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Laparoscopic
Gastric Banding |
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Gastric banding is the least invasive, safest and the only adjustable and reversible
surgical weight-loss option available in the United States. It helps achieve
sustained weight loss by placing an adjustable band around the upper part of the
stomach to reduce its capacity.
A gastric band
is a silicone elastomer ring designed to be placed around the upper part of the
stomach and filled with saline on the inner surface. This creates a new small
stomach pouch and leaves the larger part of the stomach below the band so the
food storage area in the stomach is reduced, and the pouch above the band can
hold only a small amount of food. The band also controls the stoma (stomach
outlet) between the two parts of the stomach. The size of the stoma regulates
the flow of the food from the upper to the lower part of the stomach. When the
stoma is smaller, you feel full sooner and have a feeling of satiety so you are
not hungry between meals.
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Allergan
Lap Band® |
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The
band is connected by tubing to an access port that is placed beneath the skin
during surgery. Later, the surgeon can change the stoma size by adding or
subtracting saline inside the inner balloon through the access port. This
adjustment process helps drive the rate of weight loss. If the band is too loose
and weight loss inadequate, adding more saline can reduce the size of the stoma
to further restrict the amount of food that can move through it. If the band it
too tight, the surgeon will remove some saline to loosen then band and reduce
the amount of restriction.
A
gastric band is
usually placed laparoscopically, or using "keyhole" surgery, which
offers the advantages of reduced pain, length of hospital stay and recovery
period. There is no cutting or stapling of the stomach or bypassing the
intestines. If for any reason the band needs to be removed, the stomach
generally returns to its original form.
Post-Surgery Diet,
Nutrition and Exercise
After surgery, you will need
a new nutrition plan. Discuss this in detail with your surgeon and/or dietitian
as they can help you learn about and help you get used to the changes in
lifestyle and eating habits you need to make.
It is very important to
follow the eating and drinking instructions starting right after the operation
to allow the new stomach structure to heal completely and in the right position.
This may take a month or more. It is also important, especially in the early
weeks, not to stretch the small stomach pouch above the band.
The First Few Days Post-Op
Right after the operation,
you can take a sip of water or suck on an ice cube. You shouldn't drink more
than this. The day after the operation, you can take a little more fluid but
only a small amount at a time. Besides water, you should also choose clear
liquids that have an adequate number of calories. To prevent nausea and
vomiting, do not drink too much.
Liquid Diet (1-2 weeks
post-op)
The goal during this early
post-operative period is to protect the stomach pouch. Only thin liquids can be
tolerated at this time. It is also important to keep hydrated with lots of
water. Other liquids recommended during this phase include:
Pureed Foods (3-4 weeks
post-op)
During this phase you may
start having slightly textured foods. Aim for the consistency of baby foods.
This will help you transition to more solid foods later. Because protein is so
important to help you maintain muscle while you are losing weight, eat protein
rich foods first, and then move on to fruits and vegetables. Foods in this stage
may include:
In the first few weeks you
may be able to eat foods that might not be allowed in your diet later as these
foods may contain too many calories. It is more important in the first few weeks
to let your stomach adjust to the LAP-BAND System than it is to lose weight.
Also, your timing and progression into each dietary phase may vary. In general,
you should follow the advice of your surgeon and/or dietitian about nutrition.
Soft Foods (5 weeks
post-op)
Your meals can now include
tender cooked foods like fish and ground turkey. Now that you can chew, make it
a habit to chew foods well. If you have dentures, be sure to cut your food into
small pieces and chew it thoroughly. If you don't follow these precautions, you
may experience vomiting, stomach irritation and swelling. You could also have
stoma obstruction.
If solid foods cause nausea
and vomiting, go back to the liquid diet you had earlier. Then you can slowly
add soft foods and eventually transition to solid foods. Always ask for advice
from your doctor or dietitian that is specific to your situation. Vomiting may
increase the incidence of band slippage, stomach slippage or stretching of the
small stomach pouch above the band.
FAQ's
Q: Will
I be sick a lot after the operation?
