Lap-Band surgery becoming more popular weight-loss option
Erik Onstott
For many people needing to lose weight, a diet of certain foods is enough to get them to their goal. However, for others, other options such as surgery are needed.
One type of surgery is Lap-Band surgery, which takes its name from the surgical technique used - laparoscopic - and the name of the implanted device, a gastric band.
According to the website of the Unversity of Southern California Department of Surgery, the technique of laparoscopic surgery - also known as minimally invasive surgery - involves a small video camera along with several thin instruments. As the surgery proceeds, the surgeon makes small cuts of up to half an inch in the patient's body and threads small plastic tubes, called ports, through the incisions. These instruments are then used to wrap the gastric band around the patient's stomach, where it is fastened around the stomach and inflated with the saline solution. A camera is attached to one of these tubes; connected to a closed-circuit TV, it acts as the surgeon's eyes during the procedure.
The procedure creates a smaller stomach pouch which holds a smaller amount of food; the silicone ring also controls the stomach outlet between the new upper pouch and the lower part of the stomach.
Once the silicone band is around the stomach, a tube connects it to a small access port fixed below the skin around the abdomen. Through this port, the doctor may change the size of the stomach outlet by putting more saltwater into the silicone ring or taking saltwater out, to make the outlet larger.
No cutting or stapling of the stomach is required in the surgery; this is a major difference from other types of bariatric surgery such as gastric bypass surgery. With gastric bypass surgery, the smaller stomach pouch is created by stapling part of the stomach and bypassing the small intestine to cut down on the body's absorbing of food nutrients, thereby restricting food intake and reducing hunger. Another difference between lap-band surgery and other types of surgery is that it is reversible; the band may be removed if needed, with the stomach generally restored to its original form.
Both gastric bypass surgery and Lap-Band surgery are much more effective than diets or diet drugs alone, according to Orange lap-band surgeon Samuel Pangburn.
"With gastric bypass surgery and Lap-Band surgery, patients lose about 65 percent of their body weight after five years," he said. "With diets and diet drugs, the number is about five percent."
The recommended weight-loss with the procedure is approximately two pounds per week, Pangburn said; ideal candidates for the procedure are about 100 pounds over their ideal weight, have a body-mass index (BMI) of over 35 and have other health problems such as diabetes or sleep apnea.
However, Pangburn said, individuals with a BMI of 40 with none of the above conditions would also be ideal for the surgery. BMI calculators for adults and children may be found on the web site for the United States Centers for Disease Control at www.cdc.gov/nccdphp/dnpa/bmi.
According to a brochure published by Inamed Health, a division of Allergan Medical, other criteria for the surgery include being at least 18 years old and at least twice one's ideal weight.
The Lap-Band procedure was pioneered and perfected on animals in the early 1990s, and the first Lap-Band surgery on humans was performed in Belgium in September 1993. However, the procedure underwent several years of trials in the United States before it was approved for use here; the first FDA-approved clinical trials took place in June 1995, and the Lap-Band system was finally approved for use in the Unted States in June 2001. As of April 2007, the Lap-Band procedure had been performed about 300,000 times worldwide.
Pangburn said gastric bypasses comprised the majority of weight-loss surgeries performed in the United States. However, he said, the number of Lap-Band surgeries was increasing.
"I think that within five years, the Lap-Band procedure will catch up," he said. "The numbers for 2007 will be significantly higher than 2006."
The Lap-Band procedure is an outpatient procedure; patients may leave the hospital the same day it is performed, though Pangburn said he currently prefers to keep his patients overnight.
However, he said, there was something those considering the procedure should keep in mind.
"It's not just a surgery. It's a program. We have dietitians; attendance at the seminar is mandatory," Pangburn said, referring to the seminar he holds periodically to discuss the procedure with interested parties. "People need to know it's a lifestyle change."
According to documentation provided by Pangburn, those interested in the procedure must attend the seminar; contact the financial office; consult with Pangburn; undergo a psychological evaluation; and schedule a final follow-up visit before surgery.
"It's a good procedure," Pangburn said. "I wasn't going to do bariatric surgeries at first, but the band convinced me otherwise. It works."