17163 Lap Band Surgery

Overview

Lap band surgery is a type of weight-loss (bariatric) surgery. The surgeon places an adjustable soft ring — the band — around the upper part of your stomach. This creates a small pouch at the top. Food stays in the pouch for a while, so you feel full sooner and eat less. The band is joined by a thin tube to a small port placed under the skin of your tummy. Your care team can add or remove fluid through this port to make the band tighter or looser — this is called an adjustment or a 'fill'. The band does not remove or re-route any part of your stomach, and it can be loosened or removed later if needed.

Weight-loss surgery overall is common worldwide, but the adjustable gastric band is used much less than it once was. In the UK and many other countries, operations such as the gastric sleeve and gastric bypass are now chosen more often. Band surgery is still offered in some specialist centres, and some people who had a band years ago still have one in place.

Most people who have this operation are adults living with obesity — usually a body mass index (BMI) of 40 or above, or 35 or above with a weight-related health problem such as type 2 diabetes or high blood pressure. It is only rarely used in teenagers and only in specialist centres. It is not usually recommended during pregnancy, and extra care is needed if you become pregnant with a band in place.

Symptoms

Common symptoms

• Living with excess weight for a long time, often after many diets that did not lead to lasting change
• Feeling hungry again soon after meals, or finding it hard to feel satisfied
• Weight-related problems such as type 2 diabetes, high blood pressure, joint pain, snoring or poor sleep
• In the first days after surgery: a sore, bloated or windy tummy, tiredness, and a need to eat only liquids at first
• Feeling full very quickly once the band is tightened — this is expected and is part of how it works
• Sometimes the band feels too tight: bringing food back up, heartburn or food sticking, which usually means an adjustment is needed

Causes

Main causes

• Weight-loss surgery is considered when obesity is likely to come from a mix of things — genes, appetite hormones, the food around us, sleep, stress and some medicines — rather than from a lack of willpower.
• It is usually offered when other approaches, such as changes to eating and activity with support from a dietitian, have not led to lasting weight loss.
• The band does not fix the reasons behind weight gain; it is a tool that makes eating less feel easier while you work on those other things.

Risk factors

• A BMI of 40 or above, or 35 or above with a weight-related health problem
• A family history of obesity or type 2 diabetes
• Health conditions and some medicines that make weight gain more likely
• Eating patterns such as frequent large portions, grazing, or drinking a lot of sugary or fizzy drinks
• Smoking, poorly controlled diabetes or previous stomach surgery, which raise the chance of problems after the operation
• Not being able to attend regular follow-up appointments, which the band depends on

When to see a doctor

See a doctor urgently if:

• You cannot keep fluids down, or you are vomiting again and again
• You have severe tummy or chest pain, or pain with a fever
• There is redness, swelling, pus or severe pain around the port or a wound
• You feel dizzy, very weak, or think you may be dehydrated
• You are pregnant, or think you may be — contact your weight-management team early

Book a routine appointment if:

• You are thinking about weight-loss surgery and want to talk through the options
• You have a band and it feels too tight or too loose, or your weight is changing in a way that worries you
• You are struggling to eat well, or finding meals difficult or stressful
• You have not been seen for a band check-up in a long time
• You feel low in mood, anxious, or are worried about your relationship with food

Diagnosis

There is no single test. Suitability for band surgery is worked out over several appointments with a weight-management team, which usually includes a doctor, dietitian, nurse and sometimes a psychologist. They look at your weight history, your health, how you eat, and what support you have — and they talk with you about the benefits and risks of each option, including non-surgical ones.

Tests that may be done

• Height and weight to work out your BMI, plus a waist measurement
• Blood tests to check for type 2 diabetes, cholesterol, liver, kidney and thyroid function, and vitamin levels
• Blood pressure and a heart tracing (ECG)
• Questions or questionnaires about your eating patterns, mood and mental health
• A sleep study if you snore heavily or feel very sleepy during the day
• Sometimes an endoscopy (a camera test of the stomach) or an ultrasound scan of the liver
• An appointment with a dietitian and, in many services, a psychological assessment

What to expect at your appointment

The assessment usually takes weeks or months, with more than one visit. This is not to put obstacles in your way — it is to make sure surgery is the right choice for you and that you have the support you need afterwards. You may be asked to keep a food diary, make some changes before surgery, or stop smoking. You should feel free to ask questions at every stage, and it is fine to take time to decide.

Treatment

Treatment for obesity is a long-term process, and surgery is only one part of it. Most people start with changes to eating and activity, support from a dietitian, and help with sleep, stress and any weight-related health problems. If these have not led to lasting weight loss and surgery is suitable, the adjustable gastric band is one of several operations that may be offered. All of them need to be combined with ongoing changes and regular follow-up to work well.