A: A gastric band
limits food intake. If you feel nauseated or sick on a regular basis, it may
mean that you are not chewing your food well enough or that you are not
following the diet rules properly. However, it could also mean that there is a
problem with the placement of the band, so contact your doctor if this problem
persists. Vomiting should be avoided as much as possible as it can cause the
small stomach pouch to stretch. It can also lead to slippage of part of the
stomach through the band and reduce the success of the operation. In some cases,
it can require another operation.
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Q: How long will
it take to recover after surgery?
A:
If a gastric band surgery is performed laparoscopically, patients typically spend less
than 24 hours in the hospital. It takes most patients about a week to return to
work and a month to six weeks to resume exercising. In the case of open surgery
or if there are complications, recovery may take longer.
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Q: How much
weight will I lose?
A:
Weight-loss results vary from patient to patient, and the amount of weight you
lose depends on several things. The band needs to be in the right position, and
you need to be committed to your new lifestyle and eating habits. Obesity
surgery is not a miracle cure, and the pounds won't come off by themselves.
It is very important to set
achievable weight-loss goals from the beginning. A weight loss of 2 to 3 pounds
a week in the first year after the operation is possible, but one pound a week
is more likely. Twelve to eighteen months after the operation, weekly weight
loss is usually less. Remember that you should lose weight gradually. Losing
weight too quickly creates a health risk and can lead to a number of problems.
The main goal is to have weight loss that prevents, improves, or resolves health
problems connected with severe obesity.
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Q: How do the
weight-loss results with a gastric band compare to those with the gastric bypass?
A:
Surgeons have reported that gastric bypass patients lose weight faster in the
first year. At five years, however, many gastric band patients have achieved weight
loss comparable to that of gastric bypass patients1,2. Focus on
long-term weight loss and remember that it is important to lose weight gradually
while reducing obesity-related risks and improving your health.
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Q: Does
gastric band require frequent visits to my doctor after surgery?
A:
Check-ups with your doctor are a normal and very important part of gastric band follow-up. Many surgeons see their patients weekly or biweekly during the
first month and every four to twelve weeks for the first year. Adjustments are
performed during some of these visits. It is typical for follow-up visits to be
scheduled every three to six months during the second and third year, depending
on the individual case.
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Q: Does
a gastric band limit any physical activity?
A: A gastric band does not hamper physical activity including aerobics, stretching and
strenuous exercise.
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Q: How is the
band adjusted?
A: Adjustments
are often carried out in the X-ray department. They are done there so the access
port can be clearly seen. When X-rays are used, your reproductive organs should
be shielded. Sometimes adjustments can be done in an outpatient clinic or
office, and local anesthesia may or may not be needed. A fine needle is passed
through the skin into the access port to add or subtract saline. This process
most often takes only a few minutes and most patients say it is nearly painless.
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Q: Do I have to
be careful with the access port just underneath my skin?
A:
There are no restrictions based on the access port. It is placed under the skin
in the abdominal wall, and once the incisions have healed it should not cause
discomfort or limit any physical exercise. The only sensation you may experience
from the port occurs when you go in for adjustments. If you feel persistent
discomfort in the port area, talk to your doctor.
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Q: Can the band
be removed?
A:
Although the gastric band is not meant to be removed, it can be, in some
cases laparoscopically. Surgeons report that the stomach generally returns to
its original shape once the band is removed. After the removal, though, you may
soon go back up to your original weight. You may also gain more.
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Q: Will I need
plastic surgery for the surplus skin when I have lost a lot of weight?
A:
That is not always the case. As a rule, plastic surgery will not be considered
for at least a year or two after the operation as, sometimes the skin will mold
itself around the new body tissue. Give the skin the time it needs to adjust
before you decide to have more surgery.
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Q: Is it true
that the gastric band seems "tighter" in the morning?
A:
This is a fairly common feeling, especially for people with bands that are tight
or just after an adjustment. During the day the water content in the body
changes and this may cause the band to feel "tighter" some of the
time. Some women have also noticed that the gastric band feels tighter during
menstruation.
