Laparoscopic Adjustable Gastric Banding
How does the Adjustable Gastric Band Work?
There are two main brands available in the United States, but both works using the principle of restriction. The band is a silicone balloon that is wrapped around the upper part of the stomach. By doing so, a small stomach pouch in created. With restriction, the stomach holds less food. People will generally feel full quicker and stop eating sooner. They will eat less, take in less calories, and lose weight. As patients lose weight, they also lose fat not only on the outside, but also in the inside. As there is less and less fat around the stomach, the band can be “adjusted” or “filled” to ensure proper restriction and continual weight loss.
How is the Gastric Band Placed?
With most bariatric surgeries performed in this modern age, the laparoscopic surgical approach has been proven to be the safest and quickest. Four to five small cuts are made, then the band is introduced into the body through a special instrument. After the band is placed around the stomach, the stomach is usually sewn to itself to keep the band from sliding or slipping out of place.
The catheter that connects to the band is brought from inside to outside of the body. The port is then attached to the catheter. The port will then fixated directly onto the abdominal wall underneath all the skin and fat.
People with small hiatal hernias can have that repaired at the same time that the band is being placed. The loose muscles that wrap around the stomach is re-approximated to fix the hernia defect. Most people with reflux symptoms will have some relieve by this repair and the associated weight loss of the gastric band
Advantages of the Gastric Band
This operation is one of the safest of all procedures available in bariatrics. It is also very quick depending on a person’s anatomy or any prior upper abdominal surgeries, and the surgery is usually performed on an outpatient basis. With the gastric band, people can realistically expect 40-50% loss of excess weight (weight over the ideal body weight for a person’s height) over first 2 year period.
Due to this weight loss, improvement and resolution of co-morbidities can be achieved.
Potential Risks of the Gastric Band.
As with any other surgery, risk of death is always a possibility. In placement of the gastric band, the rate of death is 1 out of 2000 or 0.05%. Almost all these reported deaths are usually secondary to the medical condition associated with obesity and not related to the surgery itself. Problems during the surgery itself is very rare. Injury to surrounding organs as the esophagus, stomach, or spleen is less than 1%.
Long term problems are also rare but are worth mentioning. Unique to the gastric band, slippage of the band may occur. This is described when the band is able to move on one side allowing it obstruct the usual passage of food. If this were to occur, surgery may be needed to place back into proper position and securing it in place. Sometimes, not absolutely, the band may have to be removed.
Another rare long term problem is an infection of the band or erosion of the band. Erosion is where the balloon of the band wears into the stomach wall itself. Many of times, people don’t feel any pain and most are diagnosed with problems seen at the port site. If an erosion is suspected, upper endoscopy is indicated to look at the stomach from the inside. If an erosion is found, the gastric band must be removed.
Although transient heartburn, nausea, and even vomiting may occur after placement of the band, but usually this can be attributed to improper eating practices such as eating too fast or not chewing foods well.
Usually adjustments to the band are performed in the office quickly and easily, but with the first few band fills may be difficult due to a thick abdominal wall. If so, the initial adjustments may be done under x-ray to help guide the needle to the port. Typically, as people lose weight, less fat in the abdominal wall will make adjustments easy enough to be done in the office.
Another reason that an adjustment could be difficult is if the port doesn’t lie perfectly flat on the abdominal wall or it may even be “flipped” upside down. Adjustments can still be made in the office especially if the same person is doing the adjustments and knows exactly how the port lies. If fills become too difficult or requires too many frequent visits to the x-ray department, surgical readjustment of the port may be necessary.
The Keys to Success in the Gastric Band
As with all bariatric surgeries, sticking to the post-operative bariatric diet is so very important. In all the surgeries, there are ways to cheat the surgery and to still gain weight by eating the wrong foods and eating in the wrong ways. Especially in the band, liquid calories is the enemy of bariatric surgery. Remember that the band is only a tool to help in the process. The band only applies restriction which is food sitting in the small gastric pouch making the person feel full, eating less, and losing weight. With liquid calories, this food source passes right through with no sense of fullness, increased calories taken in, and doing away with the benefits and purpose of the band.
Behavioral modifications is another key to success in the gastric band. Not only is eating properly is important, but changing your lifestyle to increase physical activity and to include routine, regularly scheduled exercise is obviously necessary. Proper bariatric dieting will increase your metabolism, but exercise has the largest contribution to the weight loss. As more and more weight is lost, exercise becomes more and more easily. It also will result in more energy, better mobility, and more stamina.
Regularly scheduled appointments with the surgeon especially in the first year after surgery is crucial to successful weight loss. These visits should occur approximately every 4 to 6 weeks. The gastric band needs to be adjusted in order to work. Once an amount of fat is lost from around the stomach, the band will be loose. The effects of restriction will be less. Although most will not gain weight during this period (unless they are cheating in one of the two keys already mentioned.), most will find that their weight loss has reached a plateau and will not have the same weight loss as previously with good restriction.
Final key to success, not commonly thought of, but will make the ultimate difference in success and in failure is close support by family and friends. People who are closet to those having the process typically benefit as well by not only eating better, but by also joining in to increase activity. By taking the journey together, the transition and process is easier and more likely to work.
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