Gastric Banding

Adjustable gastric banding surgery, often referred to by the brand name Lap-Band, is a restrictive surgery that works by decreasing the amount of food that is able to be consumed before feeling full. During gastric banding surgery, a firm silicone band with an inner inflatable ring is placed around the stomach to slow the passage of food from the upper portion of the stomach to the lower portion. What makes the procedure unique is the ability to adjust the fit of the band.

Ideally, the band will make the patient feel full with less food, slow the digestion of food and increase the length of time the feeling of fullness lasts after a meal. If the band allows food to pass too quickly or allows too much food to be eaten at a meal, it can be tightened by adding saline to the band. If the patient experiences vomiting or difficulty swallowing with meals, the band may be too tight and saline can be released.

A port connects to the band, allowing the band to be adjustedthroughthe skin with a syringe, adding or releasing saline.he portispermanent, and because it is rests just below the skin, there are noconcerns with swimming or bathing.

Procedure

The surgery is typically performed in a hospital or a surgery center, using general anesthesia. Most surgeries are performed laparoscopically, via 4-5 incisions 1-2 centimeters long.

Thesurgery begins by positioning the band around the stomach. Once inplace, the band is inflated with saline, adjusted for the proper fitand placement, and closed around the stomach.

The port is injected with saline to insure that it works properly, inflating and deflating the cuff without leaks.

The Typical Outcome

The surgery is the least invasive of all the weight loss surgeries, requires the least amount of recovery time and poses no risk of malnutrition when properly adjusted. Some patients return to work within days and resume their normal activity level in a week or two, on average, patients take a week or two to return to work and a month to return to full exercise.

The adjustable nature of the band allows for steady weight loss of 0.5-1 kg per week, a slower rate than with many surgeries that helps prevent some side effects like gallstones and skin that hangs from the abdomen as the area shrinks. The band is typically empty of saline, or has minimal inflation, in the first six weeks after surgery.

Once healing is complete, the adjustments begin, working to restrict the flow of food without completely obstructing the movement of food through the digestive tract. These adjustments may continue for over a year after the procedure in order to optimize the effects of the band.

The adjustment capability also allows the band to be completely emptied in times of need, such as pregnancy or serious illness, allowing the stomach to return to its full capacity when the patient needs more nutrition, and re-inflated later.

In the rare event that there is a problem with the band, it can be replaced laparoscopically. There is a risk that the band will slip, or move out of position, especially when the saline level in the band is being altered.

Adjustable band weight loss surgery requires significant behavior modification by the patient. A patient who does not drastically alter his eating habits will not have the weight loss that other patients experience after this procedure. The stomach can stretch, allowing larger quantities of food, if the patient does not adhere to the surgeon’s instructions regarding meal size.

In addition, exercise remains an important component of weight loss and contributes greatly to long-term success. When working properly, the band poses no additional risk of malnutrition, and there is no risk of dumping syndrome as in other surgeries.

In the first year after surgery, patients can lose as much as 1-1.5 kg per week, with higher BMI patients losing more kelograms per week than lower BMI patients. After the first year, the average rate of loss slows to a 0.5 kg per week. Weight loss usually moved into the maintenance phase 18 to 24 four months after surgery. Long-term maintenance of significant weight loss is not as successful as with combination procedures such as roux-en-y gastric bypass.