Lap Band Surgery/also known as adjustable gastric banding or lap-band/
Definition: Laparoscopic adjustable gastric banding is a restrictive procedure that connects a balloon to a band around the upper part of the stomach. A reservoir is placed under the skin and is used to inflate the balloon and adjust the gastric band. With the inflation of the balloon the gastric band tightens and decreases the amount of food passing through at the given time. When the balloon is deflated the band loosens and the weight loss begins to be reduced. The LAP-BAND ® System, Swedish Adjustable Band and the Mid-Band are the different types of bands for the procedure. Unlike the other restrictive procedures, LAGB does not permanently alter the anatomy of the stomach or small intestines. LAGB can be a reversible procedure and it produces no risk of severe nutritional deficiencies. Based on these facts, LAGB may be considered to be a safer procedure than the gastric bypass or malabsorptive procedures. However, weight loss induced by LAGB is lower.
Is it right for me?
If your BMI, or body mass index, is between 35 and 39, then you must also have associated severe medical problems, or co-morbid conditions, in order to be a candidate for the Lap-Band.
Surgery: After performing a series of small incisions, your surgeon would use a small camera, called a laparoscope, to visualize placement of the Lap-Band. The Lap-Band is placed around the top of the stomach and secured in place with sutures. The port is then placed underneath the skin on the top part of the abdomen. Surgery should take only about an hour, and an overnight stay in the hospital may or may not be required.
Risks: The port may leak or twist, requiring an operation to correct the problem.The lack of fullness after eating is a feeling some may not be satisfied with. Dumping syndrome, used as a warning mechanism, does not occur. Band may erode into the stomach wall. Band may move or slip. Weight loss is slower than that following Roux-en-Y gastric bypass surgery.
Results: Weight is lost during the first 2 to 3 years after surgery. The systematic review reports 56% excess weight loss (EWL) at 5 years (three reports). In comparison, Roux-en-Y gastric bypass is reported to have achieved 59% EWL at 5 years (four reports).
Recovery time: Following surgery, you should be able to return to work within a week, with minimal discomfort. You will need to follow a nutrition plan (which may include vitamin supplements) prescribed by your surgeon and/or nutritionist. The nutrition plan will likely include a liquid diet for a few weeks, until you can tolerate soft foods, and later solid foods. A specific exercise program, as well as behavioral-modification therapy, may also be recommended.
Stomach Stapling (vertical banded gastroplasty)
Definition: Gastroplasty is the origin of the term stomach stapling, and is the prototypical "restrictive" procedure. In this procedure, a portion of the stomach is isolated by applying surgical staplers to seal off the stomach. The original form of the surgery involved stapling the upper portion of the stomach horizontally. A small opening was left in order for food to pass to the lower portion. Unfortunately, horizontal stapling alone led to poor long-term weight loss, and the operation was abandoned. VBG combines the process of stomach stapling and a polypropylene mesh band around the opening of the created pouch.
Is it right for me?
The best candidates for VBG have a BMI of over 40, and many patients have attempted other weight loss methods without success.
Surgery: There are two surgical methods used for vertical banded gastroplasty. The open method begins with an 8-10 inch incision to open the abdomen. The laparoscopic method begins with several small incisions in the abdomen. Gas is pumped in to inflate your abdomen, making it easier for the surgeon to see. Your surgeon passes a laparoscope and surgical tools through these incisions. A laparoscope is a thin, lighted instrument with a tiny camera that projects images of your abdominal cavity on a monitor; your surgeon performs the operation while viewing the surgical area on this monitor. Both surgical methods proceed as follows: Your surgeon uses surgical staples to divide your stomach into two unequal portions. The upper portion is a small pouch that empties through a tiny opening into the lower portion. Next, your surgeon wraps a band of polypropylene mesh around the tiny opening to prevent it from stretching. This band can be adjusted after surgery, if necessary. The small pouch can hold about ? to 1 cup of soft, moist, and well-chewed food, therefore limiting the amount you can eat. A normal stomach can hold 4-6 cups. The tiny opening causes food to move out of the pouch very slowly, making you feel full quicker and for a longer time. This procedure does not interfere with normal digestion. To complete the procedure, your surgeon will close the incisions with staples or stitches.
Risks: These risks that are associated with the procedure can include things like the chances of infection as well as internal bleeding and leaking of the digestive tract. The first three possible risks are obviously no laughing matter. An infection cause by the surgery can be either at one of the various incision points in which the care for them is relatively simple however if that infection is inside the abdominal cavity is can be life threatening. The same goes for the internal bleeding. While the average stomach stapling patient can expect to see some blood in their stool after the completion of their stomach stapling surgery, seeing excess amount that turn the stool into a tomato soup tinge means that the patient should immediately go to the triage ward of their local hospital and try to not only replace the lost blood but undergo another surgery in an attempt to repair the point that the digestive tract is bleeding at. Then of course you have the chance of leaking of the digestive tract. In this leakage the actual acids which are found in our digestive tract and are used by our bodies to break down the food we eat can leak into the abdominal cavity and damage some of the interior soft tissue.
Results: As most of the gastrointestinal tract is left intact, there are few micronutrient deficiencies, and initial weight loss is good. Yet after long-term observance of VBG, there have been many patients that have regained weight. Surgery alone is insufficient - patients must change their lifestyle and eating habits or this procedure can be compromised. Over time, the pouch can dilate and serve as an increased reservoir, along for higher caloric intake and consequent weight gain.
Recovery time: After gastric stapling surgeries such as vertical band gastroplasty, patients may typically expect to rest carefully for a few days, before gradually increasing their activity. Many patients can return to light work or activities in about 10 days, although bariatric surgeons advise all patients to avoid any form of strenous activity for about 6 weeks after surgery.
