Laparoscopic Lap Band Surgery
AA Lap-Band is an inflatable silicone device that is placed around the top portion of the stomach, via laparoscopic surgery, in order to treat obesity. Adjustable gastric band surgery is an example of bariatric surgery designed for obese patients with a body mass index (BMI) of 40 or greater—or between 35–40 in cases of patients with certain co morbidities that are known to improve with weight loss, such as sleep apnea, diabetes, osteoarthritis, GERD, Hypertension (high blood pressure), or metabolic syndrome, among others.
Theory of gastric banding
According to the American Society for Metabolic Bariatric Surgery, gastric reduction surgery is not an easy option for obesity sufferers. It is a drastic step, and carries the usual pain and risks of any major gastrointestinal surgical operation. Some patients who undergo adjustable gastric band surgery lose more than 60% of excess body weight. Typically, patients who undergo adjustable gastric banding procedures, such as Lap-Band or Realize Band lose less weight over the first 3.5 years than those who have gastric bypass, or other surgeries such as Biliopancreatic Diversion (BPD) or Duodenal Switch (BPD-DS). However, over 7 to 8 years weight loss from gastric banding and bypass are essentially equal according to the American College of Surgeons. Most patients reach 65 to 90% of their ideal weight. However, in order to maintain this type of weight reduction, patients must follow carefully the post-operative guidelines relating to diet, exercise, and band maintenance. The placement of the band creates a stoma, or small pouch at the top of the stomach that holds approximately 110 to 220 grams of food each meal. This pouch fills with food quickly and the band slows the passage of food from the pouch to the lower part of the stomach. As the upper part of the stomach registers as full, the message to the brain is that the entire stomach is full and this sensation helps the person to be hungry less often, to feel full more quickly and for a longer period of time, to eat smaller portions, and lose weight over time. The gastric band is inflated / adjusted via a small access port placed just under the skin. Saline solution is introduced into the gastric band via the port. A specialized non-coring needle is used to avoid damage to the port membrane. There are many port designs (such as high profile and low profile) and they may be placed in varying positions based on the surgeon’s preference but are always attached to the muscle wall in and around the diaphragm. The port is sutured or stapled, in case of the Realize Band into place. When saline is introduced into the band it expands, placing pressure around the outside of the stomach. Gastric Bands usually can hold 8 to 10 cc of saline. One great way to save your credit and money, is to compare health insurance quotes and find an affordable option. This decreases the size of the passage between the pouch created from the upper part of the stomach and the lower stomach, and further restricts the movement of food. Over the course of several visits to the doctor, the band is filled such that the patient feels s/he has found what is colloquially known as the “sweet spot” or "green zone", where optimal restriction has been achieved, neither so loose that hunger is not controlled, nor so tight that food cannot be consumed. This is an individual experience and cannot be predicted. There are 2 brands of gastric band on the market with approximately 4–5 varieties of each. The total volume of saline each can hold varies.
Adjustable bands
Adjustable bands
The development of the modern adjustable gastric band is a tribute both to the vision and persistence of the early pioneers, particularly Lubomyr Kuzmak and a sustained collaborative effort on the part of bio-engineers, surgeons and scientists. Early research on the concept of band “adjustability” can be traced back to the early work of G. Szinicz (Austria) who experimented with an adjustable band, connected to a subcutaneous port, in animals. In 1986, Lubomyr Kuzmak, a Ukrainian surgeon who had immigrated to the United States in 1965, reported on the clinical use of the “adjustable silicone gastric band” (ASGB) via open surgery. Kuzmak, who from the early 1980s had been searching for a simple and safe restrictive procedure for severe obesity, modified his original silicone non-adjustable band he had been using since 1983, by adding an adjustable portion. His clinical results showed an improved weight loss and reduced complication rates compared with the non-adjustable band he had started using in 1983. Kuzmak’s major contributions were the application of Mason’s teachings about VBG to the development of the gastric band; the volume of the pouch; the need to overcome staple line disruption; the ratification of the use of silicone and the essential element of adjustability. Separately, but in parallel with Kuzmak, Hallberg and Forsell in Stockholm, Sweden also developed an adjustable gastric band11. After further work and modifications this eventually became known as the Swedish Adjustable Gastric Band (SAGB).
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