Category: complication of lap Band
It is interesting to encounter patients who are still being recommended for Lap Band placement to treat morbid obesity. There is a vast body of scientific evidence supporting that Lap Band not only does not result in a sustained weight loss for majority of the patients, but that it results in significant long term complications for some.
One of the complications is a significant stricture (narrowing) where the band is located even when it is completely empty. This is cause by:
1- either scarring of the tissue around that band causing a “belt” effect around the stomach, or
There are numerous other complications that are associated with Adjustable Gastric Bands that encompass a wide range of areas that are not discussed in this blog. This recent article (yes another one) outlines the dismal long term outcome of the Adjustable Gastric banding- Buyer Beware.
For years, we have seen patients who have had Adjustable gastric bands placed and continue to suffer from the complications associated with it. Gastric Band complications include erosion, persistent nausea, vomiting abdominal pain, inadequate weight loss and weight regain, etc. . Unfortunately, when seeking help, they are often told that this never happens to others and that complications are a rare occurrence. Let’s remember that the Adjustable Gastric Band was promoted and sold as a procedure with almost no down side, low risk and easily revisable!
There is an unfounded expectation that the band can be deflated and all the Gastric Band complications will resolve. This could not be any further from the truth. The reality is that there are patients whose symptoms may somewhat improve but will continue to have the abdominal pain, the nausea and or vomiting-albreit, not to the same intensity. There are several Gastric Band complications that are considered emergency situations that require immediate attention by a physician.
Our position has always been, and continues to be, that all Adjustable Gastric Bands should be removed by a surgeon who is experienced with the Gastric Band complications and revisions.
The Curved Adjustable Gastric Band will be discontinued. Johnson and Johnson, the parent company of the Ethicon, is removing the Curved adjustable Gastric Band from its’ product line. This particular band is known as the Realize Band launched by Johnson & Johnson and did not gain much traction. The number of Adjustable gastric band placements have gone down significantly as the data have shown poor outcome over long term and a high complication and re-operative rates.
In a recent review article published in the September 2015- Volume 42:10 of General Surgery News, the surgical outcomes of different procedures were summarized. There were evaluated based on a number of measures, including re-operation rates. So interesting to note that the re-operation rate of the duodenal switch is the lowest of all surgical procedures.
The band in place and after being taken down
The dissection of the wrap over the band that shows erosion
Part of the hiatal hernia repair.
The band and the port removed.
My name is Odessa D. I am going to talk about my weight loss journey with the lap band which started in 2006. At my heaviest I weighed 270 pounds and was a size 24 waist. I had high blood pressure, was a border line diabetic, had lower back pain, I had no energy, I was tired all the time, and I had sleep apnea.
My family doctor had suggested weight loss surgery but I was hesitant because I was afraid of surgery. Until one night my 8 year old daughter found me not breathing in my sleep. I made the decision to go through with the surgery.
Prior to surgery I did as much research as I could about the lap band. At the time I felt it was the right decision. On the day of the surgery everything went well. The first few months were great. I was losing weight, feeling good, feeling happy, and healthier then I have in years.
Then it began, all the symptoms of a slipped band. I started vomiting, nausea, acid reflux, and I was having trouble drinking and eating on a daily basis. My doctor confirmed it was a slipped band. We decided to replace the band because I was still overweight. On day of surgery I weighed 210 lbs.
After a month I started having symptoms of a slipped band. My doctor performed x-rays but everything looked fine. After 2 years with these symptoms and numerous doctor visits and x-rays I just gave up and learned to live with it. In 2 years I lost 4 lbs. My high blood pressure and sleep apnea came back. I finally decided to get the lap band removed. I wanted my life back and if that meant gaining the weight back that I lost then I was willing to make that sacrifice.
Dr. Keshishian was referred to me by 2 of his past patients. From the moment I walked into his office I was already at ease. When I first met Dr. Keshishian, I knew I was in good hands and I knew he could help me. He confirmed I had another slipped band and a detached port. At this point we discussed removing the lap band and switching to the Sleeve Gastrectomy. Finally everything was going to be fixed and everything was going to be right.
