Revising A Gastric Band / Lap-Band®

The gastric band or adjustable laparoscopic gastric band, known by its trade names Lap-Band® and the now defunct Realize® Band, was at one time a prevalent procedure with a great deal of promise. Indeed, this was the first procedure that was adjustable and fully reversible without causing lasting effects on the stomach if it was ultimately explanted. While patients did not enjoy the excess weight loss potential of a stapled procedure like gastric bypass or gastric sleeve, many lost enough weight to eliminate their comorbidities and live healthier and more productive lives. Indeed, because of the success and relative minimal invasiveness of the procedure, the Lap-Band® was the first major bariatric surgery to be approved for patients with a BMI as low as 30 with obesity-related co-morbidities.

Unfortunately, however, it became clear over the years that the complication rate associated with the gastric band was too high. Many patients began experiencing significant concerns, including band erosion into the esophagus, injection port flipping, and band slippage. Each of these required a revisional surgical procedure to correct. This, combined with significantly improved techniques in stapled procedures, slowly phased out the gastric band, and very few surgeons still perform this procedure today. If they do, it is for particular cases.

Removing a Gastric Band

Because the gastric band does not require cutting stomach tissue, its removal is relatively straightforward. By simply cutting away the band and removing it from the abdomen, the patient’s stomach could eventually return to its normal shape. However, eliminating the band with no replacement procedure increases the risk of overeating and ultimately regaining weight.

Converting a Gastric Band

During a procedure to remove a gastric band, bariatric surgeons can use the still-intact stomach to perform any other bariatric surgery, depending on the patient’s preference and what their surgeon believes is the best option. In other words, a band can be converted to a gastric bypass, gastric sleeve, or any other bariatric surgery. Most patients opt for conversion to a gastric sleeve as this is the most straightforward stapled bariatric procedure while still offering excellent excess body weight loss. If patients are suffering from significant or uncontrolled acid reflux or diabetes, the bariatric surgeon will likely suggest a gastric bypass, which is more suited to improving or eliminating these concerns. Conversion from a band to a gastric sleeve or a gastric bypass requires the same technique as if it were a primary bariatric procedure; however, potential complications at the esophageal level, because of the gastric band and scar tissue that may have formed after the initial procedure, warrant the knowledge and skill of a well-trained and high volume revisional bariatric expert.

Converting a gastric band confers the potential results of the new procedure as if it were the patient’s primary procedure. Of course, life with a stapled procedure is somewhat different from that with a gastric band, so speak to your surgeon about the differences. If you have a postoperative packet from your primary surgery, follow the new guidelines from your revision, as they will differ somewhat.

Conversion of the gastric band is very successful and eliminates many of the uncomfortable and painful side effects of a gastric band. However, if you have a gastric band and no issues or symptoms, it’s unlikely that you need to pursue a revision, though you can certainly ask your bariatric surgeon if you have concerns.