LAP-BAND® System

updated September 6, 2017

Gastric banding with the LAP-BAND® System is one of the safest surgical weight loss alternatives available, but the procedure is not entirely risk-free. There are certain risks associated with any surgical procedure, and LAP-BAND® System surgery is no exception. Choosing a skilled, experienced surgeon can help to minimize the risks and complications of weight loss surgery while maximizing its potential for effective and lasting results. Learn more about the LAP-BAND® System procedure, including its risks, benefits, and how the procedure works.

• RELATED: Find a qualified bariatric surgeon in your area

Preparing for Surgery

Bariatric surgeons typically provide each patient with a detailed list of instructions to follow on the day before surgery. These typically include dietary limitations, as the stomach must be empty to minimize risks during LAP-BAND® System surgery. Most patients will be checked into the hospital a few hours early for pre-surgical testing and evaluation to ensure that it is safe to proceed with surgery. In addition, patients should take the time to prepare for surgery. Any form of weight loss surgery necessitates a major commitment, and detailed medical, nutritional, and psychological preparation is needed before surgery can be performed.

• Pre-operative Medical Testing: Every patient needs to undergo careful pre-operative examination before committing to surgery. In order to maximize the safety and efficacy of the treatment, it is absolutely crucial for all medical professionals, including nurses, doctors, surgeons, and anesthetists, to have a thorough understanding of the patient's health history. This includes allergies, specific health conditions, and co-morbidities related to obesity.
• Counseling: Preparing psychologically is at least as important as preparing physically. Often, losing weight successfully means changing lifelong habits. It also means confronting challenges and setbacks during the weight loss process. Most bariatric surgery practices offer counseling and support groups both for patients who are preparing for surgery and for those who are in the process of losing weight. Many patients describe these sources of emotional support as being essential to their success.
• Lifestyle Changes: Before undergoing surgery, each patient must work with experts in nutrition and physical fitness to establish good dietary and exercise habits. It is important to become accustomed to these changes before undergoing surgery so that the transition to a healthy post-surgical lifestyle is as smooth as possible.
• Smoking: it is important to quit smoking well before surgery. Tobacco use can create complications during surgery, and it can also cause problems during recovery and afterward.

Procedure

• First, patients are placed under general anesthesia for their comfort and safety.
• Next, the band is carefully inserted through an abdominal incision and then maneuvered into place.
• The gastric band is positioned around a small section of the upper stomach, near the esophagus. The LAP-BAND® System itself has a clasp that fastens securely into position, creating the stomach pouch.
• Finally, the surgeon implants a valve, just beneath the skin, that is connected to the band by a length of tubing.
• Your bariatric surgeon can then adjust the gastric band by injecting saline fluid through this valve, adjusting the size of the stomach pouch to optimize healthy weight loss.

Gastric banding surgery is usually performed laparoscopically. Rather than opening the body cavity to access the internal organs, a laparoscopic surgeon makes multiple small incisions. Through these incisions, specialized surgical implements are inserted along with a camera that gives the surgeon a clear view inside the body. Using these implements, a highly trained surgeon can maneuver the LAP-BAND® System into place around the stomach without affecting the surrounding organs.

Placement of the LAP-BAND® System normally takes about an hour, though the entire operation takes about three hours from beginning to end. The procedure, which has been approved by the FDA, has an excellent safety record. Many surgeons report that they have treated hundreds of patients without serious complications during or immediately following surgery.

Recovery

After LAP-BAND® System surgery, most patients spend about 24 hours in the hospital. During this period, patients are able to rest and heal under close medical supervision to ensure that no serious post-surgical complications arise. Most gastric banding patients spend a week or two at home resting and recovering after being discharged from the hospital. It is important to closely follow doctors' instructions during this recovery period in order to avoid unnecessary discomfort and complications. After about a week, most people feel able to return to some normal activities and even light exercise. Throughout the recovery process, it is important to stay well hydrated by drinking water regularly between meals.

