Lap-Band Surgery-The Surgical Weight Loss Centre at The Plastic Surgery Clinic
Almost every day, you see reports in the media about an amazing new diet or some new pill for weight loss. Even so, the number of people with a serious weight problem keeps going up. If you are one of those people, you probably already know that weighing more than you should is harmful to your health.
If you are severely obese, you have higher risk for problems such as heart disease and diabetes. It can give you a negative self-image and affect the way you interact with family, friends and co-workers. It can cause you to become socially isolated.

The best remedy for being overweight is to exercise more while you eat less and eat sensibly. That way you can use up more energy than you take in and lose weight. A diet can help people lose weight but rarely is dieting alone effective at eliminating excess weight. Some people can have success with drugs that make them feel less hungry. But over the long term, these methods don’t work for everyone. Some people quickly regain the weight they lose on a diet. Some even end up weighing more. Drugs that make you feel less hungry do not usually produce weight loss that lasts. If you’ve tried these methods and still have a problem with excess weight, you may want to consider surgery. Surgery can help some people lose weight and keep it off.

Through the Surgical Weight Loss Centre at The Plastic Surgery Clinic we offer a safe and effective surgical procedure known as Laparoscopic Adjustable Gastric Banding (LAGB) using the Lap-Band® System.  LAGB is a procedure that has been shown to be effective in more than 200,000 patients worldwide. The goal of Lap-Band surgery is to provide over 90% long-term weight control with a target loss of at least 60% of excess weight. 

What is Laparoscopic Adjustable Gastric Banding (Lap-Band)?
The Lap-Band System is an adjustable ring that is placed over the upper stomach to create a small pouch. The ring is attached to tubing which itself is attached to a port that lies under the skin. The tightness of the ring is adjusted after surgery during routine office visits. If a patient does not experience adequate weight loss, fluid is added through the port and the band tightens creating a smaller pouch and a sense of early fullness after meals. If too much fluid is present such that the patient cannot tolerate any solid food, fluid is removed from the band. Using these adjustments, the band can be fine-tuned for each patient.

This product has been used extensively throughout the world since its introduction in 1993. There are over 125,000 devices implanted in the world. It is the only FDA approved gastric banding device that has shown proven quality and been the subject of rigorous scientific testing.

The Lap-Band System is a prosthetic device made out of plastic. It was FDA approved (United States) for the treatment of obesity in 2002 after being studied in the United States. European and Australian surgeons have had experience using the Lap-Band System for over ten years. Currently, over 1000 Lap-Bands are placed in the United States every month.

Laparoscopic adjustable gastric banding is much safer than the traditional surgical technique of gastric bypass or stomach stapling.  There is no cutting, stapling or bypass of the intestine with LAGB.  Lap-Band surgery works by restricting caloric intake and does not cause malabsorption which is the major mode of action of gastric bypass.

Gastric Band Surgery At The Surgical Weight Loss Centre at The Plastic Surgery Clinic
The Plastic Surgery Clinic is a fully accredited Independent Health Facility licensed and inspected by the Ministry of Health of the Province of Ontario. We are also accredited by the Canadian Association for the Accreditation of Ambulatory Care Facilities. Both of these accreditations are achieved by regular inspection and review. This helps to guarantee our patients the most modern and highest level of care possible.

Laparascopic adjustable gastric band surgery is performed at the Clinic by Dr. Chris Cobourn and Dr David Mumford. Both Dr. Cobourn and Dr. Mumford are certified specialists in General Surgeon by the Royal College of Physicians and Surgeons of Canada.  They have specialty interests in laparoscopic surgery. They are  fellows of The Royal College of Physicians and Surgeons of Canada and the The College of Physicians and Surgeons of Ontario and are members of both The Canadian Association of General Surgeons and The Ontario Association of General Surgeons.

Dr. Cobourn has over 16 years experience in Abdominal Surgery. He has performed more than 6,000 laparoscopic procedures including gall bladder removal, hernia repair, bowel surgery and spleen removal. Dr. Cobourn introduced laparoscopic surgery to the Mississauga area in 1991 and has been focusing his practice on advanced laparoscopic surgery since that time. He was Chief of Surgery at Trillium Health Centre for over 8 years and is the medical director of the Surgical Weight Loss Centre at The Plastic Surgery Clinic.