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Q: Will I feel
hungry or deprived with a gastric band?
A:
A gastric band makes you eat less and feel full in two ways - first by reducing
the capacity of your stomach and second by increasing the time it takes food to
get through the digestive system. After a small meal, the amount of which varies
from person to person, you should feel full. If you follow the nutrition
guidelines when you choose your food and then chew it well, you should not feel
hungry or deprived. Remember that a gastric band is a tool to help you change your
eating habits.
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Q: What will
happen if I become ill?
A:
One of the major advantages of a gastric band is that it can be adjusted.
If your illness requires you to eat more, the band can be loosened by removing
saline from it. When you have recovered from your illness and want to lose
weight again, the band can be tightened by increasing the amount of saline. If
the band cannot be loosened enough, it may have to be removed.
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Q: What about
pregnancy?
A:
Becoming pregnant can be easier as you lose weight. Your menstrual cycle may
become more regular. If you need to eat more while you are pregnant, the band
can be loosened. After pregnancy, the band may be made tighter again and you can
resume losing weight.
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Q: Will I need to
take vitamin supplements?
A: You
may. It's possible to not get enough vitamins from three small meals a day. At
your regular check-ups, your specialist will evaluate whether you are getting
enough vitamin B12, folic acid, and iron. Your surgeon may advise you to take
supplements.
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Q: What about
other medication?
A:
You should be able to take prescribed medication, though you may need to use
capsules, break big tablets in half or dissolve them in water so they do not get
stuck in the stoma and make you sick. Always ask the doctor who prescribes the
drugs about this. Your surgeon may tell you to avoid taking aspirin and other
nonsteroidal anti-inflammatory pain relievers because they may irritate the
stomach. The problems these drugs may cause could result in band removal.
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Q: What if I go
out to eat?
A:
Order only a small amount of food, such as an appetizer. Eat slowly. Finish at
the same time as your table companions. You might want to let your host or
hostess know in advance that you cannot eat very much.
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Q: What about
alcohol?
A:
Alcohol has a high number of calories and breaks down vitamins. An occasional
glass of wine or other alcoholic beverage, though, is not considered harmful to
weight loss3.
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Q: Can I eat
anything in moderation?
A:
After your stomach has healed, you may eat most foods that don't cause you
discomfort. However, because you can only eat a little it is important to
include foods full of important vitamins and nutrients as advised by your
surgeon and/or dietitian. If you eat foods that contain lots of sugar and fat or
drink liquids full of "empty" calories, such as milkshakes, the effect
of a gastric band may be greatly reduced or even cancelled.
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Q: Will I suffer
from constipation?
A:
There may be some reduction in the volume of your stools, which is normal after
a decrease in food intake because you eat less fiber. This should not cause you
severe problems. If difficulties do arise, check with your doctor. He or she may
suggest you take a mild laxative and drink plenty of water for a while. Your
needs will vary, but you should drink at least 6-8 glasses of water a day.
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It is important to
ask your surgeon all the questions you have about obesity surgery and a
gastric band. It is also essential that you follow his or her advice.
- Clegg
A., Colquitt J., Sidhu M.K., et al. The clinical and cost effectiveness of
surgery for people with morbid obesity. Health Technology Assessment 2002;
6(12): 1-153.
- O'Brien
et al. LAP-BAND®: Outcomes and results. J of Laparoend & Adv Surg
Techniques 2003; 13 (4); 265-270. (55% for the LAP-BAND vs. 59% for
Gastric Bypass)
- Dixon J., Dixon
A., O'Brien P. Light to Moderate Alcohol Consumption: Obesity and the
Metabolic Syndrome. Am J Bariatric Medicine 2002; 17(4): 11-14.
A gastric
band is not right for everyone. You and your surgeon should work
together to decide if this is the right treatment for you. Here are some of the
things your surgeon will consider.
Indications*
A
gastric band may be
right for you if:
- You are an adult (at least 18
years old).
