FAQ's

This is different for everyone but mostly people do not feel much pain with a band adjustment. Sometimes there may be an uncomfortable feeling related to the sensation of the needle hitting parts of the port but usually this is very tolerable. When ports are difficult to access (e.g. very deep) or placed under the muscle there may be a little more discomfort involved. Generally it is not useful to use local anaesthetic to numb the skin as the anaesthetic itself causes a degree of pain and discomfort when infected.

Weight loss success with the band is quite variable. For some individuals the key seems to fit the lock and the weight comes off very easily. Others have a constant struggle with food choices, food portions, eating style and suffer frequent vomiting. It is not easy to predict who will succeed with the band and who will not.

Most studies suggest that the average excess weight loss with the band is about 50%. This means that if you start out 120kg and your ideal weight is 70kg (if your BMI was 25) then you would expect to lose about 25kg all together. Many people do manage to lose more than 50% of excess weight with the band, but many do not even lose this much. Over a period of time, the chance of an individual losing 50% of their excess is itself about 50%. This variability in outcomes with the band is key reason why some individuals prefer to look at gastric bypass or sleeve gastrectomy which tend to bestow a greater reliability of success.

Weight loss with the band is a slow and steady process and can take up to 18 months to complete.

Whether you can feel your access port depends on a number of factors including the surgeon’s choice of port position and how much fat you have between the skin and the muscle layers. If you try hard enough you can almost always locate your port in the upper abdomen as a small firm lump deep underneath the skin.

Occasionally ports cause discomfort during usual activities of life, such as at work, playing sport or even during sex. If the sensation of the port is excessively uncomfortable, it is possible to place the port underneath the muscle of the abdominal wall which will make it much more difficult to feel or see. The downside of this port position is that needle access to the port tends to be a little more difficult and painful.

It is a common misconception with gastric banding surgery that one can lose the weight then have the band reversed (removed) and all will be well. It is well understood that having the band removed leads to weight regain in almost every circumstance. Those who have had success with the band are never interested in having the band removed!

The older guidelines for bariatric surgery did not include the range BMI 30 – 34.9. However these guidelines were originally penned in 1991 when most surgery was performed open rather than keyhole and gastric bypass surgery was primarily used for outcome analysis. These days we can perform most weight loss surgery laparoscopically and the safety and knowledge regarding these operations has improved.

In 2010 a meeting of medical and surgical experts released a consensus statement after a conference in Rome, Italy. This statement related to poorly controlled diabetics with BMI 30-34.9 and was supportive of a role for weight loss surgery in selected patients in this range. The FDA of America in 2011 approved the Lap Band system for use of in selected patients with BMI between 30 and 34.9.

In practice, if your BMI is less than 35, selection is individualized rather than guaranteed. You will need to demonstrate a strong understanding of the pros and cons and basic rationale for surgery to be considered. The responsibility for the decision for surgery is more in your hands as the overall metabolic benefits of weight loss in this group is likely to be less than those with BMI > 40 for instance.

The band is placed around the top of the stomach and usually stitched into place. In up to 5% of cases, the band will slip out of position and end up further down the stomach. Usually the symptoms of this will be difficulties tolerating foods that were previously ok, increase in reflux symptoms and vomiting. It can occur any time after the original band placement.

In the worst case scenario the pressure within the slipped band gets so high that the blood flow to the stomach is compromised. In this situation it is impossible for the patient even to keep fluids down as the band is completely obstructed. If there is a delay to surgery in this case it could lead to death of part of the stomach which is a very serious and even life-threatening condition.

Key Point: If you are unable to tolerate fluids with the band you should seek urgent medical attention

In ordinary circumstances, however, band slips are not dangerous and can be fixed with further surgery. Revision surgery may involve simply re-positioning the band back into the correct position, placing a new band in the correct position or removing the band altogether. If the condition of the entrapped stomach is poor, temporary removal of the band may be the safest choice.

If your weight loss has slowed or stopped with the band, there are a number of possible reasons:

You may have reached your plateau weight. The average weight loss with the band is 50% of your excess weight (your weight above BMI 25). If you have reached around this point, it may be as far as you are going to go without making some further significant changes to your lifestyle. If you and your dietician are happy with your eating choices and habits, increasing your exercise and activity levels may improve and maintain your weight loss at this point.

You may need a further fill of your band. If your band is not restricting your portion size and inducing satiety it may be too loose.

You may be choosing high calorie foods and liquids which are not easily prevented by the band. For example soft drinks, cordials, fruit juices, milkshakes, crackers, cheese, lollies, chocolate and so forth. If you are having trouble avoiding these foods or are a frequent comfort eater you might consider consulting a psychologist for advice on behavioural intervention strategies.

You may have a technical problem with the band. If you have a band erosion or a leak from the system you will not be getting the restrictive effects that you need from the band. Your surgeon can investigate for these problems if need be.

The band may not be suitable for your weight loss needs. Some people simply do not manage to lose the desired amount of weight despite prolonged attempts with the band.

If banding does not appear to be giving you the results you need after prolonged attempts it may be worth considering converting to gastric bypass or sleeve gastrectomy surgery

The amount of fluid required to produce the correct degree of restriction and satiety is highly variable between individuals. There are also differences between the types of band, for example, the Lap Band APS system has a maximum of 10ml, whereas the Lap Band APL has up to 14ml. The old style Lap Band is smaller and only takes around 4ml altogether. Differences in restriction from filling the band may also related to the size of your stomach or other anatomical factors. Generally speaking it is best to get by on as little fluid as possible in the band to minimize vomiting and poor food choices.

The main change you have to make with the band is not so much the kind of food you eat but rather how you eat it. In theory there should be no particular food restrictions with the band, but foods need to be in smaller portions, chopped carefully and chewed well. It is important to slow your rate of eating so that food does not accumulate in the oesophagus above the band during your meal. This leads to vomiting and regurgitation. You will need to learn to pause between each mouthful to allow the last quantity of food to start moving beyond the band.

Sometimes you will need to alter the textures of some of the foods that you like to eat. For example, minced meat is usually easier than a standard cut of meat and casseroled dishes tend to be more easily tolerated. Bread, rice and meat products tend to be the most difficult to eat but it is important to continue with these products in your diet – just reduce the quantities that you consume.

The band is made of silicone and does not stimulate the body’s immune system, so there should be no concerns regarding rejection of the band. The band may become infected (rarely) but this is a different problem. Apart from mechanical and technical issues which may rise, such as band slippage, the band is a safe device which will co-exist harmlessly inside your body.