Dr. Mumford has performed over 6000 laparoscopic procedures including gallbladder removal, appendectomy, advanced bowel surgery, and hernia repair including hiatus hernia repair. By attending courses and conferences he is constantly updating his knowledge and surgical skills. Following advanced training in the use and placement of the Lap-Band, INAMED has certified Dr. Mumford as a Lap-Band surgeon. He is widely recognized as an innovative, skilled and compassionate surgeon.

More information about Dr. Cobourn and Dr. Mumford can be obtained by visiting our Surgical Weight Loss Centre Lap-Band website at www.obesitysurgery.ca

Non-Operative Treatment of Obesity
The most common approach for losing weight is to eat less, eat more sensibly, and exercise more. But if you are severely obese, this approach may not be enough. Sticking to a diet and exercise plan is hard and sometimes painful. Many who lose weight quickly gain it back when the diet ends. That leads to more diets, or taking special drinks that replace a meal, or using a so-called “wonder pill.” The cycle of losing weight and gaining it back is called the yo-yo effect. While temporary weight loss can help, the yo-yo effect can also make it harder to lose weight in the future.

Published scientific reports document that non-operative methods alone have not been effective in achieving a medically significant long-term weight loss in morbidly obese adults. The average medical weight reduction trial is a 10-12 week study with average weight loss of 2.5 kg.

Source: Drs, Dixon, O'Brien Melbourne, Aus

Prior to Surgery
If it is felt that Gastric Banding is the appropriate procedure for you, the following steps will become part of the pre-operative work up:

1. Consultation with Dr. Cobourn or Dr. Mumford – to discuss the procedure in detail, including general and specific risks and to complete the process of informed consent.
2. Assessment by our nurse specialist –this gives us a detailed report on your dietary history including prior attempts at weight loss. It also identifies any potential dietary factors that may affect the anticipated success of the surgical procedure
3. History and Physical – by your family physician. This allows us to identify any potential medical conditions that could affect the safety of the operation or the post-operative course.
4. Anesthesia consultation, if necessary, to determine your fitness to undergo this procedure
5. Pre-Operative Ultra Low Calorie Trial – Optifast is a  prescribed nutritionally complete dietary regimen which is used pre-operatively for 1 – 2 weeks to reduce fat stores in the liver and make the surgical procedure easier and safer.

The Surgical Procedure
A series of small puncture wounds are made in the abdominal wall in order to allow insertion of the small laparascopic instruments. A video camera is attached to a special telescope to provide visualization in the abdominal cavity.

A tunnel is created around the upper stomach and the Lap-Band device is placed into the proper location around the upper part of the stomach. Tubing from the Lap-Band is then attached to a port, which is placed under the skin, but on top of the muscle of the abdominal wall. Saline can be injected through the port to precisely adjust the size of the Lap-Band reservoir and thus modify the size of the opening into the rest of the stomach.

The operation usually takes less than two hours to complete. After the surgery you will be closely monitored in the Recovery Area until you are ready to be sent home.

What are the advantages of the Lap-Band System?
The LAP-BAND System has the following advantages:

• It is less invasive than other surgical techniques (such as gastric stapling or other bypass type surgery)
• The band can be adjusted to optimize weight loss at a safe controlled rate.
• The process can be reversed if necessary.
• It can be performed in an out-patient setting and recovery is much quicker than all other surgical techniques for obesity.
• The procedure restricts the amount of food that can be consumed at a meal
• Food consumed passes through the digestive tract in the usual order allowing it to be fully absorbed by the body
• In multiple studies involving over 3000 patients, excess weight loss averaged greater than 50 percent, with a minimum of two year postoperative follow-up
• The band can be adjusted to increase or decrease the restriction of food.
• The surgery can be fully reversed if necessary.

Patient Participation (compliance)
The LAP-BAND System depends on the success of the surgical procedure and the ability of the patient to change his or her diet and eating behavior. After surgery, LAP-BAND System patients are encouraged to eat a balanced diet and to avoid the eating patterns of their pre-surgery lifestyle. Patients are particularly discouraged from consuming fatty or sweet liquids as these pass through the narrow band opening without restriction. Likewise, drinking fluid while eating liquifies the food which then passes quickly through the opening. By eating well-chewed solid food, the restrictive effect of the band produces a feeling of early satiety and long-lasting fullness and reinforces the patient's ability to eat smaller meals.

