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Laparoscopic Gastric Banding

 

WHAT IS LAPAROSCOPIC GASTRIC BANDING?

Adjustable gastric banding is a restrictive type of weight loss surgery. In a nutshell, it involves placing a silicone band with an inflatable inner collar around the upper stomach to restrict food intake. This creates a small pouch and a narrow passage to the lower stomach. This small passage delays the emptying of food from the pouch and causes a feeling of fullness. The silicone band can be tightened or loosened over time to change the size of the passage.

HOW DOES GASTRIC BANDING WORK?

The silicone band is connected to a small port that is placed in the abdominal wall. The inner diameter of the band can be adjusted by injecting saline through this port. This is called a fill. Your surgeon can make periodic adjustments or fills based on your weight loss, food cravings and other physical reactions to the surgery.

Adjustable gastric banding is usually performed laparoscopically, meaning that the surgeon makes small incisions as opposed to one large incision. To perform the gastric banding, he or she inserts a viewing tube with a small camera (laparoscope) and other tiny instruments into these small incisions.

Currently two types of gastric bands are on the market in the United States: the Lap-Band System and the newer Realize Band.

Gastric banding surgery takes about one to one and a half hours. It can be done on an outpatient basis or may require a one-day hospital stay.

WHO IS A GOOD CANDIDATE FOR GASTRIC BANDING?

The National Institutes of Health (NIH) requirements for adjustable gastric banding are the same as for other weight loss surgeries. For example, the NIH requires a body mass index (BMI) greater than 40. This is the equivalent of being about 100 pounds overweight for men and 80 pounds overweight for women. BMI takes height and weight into account to measure body fatness, and a BMI of 30 or above in adults is considered obese.

People with BMIs between 35 and 39 may also be candidates for gastric banding if they have obesity-related illnesses such as diabetes, high blood pressure or high cholesterol.

Several studies suggest that people with BMIs between 30 and 35 can also safely undergo gastric banding with excellent results in terms of weight loss and health improvements. In some cases, people with BMIs between 30 and 40 have longer lasting success with gastric banding than with exercise and diet.

Gastric banding may be an option also for people in whom the more invasive gastric bypass surgery is deemed too risky due to underlying health complications.

The body mass index range for adults 20 and over is shown here:
  • Below 18.5 Underweight
  • 18.5 - 24.9 Normal
  • 25.0 - 29.9 Overweight
  • 30.0 and above Obese

PREPARING FOR LAPAROSCOPIC GASTRIC BANDING

Regardless of the surgical method chosen, preparing for weight loss surgery starts with making a lifelong commitment to the dietary and lifestyle changes necessary for success. Weight loss surgery is not a quick fix, nor is it a decision to enter into lightly. Once you have made the decision together with your surgeon and your family members, the preoperative evaluations can begin. These include:

  • Meeting with a registered dietician to discuss how the diet needs to change both before and after weight loss surgery.
  • A comprehensive psychological evaluation.
  • An upper endoscopy exam or barium swallow to make sure there are no polyps, tumors, ulcers or bacteria that cause ulcers in the stomach.
  • Additional pre-operative evaluations for the heart and lungs, if deemed necessary.

It's wise to tell your surgeon about any medications you are taking or plan to take throughout recovery. Vitamins, minerals and herbs also interact with medications. Don't leave anything out.

Some of your lifestyle changes will begin before surgery. They include:

  • Quitting smoking for at least 30 days before and after weight loss surgery. Smoking can increase the risk of complications, including potentially fatal blood clots. What's more, smoking also increases the risk of pneumonia and other lung problems after surgery. Smoking can also affect healing of the incisions and increase the risk of infection.
  • Not drinking alcohol for at least 48 hours before weight loss surgery.
  • Losing 5 to 10 percent of excess body weight. People who lose a moderate amount of weight before weight loss surgery have a shorter hospital stay and more rapid postoperative weight loss, according to a study in Archives of Surgery.
  • Practicing eating slowly, which includes chewing each morsel of food 15 times and putting the fork down between bites.

WHAT TO EXPECT AFTER GASTRIC BANDING SURGERY

After adjustable gastric banding, you must get used to eating solid foods again. The regimen typically starts with two weeks on a liquid-only-diet, two weeks of semi-solid pureed foods and then solids.

Many people say that until their first fill, they can still eat relatively normal portions of food. Some refer to this phenomenon as bandster hell, because they become convinced that the surgery was not a success.

The stomach needs to heal from surgery before the first fill. So the first adjustment won't occur until around six weeks after surgery. Gastric bands need to be adjusted an average of four to six times in the first year after surgery. These fills are done to make sure the band is not too tight or too loose and/or to encourage continued weight loss. Band adjustments are painless, and your surgeon can make them during a regular office visit.

The weight loss that occurs with adjustable gastric banding is more gradual then with some other weight loss surgeries. You may lose about five to 10 pounds a month and will likely lose two-thirds of your excess weight within two years of having the surgery.

After surgery you must be mindful about what you eat, how you eat and when you eat. This includes eating smaller meals, because the new stomach can hold only about a quarter-cup to a full cup of food at a time. Sometimes people who have undergone gastric banding can eat a lot, and sometimes they can't eat anything. It is important to "listen to the band" and not just try to eat the same amount each day.

It is also important to chew carefully and stop eating when you feel full, or nausea and vomiting can occur. Don't eat and drink at the same time, because this may increase the chance of discomfort and vomiting.

Individual experiences with food and eating after gastric banding surgery tend to vary. Some people report difficulty eating solid foods in the morning. It is important to pay attention to your body and how you feel when you eat different foods at different times. Talk to your surgeon or a registered dietician about any problems you experience, as he or she will be able to offer tips on how to tweak your diet and eating habits.

WHAT ARE THE RISKS AND COMPLICATIONS OF GASTRIC BANDING?

Risks and complications include:

  • Bleeding
  • Infection
  • Slippage of the band can occur with persistent vomiting if behavioral changes are not made.
  • The band may erode into the inside of the stomach.
  • The band can spontaneously deflate due to leakage.
  • The stomach pouch can enlarge.
  • The stoma (stomach outlet) can be blocked.
  • Gastroesophageal reflux or GER, when stomach contents rise up into the esophagus (the tube that carries food from the mouth to the stomach).
  • Death. The risk of death due to gastric banding surgery is about one in 2,000.

Other disadvantages of gastric banding include:

  • Frequent visits for band adjustments or fills.
  • The pouch may stretch with continued overeating.

WHAT ARE THE ADVANTAGES OF ADJUSTABLE GASTRIC BANDING?

Compared with other types of weight loss surgery, adjustable gastric banding has these advantages:

  • Reversible
  • Adjustable
  • Less invasive
  • Less operating time
  • Can be done on an outpatient basis
  • Does not interfere with absorption, so vitamin deficiencies are less likely to occur.
  • Lower risk of dumping syndrome, which occurs when the undigested stomach contents are "dumped" into your small intestine too quickly. It is marked by abdominal cramps and nausea.
  • Improves health problems related to excessive weight, including type 2 diabetes, high cholesterol, sleep apnea, high blood pressure and asthma.
  • Slow and steady weight loss

 
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