Gastric Banding

Nearly 97 million American adults are overweight; it is estimated that of these, 4 million are severely obese and 1.5 million are morbidly obese. Furthermore, from 1960 to 1990, the incidence of obese American adults increased from 13% to 35%. The NAO states that, in 1998, the prevalence of obesity in the UK was 19% (more like 25% now) and cost the economy between £½bn and £2bn.

Gastric banding is quite simply a form of surgery which reduces the size of the stomach so that you feel fuller sooner and therefore eat less. The procedure involves placing an adjustable band around the upper part of the stomach to create a pouch.

The pouch fills up quickly and the food passes slowly through a gap, formed by the band, into the rest of the stomach (as shown in the diagram above). The food then passes normally through the rest of the digestive system.

Laparoscopic gastric banding offers the advantages of minimally invasive surgery, adjustability, and reversibility. The Swedish adjustable gastric band (SAGB) was engineered as a low-pressure device with a smaller pouch that could overcome some of the adverse effects of some of the earlier gastric bands (band erosion, slippage) caused by high pressure.

Am I a Candidate for Gastric Banding? Am I obese?

The Body Mass Index (BMI) is used to define obesity. This figure is obtained by dividing your body weight by the square of your height in meters. If your weight is 80 kg and height is 5 feet 7 inches (1.70 m ), then your BMI would be 80/2.89 = 27.68 kg per m2
 
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Weight Classification Body Mass Index (BMI)
Normal less than 25 kg per m 2
Overweight more than 25 kg per m 2
Obese more than 30 kg per m 2
Severe obesity more than 35 kg per m 2
Morbid obesity more than 40 kg per m 2

Morbidly obese patients who are 20 - 40 years old experience a 12-fold reduction in life expectancy.

The prevalence of obesity (BMI of 30 or more) in the United States was 19.8% in 2000.

What are the Effects of Morbid Obesity?

Hypertension is the most common form of death amongst the obese, which drops by 66% for those who have undergone surgery. Coronary artery disease, venous statis disease, diabetes, and cancer also have a much higher incidence amongst the obese. The excessive levels of androstenedione and estradiol hormones leads to feminisation in men; masculinisation and infertility in women.

Gastric Banding Vs. Gastric Bypass? What is Gastroplasty?

Gastroplasty is most commonly known as ‘stomach stapling’. (Roux-En-Y) Gastric Bypass surgery is also a permanent operation which sections off a pouch of your stomach that bypasses the first part of the small intestine. Gastric banding is adjustable and reversible.


The Appeal of Laparoscopic Adjustable Gastric Banding:

  • The Lap-Band is the safest weight loss procedure. The mortality rate associated with the Lap-Band procedure is ten times less than with Gastric Bypass and over 20 times less than the malabsorptive procedures. The mortality rate with the Lap-Band is 0.05 % (1/2000), with Gastric Bypass 0.5% (1/200), and with the malabsorptive procedures is 1.1% (>1/100).
  • The Lap-Band provides better short term and long-term safety. The Lap-Band generally has fewer complications and the complications overall are less significant.
  • The Lap-Band is less ‘physiologically’ disruptive. The recovery is faster and easier. The recovery time is the shortest of all the weight loss procedures.
  • The Lap-Band is inserted laparoscopically, without a major incision, with just a short stay - usually overnight. The recovery time is the shortest of all the weight loss procedures and can often allow the patient to take just a few days to return work.
  • With the Lap-Band, there is no opening made into the stomach or intestine and no staple lines, so the risk of leakage and infection is profoundly reduced.
  • The Lap-Band does not radically reconfigure the intestine or the stomach and food passes through the digestive tract in the natural sequence order.
  • With the Lap-Band, problems with vitamin and mineral deficiencies and metabolic problems are virtually non-existent.
  • The Lap-Band is reversible, by laparoscopic removal of the band.
  • The Lap-Band is potentially convertible to another operation, if the procedure fails to maintain the desired weight loss. A conversion is associated with a higher risk.
  • Lap-Band patients continue to get a sense of fullness with very little oral intake.
  • The Lap-Band is adjustable. Weight loss can be customized. The band is adjustable in the office setting.

How is Gastric Banding Performed?

The gastric band is usually fitted using laparoscopic (keyhole) surgery. About five small cuts (1 - 2 centimetres long) are made on your abdomen and chest. Your surgeon will insert a tube-like telescopic camera to view the area either by looking directly through this, or at pictures it sends to a video screen. The adjustable band is a 12-mm-wide soft silicone band with an elastic balloon that can be inflated by injection according to individual need. The band is fitted around the upper part of the stomach, dividing it into two sections, the smaller of which is above the band and has a capacity of approximately 15–20 ml (pouch); the larger remaining part is below the band. The constriction is called a stoma. The SAGB makes it possible for the surgeon to alter the stoma diameter.

How Will I Feel Post-op?

Many patients may feel nauseous and constipated after surgery. Don’t worry; this is to be expected due to the reduced size of your new stomach. Temporary hair loss may also ensue due to the relative starvation. Normal growth will return though. You will need to be on a liquid diet for the first four weeks after your surgery. This will allow time for your stomach to heal and the band to anchor. Eating solid foods too quickly can hurt your stomach and the band. This will be followed by a two week puree diet, then normal eating may resume. You will need to chew your food a lot more than usual in order to digest it properly. Remember how small your new stomach has become.

What are the Risks and Benefits?

Gastric banding surgery is relatively safe, however, complications may occur. Haemorrhaging or injury to the spleen, stomach or oesophagus may occur during surgery. Post-op, the band may slip, the balloon may leak and infection may occur. A second operation may be necessary in 15-30% of the cases. In the case of morbid obesity, the benefits of surgery greatly outweigh the risks. After gastric banding surgery there will be major improvements in a whole range of weight-associated conditions, including sleep apnoea, asthma, joint pain, arthritis, reflux, fatigue and shortness of breath, not to mention an associated reduction in hypertension, reduced risk of heart disease and cancers as well as an improvement in your general longevity.

What are the Long Term Effects?

Weight loss with the Lap-Band is steady and slow. The goal is to lose one to two pounds a week. The dramatic weight loss seen with gastric bypass is not the case. Weight loss may be similar over the long term, although most gastric bypass surgeons think that this is not true and weight loss may be somewhat better (10-15%) over the long term with gastric bypass. Weight loss is given in the literature as BMI 43–46 pre-operatively to BMI 28–32 post-operatively. The target of a 50–60% reduction of excess weight is achievable. Studies with a follow-up of over 5 years confirm that the weight loss is long-term. Remember that you will still need to exercise and maintain a proper diet to ensure you keep the weight off.