What Digestive Changes Occur After Lap-Band Surgery

How Does a Lap-band Affect Dieting and Help Weight Loss?

Most people choose bariatric surgery, a gastric lap-band included, as a physical solution to a medically serious and seemingly intractable weight problem. With the emphasis on the procedure, it’s very easy to think of the lap-band itself as a device that does all the work necessary to lose substantial weight. In truth, it helps and may be essential; but to be effective, especially in the long-term, the lap-band is only part of what should be a new regime for your digestive system – a regime that requires your attention and effort. It’s very important to understand that a digestive regime includes not only the alteration to your stomach created by the lap-band, but also the way you eat, your daily schedule, your diet and the exercise you get.

What happens to your digestive system and eating habits with a lap-band?

It’s been said, to make a point, that the digestive system begins at the dinner plate. Meaning, of course, that what you eat and drink is the beginning of digestion. It all starts with what you put in your mouth. What kind of food and how much you eat obviously plays a big role in gaining or losing weight.

The typical stomach can hold about 6 cups (48 oz.) or about 3 lbs. of food. Hopefully very few people eat 3 lbs. of food at a meal, but with the common western diet, there’s plenty of room to eat far more than is needed for normal activity. The usual result is the consumption of too many calories, which the body turns into fat and sooner rather than later ends up with obesity.

One way to combat the tendency to overeat is to have a lap-band (laparoscopic banding) procedure. Inserted with a minimally invasive laparoscopic technique, the lap-band is an inflatable ring placed around the upper part of the stomach. It’ usually located not far below the point where the esophagus enters (the gastroesophageal junction). Controlled by a supply tube leading outside the abdomen, when the ring is inflated with salt-water, it constricts the stomach, creating a small gastric pouch. In effect, this is a ‘first stomach’ about the size of a chicken egg that holds roughly a half-cup (4 oz.) of food and liquid.

You might visualize the lap-band acting like a tollbooth on highway. It slows down the passage of food from the esophagus to the rest of the stomach. This makes it easier to eat a relatively small portion of food that fills the pouch. With a full pouch, a physical response system kicks in. The left side of the stomach (the gastric fundus) signals that the stomach is ‘full’ by producing the hormone ghrelin, which tells the brain more food is not needed. This increases the feeling of satiety and decreases the desire to eat. That’s one way in which a lap-band becomes a driver of a significant weight-loss program.

Another way is what happens If you eat too much too fast. The exit from the gastric pouch will not be able to pass enough material to the lower stomach and the resulting pressure will become obvious, causing discomfort or even nausea. Either way, the lap band physically helps to limit the amount of food you eat.

The lap-band approach has become very popular in the last few years, most likely because it can be installed with minimal surgery, it’s adjustable, and most of all because it is reversible. If it doesn’t work, or there are problems, the lap-band can be removed and in general, the stomach will return to its previous functioning.

How to manage your eating habits and digestion to make the most of a lap-band

While a lap-band can be effective for significant weight-loss, studies show that it often is not as effective as other forms of bariatric surgery such as a gastric bypass or a gastric sleeve. Much of the reason for this is that it’s relatively easy to cheat on the regulatory effect of the gastric pouch created by a laparoscopic banding procedure. For example, self-destructive patients could continue to eat fatty, high-calorie junk food, chew it fairly well before swallowing and follow it with a chaser of high calorie liquid that will wash it almost immediately out of the gastric pouch. Some people learn tricks like this without even being conscious of it.  Simply stated, there will not be a physical nor physiologic barrier to snacking on ice-cream and potato-chips. If you already recognize that this food behavior is one of your problems, then a lap-band will do very little to help you with your diet.

It’s ironic that the standard advice for how to eat when you have a lap-band stomach is to eat slowly, chew well, and take smaller mouthfuls. Most people develop a kind of rhythm to their eating so that they don’t send too much food or drink into the stomach at one time. The slower pace, combined with a full gastric pouch tends to produce a psychological reaction – you feel full very quickly. However, the same approach can be used to eat more food, since it takes longer for the pouch to fill.

It also helps to understand that once the food and drink pass by the band, the rest of the stomach and intestines function normally. That means all the fats and calories you eat are processed in the usual way. If you manage to eat too much of the wrong thing, then not only will weight-loss end, but you’re likely to start gaining weight again. Other forms of bariatric surgery not only modify the size of the stomach, but also bypass the upper part of the intestine. This results in a decrease in the absorption of calories and nutrients, which becomes an additional factor in weight-loss.

How does a lap-band affect what foods to avoid or eat with caution?

The gastric pouch created by a lap-band is the smallest initial stomach space of any bariatric approach and that (should) affect the diet. After the first phase following a lap-band procedure (which is typically an all liquid diet), you slowly return to a more or less normal diet, the physical requirement of the gastric pouch means there are some foods you shouldn’t eat, or only eat with caution and on the advice of your doctor. Here’s a short list of problematic foods and why they might cause trouble. As you’ll see, there are similarities with the other bariatric surgery procedures that also reduce the functional size of the stomach.

Nuts – while nutritionally excellent, nuts generally pass into the digestive system in small, relatively sharp-edged pieces, which could potentially cause problems. Nuts are also more difficult to digest than many other kinds of food.

Seeds – there are many shapes and sizes, but from sunflower to millet, they tend to be small and hard, which makes them more difficult to digest and may have a tendency to lodge in band folds.

Popcorn – this favorite movie meal is unfortunately both rough and hard (the kernel portion) and expansionary (the puffed part), properties inconsistent with protecting gastric pouch.

Dried fruit – eaten whole (not rehydrated or pulped) is likely to expand in the gastric pouch, potentially posing problems from filling the pouch or for blocking the small passageway exiting the pouch into the rest of the stomach.

Soft drinks with carbonation – are not only bad for any diet (too much sugar) but the gas expansion effect of carbonation can be a real pain in the stomach pouch.

Broccoli, corn or cabbage – are excellent foods, but they don’t digest easily (especially corn and broccoli).

Breads – might be a surprising avoidance food, however, it’s not just the high carbohydrate factor but the ability of bread to expand when exposed to moisture. This expansion can cause real problems in the tiny stomach pouch.

From this list, it’s obvious that rules for safe food exclude – anything difficult to digest, foods that might block the gastric pouch exit, any food with sharp edges, and food or drink that has a tendency to expand in the stomach.

Signs that a lap-band is causing problems

With any procedure that alters the digestive system, it is possible to have complications; the lap-band is no exception. Some of the problems are more or less unique to a lap-band; others are generic for any kind of bariatric surgery. For example, because drinking liquid with meals (water or otherwise) tends to flush food out of the gastric pouch, people are advised not to drink with meals. However, this can lead to dehydration. Likewise some foods, particularly those that remain in large chunks or are tough and fibrous (some meats fit this description), can block the exit from the stomach pouch, causing bloating (at minimum) to nausea and severe pain.

There are other, potentially serious medical complications with a lap band such as slippage (it changes position on the stomach) and erosion (damage to the outer walls of the stomach), but by far the most important problem is when the lap-band simply doesn’t work. It doesn’t produce the desired weight-loss.

If the lap-band isn’t getting results, there might be a mechanical or biological reason, which a doctor might be able to fix – for example, by tightening the band. However, more often than not, the most important thing is not getting the right mix of diet, mealtime habits, proper chewing, and physical exercise. All these things work together to make the lap-band approach effective.