How does it work?

The Lap-Band explained

The Lap-Band is a prosthetic device made out of silastic, an inert material that has been used in medical devices for decades. It does not break down or deteriorate over time and can be safely left inside the body for life. The Lap-Band is designed not to leak and has not shown deterioration in any reported studies. The name "Lap-Band" comes from the surgical technique used (laparoscopic) and the name of the product used (gastric band).

The Lap-Band is an adjustable ring that is placed around the upper stomach. It creates a small, proximal stomach pouch, with the larger part of the stomach below the band. The band controls the opening between the two parts of the stomach. The upper part fills when solid food is eaten and this causes you to feel full with a smaller portion of food. There are stretch receptors in the wall of the upper stomach, which send a signal to the brain that you are full, or satiated. The ingested food empties into the lower stomach at a controlled rate. This maintains a feeling of satiety and avoids the constant sensation of hunger that can be associated with dieting. If someone continues to eat after filling the upper pouch with food, you will likely feel uncomfortable and there may be a risk of vomiting, which can cause problems with the Lap-Band.

 

The ring around the stomach is attached to tubing, which is connected to a port (reservoir) that lies under the skin and fat of the abdominal wall. At the time of the surgery it is attached to the muscle of the abdominal wall midway between the umbilicus and breastbone in the front part of the abdomen. It is deep beneath the skin and cannot be seen. It is unlikely that you will be able to feel the port until there has been significant weight loss.

Prior to the procedure

Once you have decided that Lap-Band surgery is the best option for you, the following steps are part of the pre-operative process:

1. Consultation with a surgeon. We will discuss each patient’s medical and weight history, and the procedure in detail, including general and specific risks in order to complete the process of informed consent. All patients must complete and forward the Patient Questionnaire prior to the consultation so we can review their medical history. A link to the Patient Questionnaire is available on the Contact Us page of this website.

2. Consultation with a clinical nurse specialist. The pre-operative preparation, including a Very Low Calorie Diet (VLCD) (see below) as well as the pre-op and post-op dietary guidelines, will be discussed.

3. Pre-op physical and testing. A pre-op physical by the family physician and blood tests must be completed in the two weeks prior to surgery. We also require an ECG if you are over the age of 45. This allows us to identify any potential medical conditions that could affect the safety of the operation or the post-operative course. This testing can be done at laboratories close to where you live if this is more convenient.

4. Pre-operative VLCD. Our surgeons will be prescribed a nutritionally complete VLCD meal replacement product for at least two weeks prior to surgery. Studies have shown (Obesity Surgery, 2004) that pre-operative VLCDs will reduce the fat stored in the liver and shrink the liver by up to 25%, which makes the surgical procedure safer and easier.

5. Pre-operative assessment by other specialists (if indicated). During the consultation with the surgeon, it may be determined that, based on your health, an assessment with other specialists is required. These could include:

1. Anesthetist, Internist or Cardiologist
2. Sleep studies
3. Psychologist
4. Dietitian

The procedure

Lap-Band procedures are performed under general anesthesia and most procedures are performed at the Surgical Weight Loss Centre. Fellowship-trained anesthetists with extensive experience in bariatric surgery will be performing the anesthesia and directing the immediate post-surgical care. Patients with compromising health problems or previous major upper-abdominal surgery may require their surgery to be performed at the Trillium Health Centre in Mississauga.

Lap-Band surgery is minimally invasive and performed laparoscopically. A series of small puncture openings are made in the abdominal wall to accommodate the instruments. A video camera is attached to a special telescope to provide visualization of the abdominal cavity. The abdominal cavity is filled with absorbable gas to create the space necessary to complete the procedure. Very rarely is it necessary to make a large incision to perform the surgery. If this possibility is anticipated during your consultation, it will be discussed thoroughly with you.

A tunnel is created around the upper stomach and the Lap-Band device is placed in the proper location. Sutures are placed to hold the Lap-Band in place and prevent it from sliding into a less optimal position (band slippage). Tubing from the Lap-Band is then attached to the port, which is placed under the skin and fat (but on top of the muscle) of the abdominal wall. During post-operative visits fluid can be injected through the port to precisely adjust the size of the Lap-Band and thus modify the size of the opening into the lower part of the stomach.