HOW DOES THE LAP-BAND WORK?
Food travels down the esophagus (E) into the reservoir (R). Food then travels slowly through the narrow opening created by the Lap-Band into the lower portion of the stomach and to the rest of the intestine for normal digestion and absorption of nutrients.

How Effective is Gastric Band Surgery in Promoting Weight Loss?

The LAP-BAND System encourages weight loss by restricting the amount of food an individual can consume and by inducing a feeling of early satiety. Published literature reports data for up to four years post LAP-BAND System surgery with sustained weight loss. To date, there are no publications noting average weight regain. These results are from studies with at least two-year follow-up follow:

Dr. Belachew et al. reported that 80% of his patients have lost 60% of their excess weight at 12 months post LAP-BAND System placement. There was a marked improvement in BMI from an average of 43 Kg/m2 pre-operatively to a mean BMI of 30-33 Kg/m2 at 12 months post-surgery, which has been sustained for 3 years.

Dr. Belva et al. reported the results of a multi-country, European study of 3,800 procedures, indicating that at 3 years the mean percentage excess weight loss (%EWL) was 73%.

Becoming Healthier Through Weight Loss
Morbid obesity is associated with serious medical problems. Studies indicate that even a mild reduction (10%) in weight produces an improvement in blood sugar control and a reduction in blood pressure and cholesterol levels. Two studies have been published that establish a significant improvement in health associated with weight loss through use of the LAP-BAND System.

In Dixon et al, eleven patients with diabetes (Type II) either showed significant improvement (65%) or complete resolution (35%) one year after LAP-BAND placement. Twelve asthmatic patients (66%) showed reduced numbers of episodes and need for medication, and six (33%) were without therapy and free of attacks. Nine hypertensive patients were followed for one year with three (33%) improved, and six (66%) with normal blood pressures off therapy. An average 30% reduction of serum triglyceride levels was also seen in this study.

Who is a candidate for Gastic Band Surgery?
The LAP-BAND System may be right for you if:

1. You are an adult between the ages of 18 and 60.
2. You must have a BMI of greater than 35 with a medical problem associated with your weight, or a BMI of over 40 without any medical problems. Or you weigh at least 100 pounds (45 kilos) more than your ideal weight.
3. You have been overweight for more than 5 years.
4. Your serious attempts to lose weight have had only short-term success.
5. You do not have any other disease that may have caused you to be overweight.
6. You are prepared to make major changes in your eating habits and lifestyle.
7. You are willing to continue working with the Clinic and the specialists associated with it.

Who is not a candidate for Gastric Band Surgery?
Adjustable Gastric Banding is not advised in the following patients:

• Patients with inflammatory diseases of the gastrointestinal tract, including severe intractable esophagitis, gastric ulceration, duodenal ulceration, or specific inflammation such as Crohn’s disease.
• Patients with severe cardiopulmonary diseases or other serious organic disease which may make them poor surgical candidates.
• Patients with potential upper gastrointestinal bleeding conditions such as esophageal or gastric varices or congenital or acquired intestinal telangiectases.
• Patients with congenital or acquired anomalies of the GI tract such as atresias or stenoses.
• Patients with cirrhosis, chronic pancreatitis, alcohol or drug addiction.
• Non-adult patients (patients under 18 years of age).
• Patients who have a chronic infection anywhere in their body or where the possibility of contamination prior to or during the surgery exists.
• Patients on chronic, long-term steroid treatment.
• Patients who are unable or unwilling to comply with dietary restrictions, which are required by this procedure.
• Patients with a known diagnosis or pre-existing symptoms of autoimmune connective tissue disease such as systemic lupus erythematosus or scleroderma.

Potential Risks, Complications and Adverse Events
All surgical procedures have risks. Complications are very rare with this surgery but when you decide on a procedure, you should know what the risks are. Dr. Cobourn or Dr. Mumford will speak with you in detail about the risks and complications that might arise. You will also be given a detailed consent form outlining the most common and significant risks.

