Lap-Band – Potential Complications & Risks

What are the Risks?

All surgical procedures have potential risks and complications. At the time of the consultation the surgeon will discuss the possible risks and complications that might arise.

General Risks

Lap-Band surgery includes the same risks that come with most operations, such as bleeding and infection. There are also additional risks of surgery in patients who are seriously overweight. Certain diseases, such as heart, liver or kidney disease, can increase the risks of surgery. The reported mortality rate with Lap-Band surgery is estimated to be approximately 1 in 5,000 patients.

Adverse events that are considered to be non-serious and that occur in less than 1% of Lap-Band patients include: esophagitis (inflammation of the esophagus), gastritis (inflammation of the stomach), dehydration, gallstones and gastric erosion (see below).

Specific risks and complications

Studies (J Gastro Surg, 2005) show that Lap-Band surgery has fewer risks than any other surgical treatment for obesity. Most complications are not serious but some may require hospitalization and/or re-operation.

• Slippage or pouch dilatation can occur if the Lap-Band moves down the stomach, or if the pouch above the band stretches up. Patients with these problems may notice heartburn or regurgitation of food at night when they lay down. Slippage of the band is unusual and occurs in approximately two to three percent of patients. It can cause acute symptoms of abdominal pain, or can cause failure to lose weight. The acute symptoms are pain, bloating, vomiting or difficulty in swallowing liquids and solids.
  
  At SWLC we routinely place sutures to anchor the Lap-Band in place at the time of surgery. We routinely look for and repair any evidence of a hiatus hernia. Our data and other studies have shown that these manoeuvres can significantly reduce the incidence of band slippage or pouch dilatation. If slippage or pouch dilatation is suspected, it can be diagnosed with a barium study of the stomach or endoscopy. These problems can usually be repaired with a laparoscopic procedure and only rarely is it necessary to remove the Lap-Band.
  
  
• Erosion occurs when the band slowly works its way through the stomach wall and is no longer outside the stomach. Due to changes in the surgical technique used to implant the band, this complication now occurs in less than 1 in 1,000 patients.
  
  Erosion may present as infection in the abdominal wall near the port and is rarely an emergency. If erosion occurs the Lap-Band will need to be removed with a laparoscopic procedure and then replaced at a later date.

Our data indicates that revision surgery (reposition, replace or removal of the Lap-Band) is necessary in less than 3% of our patients. This rate compares favorably with other high volume Lap-Band centers. Currently there is no further cost to the patient as these cost of revision surgery is subsidized by provincial health plans (subject to change). We offer comprehensive support and will continue to support you in your weight loss journey.

The following are rare complications of Lap-Band surgery:

• Port site pain, port displacement or port infection
• Leakage of the reservoir, tubing or band
• Spleen or liver damage (sometimes requiring spleen removal)
• Perforation of the stomach or esophagus during surgery

Laparoscopic surgery is not always possible. The surgeon may need to switch to an “open” method due to unanticipated difficulties with adhesions from previous surgery or if the patient has unusual anatomy. This occurs in less than 0.1% of Lap-Band operations.

Some complications may require surgery to remove, reposition, or replace the band. If serious complications occur, you may need to be admitted to a hospital or return to the clinic later.

Psychological issues

Some patients who are obese experience a variety of psychological issues such as “emotional” or “comfort” eating as well as depression, altered body image and poor self-esteem. Studies have shown that these conditions do not preclude the patient’s ability to achieve significant and sustained weight loss with Lap-Band surgery.

As part of the pre-op consultation, patients will be asked about any psychological issues that they are specifically concerned about. If it is felt that a patient requires counseling or assessment prior to surgery, we will assist in making arrangements for an appropriate consultation. Lap-Band surgery is not a cure for depression or psychiatric illness but studies show that a patient’s quality of life improves with sustained weight loss.

If there are concerns regarding psychological issues after surgery, it is important that these concerns be brought to the attention of the surgeon or the clinic staff. We will assist in helping our patients to obtain appropriate counseling or support in order to deal with any issues that may arise.