types.

Can’t eat and drink at the same time with a Lap-Band®

The idea that you shouldn’t eat and drink at the same time is another old chestnut, based on an entirely outdated idea of exactly how the Lap-Band® works. The belief was that food needs to stay in the pouch above the Lap-Band® in order to give the feeling of fullness (satiety) and that drinking and eating at the same time will “wash” the food through the Lap-Band® and into the stomach. This is not the case.

In fact, when food passes into the pouch, there is almost no delay at all before it passes through the Lap-Band® into the stomach. The sensation of fullness is created by special nerves in the upper part of the stomach and is not the result of any significant delay in the pouch emptying. So, drinking whilst eating with a Lap-Band® makes no difference and does no harm.

When you fly, the Lap-Band® gets tighter

The idea seems to be that because of changes in cabin pressure whilst flying, the air in the Lap-Band® will expand and cause a tightening of the device around the stomach. This might be true if the Lap-Band® was filled (adjusted) with air, but it isn’t. A Lap-Band® is filled with a sterile saline (salt water) and there should be no air at all within the system. So, nothing happens to the Lap-Band® when flying.

However, it is true that some Lap-Band® patients say that when they fly (especially long-haul) the Lap-Band® feels tighter. But this is because air in the stomach expands due to relative cabin decompression. In other words, it is the stomach that expands against the Lap-Band®. Usually, excess air is passed or absorbed within 24-hours of being back on the ground at normal atmospheric pressure and this is not a risk to you in any way. It’s perfectly safe to fly with a Lap-Band®. In fact, one of the very early patients to have Lap-Band® surgery was a US based Bariatric Surgeon who now has his Lap-Band® for more than 20 years, flying multiple times each year without issue.

If you have a Lap-Band® it’s not safe to get pregnant

It’s perfectly OK to get pregnant with a Lap-Band® in place. In fact, many Lap-Band® patients have a condition called Polycystic Ovarian Syndrome (PCOS) which is strongly associated with weight gain and infertility. When they lose weight with the Lap-Band®, they quite often find themselves fertile again – and sometimes become pregnant quite quickly. This may even be why they wanted to have the Lap-Band® in the first place.

We have a well worked out protocol for managing the Lap-Band® during pregnancy. However, we recommend that if you are planning to start a family it’s a good idea to wait until you have achieved significant weight loss. This is because the closer your weight is to normal when you are pregnant, the lower the risks for both you and the baby. For example, losing weight before becoming pregnant will dramatically reduce your risk of developing gestational diabetes and blood pressure problems.

You have to eat mushy foods forever

Wrong again. Most experts recommend a post-operative diet of 10-14 days of liquids, followed by 10-14 days of pureed foods. But from then onwards, it’s important to eat a normal, balanced diet consisting mainly of lean meats, fish, wholegrains, fruit and vegetables. An overly tight Lap-band® commonly results in the patient turning to soft or mushy foods as they’re easier to eat, but that doesn’t make it normal or the right thing to do. Provided that you’re chewing foods well and taking your time, you should always be able to eat solid foods.

The Lap-Band® causes reflux (heartburn)

It is commonly believed that the Lap-Band® causes reflux (heartburn) or makes existing heartburn worse. This is generally not the case. In fact, there is great scientific evidence that shows that the Lap-Band® actually improves or completely resolves reflux. The exception to this is when a Lap-Band® is over-tightened when reflux is both common and distressing. ANY Lap-Band® patient with persistent reflux should have the device completed (emptied) and ask their Bariatric team to investigate this.

Having a Lap-Band® excludes other types of weight loss surgery

A unique feature of the Lap-Band® – one too easily forgotten by enthusiasts for procedures such as bypass and sleeve – is that the Lap-Band® is entirely reversible. It does not require any permanent re-configuration of the stomach or bowel, unlike more disruptive options such as sleeve and bypass. This means that if you needed to have a Lap-Band® removed and wanted to consider another type of bariatric procedure, this is entirely feasible. In fact, conversion to a bypass or mini gastric bypass can often be done at the same time as the Lap-Band® removal. A gastric sleeve is generally not recommended after a Lap-Band® as its associated with causing gastroesophageal reflux disease. The Mini Bypass would be the most recommended alternative option, following a Lap-Band®.

You don’t get the right vitamins or minerals after Lap-Band® surgery

This isn’t the case. In general, major vitamin and mineral (micronutrient) deficiencies are very uncommon after Lap-Band® surgery, unlike gastric bypass and sleeve. Gastric bypass in particular, requires intensive and lifelong vitamin and mineral supplements. We recommend that Lap-Band® patients take a daily vitamin and mineral supplement, but one of the commercially available options is perfectly adequate. Many patients don’t ever take supplements after Lap-Band® surgery and they’re perfectly fine.

The Lap-Band® activates airport security scanners

The only metal (steel) part of the Lap-Band® is in the access port, which is encased within a silicone shell. This does not set walk-through metal detector scanners off, though a hand-held wand detector may possibly identify it. The newer, so-called full body scanners make a surface map image. Nothing internal can be seen. If you lose an excessive amount of weight, the access port may be somewhat superficial and a bump may appear on the body scan. Other than this cause for celebration, no one will know you have a Lap-Band®.

You can’t have an MRI scan after a Lap-Band®

Not true. It’s actually perfectly safe to undergo magnetic resonance imaging (MRI) after having a Lap-Band® implanted. The hospital carrying out your MRI may ask you for your Lap-Band® Serial Number which you can easily obtain from your Bariatric team.

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