The actual full name of the LapBand is “The Adjustable Laparoscopic Gastric Banding System.” What sets the LapBand apart from all previous proximal stomach restrictive procedures – stomach banding or stapling operations – is the word “adjustable.”
The LapBand system has a silastic reservoir, known as a port, beneath the skin and subcutaneous fat layer on the patient’s abdominal wall. The port is anchored to the tough, fibrous envelope around one of the rectus (sit-up) muscles. In our patients this is up and to the left of the belly button. The port can be accessed with a syringe and needle, and sterile saline injected, which causes the band around the upper stomach to tighten. Conversely, saline can be drawn out of the port to make the LapBand looser.
Adjusting the LapBand is the key to making this operation effective. Failure to have proper adjustment will result in less than expected weight loss or no weight loss.
We wait until one month after the LapBand is placed before we start the adjustments. This is to allow the system to become scarred-in and stable, and to allow any swelling to go away. The goal of adjustment is to tighten the LapBand to a degree that slows emptying of the small stomach pouch above it. Thus, once the patient correctly fills the pouch to produce a “feeling of fullness” the feeling will be prolonged by slowing pouch emptying.* Ideally the patient should have a “feeling of fullness” for several hours after filling the pouch. This feeling is also known as intra-meal satiety.
LapBand Adjustments are done in the office and usually take 5-10 minutes.* The patient lies in a supine position on a standard examination table. A pillow is placed beneath the knees to flatten the abdominal muscles. The port is palpated so that the lower edge is identified. Occasionally, we may use an ultrasound machine to locate the port. The skin over the port is prepared by applying a betadine solution and some local anesthetic is injected with a skinny needle to numb the area. A special needle that will not hurt the port is used to access it. Often the patient will be asked to raise his/her head to tighten the sit-up muscles and bring the port closer to the surface. After access is confirmed by pulling out some saline from the system all remaining fluid is aspirated and measured. This saline and an additional amount are then injected back into the port and recorded in the patients chart.
Frequently, the amount of fluid aspirated does not match the amount measured on the previous adjustment. Unfortunately, because of the compliance of the system, the negative pressure applied to the syringe, and the shape of the band, among other factors, the LapBand adjustment is not an exact measurement. Importantly, this does not usually mean the system has a leak. A significant leak of the system would cause NO saline to be aspirated during an adjustment.
After adjustment the patient must drink a test amount of water (8-12 oz) to be certain that the band is not too tight. If the patient has difficulty drinking this amount we will remove part, or all, of the new adjustment amount.
After a new adjustment, we recommend the patient take only liquids for 24 hours, followed by soft food (able to be mashed easily with a fork) for another 24 hours. Large pills or capsules should be crushed or opened for 48 hours after an adjustment.
The timing of adjustments is individualized. Most patients will need several adjustments in the first 6 months after LapBand placement. Later, adjustments should be less frequent with a maximum of 12 months between visits. The goals for the LapBand patient are: 1-2 lbs weight loss each week AND an adequate “feeling of fullness” for several hours after meals.*