Gastric Banding (Lap-band) Surgery

by Christine on April 10th, 2010

filed under Gastric Banding Surgery, General Information

After many, many years of trying to get my weight under control, I decided to take the plunge and get gastric banding surgery (commonly referred to as “lap-band” surgery).  The next couple of blog posts will explain a little big about the surgery and my experiences with it.  However, I have to say: it’s been a tremendous experience. As of today I’ve lost 70 pounds, and I’m still losing.  The surgery has been a little bit of a bumpy ride at times, but overall it was totally worth it.   Today’s post will be an overview about the surgery.

A bit of my background
I have an impossible time losing weight. Prior to surgery, I gained 70 pounds in the last 5 years…..all while regularly exercising, watching what I eat, etc. None of the regular mathematics of losing weight seemed to make any bit of difference with me. I certainly did not gain weight because I was lazy (as one doctor told me). I thought perhaps an inactive thyroid might be the problem. Indeed, I found out I was hypothyroid, but since stablizing my thyroid, I still gained weight.

I had been seeing doctors for three years or more trying to get help finding out the cause of this weight gain. No doctors had been able to help. In the effort to lose weight, I was put on Adipex, Phentermine, and even put on some alternative drugs with weight loss side effects (such as Cymbalta) with no luck. I visited nutritionists with no luck. I had friends, personal trainers, and nutritionists evaluate my diet and exercise, but even with their counseling I was unable to lose the weight.  I tried more common diets with no luck,  including the Master Cleanser, Atkins, Weight Watchers, and many others.

After a few years worth of visits to my GP, I finally asked her if lap-band surgery might help me. She agreed to refer me to the bariatric center to look for help there. My boss at the time did lapband back in March of 2008 and lost in excess of 100 pounds.  I figured I have tried everything else….why not try this?

How does Lap Band Surgery Work?
Lap Band is actually called Laparoscopic Adjustable Gastric Banding. Lap-Band is actually a registered trade mark brand name. It works by putting an adjustable silicone band around the upper part of the stomach. This creates a small pouch at the top of the stomach and leaves the larger portion below the band. The band is a hollow ring that can be filled with saline. To adjust the band and tighten it, doctors will put more saline into the band to restrict the opening to the large stomach pouch below. There is no cutting or stapling of the stomach and there is no intestinal rerouting (that’s gastric bypass).

The smaller gastric pouch that is created by the gastric band limits the amount of food that can be eaten and slows the emptying process from the stomach into the intestines. The smaller stomach pouch and slower digestion rate lets you feel full sooner and feel full longer. The band can be adjusted to let in more or less food as needed.

During surgery, an access port is placed beneath the skin that is connected to the gastric band by a tube. Saline can be easily added or removed by the surgeon thru the access port using a thin needle. This process is called inflating or deflating. If weight loss is too small and the band is too loose, saline is added to reduce the opening. If the opening is too tight, saline can be removed. You have to visit your doctor every three weeks to adjust your lap band until you reach your goal weight.

Although the Lap Band CAN be removed, it is typically NOT removed. It will remain inside you for life. The good part of this is that if you ever start to have weight problems in the future, you can just go back to your doctor and begin the adjustment procedure. You don’t have to undergo surgery again.

How much does Lap Band Surgery Cost?
In the United States, the cost of LAP-BAND® surgery is approximately $15,000 to $20,000. This amount usually includes all pre-op consultations, hospital fees, and post-operative follow-up appointments and adjustments.

Many US patients are choosing to travel to other countries as they seek low-cost LAP-BAND® providers. One of the top destinations for LAP-BAND® surgery outside of the United States is Mexico, where the cost for the surgery is roughly $8,000 to $10,000. When traveling away from your home for surgery, it is important to consider travel time and related travel expenses for both the surgery and all recommended follow-up appointments.

If your surgeon approves you for LAP-BAND® surgery after a consultation, you will then be required to undergo various pre-operative exams and lab tests before you are medically cleared for surgery. The necessary tests often include blood tests, electrocardiograph (EKG), chest X-rays, sleep apnea screening, and an echocardiogram. These costs are often included in the overall price, but can cost up to $1000 if billed separately.

Follow-up care and band adjustments are an important part of the LAP-BAND® procedure. There are usually several follow-up appointments the first year and then once a year after the first year in order to monitor weight loss and adjust the band as needed. Many surgeons structure their prices to include some band adjustments for the first year. Some self-pay patients (without insurance coverage) opt to pay for the surgery separately and then pay for adjustments as needed. Adjustments for patients commonly range from about $100 to $300 each. Some surgeons may make adjustments for people who have had their surgery elsewhere, but the fees are usually quite a bit more than for their own patients.

NOTE: Most insurance will cover the cost of lap band surgery. You may need to undergo six months of alternative weight loss attempts (like, joining Weight Watchers), and you will almost certainly need to have a BMI of 40 or above. Fortunately, my insurance (BCBS) paid for the surgery for me.  I had to pay for each doctor’s visit ($30 per visit) and then a $100 hospital fee, so in total I may have paid $300 out of pocket for the surgery, if I had to guess.

How do you qualify for Lap Band Surgery?

You could possibly qualify for Lap Band Surgery if:

* Your BMI is more than 40 or more than 35 with obesity related health conditions
* You weigh twice your ideal weight or are at least 100 pounds overweight
* You are between the ages of 18 and 60
* You have been overweight for 5 years or more
* You have been unable to lose weight through diet and exercise
* You do not have an illness that has caused you to be overweight (<< depression counts!)

What are typical Results with Lap Band Surgery?

In one early study involving 271 US patients undergoing lap band surgery the average weight loss achieved 3 years after surgery was 47% of excess body weight, while a second US study of 63 patients showed an excess weight loss of 53%. Several studies involving larger groups of patients from both Italy and Australia over a similar 3 year period show excess weigh loss ranging from 49% to as high as 68%.

I recently had a conversation with my surgeon about this. He was praising my progress with the surgery, and I said, “ah, but you must have tons of successful patients!”  He said no, he actually does not – the success rate with gastric banding patients is surprisingly low. He said that he has found that younger patients with LESS weight to lose are typically more successful.  According to him, this is because older, more grossly obese patients, have adopted a sedentary lifestyle, and without adding exercise to the mix, the surgery just isn’t as effective.  His observations were surprising to me!

Tomorrow I will discuss all the pre-hospital testing and the Medifast period that I had to endure prior to surgery.

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