LAP-BAND® Revision Surgery
After LAP-BAND® surgery, patients may need revision weight loss surgery for a number of reasons. The lap band could slip leading to a slow chronic condition or an acute condition requiring emergency surgery. Both circumstances ultimately lead to the lap band not functioning the way it should. While each circumstance is different, treating these issues may require removing the lap band, repositioning the lap band or replacing the lap band all together. Removing the lap band obviously opens the door for potential weight regain.
Lap band erosion is another possible complication of lap band surgery. Lap band erosion occurs when the lap band causes a hole to be worn into the stomach, making the lap band rather ineffective. Patients may experience a single occurrence of vomiting blood as the first signal of lap band erosion. The most frequent symptom of lap band erosion is an infection around the site of the port. Due to erosion caused by the lap band, saliva leaks through the hole in the stomach and flows along the lap band tubing, causing the tissue under the skin of the lap band port to become infected. Treatment requires removing the lap band, leaving the patient with no weight loss surgery and a high likelihood of weight regain. It is often recommended to treat lap band erosions by converting the patient to either laparoscopic gastric bypass or vertical sleeve gastrectomy. Since the portion of stomach that has been eroded is weakened and more prone to leaking, these weight loss surgery procedures should be done only after a waiting period of 2-3 months to allow for healing to occur.
The lap band may simply fail to produce the desired results and require revision bariatric surgery. Lap band is a restrictive weight loss surgery and some patients may not have the metabolism needed to lose weight with the lap band. Other patients may not be able to eat the way that is needed to achieve success after lap band surgery. This may in turn lead to maladaptive eating behaviors ultimately resulting in failure and/or weight regain. Lap band failures may be converted to any other weight loss surgery but it should be considered that a patient will more likely achieve success if a more metabolically active procedure is performed instead of a purely restrictive weight loss surgery. There is a decent amount of evidence suggesting that a well managed lap band is almost as good as gastric bypass over time, since both depend on maintaining restrictive eating via a similar size pouches. Converting a patient to gastric bypass after lap band failure will produce best results since it will add malabsorption to restriction and control hunger.
For patients who want nothing but restrictive weight loss surgery, vertical sleeve gastrectomy is a great option. Vertical sleeve gastrectomy will still be limited by the metabolic activity of the surgery itself, in addition to the patients metabolism, but there are several reasons why the vertical sleeve gastrectomy will produce better results than the lap band over time.