Wednesday, September 9, 2009

Laparoscopic Banding Bariatric Surgery

A common alternative to Roux-en-Y gastric bypass (and sometimes a precursor) is adjustable laparoscopic banding (aka Lap-Band). Like a gastric bypass, the procedure is a full surgical procedure requiring anesthesia. However, it is not invasive as a gastric bypass and requires less recovery time, but often has less dramatic results as well.

What is a adjustable laparoscopic banding (Lap-Band)?

Adjustable laparoscopic banding, or lap-banding, involves the placement of an adjustable inflatable device around the stomach via laparoscopic surgery. This form of surgery does not require a full stomach incision, but rather uses three to five small incisions for "ports" which allow for a camera and instruments to be inserted into the abdominal cavity. Laparoscopic surgery is also known as minimally invasive surgery.

The procedure is as follows. First, the patient is brought into the operating room and placed under general anesthesia by an anesthesiologist. Then, the ports are placed into the abdomen, starting with the camera. After visualizing the stomach, the lap band is introduced and placed around the stomach, creating two pouches. The band itself is connected via a tube to a small port with a membranous covering. This port is sutured into the muscle near the skin. After the procedure, saline can be injected or removed via this port to adjust the size of the band. When saline is injected in the port, its pressure is transmitted via the tube to the lap-band, causing the band to constrict around the stomach and reduce the size of the pouch, the size of the passage from the proximal pouch to the distal pouch, or both. After the placement of the band and port, the laparoscopic ports are removed.

How does laparoscopic banding lead to weight loss?

As mentioned previously, all bariatric surgery works either by reducing the volume available for digestion, the amount of digestive tissue, or both. Roux-en-Y gastric bypass works by doing both; in contrast, lap banding only reduces the volume available for digestion but does not affect the amount of digestive tissue available. It promotes weight loss because when the patient eats after the procedure, the smaller proximal pouch fills quickly, giving the sensation of satiation. Additionally, the band reduces the speed that food passes through the stomach and into the digestive tract.

What are the benefits of laparoscopic banding over gastric bypass?

There are several benefits to laparoscopic banding, besides the obvious fact that it is a less invasive procedure. Wikipedia lists the following few:
  • Lower mortality rate: only 1 in 2000 versus 1 in 250 for Roux-en-Y gastric bypass surgery
  • Fully reversible: stomach returns to normal if the band is removed
  • No cutting or stapling of the stomach
  • Short hospital stay
  • Quick recovery
  • Adjustable without additional surgery
  • No malabsorption issues (because no intestines are bypassed)
  • Fewer life threatening complications
Additionally, the procedure will often be more affordable for the patient. Initially, weight loss is not as drastic as with bypass; however, over time, with proper behavior modification, lap banding approaches the weight loss achieved by gastric bypass.

Tips For A Successful Laparoscopic Banding Procedure

Research the procedure beforehand. Find out who will be performing the procedure and how much experience they have. Don't forget that you still need to follow healthy habits, such as eating right and exercising. Simply having the procedure alone will not change your life permanently. If you continue to eat high calorie foods, you will eventually gain back all the weight you lose in the first few months after the procedure. Remember, the procedure is an extreme effort to help you lose your weight, but at the end of the day, you are in control and in charge of your weight loss, not the surgeon's knife. Help the procedure help you.


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