- Your BMI is 40 or higher, or
your BMI is at least 35 and you have one or more severe co-morbid
conditions, or you weigh at least 100 pounds (45 kilos) more than your ideal
weight.
- You have been overweight for
more than 5 years.
- Your serious attempts to lose
weight have had only short-term success.
- You do not have any other
disease that may have caused you to be overweight.
- You are prepared to make major
changes in your eating habits and lifestyle.
- You are willing to continue
working with the specialist who is treating you.
- You do not drink alcohol in
excess.
If your BMI is less
than 40, a gastric band may not be right for you. On the other hand, your
surgeon may consider it if you have health problems that are related to obesity.
Your surgeon may also have other criteria he or she uses. Ask him or her to
discuss the criteria with you.
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Contraindications
A gastric band is not
right for you if:
- You have an inflammatory
disease or condition of the gastrointestinal tract, such as ulcers, severe
esophagitis, or Crohn's disease.
- You have severe heart or lung
disease that makes you a poor candidate for surgery.
- You have some other disease
that makes you a poor candidate for surgery.
- You have a problem that could
cause bleeding in the esophagus or stomach. That might include esophageal or
gastric varices (a dilated vein). It might also be something such as
congenital or acquired intestinal telangiectasia (dilation of a small blood
vessel).
- You have portal hypertension.
- Your esophagus, stomach, or
intestine is not normal (congenital or acquired). For instance you might
have a narrowed opening.
- You have or have experienced
an intra-operative gastric injury, such as a gastric perforation at or near
the location of the intended band placement.
- You have cirrhosis.
- You have chronic pancreatitis.
- You are pregnant. (If you
become pregnant after a
gastric band has been placed, the band may need
to be deflated. The same is true if you need more nutrition for any other
reason, such as becoming seriously ill. In rare cases, removal may be
needed.)
- You are addicted to alcohol or
drugs.
- You are under 18 years of age.
- You have an infection anywhere
in your body or one that could contaminate the surgical area.
- You are on chronic, long-term
steroid treatment.
- You cannot or do not want to
follow the dietary rules that come with this procedure.
- You might be allergic to
materials in the device.
- You cannot tolerate pain from
an implanted device.
- You or someone in your family
has an autoimmune connective tissue disease. That might be a disease such as
systemic lupus erythematosus or scleroderma. The same is true if you have
symptoms of one of these diseases.
Some surgeons say
patients with a "sweet tooth" will not do well with a
gastric band. If you eat a lot of sweet foods, your surgeon may decide not to do the
procedure. The same is true if you often drink milkshakes or other high-calorie
liquids.
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Your motivation
is key
Your surgeon will not do the
operation unless he or she knows you understand the problems your excess weight
is causing. Also, your surgeon will make sure you know you have
responsibilities. These include new eating patterns and a new lifestyle. If you
are ready to take an active part in reducing your weight, your surgeon will
consider the treatment. First, though, your surgeon will want to make sure you
know about the advantages, disadvantages, and risks involved.
Risks,
complications, and adverse events you need to know about
All surgical procedures have
risks. When you decide on a procedure, you should know what the risks are. Talk
with your surgeon in detail about all the risks and complications that might
arise. Then you will have the information you need to make a decision.
What are the
general risks?
Using a gastric band
includes the same risks that come with all major surgeries. There are also added
risks in any operation for patients who are seriously overweight. You should
know that death is one of the risks. It can occur any time during the operation.
It can also occur as a result of the operation. Death can occur despite all the
precautions that are taken. There is a risk of gastric perforation (a tear in
the stomach wall) during or after the procedure that might lead to the need for
another surgery. In the U.S. clinical study this happened in 1% of the patients.
There were no deaths during or immediately after surgery in the U.S. study. Your
age can increase your risk from surgery. So can excess weight. Certain diseases,
whether they were caused by obesity or not, can increase your risk from surgery.
There are also risks that come with the medications and the methods used in the
surgical procedure. You also have risks that come from how your body responds to
any foreign object implanted in it. Published results from past surgeries,
however, do show that a gastric band surgery may have fewer risks than other
surgical treatments for obesity.
