Whether the problem is never losing weight, or complications such as a slipped lap band, or successful weight loss but ongoing vomiting or being unable to eat, it is possible for problems to occur. In some cases the problems can be resolved by correctly adjusting the fluid in the band; for others, lap band adjustment is not enough and lap band reversal is required, or even revisional bariatric surgery such as a sleeve gastrectomy after lap band or gastric bypass after lap band.
Signs that a band may be failing
A successful outcome following adjustable gastric banding surgery generally results in weight loss of about 50% of “excess body weight” 
, often about 20% of total body weight, over about two years. Most people with a well-adjusted lap band need to eat slowly and chew thoroughly, and many find dry fibrous foods challenging, but softer foods and liquids should be tolerated without vomiting. A small meal should be enough to avoid hunger; extreme hunger is unusual with a well-adjusted band. Reflux or heartburn should be, at worst, an occasional problem; continuous reflux or regurgitation is a concern.
Revisional surgery following a gastric band
Sometimes a band needs to be surgically adjusted or removed. One of our special interest areas is revisional surgery following previous bariatric operations, such as vertical banded gastroplasty (VBG), non-adjustable gastric bands, or “failed” or eroded lap bands.
Because of the scarring that occurs with gastric banding surgery, it is not always advisable to replace a failed band, particularly if the reason for failure is a gastric erosion. Options include sleeve gastrectomy (after a delay following gastric band removal, to allow the scar tissue to mature) or gastric bypass; or, indeed, a supervised diet and exercise program in some cases.
Dietary difficulties following adjustable gastric banding
Because the gastric band forms a relatively fixed narrowing at the top of the stomach, the ability of solid food to pass into the main part of the stomach can be impaired. It is essential that food is chewed thoroughly and eaten slowly; this can be difficult with some foods, such as fibrous vegetables (broccoli skin, rocket, similar stringy salad leaves and vegetables), starchy foods (bread, rice, dry potato) and stringy or tough meats. Most people with a gastric band have one or two episodes of food getting stuck, which usually clears only after vomiting. This problem should be completely avoidable by chewing thoroughly and avoiding problem foods; if obstructions continue, urgent review is needed. If food gets stuck at lunch time, please call immediately, don’t wait until the evening!
The silicone tubing used in gastric bands can become brittle over time, leading to cracks and loss of fluid. The amount of gas (air) dissolved in the fluid used to fill the band varies and the degree of restriction can vary if the amount of gas changes, such as if you travel by air. The body changes over time, losing fat from around the stomach. All of these factors can contribute to less pressure on the stomach and a return of hunger.
Regular follow up is required, particularly in the first year or two, to achieve good results with a gastric band. We ask you to keep your appointments, whether things are going well or not, so that we can monitor for any problems.
1. Excess body weight is the weight above a healthy body weight. For example, if your healthy body weight is up to 50kg, and your current body weight is 100kg, your excess body weight is 50kg, making the expected weight loss following lap band surgery about 25kg, resulting in a target body weight of 75kg. Please note that this is the “default” target weight without particular attention to diet and exercise; some achieve significantly lower body weights after surgery.