Laparoscopic Gastric Banding

Introduction

A gastric banding procedure involves placing an adjustable band around the top of the stomach via keyhole surgery making a 30cc gastric pouch above the band, and an access port inserted deep under the skin, which is connected to the band by special tubing. During surgery we place 1-2 ml of fluid in the band. From four weeks post surgery, adjustments are performed at two to four week intervals until the optimal level of restriction is reached.

Initially, very little to no fluid is inserted into the band to allow the band to ‘settle in’ after the operation. A small amount of fluid is injected into the access port to expand the band and increase restriction on the stomach. Adjustments are made at two to four week intervals until optimal restriction is reached. This is the so-called ‘green zone’, where you will be able to eat a small amount of most foods without obstruction, but also without feeling hungry after or between meals.

Through all of this, patients work closely with our dietician to make the lifestyle and behavioural changes needed to achieve and sustain their weight loss.

How does gastric banding work?

The gastric band allows you to eat much less, while still enjoying your food and feeling satisfied, by:

• Portion control – it allows you to feel full and satisfied with smaller meals, preventing overeating.
• Hunger control – you feel less hungry in between meals.

How much weight most people lose after Gastric Banding?

On average, patients lose 50 per cent of their excess weight. By comparison, non-surgical weight loss options achieve an average weight loss of 5 to 10 per cent that only last few months.

The best results are achieved when a multidisciplinary team supports patients through both surgical and lifestyle choices. Some of our patients have lost up to 100 per cent of their excess weight with our program through the regular follow up visits to various members of our team.

What are the advantages of gastric band?

Gastric banding is very safe. It is safer than other forms of weight loss surgery at least on the short term. No surgery is completely risk free, but in comparison to the risks of chronic untreated obesity, the surgical risk is acceptable.

Gastric banding was popular because:

• It is removable.
• It involves no stapling of the stomach, removing part of the stomach or bypassing parts of the intestine.
• When patients follow a balanced diet, it does not lead to deficiencies in vitamins and minerals since food is absorbed exactly the way it was before surgery. If however, there are problems with over-restriction and/or vomiting, the patient will start to develop maladaptive eating patterns with an unbalanced diet and they can develop nutritional deficiencies.
• Gastric banding has been performed in Australia since 1992.  Conflicting long-term results are available throughout the world.

What are the disadvantages of the gastric band?

Although the band is reversible, the scar that body develops around the band is not reversible. The band also has some effect on the lower oesophageal sphincter.

The average weight loss after gastric banding is lower than after a sleeve gastrectomy or gastric bypass. Typically, excess weight loss after gastric banding is 48 per cent compared with 67 per cent after a gastric sleeve or bypass.

Weight loss is less predictable. After a gastric band, the amount of weight loss varies from person to person as the patient learns to use their gastric band as a tool to assist them with behavioural and lifestyle changes. There is a wider range of weight loss after a gastric band compared to after a sleeve or bypass, because a band is more dependent on patient behaviour.

Gastric band has the highest rate of re-operation over the long term. Up to one in five people who have had a gastric band will require a further operation. This re-operation rate is much higher than after a sleeve gastrectomy (approximately three in 200 people) or gastric bypass (15 in 200 people).

A gastric band does not have a metabolic effect. It only restricts the capacity of the stomach but does not affect the complex biochemical pathways regulating appetite and metabolism, therefore patients typically do not experience the same shift in food preferences, away from sweet or fatty foods, as with a sleeve gastrectomy or gastric bypass.

After gastric banding, re-operation may be required for:

• Infection of the port or the band.
• Slippage of the band and pouch dilatation which, if untreated, leads to weight gain and indigestion or gastro-oesophageal reflux.
• Leakage of saline from the connecting tube or the balloon of the band.
• Dislocation of the port.
• Erosion of the band through the stomach wall.
• Insufficient weight loss.
• Obstruction of the band where it may suddenly become over-restricted or obstructed. This frequently requires an urgent adjustment. Under these circumstances it is best to be close to an appropriate facility that is familiar with gastric bands and can perform an adjustment competently. For this reason, a gastric band is less suitable for people living in remote areas, or for those who travel to remote destinations.
• Less effective at resolving obesity-related health problems including type 2 diabetes. After a gastric band, only five out of 10 patients have a remission of their disease – compared to eight out of 10 people after a sleeve gastrectomy or bypass. Resolution of obesity related health problems after gastric band is dependent on weight loss and takes longer compared to sleeve or bypass procedures.

Am I eligible for gastric banding?

The general requirements are:

• Your BMI is above 40.
• Your BMI is above 35 and you already have one of the medical conditions associated with obesity.
• Your BMI is above 30 and you have difficult to control Type 2 Diabetes and an increased risk of heart disease.
• You do not have an underlying medical disorder or medication causing your weight problem.
• You do not live in, or travel to, remote locations.
• You are prepared to participate in ongoing follow-up visits.
• You have lost weight through diet and exercise in the past, but have regained the weight.
• You are over 16 years of age.

Who gets the best results from gastric banding?

People who get the bests results from gastric banding are those who:

Do not need to lose a very large amount of weight.

Have been able to lose weight quite easily in the past with diets and exercise, but struggle to keep the weight off.

Are well motivated to make behavioural and lifestyle changes with the support of our multidisciplinary team.

How will I recover after gastric banding?

Patients recover quickly after gastric banding and experience minimal pain as a result of laparoscopic, or ‘keyhole’, surgery.

Most patients can move around a few hours after a gastric band procedure. They can drink liquids the following day and are generally home from hospital one or two days after surgery. Most people feel well enough to perform gentle day-to-day activities within a few days, however we recommend taking one to two weeks off work