Restrictive Operation: Laparoscopic Adjustable Gastric Banding (LapBand)

This operation, which is the procedure of choice of 10% of people, is an treatment for patients with serious obesity that relies on reducing the amount of fod that you eat. This operation is meant to help you limit your eating by giving you a sense of "satiety" with a small meal. Satiety is the signal that your stomach sends to your brain when it has stretched due to food. Your brain interprets this signal as a sense of "satisfaction," "fullness," or that you've "had enough." Once you have received this signal, you need to make a conscious choice that since you feel that way, that it is time to stop eating.

Most people say that this restored sense of satiety is a major change for them. Many obese people simply do not have satiety, and therefore may overeat. If this is the main cause of your overeating, a restrictive procedure is a very good choice for you. By restoring the natural feedback from your stomach to your brain, you will eat a smaller quantity yet not feel deprived. Many people say, "If I could eat smaller portions, I wouldn't have a problem!" The difference between a "diet" where you might eat smaller portions, and a LapBand is that you have a source of satisfaction with the smaller portion. Diets generally do not provide this positive reinforcement, and therefore often fail.

How Your Anatomy Is Changed
One of the the advantages of this operation for many people is that your underlying gastrointestinal anatomy is NOT changed with this operation. No part of the stomach or small intestine is cut, sewn, or altered. The LapBand is a belt-like device that is placed gently around the upper portion of the stomach, creating a narrowing at the top of the stomach where the band sits. The part of the stomach that is above the band becomes stretched by solid food, providing the sense of satiety. Food slowly empties out of the small pouch, into the larger stomach where it is digested and absorbed just like before surgery.

The Operative Procedure
The Band is placed around the top of the stomach through five or six small incisions in your abdomen, "laparoscopic" surgery. The devices is connected to a "port" which is sewn to the front of the abdominal muscles. This allows the port to be accessed with a needle in the office. Through this needle, fluid can be added to the Band to make it tighter, with more restriction, or looser, to allow less restriction. Many people who have this operation can be discharged from the hospital the same day, or the next day.

Results
This operation has good results in helping relieve obesity-related conditions. High blood pressure, high cholesterol, sleep apnea, diabetes, joint pains, and other illness can slowly improve in a large number of patients. Since most people have obesity surgery to improve their health, this is one of the ways we measure success. In terms of weight loss, most people lose about 25% of the excess weight they carry at about one year after surgery. Weight loss is gradual in most people, perhaps about 10% per year. Over three years, many have maintained 35% of their excess weight. Longer-term results in the American population is not available yet, given that this devices has been used in the United States for less than 5 years.