Patients can
experience complications after surgery. Most complications are not serious but
some may require hospitalization and/or re-operation. In the United States
clinical study, with 3-year follow-up reported, 88% of the 299 patients had one
or more adverse events, ranging from mild, moderate, to severe. Nausea and
vomiting (51%), gastroesophageal reflux (regurgitation) (34%), band
slippage/pouch dilatation (24%) and stoma obstruction (stomach-band outlet
blockage) (14%) were the most common post-operative complications. In the study,
25% of the patients had their band systems removed, two-thirds of which were
following adverse events. Esophageal dilatation or dysmotility (poor esophageal
function) occurred in 11% of patients, the long-term effects of which are
currently unknown. Constipation, diarrhea and dysphagia (difficulty swallowing)
occurred in 9% of the patients. In 9% of the patients, a second surgery was
needed to fix a problem with the band or initial surgery. In 9% of the patients,
there was an additional procedure to fix a leaking or twisted access port. The
access port design has been improved. Four out of 299 patients (1.3%) had their
bands erode into their stomachs. These bands needed to be removed in a second
operation. Surgical techniques have evolved to reduce slippage. Surgeons with
more laparoscopic experience and more experience with these procedures report
fewer complications.
Adverse events that
were considered to be non-serious, and which occurred in less than 1% of the
patients, included: esophagitis (inflammation of the esophagus), gastritis
(inflammation of the stomach), hiatal hernia (some stomach above the diaphragm),
pancreatitis (inflammation of the pancreas), abdominal pain, hernia, incisional
hernia, infection, redundant skin, dehydration, diarrhea (frequent semi-solid
bowel movements), abnormal stools, constipation, flatulence (gas), dyspepsia
(upset stomach), eructation (belching), cardiospasm (an obstruction of passage
of food through the bottom of the esophagus), hematemsis (vomiting of blood),
asthenia (fatigue), fever, chest pain, incision pain, contact dermatitis (rash),
abnormal healing, edema (swelling), paresthesia (abnormal sensation of burning,
prickly, or tingling), dysmenorrhea (difficult periods), hypochromic anemia (low
oxygen carrying part of blood), band system leak, cholecystitis (gall stones),
esophageal ulcer (sore), port displacement, port site pain, spleen injury, and
wound infection. Be sure to ask your surgeon about these possible complications
and any of these medical terms that you don't understand.
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Is there a chance
the device will need to be removed?
The gastric band is a
long-term implant, but it may have to be removed or replaced at any time. For
instance, the device may need to be removed to manage any adverse reactions you
might have. The device may also need to be removed, repositioned or replaced if
you aren't losing as much weight as you and your doctor feel you should be
losing.
What are the
specific risks and possible complications?
Talk to your doctor about all
of the following risks and complications:
- ulceration
- gastritis (irritated stomach
tissue)
- gastroesophageal reflux
(regurgitation)
- heartburn
- gas bloat
- dysphagia (difficulty
swallowing)
- dehydration
- constipation
- weight regain
- death
Laparoscopic surgery
has its own set of possible problems. They include:
- spleen or liver damage
(sometimes requiring spleen removal)
- damage to major blood vessels
- lung problems
- thrombosis (blood clots)
- rupture of the wound
- perforation of the stomach or
esophagus during surgery
Laparoscopic surgery
is not always possible. The surgeon may need to switch to an "open"
method due to some of the reasons mentioned here. This happened in about 5% of
the cases in the U.S. Clinical Study.
There are also
problems that can occur that are directly related to the
gastric band:
- The band can spontaneously
deflate because of leakage. That leakage can come from the band, the
reservoir, or the tubing that connects them.
- The band can slip.
- There can be stomach slippage.
- The stomach pouch can enlarge.
- The stoma (stomach outlet) can
be blocked.
- The band can erode into the
stomach.
