What is a Lap-band slip?
The Lap-band is forced down the stomach – it really doesn’t slip. This typically happens when the upper pouch (the stomach above the device) is dilated.
As you eat too fast or get things stuck the upper pouch dilates. The Lap-band goes from pointing to the heart to a horizontal position. This is either an acute slip - or a chronic one.
At this point the Lap-band has slipped. It may need surgical repair.
To repair the slip we place the Lap-band above the slip. Then the dilated stomach is tacked up so it drains well. Sometimes we have to remove the device - sometimes we can unbuckle it.
Types of Lap-band Slips
There are three types of slips – and all are treated differently:
The most common slip is a chronic Lap-band slip - where the upper pouch is dilated slowly over time and forces the device down. This is also called a Type 1 slip – it requires one of three types of repair (reposition, remove, or unbuckle - see below).
An acute Lap-band slip, Type 2 slip – happens when something gets stuck - as a result the upper pouch acutely dilates, forcing the device down and obstructing it. This repair, if gotten to quickly, is fairly simple – all one has to do is open the Lap-band, pull down the stomach and close it. Often will require some suturing. Sometimes this can be fixed by letting fluid out and allowing the stomach to slip back to normal.
An acute on chronic Lap-band slip – Type 3 slip – is a chronic slip that gets an acute component to them – there is a chronic dilation of the pouch, then something happens that acutely dilates the upper pouch (something gets stuck). These require removal, repositioning, or unbuckling of the Lap-band.
What causes a Lap-band to slip?
Eating too fast is the primary cause. By eating too fast the food is not given time to go past the Lap-band. So the upper stomach begins to dilate above the device. Once the stomach begins to dilate, it s easier and easier to dilate (think of blowing up a balloon, it is easier to blow it up the larger the balloon becomes).
Getting food stuck can also cause a slip. When food gets stuck some people try to force it down with water or soda – and this causes a dilation of the upper stomach. Your body produces a lot of “slime” to try to lubricate the stuck food. Typical foods that have caused slips include: goldfish crackers, white bread, rubbery eggs (they need to be cooked properly), and dry chicken.
Can a Lap-band slip be fixed?
If we take the pressure off - remove the fluid, and you can tolerate liquids sometimes the device will return to normal size. This happens a lot if we can get to it early.
If we don’t get there early then we try “conservative” measures in the hospital – if the person cannot drink. IV fluids, steroids to reduce swelling, and keeping the person without food or drink will resolve some.
If that doesn’t work then an operation is needed. The Lap-band will either need to be removed, repositioned, or unbuckled for a bit. Sometimes we leave it unbuckled - remove adhesions, and leave the device unbuckled for a few months. This is an option for when the stomach is too dilated to allow operative reposition of the Lap-band. But it does require another operation to go in and re-buckle it.
Can this be dangerous?
If the upper pouch is too stretched out sometimes we cannot replace the Lap-band, and have to remove it for a while. We cannot always just “unbuckle” it - especially in some of the older devices – or in the act of unbuckling it the balloon is injured.
Re-do surgery is always at an increased risk above just placing a Lap-band.
What are the signs of a Lap-band surgery slip?
Typically patients develop heartburn, nighttime cough, or reflux of food at night. These symptoms are not normal. If you have these you at least need to have fluid removed, but need to get an evaluation by the surgeon. Sometimes we catch things in time that it can correct itself- but then the real correction will be the person learning to eat better.
How do you fix the slip?
From the last two illustrations above – we place the Lap-band above the slip – then tack the dilated stomach so that it will easily drain into the stomach. The surgery takes about an hour or less to do.
If I get my Lap-band surgery repaired how can I avoid this in the future?
The Lap-band works great for weight loss - but it does mean you have to change some things. Usually patients have the slip long before they know it, and have changed things - so it isn’t an issue. Finishing a meal in 20 minutes instead of five minutes - and avoiding foods that get stuck are the two biggest contributors to this.
The other is when you get in trouble; call your surgeon sooner rather than later. Know that heartburn and reflux are not normal. They are an early warning signal that your Lap-band is too tight. Sometimes this resolves with removing fluid (unfill) - but if it does not then your surgeon will want to have an x-ray with you swallowing barium