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Gastric Lap Band (Gastric laparoscopic banding)
Obesity is defined as a BMI of greater than 30. Obesity is strongly implicated in the development of a number of health conditions that may include: type 2 diabetes, arthritis, heart disease, obstructive sleep apnea, liver disease, certain cancers, depression and stroke. Multiple outcome studies have demonstrated the effectiveness of lap band surgery in reducing health risk.
Some statistical improvements include:
- Diabetes: Resolved in 77% and improved in 86%.
- High cholesterol: Improved in 70%.
- High blood pressure: Resolved in 62% and improved in 79%.
- Sleep apnea: Resolved in 86% and improved in 84%.
- 40% reduction in death rate from all causes.
Patients who have had obesity surgery benefit in many other ways:
- Improved quality of life
- Improved psychiatric well being
- Decreased cost of medications
The overwhelming evidence is in favor of obesity surgery when non-surgical methods have failed to achieve weight loss. If you have decided that obesity surgery is right for you and you do not have adequate insurance coverage and you do not have the financial means to have surgery where you live, consider having your surgery done by a qualified surgeon in a safe hospital in Mexico or Costa Rica.
The two types of obesity surgery are restrictive and malabsorptive. Some procedures combine both restrictive and malabsorptive properties. Before you go you should decide what type of surgery is best and that it is safe for you to have surgery. You should also arrange for appropriate follow up care which may include medical management and nutritional counseling. Each type of surgery will require that you have some sort of responsible follow up. Many people have successfully traveled to other countries for obesity surgery. There are many clinics and doctors available everywhere that can help you manage life after surgery.
Restrictive surgery limits the amount of food you can put into your stomach at any one time. Examples of restrictive surgeries include the laparoscopic adjustable gastric banding (LAGB), commonly known as the Lap Band TM or the vertical banded gastroplasty (VGB). VGB provides a 66% two year weight loss.
Statistically speaking, you can expect about a 55% weight loss up to 9 years later. Unfortunately the complication and revision rate in VGB is a little high and most purely restrictive surgery is accomplished now with the LAGB.
The LAGB utilizes a synthetic fluid-filled, doughnut-shaped band, which is wrapped around the top portion of the stomach. A small port is attached to the band by a thin piece of synthetic tubing and the port is surgically placed just under the skin on the abdomen. The port is therefore easily accessed so that a healthcare professional can inject or remove sterile saline from time to time to adjust the size of the band. This ability to adjust the restrictive nature of the band has eliminated the need for revision surgery that used to be necessary with the VGB procedure. In addition, the stomach is not cut so there is minimal risk of leaking from the stomach. LAGB is the safest of all bariatric procedures and carries a very low 0-0.05% mortality rate. And, because the lap band is very simple to perform the cost is generally much more affordable. Weight loss with the LAGB is 42% at one year and about 55% at five years. Weight loss tends to be more gradual compared to malabsorptive procedures but at three and five years, the comparative data between the two types of surgery is nearly identical.
Strictly malabsorptive procedures cause food to bypass certain areas of the intestinal tract that absorb nutrients. Calories are not absorbed by the intestines and end up in the toilet and not in your body. Standard strictly malabsorptive procedures include the biliopancreatic diversion (BPD) or the BPD with duodenal switch (DS). Malabsorptive procedures result in more rapid, long lasting weight loss. One study on BPD reported a 72% average weight loss at 18 years. Nutrient malabsorption and a higher complication rare are the major drawbacks of these procedures.
Complications of BPD and DS:
- Diarrhea and foul smelling gas (due to fat malabsorption), with an average of 3-4 loose bowel movements a day
- Malabsorption of fat soluble Vitamins A, D, E, and K
- Vitamin A deficiency, which may cause night blindness
- Vitamin D deficiency, which may cause osteoporosis
- Iron deficiency –a similar incidence with the RYGB (less frequent with DS)
- Protein-calorie malnutrition
- Ulcers (less frequent with DS)
- Dumping syndrome (less frequent with DS)
Some procedures, such as the Roux-en-Y gastric bypass (RYGB) combine both restrictive and malabsorptive components. The RYGB procedure is similar to the BPD and DS operations in that the stomach is divided and the intestines are reattached in a manner that allows food to go around (bypass) the absorptive portion of the small intestine. With the RYGB the attachment is higher up (when compared to BPD) resulting in less dramatic malabsorption. Because the RYGB also involves a restrictive procedure (stomach is divided and a small pouch is formed), rapid, profound weight loss is also achieved. Also, there seems to be more appetite suppression with the RYGB.
Advantages of RYGB
- Better weight loss than after purely restrictive procedures
- Low incidence of protein-calorie malnutrition and diarrhea
- Rapid improvement or resolution of weight-related health problems
- Appetite suppression
All Patients who wish to undergo Obesity Surgery should:
- Be well informed and motivated
- Have a BMI >40; for individuals with a BMI between 35 and 40 with at least one serious concomitant obesity related medical problem such as diabetes, sleep apnea, obesity-related cardiomyopathy (heart damage) or severe joint disease may also be candidates.
- Have acceptable risk for surgery
- Have failed previous non-surgical weight loss interventions
Situations where people who should not have bariatric surgery:
- Untreated major depression or psychosis
- Recent history of binge eating disorders (Anorexia or Bulimia)
- Current drug and alcohol abuse
- Severe cardiac disease that poses a high risk for anesthesia
- Severe coagulopathy (blood clotting disorder)
- Inability to comply with nutritional requirements including life-long vitamin replacement (Some bariatric surgical procedures result in nutritional deficits that require life-long vitamin supplementation).
Potential conditions where Lab Band Surgery should not be done:
- Crohn’s Disease
- Large Hiatal Hernia
- Portal Hypertension (Seen in Cirrhosis of the Liver)
- Connective Tissue Disorders (Scleroderma, Lupus, Rheumatoid Arthritis, etc)
- Prior Ulcers of the stomach
- Chronic steroid use
Summary of Bariatric Procedures