Obstruction of the
stoma can be caused by:
- food
- swelling
- improper placement of the band
- the band being over-inflated
- band or stomach slippage
- stomach pouch twisting
- stomach pouch enlargement
There have been some
reports that the esophagus has stretched or dilated in some patients. This could
be caused by:
- improper placement of the band
- the band being tightened too
much
- stoma obstruction
- binge eating
- excessive vomiting
Patients who have a
weaker esophagus may be more likely to have this problem. A weaker esophagus is
one that is not good at pushing food through. Tell your surgeon if you have
difficulty swallowing. Then your surgeon can evaluate this.
Weight loss with a
gastric band is typically slower and more gradual than with some other
weight-loss surgeries. Tightening the band too fast or too much to try to speed
up weight loss should be avoided. The stomach pouch and/or esophagus can become
enlarged as a result. You need to learn how to use your band as a tool that can
help you reduce the amount you eat.
Infection is
possible. Also, the band can erode into the stomach. This can happen right after
surgery or years later, although this rarely happens.
Complications can
cause reduced weight loss. They can also cause weight gain. Other complications
can result that require more surgery to remove, reposition, or replace the band.
Some patients have
more nausea and vomiting than others. You should see your physician at once if
vomiting persists. Rapid weight loss may lead to symptoms of:
- malnutrition
- anemia
- related complications
It is possible you
may not lose much weight or any weight at all. You could also have complications
related to obesity.
If any complications
occur, you may need to stay in the hospital longer. You may also need to return
to the hospital later. A number of less serious complications can also occur.
These may have little effect on how long it takes you to recover from surgery.
If you have existing
problems, such as diabetes, a large hiatal hernia (part of the stomach in the
chest cavity), Barrett's esophagus (severe, chronic inflammation of the lower
esophagus), or emotional or psychological problems, you may have more
complications. Your surgeon will consider how bad your symptoms are, and if you
are a good candidate for the LAP-BAND System surgery. You also have more risk of
complications if you've had a surgery before in the same area. If the procedure
is not done laparoscopically by an experienced surgeon, you may have more risk
of complications.
Anti-inflammatory
drugs that may irritate the stomach, such as aspirin and NSAIDs (Ibuprofen which
is Motrin®
and Advil®), should be used
with caution.
Some people need
folate and vitamin B12 supplements to maintain normal homocycteine levels.
Elevated homocycteine levels can increase risks to your heart and the risk of
spinal birth defects.
You can develop
gallstones after a rapid weight loss. This can make it necessary to remove your
gallbladder.
There have been no
reports of autoimmune disease with the use of a
gastric band. Autoimmune
diseases and connective tissue disorders, though, have been reported after
long-term implantation of other silicone devices. These problems can include
systemic lupus erythematosus and scleroderma. At this time, there is no
conclusive clinical evidence that supports a relationship between
connective-tissue disorders and silicone implants. Long-term studies to further
evaluate this possibility are still being done. You should know, though, that if
autoimmune symptoms develop after the band is in place, you may need treatment.
The band may also need to be removed. Talk with your surgeon about this
possibility. Also, if you have symptoms of autoimmune disease now, a
gastric band may not be right for you.
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Removing
the band
If a gastric band
has been placed laparoscopically, it may be possible to remove it the same way.
This is an advantage of a
gastric band. However, an "open"
procedure may be necessary to remove a band. In the U.S. Clinical Study, 60% of
the bands that were removed were done laparoscopically. Surgeons report that
after the band is removed, the stomach returns to essentially a normal state.
At this time, there
are no known reasons to suggest that the band should be replaced or removed at
some point unless a complication occurs or you do not lose weight. It is
difficult, though, to say whether the band will stay in place for the rest of
your life. It may need to be removed or replaced at some point. Removing the
device requires a surgical procedure. That procedure will have all the related
risks and possible complications that come with surgery. The risk of some
complications, such as erosions and infection, increase with any added
procedure.
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*American
Society for Bariatric Surgery, National Institutes of Health, and the
International Federation for the Surgery of Obesity Guidelines.
Caution:
This device is restricted to use by or on the order of a physician.
The LAP-BAND® System
and REALIZE™
Band and accessories contain no latex or natural
rubber materials.
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