A 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 greateror 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. 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.
History and development
At the end of the 1970s, Wilkinson developed several surgical approaches whose common aim was to limit food intake without disrupting the continuity of the gastro-intestinal tract. In 1978 Wilkinson and Peloso were the first to place, by open procedure, a non-adjustable band (2 cm Marlex mesh) around the upper part of the stomach. The early 1980s saw further developments, with Kolle (Norway), Molina & Oria (US), Naslund (Sweden), Frydenberg (Australia) and Kuzmack (United States) implanting non-adjustable gastric bands made from a variety of different materials, including marlex mesh, dacron vascular prosthesis, silicone covered mesh and gore-tex, amont others. In addition, Bashour developed the “gastro-clip” a 10.5 cm polypropylene clip with a 50cc pouch and a fixed 1.25 cm stoma, which was later, abandoned due to high rates of gastric erosion. All these early attempts at restriction using meshes, bands and clips showed a high failure rate due to difficulty in achieving correct stomal diameter, stomach slippage, erosion, food intolerance, intractable vomiting and pouch dilatation. Despite these difficulties, an important ancillary observation was that silicone was identified as the best tolerated material for a gastric device, with far fewer adhesions and tissue reactions than other materials. Nevertheless, adjustability became the “Holy Grail” of these early pioneers.
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).
The Laparoscopic era
The advent of surgical laparoscopy transformed the field of bariatric surgery and made the gastric band an even more appealing option for the surgical management of obesity.
In 1992, Cadiere was the first to apply an adjustable band (the early Kuzmak ASGB) by the laparoscopic approach. In 1993, Broadbent in Australia and Catona in Italy implanted non-adjustable (Molina-type) gastric bands by laparoscopy. In the period between 1991–1993, the original Kuzmak ASGB underwent important research and design modifications in order to make it suitable for laparoscopic implantation, eventually emerging as the modern Lap-Band. This landmark innovation was driven by Belachew, Cadiere, Favretti and O’Brien and the Inamed Development Company engineered the device. The first human laparoscopic implantation of the newly developed Lap Band was performed by Belachew and le Grand on 1st Sept 1993 in Huy, Belgium, followed on 8 September, by Cadiere and Favretti in Padua, Italy. In 1994, the first international Lap-Band workshop was held in Belgium and the first on the SAGB in Sweden. The Lap Band (Allergan Inc., Irvine, CA) obtained FDA approval in 2001. The device has undergone further modification over the years. The latest models have largely eliminated problems related to tubing fracture and leakage which were such a conspicuous feature of the early devices.
Many Benefits of Gastric Banding
There are many benefits to the gastric banding procedure that make it an attractive alternative to other medical weight loss procedures: Very high success rate for both long-term and short-term weight loss and health. No long-term recovery and no long-term hospital stay, decreased pain, procedure performed under general anesthesia, procedure takes between 30 minutes to one hour, no cutting or stapling of the stomach, fully reversible. Adjustable - band will be easily and quickly adjusted as you make progress or have other health issues
A commonly reported occurrence for banded patients is regurgitation of non-acidic swallowed food from the upper pouch, commonly known as Productive Burping (PBing). Productive Burping is not to be considered normal. The patient should consider eating less, eating more slowly, or chewing their food more thoroughly. Occasionally, the narrow passage into the larger / lower part of the stomach may become blocked by a large portion of unchewed or unsuitable foodstuff. Other complications include Ulceration, Gastritis (irritated stomach tissue), Erosion - The band may slowly migrate through the stomach wall. This will result in the band moving from the outside of the stomach to the inside. This may occur silently but can cause severe problems. Urgent treatment may be required if there is any internal leak of gastric contents or bleeding. Slippage - An unusual occurrence in which the lower part of the stomach may prolapse through the band causing an enlarged upper pouch. In severe instances this can cause an obstruction and require an urgent operation to fix. Band placement - (high or low on stomach) - Extensive vomiting during the early postoperative period - This complication can be caused by lack of experience of the surgeon. Patients must undergo a second operation to reposition the band. Band was not placed on the stomach - (very rare - especially with an experienced bariatric surgeon) However, in two asymptomatic patients, the band had not enclosed the stomach but only per gastric fat. The psychological effects of any weight loss procedure also should not be ignored.
Why Consider India?
As the prices of various obesity surgeries skyrocket, Laparoscopic Lap Band Surgery in India is available at low cost at various Laparoscopy Centers of Mumbai, Chennai, Bangalore, Hyderabad and New Delhi. India is the new hub of medicine accredited to the ever increasing reputation and faith in Indian hospitals and doctors. India has the best qualified and most capable doctors in every field and this has been realized world wide. You can get the highest level of treatment at costs which in India are about a tenth of those in Europe and about a fifth of those in Southeast Asia, including Thailand. With the money thus saved, you can visit various attractive Indian tourist destinations, as and when advised by the doctors. We assure you a value for money treatment and travel facilities without compromising on quality at any time.