If you already have a Lap-Band, you have three broad choices: keep it as it is, adjust it, or remove it, either alone or as part of a conversion to another operation. Which one fits depends on three things: whether the band is comfortable, whether it is still helping you control your weight, and what tests show about its position and the tissue around it.
Start with three questions
- Is it comfortable? Can you eat small portions of solid food without pain, regular vomiting, or reflux and coughing at night?
- Is it doing its job? Do you feel satisfied with small meals, and is your weight steady or moving in the direction you want?
- Is it intact and in the right place? This one you cannot answer at home. It may need an upper GI X-ray or an endoscopy.
If the answer to all three is yes, keeping the band is usually reasonable. A no to the first or second question is a reason to be seen, and the third question decides what happens next.
When keeping your band makes sense
Some people keep a working band for many years. In an Australian study of 3,227 band patients, those followed for 10 years or more had lost, on average, 47% of their excess weight, meaning the extra weight above an ideal weight. If your band is comfortable and your weight is stable, there is no rule that says it must come out because of its age.
Keeping a band still means looking after it. The FDA labeling describes the band as a long-term implant that may need removal or replacement at any time, so a yearly check is worthwhile. See what an annual Lap-Band checkup involves.
When an adjustment may be enough
Adjusting the band, adding or removing saline through the port, can solve problems of restriction:
- Too loose: hunger soon after meals, larger portions, slow weight regain, with no other symptoms.
- Too tight: solid food sticking, bringing up food or saliva, reflux or coughing at night, relying on soft foods and liquids.
The FDA labeling notes that nausea, vomiting and reflux with an early or minor slip may resolve with deflation in some cases, and that deflation is recommended if the esophagus starts to widen. The site's page on Lap-Band adjustments and tightness explains what good restriction feels like.
There is an important limit. The labeling warns that poor weight loss may be caused by an enlarged pouch or, less often, by erosion, the band wearing into the stomach. In those cases more fluid "would not be appropriate." If fills stop working, or symptoms come back after each one, the next step is a test, not another fill.
When removal enters the conversation
The FDA labeling describes situations where removal is required or indicated:
- Erosion: reoperation to remove the device is required.
- Infection of the device: removal is indicated.
- Complete blockage that does not improve with deflation, or blockage with abdominal pain: immediate reoperation to remove the band.
- A widened esophagus or a slip that does not settle with deflation: surgery to reposition or remove the band may be needed.
Weight regain is less clear-cut. The 2019 guidelines published with the American Society for Metabolic and Bariatric Surgery recommend a full evaluation first: eating patterns, medications that promote weight gain, emotional factors, and imaging or endoscopy to check band restriction. They suggest starting with diet, activity and behavior changes with close follow-up, then medication and/or surgical revision if appropriate. For more on this, see weight regain with a Lap-Band and Lap-Band vs GLP-1 medications.
A quick guide to common situations
| What you notice | What it may point to | Usual next step |
|---|
| Comfortable, weight stable | Band working | Keep it; yearly check |
| Hungry soon after meals, no other symptoms | Band too loose | Evaluation; a fill may help |
| Food sticking, night reflux, regurgitation | Band too tight, slip or pouch enlargement | Loosening and often imaging |
| Fills no longer give restriction | Leak, pouch enlargement or erosion | Tests before any more fluid |
| Port red, hot or draining | Possible infection, sometimes linked to erosion | Prompt evaluation |
| Steady regain despite a well-adjusted band | Restriction no longer enough | Full evaluation; discuss medication or conversion |
If removal is recommended, the next decision is whether to remove the band alone or convert to a sleeve or bypass. That is covered in Lap-Band removal vs conversion.
Frequently asked questions
Can I just leave a band in that is empty and not doing anything?
Some people do. An empty band gives little or no restriction, but it is still an implant that can slip, erode or become infected, so it still needs occasional checks. Studies of band removal also show that weight tends to come back once restriction is gone, so an empty band is often a step toward deciding on another plan.
Can my band be replaced with a new band?
It is possible but less common today. In the original US study reported in the FDA labeling, some reoperations removed the band and placed a new one in the same procedure, usually for incorrect placement, blockage or slippage. Whether a new band makes sense for you depends on why the first one failed and on what other options suit you.
How do I know if the problem is my band or my eating?
Often it is both, and you cannot tell from symptoms alone. Regurgitation, night reflux and food sticking can come from a band that is too tight or has moved, and also from eating too fast. A review of your eating plus an X-ray or endoscopy usually answers the question. That is why the guidelines recommend a full evaluation before any major decision.
If I keep my band now, can I still change my mind later?
Yes. Keeping a band does not close off removal or conversion later. What matters is that you are checked if symptoms appear, because the first step for some problems, such as a widening esophagus, is simply loosening the band. A Dutch study found weight returned in patients whose band was removed without another procedure, which is worth knowing whenever you decide.
Talk with Dr. Davtyan in Rancho Cucamonga
Dr. David G. Davtyan, MD, FACS, FICS, FASMBS, is a bariatric surgeon who has a Lap-Band himself, and the practice also offers revision surgery, gastric sleeve, gastric bypass and medical weight loss with GLP-1 medications. Call the Rancho Cucamonga office at 8330 Red Oak Street, Suite 201, Rancho Cucamonga, CA 91730, at 909-355-2525 or toll free 877-9-BE-SLIM (877-923-7546), or use the contact page. The first consultation is complimentary, Spanish is spoken, and the Lap-Band in Rancho Cucamonga guide collects related topics.
Sources
More in the Lap-Band in Rancho Cucamonga guide
Start at the Lap-Band in Rancho Cucamonga page, or go straight to a topic.
Understanding your band
Weighing your options
Getting care in Rancho Cucamonga
