Why do some adjustable gastric bands "slip"?

Band "slippage" is a frustrating and often disappointing known consequence of selecting an Adjustable Gastric Band as the choice for bariatric surgery. At present I know of no definite way t assure that slippage will not occur after surgery. In fact, about 5% of patients who have an Adjustable Gastric Band placed will need to return for a laparoscopic operation to reposition the band because of "band slippage". usually this occurs several months or a few years after the band is placed and can happen regardless of which product is used, the Lap-Band or the Realize Band.

Actually I believe "band slippage" is a poor name for this problem. Maybe a more accurate term would be "Forced Upward Migration of the Stomach". May be we should even label the problem "FUMOS" after this phrase!

Let me explain why I feel "slippage" is a poor term. When a person that has a gastric band in place eats more than the volume the gastric pouch above the band can accommodate, the extra volume remains in the esophagus. Of course the esophagus contracts forcing the food down into the gastric pouch increasing the pressure in the pouch. Often the patient will experience a severe squeezing pressure sensation in their chest. This force causes pressure on the sides of the pouch. If this occurs repeatedly this is likely to force the stomach wall just below the band to be pulled up or "migrate" up under the band. As the stomach migrates upward the size of the gastric pouch increases. This may occur even though the stomach below the band is stitched to the gastric pouch above the band in an attempt to keep this from happening. As one of our team members,Mike Palasek, RN, CRNFA, says "the determined user can overcome any amount of stitching" and the a gastric pouch will become too large. Also eventually so much stomach is drawn up into the band that the increased amount of stomach inside the band makes the band too tight so that fluid will need to be removed from the band to allow anything to pass through.

In the mean time patients will develop symptoms including vomiting and severe reflux especially at night which is a sign that the band is too tight for the amount of stomach that is within the band. Sometimes the food that comes up is food they swallowed several hours before since the enlarged gastric pouch can store allow more food and it really can not pass through the band.

If you have been doing well with no need for a band adjustment for several months and rather suddenly develop vomiting and reflux "slippage" or FUMOS could be the problem. Sometimes early in the evolution of this problem symptoms are present but the CAT scan will not show enough of a change to make the diagnosis. Your bariatric surgeon should consider removing some of the fluid. If this gives your esophagus a rest and you avoid eating more than the volume of your pouch maybe the "slippage" or FUMOS will not evolve into a problem requiring a second operation.

However, if the problem persists there is a solution. The band position can be revised laparoscopically and placed back in the correct position. I have found that the problem resolves and patients do quite well after the repositioning. To date the problem has not come back. I think this is partially because the patient is careful to not eat more than the volume of the pouch.

In this situation an ounce of prevention is truly worth a pound of cure. I suggest that my patients avoid relying on the band to keep them from eating more than the volume of the pouch. They should use the symptom of squeezing chest pressure in this setting as a signal that they are eating too much too fast. I ask my patients to use their eyes and brain to tell them how much they can eat BEFORE they notice this symptom happens to them. In this way they should be able to avoid putting so much pressure on their pouch that "slippage" or FUMOS occurs.

Now you know my best understanding of why this happens and what you can do to try to prevent this problem. I would be delighted to hear your thoughts or questions regarding this frustrating problem. Just click of the word"comments" in yellow at the end of this posting.