Lap Band
What Does Lap Band Surgery Cost? PDF  | Print |  E-mail

It is the most commonly asked question off the site, and also one of the hardest to accurately answer.

There are a number of factors that impact on the ultimate cost. Not only do you need to pay for a surgeon, you will also need to budget for hospital fees, and anesthetist fees. Some of that cost may be refunded to you by your insurer and Medicare, which can significantly reduce the burden. The refunds may be less than you expect, so it is important to check with your insurer and Medicare regarding what level of cover they provide.

Ultimately, the surgery should also save you money. Your future medical bills and general cost of living will be reduced. This long term positive effect can balance out the short term costs relatively quickly.

We strongly recommend that you contact us for a detailed quotation that takes into account your full medical circumstances. However, as general guidance, we suggest that uninsured patients with no private cover will probably need to budget for around $14,000 of up-front expenses for the procedure itself.

If you have private health insurance, out of pocket expences of roughly $4000 can be expected.

 
 
General Information PDF  | Print |  E-mail
The term “morbid obesity” is used to describe severe, abnormal and debilitating obesity. Individuals suffering with this condition are prone to develop different medical problems through their lives. The life expectancy of the severely obese people is decreased by 10 to 15 years, mainly because of increased incidence of heart attacks, strokes, hypertension and diabetes. Severely obese people also tend to develop severe arthritis in the joints of ankles, knees, hips and lower spine, due to excessive weight bearing. Self image is poor and depression may result.

Many supervised diet and exercise programs, behaviour modification programs, psychotherapy, hypnosis, group therapy and other modalities are in existence. However, some people cannot lose weight by dieting. Surgical procedures have been developed to help people who fail medically-controlled weight reduction programs. Obesity surgery is the only proven long-term effective treatment for morbid obesity.

The purpose of obesity surgery is to restrict food intake or decrease the absorption of nutrients. Surgical procedures include intestinal bypass, gastric bypass and gastroplasty. These procedures involve cutting, stapling and/or bypassing portions of the gastrointestinal tract. They produce permanent changes and are not easily reversed. Gastric Banding is an alternate procedure that restricts the functional stomach volume, but avoids the use of stomach staples. A band is placed around the stomach to form a small pouch and a small opening to the rest of the stomach. It is readily reversed by removing the band.
 
The Laparoscopic Adjustable Silastic Gastroplasty Band PDF  | Print |  E-mail

The Laparoscopic ASGB System Lap Band was developed to improve the gastric banding procedure and to allow the procedure to be conducted laparoscopically through 6 small puncture wounds. This results in less post operative pain and more rapid recovery. The Lapband can be adjusted without requiring another operation.

The Lapband is approximately 1.2 cm wide. It is made of soft, silicone rubber with an internal Dacron material to prevent it from stretching. The Lapband has an inflatable section which is connected by tubing to an injectable reservoir. This band is place around the stomach in such a way that the stomach is divided into two parts: a small 25ml capacity pouch above the band with the remaining stomach below the band. The silicone band also creates a small opening 1.3cm in diameter that is adjustable between the two parts of the stomach for the passage of food. The reservoir will be located below the left rib cage and buried in the abdominal wall muscles. The inflatable section will enable the surgeon to adjust the size of the opening after surgery, by inserting a needle, perhaps under x-ray control, through the skin whether removing or injecting saline.
 
Is It Effective? PDF  | Print |  E-mail
The weight lose with ASGB has been shown to be comparable to the best weight loss reported with alternative surgical procedures. Patients have lost an average of 58% of their excess weight in one year. Patients who have had the Lap Band on for two years have lost an average of 64.8% of the excess weight. Failure to lose weight can occur and is usually due to inability of the patient to comply with their dietary instructions, or in some cases to intolerance in 20 to 30% of patients.
 
What Are The Risks? PDF  | Print |  E-mail
Gastric banding is a major operation. There are risks common to any major operation which requires general anaesthesia. There is a 3%-4% chance of complications after obesity surgery, most are minor. Serious complications are rare and include wound infection, oesophageal stomach puncture, bleeding from the stomach, injury to the spleen, infection inside the abdomen, pneumonia, hernia in the wound. Other problems may occur.

