Lap Band Surgery Failure - 2 Types &
How to Avoid Them

Reviewed by: Nick Nicholson, MD

Lap band surgery failure occurs in anywhere from 5% to 37% of patients.1,2 Fortunately, there are ways to reduce your chances of it happening. Worst case, if your lap band failure requires band removal, there are paths to continue or maintain your weight loss…

2 Types of Lap Band Surgery Failure

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Lap band surgery failure comes in two forms:

  1. Unsuccessful weight loss
  2. Complications that require removal of the band

1. Unsuccessful weight loss

"Unsuccessful” means different things to different surgeons, but in general a procedure is considered to be a failure if you loose 25% to 30% or less of your excess weight (in other words, if you’re 100 pounds overweight that would mean you lost 25 to 30 pounds or less). Complete success generally means 50% or more of excess weight lost.

The following 3 studies directly reported on the percentage of failures, which were as low as 14% and as high as 37% of patients. Study C includes the highest number of patients and is likely closer to the national average...

Studies # of lap band patients in study % of patients with unsuccessful weight loss after a specified amount of time Year of Study
References: A, B, C
Study A 317 After 18 months -13.2%
3 Years - 23.8%
5 Years – 31.5%
7 Years – 36.9%
2006
Study B 190 3 Years – 19% 2004
Study C 1,180 5 Years – 13.7% 2004
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2. Complications that require removal of the band

Anywhere from 5% to 10% of patients have their band completely removed due to complications as the following three studies demonstrated…

Studies # of lap band surgery patients % of patients with band removal due to a complication Year of Study
References: A, B, C
Study A 172 9.3% 2008
Study B 591 8.6% 2008
Study C 1,180 5.6% 2004

Problems that require lap band removal usually include one of the following complications, however, good bariatric doctors can often repair the problems without removing the band3:

  • Band problems:
    • Band erosion (2.1% - 9.5% of patients) – (also called “band migration”) occurs when the band actually grows into the stomach. The only treatment is permanent removal of the band. See our Lap Band Erosion page for more information.
    • Band infection - (1.5% - 5.3% of patients) – if this occurs, it is usually healed with antibiotics, but removal of the band may be necessary.
    • Band intolerance symptoms include excessive vomiting or a continuous feeling of discomfort.  If these symptoms do not subside, removal of the band is the only option.
    • band slippageShort arrows show pouch dilatation;
      Large arrows show small amounts of
      contrast material passing through
      gastric band
      7
      Band slippage (2% - 18% of patients) – occurs when the lower part of the stomach “slips” through the band, creating a bigger pouch above the band. Either removing fluid (from the lap band) or surgical repositioning it is required to repair it, although band removal may be necessary.

      Symptoms include vomiting and reflux, and it's diagnosed by drinking a dye and checking for leaks via X-Ray. The band placement technique used by the surgeon also makes a difference; between the perigastric technique (PGT) and the pars flaccida technique (PFT), the pars flaccida technique appears to have a much lower rate of slippage (up to 16% less often).

      See this study for additional images of band slippage and more information about proper diagnosis.
  • Difficulty swallowing (also called “dysphagia”) is caused by eating too quickly, too much or not chewing food enough. While it can usually be avoided by addressing these issues, some patients’ bodies simply can’t get over this problem, in which case band removal is required.
  • Gastroesophageal reflux disease (GERD) is a highly variable chronic condition that is characterized by periodic episodes of gastroesophageal reflux usually accompanied by heartburn and that may result in histopathologic changes in the esophagus. It also often leads to esophagitis. GERD increases the risk of some bariatric surgery complications such as sepsis, but the condition is also improved for many patients following bariatric surgery.

