Recognized as a Center of Excellence by the American Society for Bariatric & Metabolic Surgery
Published: May 29, 2007
Updated: Feb. 2, 2011
For your insurance company, the code for this operative procedure is CPT 43770 and the ICD-9 code for the diagnosis of morbid obesity is 278.01
This procedure entails placement of an inflatable Silastic band around the top part of the stomach to create a small gastric pouch without the need for any bowel anastomoses.
This procedure is performed laparoscopically and is called the Lap-Band or the Realize banding procedure. Both are brand names. Information about these devices can be found on the manufacturers Web sites:
Your surgeon can also advise you as to which one is best for you. The surgical incisions for the needed laparoscopic ports are similar to those for the Roux-en-Y gastric bypass:
Alternatively, for some patients, the device can be placed through a single laparoscopic incision. Discuss this with your surgeon to see if this is an option for you.
The device consists of a band, connection tubing, and a plastic access port. The band has a plastic ring lining the inside that can be filled with fluid to narrow the stomach opening, thus limiting the amount of food that can pass over time. The access port is used to add or remove fluid from the band with a needle and syringe.
An area is cleared at the top of the stomach for passage of the band and the band is secured about the stomach by an interlocking mechanism. A stomach flap is sewn over the band to help keep it in position.
After placement of the band, all instruments are removed from the abdomen and a small plastic access port is implanted just under the skin. The amount of fluid in the plastic ring is adjusted by placing a needle into the plastic access port and adding or withdrawing fluid in clinic or radiology. Placement of the needle is minimally painful and frequent adjustments are critical for success with banding.
Results of the adjustable gastric banding procedure have been encouraging, however weight loss is less than for the Roux-en-Y gastric bypass and management requires more frequent clinic visits to adjust how the band narrows the stomach.
Most patients will lose between 80 and 100 pounds. The exact amount of weight you lose will depend on your compliance with the dietary instructions and your tolerance to adjustments to the tightness of the band.
Weight loss is slower with this procedure with most of the weight loss occurring after the first three months. You will need to watch your diet very carefully as the band is adjusted and continue long-term follow up to maintain weight loss.