In the long term the opening between the pouch and stomach may become too small, resulting in excessive vomiting and reflux, or the opening may enlarge resulting in weight gain. Adjusting of the inflatable section of the Lap Band may well correct these problems. These may include repositioning of the band and replacement of the reservoir, which would entail a further operation.

The band could move from where it is place, break or erode into the stomach. Nutritional deficiencies may occur due to restricted diet and should be corrected with supplements. Many of these problems can be improved by adjustment of the opening. Potential problems with the ASGB include band leakage, a break or kink in the tube connecting the reservoir to the band, or a leak from the reservoir. There is a chance that the reservoir could move from where it is sewn in. Re-operation may be necessary for some problems.

Adjustable silastic gastroplasty banding is a relatively new procedure having been used in clinical trial for about 10 years and the long-term results or late complications are unknown at the present time. Clinical trials are continuing to obtain more information on these long-term issues. In order to assist with these trials, patient follow up is crucial and patients must be prepared to return for regular visits. They should contact their surgeon if they are experiencing problems.
 
Who Can Have Obesity Surgery? PDF  | Print |  E-mail
In order to be considered for the Lap Banding surgery, you should:

  1. Be more than 50% above your ideal weight;
  2. Be at least 16 years of age;
  3. Have been obese for at least 5 years;
  4. Have been unable to lose weight by other non-surgical methods, such as supervised diet or behaviour modification programs;
  5. Have no medical problems that are causing your obesity;
  6. Be willing to accept significant changes in eating habits;
  7. Be willing to participate in post-operative follow-up visit at your Surgeon’s office and to have 6 monthly blood tests.
 
Before Deciding PDF  | Print |  E-mail
You should be convinced that you really want to make this significant change in your life style. You must be sure that you will accept the extremely small bland meals necessary after the operation. The amount of food that you will be able to eat at any meal will be permanently reduced to very small volumes. In the first four to six months, it will be extremely small. Occasionally, you will vomit until you learn how to eat. You will sometimes have a bad day when vomiting may occur repeatedly. (Vomiting is usually related to improperly chewed food). You must have only three meals a day and avoid high calorie drinks. Continuous nibbling of food and/or eating or drinking high calorie foods may “out eat” the purpose of the operation.

You should not be pressured to have this operation. The decision should be yours. However, your spouse or family should be informed. Advice from your Surgeon may be helpful.

Your recovery should be fast and smooth, providing that you follow the diet instructions. You should not do any heavy lifting for four weeks to allow the wound to heal. If you have a desk job you may return to work in one to two weeks. If your job requires heavy lifting you should not return to work for four weeks. You should not drive a car for two weeks after discharge to avoid any liability in the event
of an accident. Aspirin or other non-steroidal anti-inflammatory agents (for arthritis) must be avoided. You need to let your general practitioner know that these drugs must be avoided.
 
How Quick is Weight Loss? PDF  | Print |  E-mail
After the banding procedure, patients lose about 6kgs during their "shake" phase. After that, patients lose about 4-5 kgs per month.

Generally, patients experience 20%-25% of excess body weight loss by the third month. 30% - 40% by the sixth month and 50% - 60% by year’s end. Weight loss usually levels off anywhere from nine months to two years after surgery. Occasionally, inflation of the band (through the injectable reservoir) is necessary to reduce the size of the opening and produce additional weight loss.

If you become pregnant or very ill, and have a need for greater nutrition, the Lap Band can be deflated to enlarge the opening, allowing you to eat a little more.
 
Help With Your Diet PDF  | Print |  E-mail
A dietitian will provide you with dietary and nutritional counselling as part of the follow-up to your surgery. Review the programs and information with your Surgeon before having the surgery.
 
Make A Commitment To Health PDF  | Print |  E-mail
Severe obesity is associated with a shorter lifespan, increased risk of other health problems and social impairments. Management of severe obesity must be considered a long term commitment to health. Obesity surgery involves life-time changes. You must go into surgery with a serious commitment to change you lifestyle to focus on health, nutrition, exercise and the long term welfare of your body and mind. Lifelong behaviour modification creating an ongoing lifestyle change is vitally important in maintaining long-term weight loss. You must make this a part of your health commitment to yourself.
 