• Diet: For about two weeks after surgery, patients will be limited to an all-liquid diet. This diet allows the body to acclimate to the new stomach pouch while jumpstarting the weight loss process. Within a few weeks, surgeons may begin to recommend pureed or soft foods, and within six weeks it is usually safe to begin eating solid foods. However, many patients find that certain foods simply do not agree with them after surgery, causing heartburn and indigestion even in small amounts.
• Exercise: As soon as possible, patients should engage in light walking. This is the best way to avoid complications such as blood clots that may arise during recovery, and it is an important step toward establishing healthy long-term habits. Before surgery, patients will have established an exercise plan with a fitness counselor. Though it can be especially challenging to follow this plan in the early days and weeks after surgery, exercise is central to effective weight loss.
• Counseling and Support Groups: It can be challenging and emotionally draining to undergo the fundamental lifestyle changes required for LAP-BAND® System surgery. For this reason, many bariatric surgeons provide counseling and support groups to help patients stay motivated. Counselors specialize in helping patients confront depression and other challenges that may arise during the weight loss process, while support groups composed of other surgical weight loss patients are an invaluable source of empathy and support. Many patients say that they would not have been able to succeed without both counseling and support groups.

Risks and Complications

Patients who decide to undergo LAP-BAND® System surgery are at risk of certain surgical problems and complications. Though a skilled surgeon can minimize these risks, they cannot be completely avoided in every case, and it is important for patients to understand the risks they face when choosing a weight loss procedure.

• Death: The risk of death associated with LAP-BAND® System surgery is extremely small. However, the risk does exist, and patients choosing weight loss surgery must understand this.
• Organ damage: As is the case with all laparoscopic procedures, patients undergoing LAP-BAND® surgery occasionally sustain organ damage. The stomach, spleen, and liver are at greatest risk, though the risk is still very small. If one or more of these organs is damaged, additional surgery may be required.
• Circulatory damage: Some LAP-BAND® System patients sustain damage to major blood vessels during surgery. This can result in additional blood loss during surgery. Some patients also experience blood clots during or after surgery, which can be life-threatening if untreated.
• Wound rupture: In some cases, incision sites can tear or rupture. Though such a problem can be resolved, it may result in larger-than-expected scars.
• Band deflation: If the band, valve, or connective tubing becomes damaged, the band may leak saline fluid, causing it to deflate and requiring band repair or replacement.
• Slippage: In some patients, the band or stomach may slip out of place. This could obstruct the stomach opening.
• Band erosion: Rarely, the band may erode into the stomach.
• Stomach pouch enlargement: In some cases, the stomach pouch may stretch or enlarge over time. This increases the stomach's capacity, which may slow or reverse weight loss and require band adjustment.
• Eating-related problems: The LAP-BAND® System drastically changes the size of the stomach. As a result, some patients experience problems with eating, including gastroesophageal reflux (regurgitation) and difficulty swallowing.
• Stomach irritation: Some LAP-BAND® System patients experience stomach problems, including ulceration, gastritis, and heartburn.
• Other complications: Occasionally, patients experience symptoms such as gas bloat, constipation, and dehydration that may be linked to the LAP-BAND® System.

Cost

Though actual prices vary widely from state to state and from surgeon to surgeon, most patients can expect to pay between $15,000 and $30,000 for their surgery and postoperative care.

Insurance

Because of the high costs associated with obesity-related conditions such as diabetes, hypertension, and heart disease, many insurance providers are willing to cover the cost of a weight loss procedure. Most bariatric surgery practices are happy to help patients with paperwork and other insurance matters in order to help them get the treatment they need.

Most states in the U.S. have laws in place that require insurance companies to cover the cost of weight loss surgery for patients who meet the conditions established by the National Institutes of Health, unless the terms of a health insurance policy specifically exclude weight loss surgery. This typically means that patients are likely to be covered if they have a body mass index (BMI) of over 40, have tried and failed to lose weight through a non-surgical medical weight loss program, and/or have suffered from specific co-morbidities that could be resolved through sustained weight loss.

Financing

For patients whose insurance plans cover only part of the cost of weight loss surgery, or whose plans do not cover it at all, there are still options. Many patients choose to finance their procedures through one of many companies who specialize in financing health care. An affordable long-term payment plan can make even an expensive procedure like LAP-BAND® surgery affordable. Most weight loss practices have specific financing companies with which they have an established relationship.

Find a Surgeon

The best way to find out whether LAP-BAND® surgery is right for you is to discuss the procedure in detail with a trained bariatric surgeon. Using DocShop's nationwide database of bariatric surgeons, you can find a weight loss surgeon in your area who will help you explore the advantages and risks of surgical weight loss.