I can’t express how much my life has improved since removing the second band and switching to the sleeve. I have lost 46 pounds in 9 months. I now weigh 160 pounds and wear a size 8 waist. Now I look forward to each and every day with joy and pleasure knowing I don’t have to deal with a bad band and all the horrible symptoms that came with it.
Since the surgery and losing more weight I have been very active. I go hiking almost every weekend. I have literally climbed a mountain! I did my first 5k mud obstacle course in which my second 5k is in October. I even have a purple Mohawk! I have 100% confidence in myself and in everything that I do. My life has greatly improved since the sleeve. All thanks to Dr. Keshishian. It has been a very bumpy road with my weight loss journey but Dr. Keshishian has smoothed out the bumps and I plan on traveling the distance with many adventures along the way.
I would like to leave a huge “Thank You” to Dr. Keshishian and his staff. Thank you for making me feel welcomed, being friendly, making me feel comfortable, and especially for giving my life back to me. I can’t wait to see what the future holds for me and my family!
Thank you Dr. Keshishian and staff!
Adjustable gastric band has been promoted as a minimally invasive procedure. The long term data has proven this not to be the case. One of the complications is erosion of Adjustable Gastric Band. The adjustable gastric band results in the least amount of weight loss, as well as the lowest rate of resolution of the co-morbidities of all weight loss surgical procedures. As for the minimally invasive claim of the AGB, one has to also consider all the adjustments, the radiation exposure related to the upper GI and X-rays, as well as the upper endoscopies that are necessary to maintain a band. I would argue that an average band is much more invasive when one accounts for the total number of procedure that are done on a band patient.
Other complications arise, when, not if, a band needs to be surgical revised or removed. Band removal requires an extensive amount of scar tissue dissection to expose the band before it can be removed. This is an example of a patient with erosion of the band.
Note the very thick scar tissue that is formed around the band (the white tissue on the left lower corner)
Gastric bands are restrictive rings placed around the top part of the stomach, close to the junction of the esophagus. Their mechanism of action is to create a small tight band to restrict the flow of the food into the stomach. The theory has been that the band will decrease the time food travels down past the narrowing thereby eating less with the end result of weight loss. One of the many complications from the band is erosion of the band into the lumen of the stomach. This results in the patient presenting with nausea, vomiting and some patients develop abdominal accesses. This may present itself with symptoms of abdominal pain, fever, and redness at the port site under the skin.
The treatment for this is urgent removal of the band and repair of the erosion/ulceration. Patients who are contemplating a revision to another weight loss surgical procedure are best advised to stage the procedure because of the potential for leak from the repair site. Almost all of these procedures can be done laparoscopically.
The Adjustable Gastric Band (AGB) procedures have been advertised as “easily reversible” minimally invasive procedures. A point of interest is why doesn’t anyone ask the question, “Why would a successful device and/or procedure need to be revised or removed?”
The long term success data shows that the AGB procedure is the most inferior of all bariatric procedures. It is important, that when looking at the published data, special attention is given to the definitions in that particular study. An example would be that if a study defines “successful outcomes as weight loss for 30 days!” then all procedure will be successful.
The following is an example of a patient who had the Lap Band (R) a several years ago in another institution. She was seen for surgical follow up with minimal weight loss over a short period of time. She then developed the typical complications of the band, namely the upper abdominal pain, reflux, inability to swallow solids, persistent nausea and vomiting. Her symptoms were all “worked up” and was told that all the studies were normal. All of her symptoms were contributed to her eating habits, even though they persisted after the Lap Band (R) was completely empty.
The patient then presented n our office for a second opinion. After being seen in our office and having a full work up, she had the Lap Band removed and was revised to a Laparoscopic Sleeve Gastrectomy. She had complete resolution of all of her prior presenting symptoms.
Patricia’s success story is truly inspiring and emotional. Please take a moment to celebrate her success by watching video about her journey and revision from LapBand to Duodenal Switch. Thank you Patricia for sharing you journey with us.