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Gastric Banding: Lap Band Revision and Conversion

Gastric Banding: Lap Band Revision and Conversion

In the past, gastric banding (often referred to as the “lap-band”) was thought of as a “simple” and “less-invasive” surgery than other bariatric options. However, we now know that gastric band surgery carries high risks for long- and short-term complications, leading almost all patients to seek lap band revision surgery. Because of the high rate of complications, and because surgeons now have other, more effective weight loss treatment options, many bariatric surgery centers no longer recommend or perform a lap-band procedure for patients. There is a very high rate of lap band revision surgery among bariatric centers.

Sometimes patients need revision surgery because they fail to lose adequate weight or medical complications resulting from the first surgery.

Lap-band: What is it?

Adjustable gastric banding, or lap band, is one type of bariatric treatment for obesity. In this procedure, an inflatable silicone band is placed around the stomach, limiting the amount of food that can comfortably fit. Adjustments to the gastric band can be made by a physician that increase or decrease the size of the passageway between the two parts of the stomach. The idea behind gastric banding is that patients will feel full sooner and stay full for longer. Many patients think this procedure is less invasive and choose the gastric band because it’s minimally invasive and doesn’t change your anatomy like the sleeve and bypass procedures.

Some symptoms of band complications include nausea, vomiting, food intolerance, and a general feeling of being ill.

Gastric Band Complications

While gastric banding is minimally invasive and reversible, many patients do not have good results because of various complications. Common serious adverse effects seen in patients with gastric banding include erosion of the band, and band slippage. Patients often describe symptoms of nausea, reflux, dysphagia or dysfunctional swallowing, vomiting, and food intolerance. Rarely, stomach juices may leak into the abdomen, and emergency surgery may be needed. Weight regain is one of the most common complications in gastric banding patients once the band is removed or loosened. To evaluate problems and possible band removal, physicians recommend blood work, x-rays, and an endoscopy to evaluate the problem.

Blood labs can evaluate nutritional deficiencies and detect potential indications for revision surgery.

Band Revision to Sleeve or Bypass

Lap band revision surgery involves a few different options. Revision surgery may include band removal, band to sleeve, band to bypass, and band to duodenal switch. To find the best option to fit your health needs, you will need to work with a qualified surgeon. Band removal and conversion to another type of bariatric procedure often occur in the same procedure, but it can be done in two stages. Many patients are concerned about insurance coverage and revision surgery. This is a complicated topic and largely depends on your individual carrier’s policies. Additionally, policies may also be dictated by governmental and state regulations.

After band removal, surgeons may proceed with a sleeve gastrectomy or gastric bypass for more effective bariatric treatment.

Band Revision & Recovery

Recovery varies by individual, especially taking into account whether a sleeve or bypass is being performed at the same time. In general, patients can expect a 1-3 day hospital stay for sleeve and bypass procedures. If additional or more complicated surgeries are involved in your revision procedure such as emergency operations, then you may require a more lengthy hospital stay. Although recovery is relatively quick, all forms of bariatric surgery are significant procedures. It is essential to follow up regularly with your healthcare team and commit to lifelong changes.

Long term success after bariatric surgery requires a healthy lifestyle and support from your medical team.

Sources:

1. https://www.lapband.com/compare-weight-loss-surgeries/
2. https://baribuilder.com/blog/gastric-bypass-and-diabetes/
3. https://baribuilder.com/blog/gastric-bypass-reversal/
4. https://stanfordhealthcare.org/medical-treatments/l/lap-band-surgery/complications.html
5. http://surgery.ucla.edu/bariatrics-lap-band-removal
6. https://bariatricsurgeryco.org/bariatric-surgery/lap-band-surgery/had-lap-band-surgery/
7. https://www.bariatric-surgery-source.com/lap-band-revision-surgery.html
8.https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf
9. https://www.upmc.com/services/bariatrics/surgery-process/surgery-options/bypass-vs-sleeve
10. https://uihc.org/health-topics/general-faqs-about-bariatric-surgery
11. https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258

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Morgyn Clair, MS, RDN

Author

Morgyn is an RD specializing in weight management and surgical weight loss. She has a master's in clinical nutrition and dietetics, and currently works as a clinical dietitian in a physician’s office.

Gintas Antanavicius, MD, FACS, FASMBS

Medical Reviewer

Dr. G is a co-founder of BariBuilder. A US-based expert surgeon with over 10 years of bariatric experience, he regularly publishes research in medical journals like SOARD, Obesity Surgery, etc.