Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg, gastric band and subcutaneous port components)

CPT4 code

Name of the Procedure:

Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (e.g., gastric band and subcutaneous port components).

Common Name: Lap-Band Surgery, Gastric Banding

Summary:

Laparoscopic gastric banding involves placing an adjustable band around the upper part of the stomach to create a small pouch, which restricts food intake and promotes a feeling of fullness with less food. The procedure is minimally invasive, utilizing small incisions and a camera to guide the placement of the band.

Purpose:

Laparoscopic gastric banding is primarily used for weight loss in individuals who are severely obese. The goals are:

To reduce food intake by creating a small stomach pouch.
To promote significant and sustained weight loss.
To improve or resolve obesity-related conditions such as type 2 diabetes, hypertension, and sleep apnea.

Indications:

Individuals with a Body Mass Index (BMI) of 40 or higher, or a BMI of 35 or higher with obesity-related health conditions.
Patients who have not had success with other weight loss methods such as diet, exercise, or medication.
Adults who understand the risks and benefits and are committed to long-term lifestyle changes.

Preparation:

Patients should follow fasting instructions, typically not eating or drinking after midnight on the day of the surgery.
Preoperative tests may include blood work, EKG, and imaging studies.
Patients may need to adjust or discontinue certain medications as advised by their doctor.
Attendance at a preoperative informational session on the procedure and post-operative lifestyle changes.

Procedure Description:

Under general anesthesia, several small incisions are made in the abdomen.
A laparoscope (a small, lighted camera) is inserted through one incision to provide a view of the surgical area.
Other instruments are inserted through additional incisions.
The adjustable gastric band is placed around the upper part of the stomach, creating a small pouch.
The band is connected to an access port beneath the skin on the abdomen.
Post-procedure, the band can be adjusted by injecting or removing saline through the access port to modify the tightness and size of the stomach pouch.

Duration:

The procedure typically takes about 30 to 60 minutes.

Setting:

Laparoscopic gastric banding is performed in a hospital or an outpatient surgical center.

Personnel:

Surgeon
Surgical nurses
Anesthesiologist
Surgical assistants

Risks and Complications:

Common risks: Infection, bleeding, and adverse reactions to anesthesia.
Specific risks: Band slippage, erosion of the band into the stomach, port complications, and esophageal dilation.
Management: Some complications may require additional surgery or band adjustments.

Benefits:

Significant weight loss.
Improvement or resolution of obesity-related health conditions.
Minimally invasive with smaller scars and faster recovery compared to traditional open surgery.
Adjustability allows for personalized treatment.

Recovery:

Patients can usually go home the same day or the next morning.
Pain and discomfort can be managed with prescribed medications.
Follow a liquid diet, advancing to pureed foods, and eventually regular, but smaller, meals as guided by a dietitian.
Resume normal activities within 1 to 2 weeks, with follow-up appointments to adjust the band and monitor progress.

Alternatives:

Other bariatric surgeries: Gastric bypass, sleeve gastrectomy
Non-surgical options: Diet and exercise, weight loss medications, and lifestyle changes
Each alternative has its own risks, benefits, and suitability depending on individual patient conditions.

Patient Experience:

During the procedure: Patients will be under general anesthesia and will not feel pain.
After the procedure: Expect some pain, discomfort, and fatigue which will gradually improve. Pain management includes prescribed medications and comfort measures.
Emphasize the importance of adhering to dietary recommendations and attending follow-up appointments for band adjustments.