The biggest challenge to taking patients from other surgeons is they don’t know how the lap band works. So, let me be very clear: The lap band does not work when you eat – the band works two hours after you eat.
In our most successful patients (those who have reached a BMI of less than 24 and maintained it for at least three years) they do not have “restriction.” They will tell you that the lap band does not make them feel “full,” nor does the band make them feel “satisfied.” They know that their job is two fold (a) Eat good food (b) Measure and eat a small quantity of food. The lap band works two hours later, so you are not hungry.
A recipe for Band Slips, Heartburn, GERD, Night Cough, Esophageal Dilation
There are those patients who are successful for a year, or two with the band – but then get in trouble with a band slip or dilated pouch. Those patients are using the band to tell them to stop eating- and if they have a small dynamic band slip- they are obstructed from eating any more food. They love it, and lose weight. But ultimately that upper pouch gets too large and they start to have reflux, heartburn, or develop a full-blown slip.
Because they are using the band to feel “full” – and it is accommodating them, they are a set up for pouch dilation, where the pouch above the band becomes dilated.
Here the band is seen in a good position, with everything flowing through normally
When I read about people having trouble with the lap band it typically is because of this misunderstanding: that the band works when you eat. The only time the lap band works when you eat is if you are in trouble.
Generally, though, people who want the band to work when they eat become disappointed, because they can never get the band tight enough to where it “works.” They can always eat more, and instead of measuring they want the band to measure it for them. The band works by suppressing appetite after you eat.
Think of it this way: your brain has to decide when to send out signals for you to be hungry again. How much the brain thinks you eat for this meal determines when those signals go out. If it thinks you ate a lot the brain will start signaling for appetite in 3 to 5 hours. If it thinks you didn’t eat enough it will start those signals at two hours. So the band works by altering the signal for the next meal- not the one you are eating.
So, simple secret: Measure your portions, eat good food, and if at the two hour mark you are hungry- then you need an adjustment. If you are not- then you are doing just fine.
Keep this in mind: being hungry may manifest itself in different ways: the food looks good to you, you are thinking about food, or if you go to a grocery store the stuff you buy is not food that is pro-weight loss.
If you want the weight loss surgery to stop you from eating so much, then you don’t want a LAP-BAND you need an Imbrication, or gastric plication. We can do both operations at the same time, or later. The plication stops you from eating too much because the size of the stomach is reduced.