There may be situations (although it occurs rarely) where the surgeon may need to make a larger incision to insert the Lap-Band. This could happen if there are challenges completing the surgical procedure using the laparoscopic technique. Anatomical variation, scarring from previous surgery and unexpected findings at surgery may make this necessary. We anticipate that this would be required in less than 0.1% of procedures.

Many patients have a weakness or defect in the diaphragm muscle where the esophagus joins the stomach. This is known as a hiatus hernia. If your surgeon identifies a hiatus hernia at the time of surgery it will be repaired at the same time. This is done to minimize problems with heartburn and reflux symptoms that may occur as the Lap-Band is adjusted. There is no added charge for a hiatus hernia repair.

During the procedure you will receive antibiotics to reduce the risk of infection, as well as special compression leg stockings and blood thinners to reduce the risk of blood clots in the veins of the legs.

The procedure usually takes about 30 to 45 minutes to complete.

After the procedure

After the surgery, patients are closely monitored in the Recovery Area until they are able to be discharged. It is important that the patient is mobile as soon as possible in order to help prevent blood clots and respiratory problems. The surgical team will be available to assess progress and decide when the patient can be discharged from the clinic, which is usually about 2 hours later. When the anesthesia has worn off, there may be some temporary pain. This pain can usually be relieved with ordinary painkillers.

Patients will be given detailed instructions regarding dietary guidelines, a prescription for liquid painkillers and instructions on other aspects of their post-procedure care at the time of discharge. All patients must go home with, and be accompanied by a responsible adult for the first 24 hours after surgery.

Immediately after the operation, you can have sips of water or suck on ice cubes. The day after the operation, you can take more fluids, but they should be mostly water. You should only take a small amount at a time. In addition to water, you may also consume liquids such as soup broth, clear juices and Jello.

It is common to experience "gas pain" in the shoulder and chest area for up to 36 hours after the surgery. There may be some mild discomfort around the abdominal incisions that should be easily controlled with the medications that will be prescribed. It is important that post-op nausea be controlled.

With a routine recovery, patients should be able to resume their normal activities within 7 to 10 days after the surgery. We recommend that patients plan to take at least a week off work after the procedure. Driving is prohibited while taking any narcotic pain medications such as codeine. Patients that are not on these types of pain medication can drive within a few days, as long as the distances are reasonable and not too tiring. Some people require a shorter or longer period of time to recover from a general anesthetic, but all patients should plan to take it easy for at least a week after Lap-Band surgery.

We encourage you to gradually start exercising when you feel up to it. Walking each day is highly recommended and distances can be increased as you recover. Strenuous exercise, such as lifting weights and abdominal exercises, should be avoided for at least one month. We recommend that patients wait at least 4 weeks before sitting in a bathtub or hot tub, and 3 weeks before swimming to reduce the risk of infection. Showering is fine within two days after surgery and patients can wash normally with soap and water.

If you have surgery at the Surgical Weight Loss Centre and it is felt that you should not be discharged that day, arrangements will be made for your transfer and admission to the nearby Trillium Health Centre. This is very rarely necessary.

Transitioning to solid foods

All fluids are fine during the first week after surgery. We suggest that you consider continuing with the VLCD (that will have been prescribed pre-op) for a time after surgery. This will ensure adequate and complete nutrition while you learn to adapt to a new eating pattern. If preferred, you can choose another meal replacement liquid diet such as SlimFast in the post-op period.

Liquids that are recommended for the first week are:

• Clear broth or soup (without vegetables or meat and not creamy)
• Low-fat yogurt
• Milk (preferably skim)
• Jello
• Clear fruit juices or puréed soft fruit

Based on your adjustment period and guidelines, you will be transitioned from liquids to puréed foods, to soft foods and eventually to solid foods by about week four.

Continuing Support

Following surgery, you will continue to receive on-going support from our team. It is important that you maintain contact with the clinic and update us regularly on your progress. By keeping in touch with us, we will be able to better advise you regarding the need for, and timing of, adjustments to the Lap-Band and provide counselling as required.

After the surgery, you have the most important role to play in your progress. Your responsibilities include establishing new eating patterns and adjusting to a new lifestyle.