Laparoscopic gastric banding or Lap-band is one of the popular Bariatric surgery procedures performed with minimal invasive surgery. It involves placing an adjustable silicon band around the upper part of the stomach that is connected to a port on abdominal wall. This band can be inflated or deflated according to the requirement of the body. The band reduces the size of the stomach and patient feels satiety on small meals. As patient consumes fewer calories, weight loss occurs following this procedure.
Laparoscopic gastric banding or lap-band surgery is the safest and effective Bariatric surgery procedure with minimal complications. However, in a small number of patients who undergo lap-band surgery for weight loss, complications do occur. Complications may be trivial that settle on readjusting the band or serious and need band removal or revision bariatric surgery as an alternative. All the conditions in which patients fails to lose weight after lap-band surgery or needs removal of lap-band, are called lap band failure.
What we call lap-band failure is of two types
1. failure to lose excess weight
2. complications of lap-band that necessitate revision Bariatric surgery
1. Failure to lose excess weight
Successful weight loss in a patient after weight loss surgery is regarded as 50% loss of body weight or achieving body mass index less than 30. If patient loses only 25% of the body weight or less then it, is regarded as lap-band failure. Reasons for this failure may be multiple but the most common reason is not following dietary advice after lap band. Other reasons include wrong selection of procedure and poor surgical techniques. Whatsoever is the reason for lap-band failure, patient has to undergo revision bariatric surgery to correct this failure.
2. Complications of lap-band that necessitate revision surgery
Although complication rate with lap-band surgery is minimal but still small number of patient develop complications. Complication rate is quite high for surgery centers where in-experienced surgeons perform this important surgery. Some of the complications of lap-band surgery which are considered as lap band failure are,
- Slipping of lap-band- most common complication in which silicon band is slipped to lower part of stomach and increases the size of gastric pouch. This may lead to failure to lose weight
- Band erosion –in this condition silicon band erodes the wall of the stomach and creates irrigative symptoms like vomiting, heartburn, epigastric pain and in severe cases gastric perforation may occur.
- Band infection
- Band intolerance-presents as symptoms of vomiting, retching and pain on taking meals or without meals
- Difficulty swallowing
- Port infection
- Pouch dilation
WAYS TO CORRECT LAP-BAND FAILURE
Lap-band failure can be corrected in several ways depending upon the cause for failure. Following are the options to correct lap-band failure,
1 Repositioning of the band
Repositioning of lap-band can successfully be done in patients in whom band-slipping occurs after surgery. Band is repositioned by surgery and fixed to the stomach wall. Repeated slipping necessitates performing some other Bariatric surgery procedure.
2. Removal of the band
Lap-band needs removal in conditions in which band erosion, band infection, band intolerance or infection of the port occurs. These are conditions that need urgent removal of band and later on revision gastric surgery that may be Roux-en-Y gastric bypass surgery or some other procedure.
3. Other Bariatric surgery procedures
Patients in whom lap-band fails (either ineffective weight loss or complications that necessitate removal of the band) need other Bariatric surgery procedure for management of their excessive weight. Research shows that Roux-en-Y or other revision Bariatric surgery procedures prove extremely effective in patients who fail to lose weigh with lap-band surgery. Revision Bariatric surgery procedures that can be performed after lap-band failure are,
- Roux-en-Y gastric bypass procedure
- Duodenal switch procedure
- Sleeve gastrectomy procedure
Important to remember
The most important thing to remember is that revision bariatric surgery is a bit complicated than the procedures performed in first instance and only an expert surgeon can make a difference. For this reason, it should only be performed by an experienced surgeon at a dedicated Bariatric surgery hospital. Surgery centers that claim to be cheaper in the market may complicate revision bariatric surgery due to lack of experienced surgeon and other staff and augment the misery of the patient.