What About Your Surgery? PDF  | Print |  E-mail
Gastric Banding is a major operation. Only surgeons who have been properly trained in the gastric banding procedure should place the Lap Band. On the day of admission, blood test, electrocardiogram anaesthesia and breathing exercises are performed. The surgery is done while you are under anaesthesia, so you will not be aware of the surgery. A tubular device is placed through the abdominal wall and the abdomen in inflated with Carbon Dioxide. A telescope with a video camera attached is passed through it. 4-5 further similar devices to allow insertion of retractors and instruments are placed and a channel carefully dissected around the upper stomach. The band is placed around the stomach, and the connecting reservoir is placed in the muscle near the rib cage. A drain may be used if there is more bleeding than usual.
 
What Can You Expect After Your Surgery? PDF  | Print |  E-mail
You may initially be nauseated but this usually settles within 48 hours. You will spend 3-5 days in the hospital, during which time you will gradually be allowed a limited diet and increasing amounts of movement will be encouraged.

The Lap Band is initially placed loosely around the stomach to allow for rapid recovery. It is not, therefore, restrictive initially, it is adjusted 4 weeks after surgery if necessary and adjustment repeated until optimum restriction is reached.

After discharge, it is very important that you follow the diet instructions given to you by your Surgeon. You will have to grind or puree solid foods for one to three months. For the first four weeks, puree meals of a measured 50mls can be consumed as often as required. This avoids overfilling of the pouch which may often cause band displacement. After four weeks the band is fixed in place by adhesions and should not move. You will have to learn:

  1. To take small bites
  2. Chew thoroughly
  3. To stop eating when full
  4. To frequently drink water or other low calorie non aerated beverages to avoid dehydration. You will have to take vitamin and mineral supplements for the rest of your life.
 
How To Live With Your Band Gastroplasty PDF  | Print |  E-mail
By Dr Ian Baxter

Successful weight loss following band gastroplasty is dependent on the patient adopting proper eating techniques and accepting dietary restrictions.

PATIENTS MUST GIVE SERIOUS CONSIDERATION AS TO WHETHER THEY FEEL THAT THEY WILL BE PREPARED TO ACCEPT THE RESTRICTIONS IMPOSED ON THEM BY THE SURGERY, AND THAT THEY WILL BE ABLE TO FOREGO SWEETS. OTHERWISE WEIGHT LOSS WILL BE UNSATISFACTORY.

In the first few days following surgery patients will be on fluids only. Initially patients start on small sips of fluid. The volume is not restricted.. The patients take repeated TINY SIPS, stopping if there is nausea or fullness. If the fluid is well tolerated the patients continue to drink until they are able to drink 80ml per hour. The drip is then taken down.

FIRST MONTH AFTER SURGERY.

Once your drip is removed patients are commenced on puree food. 50ML ONLY SHOULD BE EATEN AT EACH SERVING. Bland vegetable and fruit purees should be take at first. They should be eaten using a TEASPOON and, although semifluid, should be chewed to mix with saliva so as to aid digestion. Even the tiny serves should take about 20 minutes to consume. Patients should stay on this sized serve for FOUR WEEKS. This allows all post-operative swelling to subside, and more importantly, allows the band to stabilise on the gastric wall and prevent slippage.

The Phases are:
  1. Fluid only, patient will commence Day I on clear fluids-small sips. Day 2 free fluids 70mls. Day 3 100mls. Day 4 120 mls. Then use sipper
  2. Pureed food. Smooth, no lumps. Small mouthfuls- 1 teaspoon at home. Maximum serve ¼ -1/2 cup at any time.
  3. Real food. Commence soft foods. East small quantities, ie ½ sandwich or ½ cup casserole.

EATING EXCESSIVE QUANTITIES IN THE FIRST FOUR WEEKS AFTER SURGERY WILL DISTEND THE POUCH, FORCING THE BAND DOWN THE STOMACH AND NARROWING THE OPENING. THIS WILL CAUSE VOMITING AND MAY NECESSITATE REVISIONAL SURGERY. THIS PARTICULARLY APPLIES TO THE ADJUSTABLE GASTRIC BAND BECAUSE IT HAS A SMOOTH SURFACE AND WILL SLIP MORE EASILY ON THE STOMACH WALL.


After four weeks the following advice should be followed.