Using the LAP-BAND System includes the same risks that come with all major surgeries. There are also added risks in any operation for patients who are seriously overweight. There is a risk of gastric perforation (a tear in the stomach wall) during or after the procedure that might lead to the need for another surgery. In the U.S. clinical study this happened in 1% of the patients. Your age and excess weight can increase the risk of surgery. Certain diseases, whether they were caused by obesity or not, can increase your risk from surgery. There are also risks that come with the medications and the methods used in the surgical procedure. You also have risks that come from how your body responds to any foreign object implanted in it. You should know that death is one of the risks. Death can occur despite all the precautions that are taken. There were no deaths during or immediately after surgery in the U.S. study.

Published results from past surgeries, however, do show that LAP-BAND System surgery may have fewer risks than other surgical treatments for obesity. Most complications are not serious but some may require hospitalization and/or re-operation.

Adverse events that were considered to be non-serious, and which occurred in less than 1% of the patients, included: esophagitis (inflammation of the esophagus), gastritis (inflammation of the stomach), hiatal hernia (some stomach above the diaphragm), pancreatitis (inflammation of the pancreas), abdominal pain, hernia, incisional hernia, infection, redundant skin, dehydration, diarrhea (frequent semi-solid bowel movements), abnormal stools, constipation, flatulence (gas), dyspepsia (upset stomach), eructation (belching), cardiospasm (an obstruction of passage of food through the bottom of the esophagus), hematemsis (vomiting of blood), asthenia (fatigue), fever, chest pain, incision pain, contact dermatitis (rash), abnormal healing, edema (swelling), paresthesia (abnormal sensation of burning, prickly, or tingling), dysmenorrhea (difficult periods), hypochromic anemia (low oxygen carrying part of blood), band system leak, cholecystitis (gall stones), esophageal ulcer (sore), port displacement, port site pain, spleen injury, and wound infection.

What are the specific risks and possible complications?

• ulceration
• gastritis (irritated stomach tissue)
• gastroesophageal reflux (regurgitation)
• heartburn
• gas bloat
• dysphagia (difficulty swallowing)
• dehydration
• constipation
• weight regain
• death
• Laparoscopic surgery has its own set of possible problems. They include:
• spleen or liver damage (sometimes requiring spleen removal)
• damage to major blood vessels
• lung problems
• thrombosis (blood clots)
• rupture of the wound
• perforation of the stomach or esophagus during surgery
• Laparoscopic surgery is not always possible. The surgeon may need to switch to an “open” method due to some of the reasons mentioned here. This happened in about 5% of the cases in the U.S. Clinical Study. There are also problems that can occur that are directly related to the LAP-BAND System. The band can spontaneously deflate because of leakage. That leakage can come from the band, the reservoir, or the tubing that connects them. The band can slip. There can be stomach slippage. The stomach pouch can enlarge. The stoma (stomach outlet) can be blocked. The band can erode into the stomach.

Laparoscopic surgery has its own set of possible problems. They include:

• spleen or liver damage (sometimes requiring spleen removal)
• damage to major blood vessels
• lung problems
• thrombosis (blood clots)
• rupture of the wound
• perforation of the stomach or esophagus during surgery

Complications are rare with this operation but laparoscopic gastric banding surgery can change a patient’s life forever. The only way to know if this operation is right for you is to arrange an appointment to see us at. For a detailed explanation of Lap-Band surgery and to access more information about the risks and benefits of this procedure please visit the Surgical Weight Loss Centre website at  www.obesitysurgery.ca

If you would like to contact us for more information please complete our information request at:  www.obesitysurgery.ca/contact.asp

The Surgical Weight Loss Centre provides counseling and surgical services on an outpatient basis. Surgical options are restricted to Laparoscopic Adjustable Gastric Banding (LAP-BAND®) on appropriately selected patients. We believe LAP-BAND surgery is the safest and most effective procedure available. We do not offer other surgical options such as gastric bypass. LAP-BAND surgery is not an insured service of the Ontario Health Insurance Plan (OHIP).
This website is intended for Canadian residents and has been designed to give general information about Weight Loss Surgery. This web site is not intended to solicit business. This information should not be considered all-inclusive and cannot replace a consultation with our Lap Band surgeons.