Lap-Band lowdown

Chico doctors Deron Ludwig and Erik Simchuk perform an increasingly popular life-saving procedure known as Lap-Band surgery, but the bariatric surgeons say their patients must do their part to assure the best possible outcome.

In addition to performing Lap-Band surgery, Ludwig and Simchuk also perform laparoscopic gastric bypass and laparoscopic sleeve gastrectomy.

“Really what we want to say is that bariatric surgery can save a whole lot of lives, lengthening life on average from seven to 10 years at a minimum,” said Ludwig, whose practice with Simchuk is called North Valley Surgical Associates. “It’s really the best treatment we have for a large number of serious health problems, like the epidemic we’re experiencing of type 2 diabetes.”

“The Lap-Band was approved by the FDA in 2001,” offered Simchuk. “It was studied extensively in controlled clinical trials back to 1995, especially in Australia.” The similar Realize Band, which the physicians also use, originated in Sweden in around 1992, he added. “There’s a 20-year history of laparoscopic adjustable gastric bands.”

The Lap-Band operation, Simchuk explained, “is purely a restrictive weight-loss operation that provides an adjustable stoma [a mouthlike opening], with an inner balloon, placed around the upper stomach. … Food stops in a little pouch above the band and is slowly metered out into the rest of the stomach.”

Air inside the device’s inner balloon is replaced, but not filled, with a saline solution, Simchuk said, and adjustments are made to the Lap-Band over a period of time: “The adjustments that we do, we do them carefully, cautiously, over time. What we’re doing is we’re adjusting the band to the point where [patients] can eat a small meal—6 to 8 ounces—feel full on that good healthy-sized portion, and go on about their business.”

“And often have more manageable hunger once they are adjusted properly,” Ludwig said. On average, it takes patients between four and six monthly adjustments to be adjusted properly.

“For sure, it’s attractive because it’s the least invasive,” said Ludwig of the appeal of Lap-Band surgery.

But it’s not an overnight fix. “It takes time for the patients to learn how to eat properly with the Lap-Band. You can’t take a person, put the Lap-Band in, tighten it down and expect it to work immediately,” Simchuk said.

To be an eligible candidate for the Lap-Band, one must have a body mass index (BMI) of 35 to 40 “with a medical co-morbidity related to obesity, such as hypertensive type 2 diabetes, hypercholesterolemia or sleep apnea,” said Simchuk.

One must also be willing to make lifestyle changes—eating sensibly and getting sufficient exercise—that support effective weight loss.

“The Lap-Band patient must have an ability to make proper food choices for ultimate success,” Simchuk said. “The Lap-Band cannot decide for the patient what’s put in the fridge and the cupboard, so proper food choices play such a vital role in the success of the Lap-Band patient.”

Fast food, sweets and hi-carb and fried foods will not cause the Lap-Band patient to have an adverse reaction. “If they can get it down, sweets don’t cause any reaction. Ice cream goes right down,” Ludwig said. “It won’t make them sick, as is often the case with the other two [bariatric] procedures. Therefore, they have to be dedicated to lifestyle change.”

According to the North Valley Surgical Associates website, “Approximately 75 percent of daily calories should come from protein, and the remaining 25 percent should be divided between fats and carbohydrates. Some foods, such as those that contain trans fats or excessive amounts of sugar, will need to be avoided as much as possible.”

Simchuk and Ludwig make sure that Lap-Band patients have extensive pre- and post-operational education. A licensed on-staff psychotherapist/nutritionist provides individual consultations, and there is a once-a-month support group as well. Additionally, Ludwig and Simchuk make themselves available to patients “24 hours a day, seven days a week,” said Simchuk. “That close-knit relationship with the surgeon, coupled with a close-knit relationship with the psychotherapist, is so very important to the success of the Lap-Band patient,” he said.

The surgeons also maintain close relationships with patients’ other medical providers—cardiologist, pulmonologist, nephrologist and so on.

“We partner with other specialists to make sure that, one, a patient is fit for surgery, and, two, to help us care for that patient in all respects post-operably,” said Simchuk.

Building up a patient’s ability to exercise is very important. “Our preoperative conditioning program will often include work with a physical therapist to improve someone’s exercise tolerance,” said Simchuk.

The Lap-Band was in the news earlier this year, after two brothers from Southern California named Julian and Michael Omidi, who ran weight-loss clinics associated with the widely advertised 1-800-GET-THIN campaign, came under investigation when several of their patients died following Lap-Band surgery.

The brothers face a number of government investigations and civil lawsuits, including a whistleblower suit brought by two former employees claiming the Omidis ran unsanitary facilities and billed patients for medically unnecessary procedures. Allergan, Inc., the Irvine-based company that manufactures the laparoscopic adjustable gastric band called the Lap-Band, stopped selling its product to the Omidis’ clinics as a result.

The tragedies that came out of the 1-800-GET-THIN campaign are obviously exceptional.

While unable to comment on the situation of the Omidis, Ludwig and Simchuk shared their insights on the safety of this type of procedure.

“What a person can do to ensure they are seeing an experienced team is to make sure that the facility and the surgeons are considered a Center of Excellence, which we are,” Ludwig said. “That is a designation given by the ASMBS, the American Society for Metabolic and Bariatric Surgery.

“We are extremely careful about outcomes and patient safety, and make sure the patient is in the best shape possible to undergo the procedure with the lowest risks,” he added. “Weight-loss surgery is extremely safe, all the procedures…similar to other elective operations like gall-bladder removal or even appendectomy.

“It doesn’t mean zero risk, though, but the risks of the surgery are far less than the risk of the obesity and its associated health problems.”