EATING TECHNIQUE AND CHOICE OF FOODSTUFFS

Failure to adopt the following advice will lead to adverse symptoms and failure to lose weight satisfactorily. Revision surgery may even be necessary.

After the initial four weeks patients can start to introduce more solid foods. Soft green vegetables are the easiest to digest initially. The method of eating and presentation is of great importance and will be applied to all food eaten by the patient who has had gastric restrictive surgery of this type.

  1. FOODS THAT ARE WELL TOLERATED ARE SELECTED. Attempts to eat foods that cannot be digested easily such as red meats, greasy foods, fresh bread etc. will cause vomiting. VOMITING AND REGURGITATION SHOULD BE AVOIDED.
  2. THE VOLUME OF FOOD SERVED SHOULD BE SMALL. People suffering from obesity have plenty of energy in store. They must therefore eat only small servings so that they use up some of the stored energy. If patients have excessive vomiting and are not losing weight, they are eating too much.
  3. THE FOOD SHOULD BE COOKED SO THAT IT IS SOFT AND SERVED MOIST. It will be easier to chew if it is soft and served with a little gravy or tomato sauce. Dry foods should be avoided.
  4. FOOD SHOULD BE SERVED ON A SAUCER AND EATEN WITH A TEASPOON. A small plate makes the serve appear larger and therefore the restriction of volume less obvious. Teaspoons mean small mouthfuls which is very important.
  5. ALL FOOD SHOULD BE CUT INTO PIECES LESS THAN 1CM IN SIZE. The size of the stoma is approximately 1.3cm in diameter. For food particles to pass easily through the opening they should be less than 1.3cm. This applies to food not easily chewed into fragments, such as chicken and beans.
  6. FOOD MUST BE CHEWED UNTIL IT IS PULPY AND EATEN IN SMALL MOUTHFULLS. It should be mixed thoroughly with the saliva to assist in the digestion and to help the food pass through the stoma.
  7. EAT SLOWLY. This helps to avoid over filling the pouch. Allow a few minutes between each mouthful. Make sure the food is in the pouch before taking another mouthful.
  8. EAT ONLY WHEN TIME CAN BE TAKEN. DO NOT EAT ON THE RUN! Eating rapidly when there is not enough time will lead to upsets and vomiting. If pushed for time then have some soup or other nutritious drinks. If you have children, eat after you have fed them not at the same time.
  9. EAT AS LITTLE AS POSSIBLE. Do not try to eat more because you think you should. Ignore relatives and friends who suggest you are not eating enough. Try not to take that “one extra mouthful” at the end of the meal. If weight loss is too slow, write down everything you have eaten over three days and calculate how many calories you have had. You may be able to reduce the intake by changing some of the foods.
  10. MAINTAIN A GOOD FLUID INTAKE. You should try to drink at least 1.5 litre of fluid a day. Fluid should be low in calories and taken in sips rather than in large gulps. Avoid coffee and tea if they produce heartburn.
  11. AVOID FLUIDS THAT ARE HIGH IN CALORIES. Fluids go easily through the stoma and all calories in the fluid are easily absorbed. You should avoid sucking on lollies, eating ice cream, chocolates, dunked biscuits and chips. Alcoholic drinks and gassy drinks will add calories and may cause heartburn and reflux.
  12. DON’T EAT OR DRINK FOR TWO HOURS BEFORE RETIRING. Food filling the pouch will tend to run up the gullet when the patient lies down. Allow time for the pouch to empty before going to bed. If you still have heartburn, elevate the top of the bed or use a few pillows to help gravity empty the pouch. A teaspoon of Mylanta may help just before going to bed. If the problem persists in spite of these steps, you should inform Dr. Baxter.
  13. TAKE A MULTI-VITAMIN EVERY DAY. Because the variety of foodstuffs you can eat is restricted, you will need to supplement the nutrition every day with multi-vitamins and minerals. Soluble Accomin may be taken for the first six weeks and later graduate to multi-vitamin tablets. If the tablets cause problems then stay on soluble or crush the tablet in 1 teaspoon of honey.
  14. CONSTIPATION. Reduced intake of roughage will tend to cause constipation, with only having bowel actions 2-3 times a week. If this becomes a problem try adding bran to your weetbix or porridge in the morning. Eating a small amount of creamed corn may also help.


