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Lap-band weight loss

Article-Lap-band weight loss

Procedure less risky, results more sustainable

By: Louise Gagnon
Cosmetic Surgery Times

Toronto, Canada  — Given the epidemic of obesity in North America, there is a demand for surgical procedures that treat obesity and result in significant and sustained weight loss, says one surgeon.

“Obesity is the leading cause of preventable death in Canada,” says Chris Cobourn, M.D., a general surgeon and medical director of the Surgical Weight Loss Centre in Mississauga, Ontario, Canada, noting more than 50 percent of Canadians are categorized as either obese or overweight.

Speaking at the 7th annual Toronto Breast Surgery Symposium, Dr. Cobourn adds that individuals with a body mass index (BMI) of 30 or more are at an elevated risk of developing heart disease, liver disease, sleep apnea and cancer. “Diets don’t work,” Dr. Cobourn tells Cosmetic Surgery Times. “They don’t achieve sustained weight loss in patients. Most patients regain the weight they lose on a diet and may end up weighing even more.”

At the Surgical Weight Loss Centre, about 800 laparoscopic adjustable gastric banding procedures have been performed over the last two years, says Dr. Cobourn.

Candidates for the procedure must be at least 18 years of age and are usually not older than 65. Candidates for the procedure typically have a BMI of 35 or more, but those with a BMI of between 30 and 35 may be eligible for the procedure.

As a result of having a procedure such as laparoscopic adjustable gastric banding, also known as lap-band surgery, patients shed pounds and improve their overall health by reducing blood pressure, controlling their diabetes, treating their dyslipidemia, and improving their sleep apnea, notes Dr. Cobourn. In Canada, the cost of the procedure is not covered by public health insurance, meaning patients are paying out of pocket for gastric band surgery.

“It’s an advanced laparoscopic procedure,” says Dr. Cobourn, noting that it is largely performed on an outpatient basis. “It requires that a surgeon have advanced laparoscopic skills to perform the procedure.”

The term lap-band comes from the type of procedure performed — a laparoscopic surgical technique — and the type of product used, in this case, the gastric band, explains Dr. Cobourn.

SUSTAINED WEIGHT LOSS

In effect, the band reduces the amount of food that an individual can hold in their stomach. Made of silastic, the band does not break down or deteriorate over time, according to Dr. Cobourn.

An adjustable ring is placed around the upper stomach, creating a small proximal pouch. The larger part of the stomach lies below the band. The band controls the opening between the two parts of the stomach, with the upper part distending or stretching when solid food is consumed, causing a sense of satiety or fullness. There are stretch receptors in the wall of the upper stomach that send a signal to the brain that the patient is full or satiated. Ingested food empties into the lower part of the stomach at a controlled rate.

The band is attached to tubing that is connected to a port lying under the skin and fat of the abdominal wall. At the time of the procedure, the device is sutured to the abdominal wall, halfway between the umbilicus and xyphoid in the anterior abdominal wall.

“The concept is that patients will maintain a sense of satiety or fullness after eating much smaller portions of food,” says Dr. Cobourn. “It is a tool to allow them to achieve sustained weight loss.”

Dr. Cobourn describes the use of the gastric band as one element that is part of a multifaceted approach to sustained weight loss. Pre-operatively, patients are recommended to follow a nutritionally complete very low-calorie diet (Optifast) for at least two weeks. The purpose of the diet is to decrease fat stored in the liver to increase the safety of the surgical procedure.

Patients visit the clinic after the procedure to monitor their status, receive band adjustments when necessary, and for dietary counseling. They have access, via e-mail and telephone, to clinical nurse specialists and patient care coordinators. They are also referred to post-operative support groups.

LAP-BAND VS. GASTRIC BYPASS
The alternative surgical procedure, gastric bypass, results in significant weight loss in a rapid fashion. However, patients can regain weight a few years after the procedure. By contrast, weight loss with gastric band surgery is on average one to two pounds per week with up to 70 percent of excess body weight being lost over one to two years. The weight loss is almost always sustained.

Another disadvantage of gastric bypass surgery is that it can have an adverse effect on the digestive tract and the absorption of nutrients. “It’s an invasive procedure,” says Dr. Cobourn. “The stomach is cut, stapled and divided.”

Consequently, the risk of complications is greater and severity of complications more serious with gastric bypass surgery than with the gastric band system, according to Dr. Cobourn.

“If the stapled area does not heal well [in gastric bypass surgery], leakage can occur,” says Dr. Cobourn. “This can lead to serious infection.”
 
One complication that can occur with the gastric band procedure is slippage. This occurs when the gastric band moves down the stomach, so that the pouch above the band is larger than desired. This can be corrected with a simple laparoscopic procedure.

Gastric bypass surgery results in malabsorption, so patients may require lifetime supplementation to get sufficient levels of vitamins and minerals, according to Dr. Cobourn. Moreover, there is a 1 percent mortality rate associated with gastric bypass surgery. By contrast, the mortality rate associated with lap-banding is 0.05 percent.

Gastric bypass surgery requires in-hospital stay. Patients who undergo gastric band surgery are typically back to work and their normal day-to-day activities in about seven to 10 days after the procedure.


For more information
Chris Cobourn, M.D.
www.obesitysurgery.ca

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