    Several at-home treatments are effective, including avoiding certain foods and drinks (alcohol, citrus juice, tomato-based food and chocolate), waiting 3 hours before lying down after a meal, eating smaller meals and elevating your head 8 inches when you lay down. If these don’t work, your doctor may recommend/prescribe antacids to be taken after meals and before going to bed, H2 blockers or even Proton Pump Inhibitors (PPI). If the condition becomes too severe, it may require removal of the band. See our Gastroesophageal Reflux Disease Symptoms and Treatments page for more details.
  • Port infection (1.5% - 5.3% of patients) – can occur in your abdomen at the port site. It is usually healed with antibiotics, but removal of the band or port may be necessary.
  • Pouch dilation (4.4% of patients) - refers to the enlarging of the pouch created after lap band surgery. It can often be fixed by removing fluid from the band but sometimes requires reoperation.
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How to Prevent Lap Band Surgery Failure

Choosing the right weight loss surgeon is the first line of defense.

In general, the more experience your doctor has, the lower your risks. For example, one study found that the risk of adverse outcomes decreases by 10% for every 10 cases per year that a surgeon performs.4

Your surgeon’s technique also makes a difference. Bariatric doctors performing the pars flaccida technique (PFT) when placing the band see up to 22% fewer lap band reoperations than doctors using the perigastric technique (PGT).5

Take the time to learn how to find, interview and choose the best bariatric doctors.

The rest is up to you.

Following your doctors’ orders to the letter is much easier said than done, but it will greatly increase your chances for success. Specific factors under your control that have been proven to reduce lap band surgery failure are your…

Click the above links to learn more about why each is important and what they entail.

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Your Options if Your Gastric Lap Band Fails

Even if you find the perfect surgeon and do everything that you are supposed to before and after surgery, there is still a chance of lap band failure. If it happens to you, you have a couple of options to stay on the path to a healthier body and weight…

  • Replacing the band

    This is usually only done if there is a technical problem with the band such as a leak. If your lap band failure is due to any other issue, you are likely to have better results if you convert to a different surgery, which leads us to your second option…
  • Conversion to a different procedure

    Patients who undergo a different procedure after lap band surgery failure tend to have much better outcomes than if they were to simply replace the old band with a new one.

    For instance, one study showed that patents who underwent Roux-en-Y gastric bypass surgery after a failed lap band had significantly more weight loss and exhibited better cholesterol levels than patients who underwent a rebanding operation.

    In addition, 45% of the patients who had their band replaced needed yet another operation to fix a subsequent problem, while only 20% of the gastric bypass patients required a reoperation.6

    The most common conversion procedures include Roux-en-Y gastric bypass surgery, duodenal switch surgery and gastric sleeve surgery.
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References for Lap Band Surgery Failure

  1. Topart P, Becouarn G, Ritz P. Biliopancreatic diversion with duodenal switch or gastric bypass for failed gastric banding: retrospective study from two institutions with preliminary results. Surg Obes Relat Dis. 2007 Sep-Oct;3(5):521-5.
  2. Suter M, Calmes JM, Paroz A, Giusti V (2006) A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Obes Surg 16:829–835
  3. For lap band complications references and more information, see Lap Band Problems & Lap Band Complications
  4. Relationship between surgeon volume and adverse outcomes after RYGB in Longitudinal Assessment of Bariatric Surgery (LABS) study. Mark D. Smith, Emma Patterson, Abdus S. Wahed, Steven H. Belle, Marc Bessler, Anita P. Courcoulas, David Flum, Valerie Halpin, James E. Mitchell, Alfons Pomp, Walter J. Pories, Bruce Wolfe
    Surgery for Obesity and Related Diseases - 28 September 2009 (10.1016/j.soard.2009.09.009)
  5. Bueter M, Maroske J, Thalheimer A, et al. Short- and long-term results of laparoscopic gastric banding for morbid obesity. Langenbecks Arch Surg. 2008;393:199–205.
  6. Muller MK, Attigah N, Wildi S, et al. High secondary failure rate of rebanding after failed gastric banding. Surg Endosc. 2008;22:448–53.
  7. Pieroni, S, et. al. The “O” Sign, a Simple and Helpful Tool in the Diagnosis of Laparoscopic Adjustable Gastric Band Slippage. doi: 10.2214/AJR.09.3933 AJR July 2010 vol. 195 no. 1 137-141

[Last editorial review/modification of this page: 11/8/2011]

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