When the FDA approved the Lap-Band® in 2001, it was a revolutionary medical device. Patients had an adjustable and fully reversible bariatric surgical procedure for the first time.
Up to that point, procedures in Europe and Australia were considered equivalent to gastric bypass; the only surgical alternatives were more invasive, often open operations involving stomach stapling. With the new gastric band technology came incredible hype, marketing, and a boom in band placements. Over the next decade and a half, hundreds of thousands of patients had bands placed in their bodies with varying degrees of success.
Over time, while some patients lost a significant amount of weight, the band had some critical drawbacks. Unlike most other bariatric procedures, it offers no hormonal or malabsorptive benefits – weight loss relies solely on the band’s restriction. Hunger persisted, yet recipients could no longer eat as much as before.
More concerningly, the complication rates of the band over the long term became untenable. There was slippage of the band, where it moved out of place and caused significant symptoms or a lack of restriction; other patients experienced erosion of the band into the esophagus. Some patients even experienced flippage of the injection port used to adjust the band.
All of these complications required further surgery, and patients were not achieving the kind of excess body weight loss that stapled surgical procedures, such as a gastric bypass or gastric sleeve, offered.
How We Convert a Gastric Band
If you’re wondering why we don’t simply remove the band, it’s because once the restriction is gone, significant weight regain usually follows. While a band could theoretically be replaced, most patients opt for a conversion to a stapled procedure instead, avoiding the long-term risks of repeated band complications.
Because the band does not permanently alter the anatomy of the gastrointestinal tract, patients requiring a conversion have the option of any other bariatric surgery, including the gastric sleeve, gastric bypass, or, for patients with relatively higher BMIs, a duodenal switch or SADI.
What Is the Operation Like
Patients are under general anesthesia for the entire procedure, which starts with the removal of the band. The contents of the band are drained, the band cuff is cut, and then it’s removed from the abdomen. The conversion procedure is then performed almost as if it were the primary bariatric surgery.
The entire procedure takes approximately one to two hours, depending on the type of surgery being performed and the condition of the band. The downside is that potential risks and complications of the conversion procedure are higher due to the presence of scar tissue from the initial band placement.
That said, patients who tackle weight regain early enough (i.e., at a lower weight and in a healthier state) may actually have a lower surgical risk than they did during their initial procedure. If the band has eroded into the esophagus, however, your surgeon may delay the conversion procedure and perform it separately once the stomach and/or esophageal tissue has healed.
Choosing the Right Surgeon for a Conversion
Among the many decisions a patient faces, choosing the right surgeon for a revision procedure is critical. Conversion operations are complex, and selecting the most appropriate surgical method is equally important.
Choosing an experienced surgeon with an impeccable track record in all major bariatric procedures, including the sleeve, bypass, duodenal switch, and SADI, ensures that you receive proper guidance without inherent bias for one procedure or another. Furthermore, a highly skilled surgeon in conversion procedures may have a better understanding of the complexities and potential complications that may arise during surgery.
If your gastric band/lap band is functioning well and you’re not experiencing complications, a revision may not be necessary. Revisions are typically reserved for patients facing significant weight regain or band-related issues.
At SAMPA, we welcome your questions and can help you determine if a conversion surgery is right for you. Contact our team today to schedule a consultation and explore your options with an experienced conversion bariatric surgeon.