Perigastric Surgical Technique
Slippage happens either on the front or back side of the stomach. Posterior slippage commonly occurs when surgeons use the "perigastric" technique, which allows the back side of the stomach to slide up freely through the band. Today, most surgeons prefer the "pars flaccida" technique, developed to avoid posterior slippage. The pars flaccida technique results in a much lower rate of slippage, up to 16 percent less often. Anterior slippage can be prevented by the surgeon suturing the stomach below the band to the stomach above the band, which helps lock the band into proper position.
Overeating often leads to slippage. The band pouch stretches and grows as you eat and drink more than you should, meaning more than 1 cup chewed food per meal. At this stage if the pouch is only enlarged, the slippage can be mended by taking out all of the fluid to deflate the band, allowing the pouch to eventually go back to its normal size.
Fizzy or sparkling sodas and beverages are believed to cause slippage. The carbonation in diet and regular sodas or champagne and beer incites bloating and gas, which over time results in a distended band pouch. Bariatric surgeons usually advise avoiding carbonated drinks, but some allow on rare occasions a soda or bubbly beverage if you first let it sit until the bubbles dissipate entirely.
Overfilling the Band
Most surgeons recommend waiting six weeks before getting your first Lap-Band fill. Once you start filling the band with fluid, which causes restriction, proceed slowly and conservatively. Sneak up on reaching what is called your "sweet spot," which means the band is inflated to the point where a small amount of food per meal satisfies hunger for four to five hours. Overfilling the band until it's too tight can lead to food being stuck in the pouch, stretching out the pouch and causing band slippage.
Slippage can also occur if you eat too much and vomit frequently. When you gorge, food gets stuffed down in the pouch and sometimes even in the esophagus, causing nausea and then vomiting to rid the body of the offending food. Overeating, eating too fast and not chewing thoroughly usually leads to multiple vomiting episodes after meals, whi*****reases the likelihood of a band slip.
Lap Band Erosion
Erosion is the condition in which the band erodes away the stomach where the band and the stomach come in contact with one another, eventually resulting in a hole being worn in the stomach wall.
When lap band was new the erosion rate ran as high as 10 percent. This occurred primarily in Australia and Europe because they used the peri-gastric technique. This lower placement of the band caused a higher slippage rate. The solution to that was to stitch the stomach tightly over the band. Any time you have living tissue in contact with something artificial, in this case the lap band the tissue if under too much tension can't get proper blood flow. As the tissue dies, it can't resist the pressure of the band and it erodes into the stomach. Later on the Europeans and Australians realized they were causing the erosion with their technique and changed to the the pars flaccida technique which places the band much higher on the stomach. They also don't wrap the stomach tissue so tightly over the band so the tissue doesn't die and the band won't erode in. The erosion rate is now down to less than 1%.
How to you tell if you have lap band erosion?
Probably the biggest indicator of erosion is weight regain because the band is no longer in place to restrict the food intake. Another one of the signs is redness, swelling and pain around the access port. This is caused by bacteria from the stomach getting into the capsule that forms around the band. The infection simply travels to the outside port along the tubing. Another sign that erosion is happening is that the erosion causes the band to be less restrictive than before so you can eat more than before. A lot more than before.
Causes of erosion
Usually erosion is cause by the band being in too tight of contact with the stomach. For instance in Europe when lap band first started, surgeons would stitch the stomach tightly over the band. This cause the tissue to not get enough bloodflow over time and start to dye. As tissue dies it erodes away and the band sinks lower and lower into the tissue, eventually ending up inside the stomach.
The European and Australian surgeons figured out what was going on and changed their method to the flaccida technique which is the method commonly used today.
Diagnosis of erosion
Usually it first shows up on an x-ray and the confirmation is doing an upper GI endoscopy. The band can be seen penetrating the stomach wall if you have erosion occurring. There is variance in degree of erosion in patients. There are documented cases in which the band has completely eroded into the stomach.
Treatment of erosion
Lap band erosion typically requires that the lap band and access port be removed. It is more critical to remove it quickly if the erosion has caused an infection near the access port. In extreme cases the band erodes into the stomach completely. In some of those cases the band was able to be removed directly from the stomach via endoscopy without surgery, though usually it is caught before the band erodes all the way through and surgery is required. Once removed, the eroded part can heal. This takes three to six months.
After the erosion heals, you can once again be banded. Sometimes instead of rebanding your surgeon may want to do a gastric bypass or duodenal switch rather than risk putting another band in place and having it erode as well. This is a choice for you and your surgeon to make. In any case the surgeon will make sure enough time has passed as rebanding too soon will likley lead to another failure. Six or more months is a common time frame to heal before considering rebanding
What if anything can you do to avoid lap band erosion? Avoid carbonated beverages or any other food that can cause bloating of the stomach. This goes back to the original diet plan you did when you first got banded. You drank a lot of fluids, the idea being to not push the stomach into the band and let the stomach become accustomed to the pressure exerted by the band. Eroding is less likely if there is this initial break in phase after being banded.