When is a Lap-Band Revision Surgery Necessary?January 20, 2021
If you've had a Gastric Band, when is it time to consider a Lap-Band revision? Over the last 20 years, hundreds of thousands of gastric bands have been placed in the United States. Over the last several years, however, gastric banding (Lap-Band) has gone from the most common weight loss surgery to the least common. Why is that?
Reasons for the Decline of the Lap-Band
- The increase in the prevalence of the gastric sleeve, which has a much lower long-term complication rate than gastric bypass; prior to that, many patients chose gastric banding because they did not like the complication rate of gastric bypass.
- Overall, the success rate of gastric banding was found to be lower than both gastric sleeve and bypass, especially in higher-BMI patients.
- The long-term complication rate of gastric banding has turned out to be higher than initially anticipated.
Having placed many bands myself over the years, I frequently see patients in the office who come in to discuss removing their bands because they heard that “they only last 10 years and then need to be removed” from either a friend or on the Internet.
I can assure you that no such mandate exists! Even if your band is 15 years old, if you are doing well with it there is no need for any preventative surgical intervention, although regular follow-up visits, at least yearly, with your band surgeon is recommended.
There are definitely cases, however, where a Lap-Band revision surgery or removal is indicated. To add even more complexity to the decision, a when removal is performed, sometimes conversion to gastric sleeve or gastric bypass is considered. So, if you are a gastric band patient, what are some reasons that you should consider either Lap-Band revision surgery or removal of your band?
5 Reasons To Consider Having Lap-Band Revision Surgery
Insufficient Weight Loss
If you’ve had your band for years and have had dozens of adjustments, then even with your best efforts it is rare to see major weight loss start happening. So, if after having a properly-adjusted band for more than a few years, your BMI remains over 40, or if it is 35-40 with major weight-related medical issues (such as diabetes), then it is reasonable to consider conversion to Lap-Band revision surgery such as gastric sleeve or bypass.
When this pathway is chosen, sometimes it can be done in one sitting, where the band is removed and the new procedure is immediately performed. In other situations, it requires two stages.
In the first stage, only the band is removed, and then the new procedure is done a few months later. There are advantages and disadvantages to each approach, and it is up to the individual surgeon and patient to make this decision.
Recurrent Slippage, Pouch Dilation, or Esophageal Dilation
If you are requiring frequent trips to your band doctor for unfills due to either recurrent slippage of your band this could be a reason for either removal or revision of your band.
Likewise, if you have recurrent dilation of the esophagus or the gastric pouch above the band, removal or revision could be required. Revision of a gastric band involves surgically fixing whatever problem exists, either through repositioning your current band, or removing and replacing the old one with a new band.
The decision between removal or revision is a relatively easy one--if you’ve had poor weight loss with your band that’s not likely to change with a revision, so removal with conversion to either a gastric sleeve or bypass may be the best option.
If your weight loss was great and your main problem is recurrent slippage, then you can consider a revision and keeping your band. Be forewarned, however, that you remain at risk for having the same complication occur in the future and could be facing the same decision down the road.
Device intolerance is a condition that includes patients who have pain related to their device or are very sensitive to the tiniest band adjustments that lead to the inability to tolerate any amount of solid protein such as chicken, steak, etc. In the first example, pain can be caused by the access port, which results in pain or tenderness right over the area of the port itself, or it can come from deeper inside the body from the band itself.
In the latter case, patients often have pain in the left upper abdomen or even the left shoulder. Obviously, pain caused by the device will not go away until the device goes away, so removal is the best option for these patients. For patients considering conversion to sleeve or bypass, I usually recommend this be done in two stages to make sure the pain goes away before doing any additional surgery.
Chronic, Uncontrolled GERD
For many patients, including myself, when I had my band placed, GERD is initially completely resolved after the placement of a gastric band. In my case, I went from taking Nexium every single day to requiring no GERD medications at all until I, unfortunately, had to have it removed seven years later. Even if a patient’s GERD did initially resolve with the placement of a band after a period of many years sometimes GERD returns.
Even with maximum anti-acid medications, in some patients, we are unable to maintain an adequate level of restriction with the band without worsening their GERD. For these patients I usually recommend just removing the band, making sure the GERD resolves, and then making a decision regarding converting to another procedure later if clinically necessary. If severe GERD persists after the band is removed, then gastric bypass could be a better option than gastric sleeve.
If your band has a leak of any kind then removal of the device is indicated, as it is not going to get the job done. If your weight loss has been good up until the leak occurred, then removal and simultaneous replacement may be an option, or simply replacement of the access port or tubing if that is the source of a leak.
Another common hardware failure condition is a flipped port that is not accessible anymore. Revision of only the port is a possibility, but if weight loss has been poor then removal with conversion to sleeve or bypass is a viable option.
I will also include gastric band erosion in the category of hardware failure, which is a complication where the device “wears” a hole through the side of the stomach and part of the band ends up on the inside of the stomach, instead of wrapping around the outside as it should. All eroded gastric bands must be removed, and any plans for conversion to sleeve or bypass would typically have to wait for another time down the road.
Maintaining Your Weight Loss Without The Band
One thing to note is that patients who are considering removal frequently tell me that they feel they have learned how to eat small portions after all these years, and will easily be able to maintain their weight loss without their band. This is sort of like saying “I’ve been driving for 30 years and have learned how to propel my body through the air at 60 miles an hour without actually having a car.”
Just as a car is a tool to move you around, a band is a tool to move the scale. Take away either and you aren’t likely to head in the right direction at a reasonable speed.
However, if you fit into any of the situations outlined above, then removal or replacement of your gastric band could indeed be your best option, and when paired with conversion to sleeve or bypass, can lead to significant additional weight loss and get you back on track!
ABOUT THE AUTHORTrace Curry, MD is the Founder and Medical Director of JourneyLite Physicians and the JourneyLite Surgery Center. Board-certified, Dr. Curry specializes in minimally invasive surgery. Dr. Curry and his team at JourneyLite of Cincinnati offer personalized, comprehensive management of obesity including weight loss surgery, non-surgical balloon and endoscopic procedures, and supervised medical weight loss.