Taking a moment to post something here that I posted somewhere else that talks about part of what's had me so busy and word-thirsty lately. If there are verb cases or context things that don't make sense, mea culpa. Maybe I'll have time to edit them one day.

Welcome to the world of adjustable gastric banding!

"Lap Band" is a brand name for Inamed's LAP BAND system adjustable gastric band. Perhaps because it is the only AGB available in the U.S., it's become kind of like Jell-O, Xerox, or Kleenex in that we use "lap band" to refer to all varieties because of how much they have in common. There are at least two other kinds of bands: the MidBand (the one I'm having placed) and the Swedish AGB. Have I confused you yet?

AGBs all work in primarily the same way. They comprise a solid silicone ring lined with a "balloon" (which is a bit misleading of a word) that can be expanded by filling it with a solution (usually saline, in the U.S.). The band is place around the stomach organ, near the top, creating an hour glass. The bottom of the hourglass is larger than the top.

There is a thin flexible tube running from the band to a subdermal port that is typically located on the patient's left below the rib cage, though it can also be placed immediately below the sternum. Regardless of the band selected, the ports are all made by the same company(ies) and are used for a variety of medical applications besides obesity surgery.

Fluid is added or removed from the band via the port. The port is accessed with a hypodermic needle.

Because the nerve endings that tell the brain we're full are located along a portion of the top of the stomach organ, the placement of the band is quite specific. The way the band works is by limiting the quantity of food necessary to stimulate those nerves--meaning you feel full much sooner--and by pacing the rate at which the food moves from the upper portion of the hourglass to the lower portion of the hourglass.

The stomach functions are kept entirely intact. There is no cutting of any organs, or rerouting of anything. No malabsorption is involved and no intolerance of entire food groups.

After healing from the initial surgery, each patient receives 0-6 "fills" the first year post-op in order to hit the "sweet spot"--the point at which you are restricted enough to lose weight at a healthy and steady pace while feeling well-sated. Why the range? Because the amount of fluid required for a proper rate of food movement from the top of the hourglass to the bottom varies by individual. My anecdotal sense is that it takes 2-3 fills for most folks to hit that point. I haven't done formal research about that, though, and I could be wrong.

Also, as the patient loses weight, periodic additional fills are usually required. The stomach shrinks as the fat surrounding it is lost, and small amounts of the fluid in the band can osmose out into the body. Since the fills are a matter of ccs or tenths of ccs, a little change makes a big difference.

This pattern of losing weight and having fills continues until the patient has lost as much weight as she wants. To maintain the weight loss, the fill level can be adjusted until the patient is neither gaining nor losing beyond the normal monthly fluctuations people go through.

You can control to rate of loss to a large extent. The goal is to lose 1-2 pounds per week. Sometimes, people lose a bit faster in the beginning, perhaps at a rate of 3 pounds per week.

As we all know, losing a lot of weight requires emotional and mental adjustment as well as physical. It's nice to know that if you want to take a break and get used to a certain point of weight loss, you can do that. You can decide to wait before having another fill.

One of the biggest benefits to the band, in my opinion, is that it is really about supporting the health of the person. It doesn't traumatize the body with drastic rapid weight loss. It encourages a gentle progress toward improved health, allowing the organs and tissues of the body to process all of the stuff that gets dumped into the system as fat is burned. There's nothing frantic about it. You don't have to beat a clock. There's not "window of opportunity". You can continue to lose weight for as long as you need to do so. Weight regain is mitigated by the adjustability of the band.

Also, and this is key for me, it doesn't induce shame. It supports. There's no punishment involved. You don't have to dump or eliminate entire categories of food. You don't have to feel guilty for being hungry. You don't have to starve your body or compromise its ability to absorb critical nutrients. In fact, the band only works effectively if you stay out of starvation mode. For those of us who have dieted our metabolisms to the point where we can gain weight on 1100 calories per day, it's a real blessing. Stimulating the nerves that tell the brain that enough food has been received triggers the release of endorphins and other chemicals and hormones that kick the metabolism into gear.

As with any abdominal surgery, there are risks. And there are post-op things to learn. The good news is that the band-specific complication rates are quite low and all of the complications can be treated and resolved pretty simply.

The most common complications are:

Port problems
These are almost entirely based upon the skill of the doctor doing the follow-up fills.

Doctor-related port complications include:
~ Puncturing the port or the tubing with the fill needle (this is largely mitigated by having the tubing closest to the port protected with a relatively pierce-proof covering).

~ Twists. Doctors experienced with ports can usually massage them back into place--especially if they are not stitched to the muscle tissue. Less experienced doctors can have a harder time.

Non-doctor related port complications include:
~ Manufacturing problems (just like with lamps, cars, and dishwashers, there's going to be a lemon now and then).

~ Random events. Like, if you got hit in the port with a batted baseball and it cracked. (OK. I'm mostly joking on this one. My point is that there's always something unexpected that can happen.)

Other Complications:
The second most common complication is slippage of the band. Calling it common is kind of misleading as, in fact, it's quite uncommon, particularly now that most protocols include using one stitch to keep the band in place. Generally, when the band slips, restriction is lost and surgery is required to put it back into place. Sometimes, removal of the fluid and waiting are enough to coax it back where it should be.

Slippage is primarily caused by increasing the fill level too quickly. My surgeon, Dr. Frering (who designed the MidBand), reports the following slippage rates. Bear in mind that he did not do the follow-up in all of these cases. Some people traveled to have surgery with him and then had their follow-up work done by another surgeon (or radiologist, or nurse, etc.):

~ He did 900 LAP BAND system surgeries, with a slippage rate of 7%.

~ He did 1,000 Swedish AGB surgeries, with a slippage rate of 1%.

~ He's done more than 1,100 MidBand surgeries, with a slippage rate of .4%.

At this time, there is not enough information available to assess the degree to which the design differences between the three kinds of bands influences the rate of slippage, though statistics from other doctors tend to validate those of Dr. Frering.

The next most common complication is erosion of the band through the stomach wall. This is extremely rare. Study results vary and the skill of the doctors is the number one factor in the percentage of cases with this complication. Among the most experienced doctors (those with more than 350 bands placed, let's say) the rate appears to be approximately .27% according to the aggregate statistics from several studies I read.

The two primary causes for erosion are: using too many stitches to hold the band in place, and filling it to tightly.

I'll mention that to date, Dr. Frering has had only one case of erosion with the MidBand--and it was a woman who had previously experienced erosion with a Swedish AGB. The operating conclusion is that she has an extremely rare allergy to silicone. And, even if that hadn't happened, 1,100 placements may not be enough to state categorically that it is not a risk with the MidBand. I'm no statistician. If one of you is, let me know where that stands in terms of being a statistically significant quantity.

Life after being banded I'll leave to those who are post-ops. I can share that as I understand it, the rules are pretty simple:

~ Avoid high calorie liquids (I have a question about this I'm going to put in another post)

~ No carbonated beverages

~ Chew like mad

~ Drink lots of water

~ Beverages ok up until beginning to eat, then a no-no until at least half an hour after eating

~ When eating, eat protein first, then complex carbs, then other stuff

~ Learn how to eat slowly enough to know when you are full and don't push it with even one more bite

OK. This post is long enough.

As always, if I've got something wrong, somebody please correct me. I'm not a doctor. I don't even play one on television and I never want to mislead anyone. What I write is based upon what I've read and heard (directly). I've read many studies and extracts, though, so I reserve the right the dismiss hearsay or undocumented data out of hand.

Any questions?

Copyright 2002 Seasmoke All rights reserved.