In general terms, after you have completed your one month of bland puree you should start introducing normal food for your DINNER. Try soft boiled vegetables first, beginning with 50mls and increasing to an amount that produce satisfaction without discomfort. Stay on these for as long as it takes to feel comfortable and confident and then try a small piece of fish. A dessertspoonful is enough. Eat it steamed with a white sauce to aid digestion. Chicken may be tried in the same way.
MAXIMUM FOOD VOLUME SHOULD BE FOUR DESSERT SPOONS OF FOOD. MEASURE YOUR VOLUMES SO THAT YOU AVOID OVERFILLING THE POUCH.

Try a few new foodstuffs to test what will or will not agree with you. Avoid spices and oils in preparation. Use skim milk not full cream milk.

BREAKFAST. Try a weetbix with a teaspoon of bran added and warm skim milk, allowing it to go soggy before eating. Porridge is another alternative. A slice of toast with vegemite, cheese or tomato may be well tolerated. Soft boiled or poached egg is usually easily digested. It also adds vitamins and minerals.

LUNCH. Cruskette biscuits topped with cheese, egg, salmon, vegemite or pate. Many patients can manage half a sandwich or fine cut salad so long as they have time to eat slowly and chew thoroughly. If you are in a hurry, have a drink.

DINNER. Soft boiled vegetables, mashed potato and pumpkin together with a spoonful of white meat is usually well tolerated. Pasta with a little sauce is satisfactory.

FLUIDS. Drink 500mls of shape or skimmed milk per day. Overall try to drink 1.5 litres of fluid per day, especially when it is hot.


EAT THREE MEALS PER DAY. DO NOT SNACK IN BETWEEN. DO NOT ALLOW YOURSELF TO BECOME RAVENOUS AS YOU WILL EAT TOO QUICKLY AND WILL VOMIT. DO NOT SKIP MEALS.

  1. Eat any normal foods that you tolerate well
  2. Eat three meals per day and do not snack.
  3. Avoid high calorie fluid foods, fats and spices.
  4. Adhere to correct eating habits.
  5. Notify me if you are having any problems at an early stage.
  6. Attend for follow up. This surgery is still relatively new and it is essential that you are monitored over time. Top ups (fluid put into the band to tighten it) are done in my rooms and there is a fee for this. If you cannot attend then ring up and let us know how things are. If you change your address, please let us know.
  7. Have regular blood tests for IRON, VIT B12 & FOLIC ACID each six months for the first two years.

 
 
External Links PDF  | Print |  E-mail

There are a number of different gastric banding devices that can be used to assist weight loss. The websites listed are the official home pages of each of the devices. These sites give advice and information specific for their gastric banding device.

MidBand (The French Band)
This site is home to the newest gastric banding device. In our clinic we have been using the MidBand with good success for our clients. This site has information for people considering gastric banding. It has basic explanatory videos that show how the band works and how it is fitted.

LapBand System
This site is home to the Inamed LapBand. The site has lots of useful information about weight loss surgery and reviews the Inamed LapBand device.

The Swedish Band
Click on the above link and it will direct you to the weightloss surgery webiste. Here you can fill out a form to request a very comprehensive information pack.

General information:

eMJA - Obesity, weight loss and bariatric surgery
This article in the online version of the Medical Journal of Australia reviews surgery for weight loss from a medical and community perspective.

Obesity Surgery Society of Australia & New Zealand
A comprehensive website that has information about all types of weight loss surgery.

The LapBand Book
A very useful book that gives a detailed review of the laparoscopic gastric band. A copy of this book will be provided to clients at their first visit with Dr Baxter as part of the consultation cost.

Other useful sites:

Ozband
An Australia support group for weight loss surgery including the laparoscopic adjustable gastric band

Diabetes Australia

Australasian Society for the Study of Obesity

The Heart Foundation

Centre for Obesity Research and Education (CORE)

 

Links from the Newsletter

The Health Report - Personal Carbon Trading to Fight Obesity

 

 
 

I started my life as a fairly normal weight. I was never a skinny kid but I was always healthy and just average. I have mixes genes in regards to weight with one half of my family being extremely thin and the other half being more prone to gain weight.
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