LAP BAND FACTS
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Laparoscopic Adjustable Silicone Banding with the LAP-BAND'
has proven to be a safe Bariatric surgical procedure. It is minimally
invasive, adjustable and easily reversible. It does not involve
rerouting or rearranging of the intestines. It does not involve
dividing the gastrointestinal tract, and therefore it involves no
staple lines. It is a purely restrictive procedure, and thus, does not
involve any malabsorption. The operative time is among the shortest of
Bariatric procedures, and the length of hospital stay is usually one
night. This procedure has also been proven to be one. of the safest
operations, with a mortality rate of approximately I in 2,000. This is
about one tenth the mortality rate of gastric bypass'. It works because
patients eat less and have a sense of fullness, otherwise known as a
sense of satiety. The procedure was first introduced by BelacheW2 in
1993. There have been more than 100,000 of these surgeries performed to
Living with the LAP-BAND presents unique lifestyle adjustments and
challenges. We will provide an overview of the dietary guidelines, role
of exercise, and adjustment schedule. It cannot be overemphasized that
the LAP-BAND is a purely restrictive model for weight loss. This is in
stark contrast to both the Roux-en-Y Gastric Bypass and the Duodenal
Switch which involve a malabsorptive component to the operation.
Comparing weight loss from a LAP-BAND to either of these operations is
like comparing apples to oranges. The first rule in living and thriving
with the LAP-BAND is to remember that the weight loss is slow and
gradual. Weight loss in the range of 1-2 lbs. per week is considered
successful. A common source of disappointment and frustration comes
when a LAP-BAND patient compares his or her weight loss to a sibling or
coworker who has had a gastric bypass. Patience and understanding are
critical components to success with the LAP-BAND.
After surgery, patients will be required to make changes in their
eating habits and modifications in behavior in order to achieve weight
Diet Progression after Surgery
Day 1-3 - Liquid Diet
Day 4-5 - Full Liquid
- All of the above PLUS
- Mashed potatoes
- Chicken noodle soup or Condensed chicken and rice soup
- Oatmeal or malt o meal
Week 2-3 - Soft mushy food
Week 4-6 - Soft regular food
Week 7 and on - Regular food
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It is important not to drink with meals. Drinking liquids with meals or
too close to mealtime may cause bloating, nausea, or vomiting. Fluid
intake is very important for prevention of dehydration and
constipation. Sip on water all day. Do not drink liquids 30-45 minutes
before and 45-60 minutes after meals. This will avoid flushing out the
stomach for longer periods of time and therefore prevent rapid hunger.
Early hunger can cause increased calorie intake and weight gain. Do not
use a straw. This can cause your stomach to fill with air. Avoid
regular soda and adding sugar to beverages. Most fluids should be
non-caloric such as water, Crystal Light, sugar-free Kool Aid, coffee,
unsweetened tea, or broth. Avoid carbonated beverages and sodas for one
month after surgery. These can cause bloating. Avoid alcoholic
Exercise is absolutely critical to obtaining maximal success following
Bariatric surgery. Durability of weight loss is predicated on
compliance of diet but predominately on exercise habits. This is even
truer with the LAP-BAND than with gastric bypass or duodenal switch
because these surgeries have a malabsorptive component. Patients must
exercise at least 30 minutes a day, 3-4 times a week. Any activity that
increases the heart rate for an extended period of time can be chosen.
This can include walking, running, swimming, aerobics, or hiking. The
key is to find something that is enjoyable and make it part of the
The adjustability of the LAP-BAND is one of the great advantages of the
LAP-BAND over the gastric bypass or duodenal switch. The Vertical Band
Gastroplasty, or VBG, is a restrictive operation but is not adjustable.
After a period of 6 weeks following LAP-BAND placement, a patient may
require an adjustment, also known as a "fill."
Three main factors are used to determine whether or not to add fluid to
the LAP-BAND: weight loss, level of hunger and degree of restriction.
If a patient is not losing adequate weight (less than 1-2 lbs. per
week), is ravenous, and seems to be able to eat more with meals, then
it is time to do a fill. Most adjustments can be done in the office in
less than 15 minutes. Fluoroscopy or X-ray is only necessary if the
adjustment port cannot be accessed in the office. The first adjustment
is done no sooner than 6 weeks post-operatively. Subsequent adjustments are done at 4-6 week intervals based on
the aforementioned criteria.
It is also important to look out for negative symptoms after an
adjustment. Symptoms of chest pain after eating and drinking, nausea,
vomiting and reflux can mean that the LAP-BAND is overly tight. More
subtle signs can be nighttime coughing or choking, and an inability to
eat a range of foods. It is important that patients remember that
weight loss should be gentle and gradual. Patients must resist the
temptation to be too tight too fast. This can lead to dysfunctional
eating habits, in which patients convert their diet to liquid calories.
If obstructive symptoms are present, then fluid should be removed from
Patients will be seen at 4 week intervals in the first year following
LAP-BAND placement. Follow-up with a nutritionist is
encouraged, as is attendance in a support group. Medical co-morbidities
can also be improving as weight loss is progressing, and as result,
medications and dosages need to be adjusted. It is, therefore, critical
that close follow-up is also occurring with a patient's primary care
physician. The LAP-BAND is easily reversible, but must be viewed as
permanent. It should not be removed when patients have reached their
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