Self-care at home

• Eat small portions, slowly, and chew food well — put your fork down between mouthfuls
• Stop eating as soon as you feel full, and do not drink while you eat
• Avoid very fizzy drinks, and go easy on very dry, stringy or doughy foods that are hard to swallow
• Sip fluids steadily through the day so you do not become dehydrated
• Follow the staged eating plan your team gives you, starting with liquids and moving on to soft, then firmer foods
• Take any vitamin or mineral supplements your team advises, and have your levels checked when asked
• Keep moving — walking daily is a good start, and build up as you feel able
• Attend your adjustment and follow-up appointments, even when things are going well
• Weigh yourself no more than once a week, and focus on habits rather than the number on the scale

Medical treatments

Non-surgical weight management usually comes first. That can include structured programmes with a dietitian, group support, activity programmes, help with sleep and stress, and treatment for related conditions such as high blood pressure or type 2 diabetes. Some people are offered medicines for weight management through a specialist service — your doctor can discuss whether these might be suitable for you, how they are taken, and what the possible benefits and side effects are. This article does not recommend any particular medicine. If a band is in place, the main 'treatment' is the adjustment itself: your team adds or removes fluid through the port to get the band to the right tightness for you.

When is surgery considered?

Band surgery is carried out in hospital under a general anaesthetic, usually by keyhole surgery. The surgeon makes a few small cuts, places the band around the top of the stomach, and fixes the port under the skin. Most people go home the same day or the next day. The band is usually left empty at first and adjusted in the weeks and months afterwards. Surgery may be suggested when your BMI is high enough, other approaches have not worked, and you are well enough for an operation. It is not suitable for everyone, and your team will explain the alternatives — including other types of weight-loss surgery — so you can choose what fits you best.

Living with this condition

At first, eating with a band takes practice. You will move from liquids to soft foods and then to normal textures over a few weeks. Many people find they need to eat three small meals and avoid snacking, because the pouch holds only a small amount. Adjustments are usually every few weeks at first, then less often. Some foods may not suit you — this is different for everyone, and a dietitian can help you find meals that work.

Lifestyle tips

• Plan small, regular meals rather than skipping meals and then eating quickly
• Keep a simple food and symptom diary to spot patterns and to share with your team
• Build activity into your day in a way you enjoy, and aim to be a little more active over time
• Get enough sleep, and ask for help if snoring or poor sleep is affecting your days
• Limit alcohol, which is high in calories and can irritate the stomach
• Tell any doctor, nurse, dentist or pharmacist that you have a gastric band, especially before any operation or scan
• Keep your follow-up appointments, even years after surgery

Diet and exercise

There is no single perfect diet, but most people do best with small portions of foods that are high in protein, with vegetables and some wholegrains, and with sugary and very fatty foods kept to occasional treats. Eating slowly and chewing thoroughly matters more with a band than with almost any other way of eating. For activity, aim for something you will keep doing — walking, swimming, cycling, dancing or gardening all count. Start where you are and build up gradually; your team can help you set realistic goals.

Mental health and emotional wellbeing

Weight and eating are tied up with mood, stress, body image and how other people treat us, and it is common to have mixed feelings before and after surgery. Some people feel low or anxious when weight comes off more slowly than they hoped, or when old eating habits return under stress. Others find relationships and social eating harder for a while. These feelings are real and worth talking about — with your team, your GP, or a counsellor. If you ever feel you cannot cope or have thoughts of harming yourself, contact your local crisis line or emergency services straight away; you deserve support quickly.

Prevention

There is no sure way to prevent obesity, because genes, hormones and the world around us all play a part — so it is not something to blame yourself for. Small, steady changes to eating and activity, good sleep and support with stress can help prevent weight-related health problems, and they matter just as much after surgery. For people who already have a band, many of the problems it can cause are less likely if you follow your eating plan and keep your follow-up appointments.

Screening programmes

If you have a gastric band, you need lifelong follow-up rather than one-off screening. That usually means regular check-ups, band adjustments, and occasional blood tests to check vitamins and minerals. Your team may also check for problems such as heartburn or swallowing difficulties, and monitor weight-related conditions like type 2 diabetes and blood pressure.

Complications

If left untreated

• Living with obesity raises the risk of type 2 diabetes, high blood pressure, heart disease, joint problems, sleep apnoea and some cancers.
• Without follow-up, a band can become too tight or slip, leading to heartburn, vomiting, poor nutrition or dehydration.
• The band can wear into the stomach over time (erosion), or the port or tubing can become infected or damaged.
• Weight can come back, especially if eating habits and activity do not change alongside the band.
• Some people need a further operation to reposition, replace or remove the band.

Long-term outlook

Many people lose weight steadily with a gastric band and keep it off, particularly when they have good follow-up and support. It is usually a slower journey than with other operations, and it works best as one part of a wider change in how you eat, move and look after yourself. Some people later choose to have the band removed or converted to another type of surgery, and that is a normal part of the conversation with your team. Whatever happens, help is available — the goal is better health and a life you feel good in, not a perfect number on the scale.

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