Laparoscopic Gastric Banding
Adjustable gastric banding (also known as “Lap Band” or “Realize band”) is considered by many to be the least invasive surgery for weight loss. The procedure involves placing an implant, a soft silicone ring with an expandable balloon in the center, around the top part of the stomach. It effectively creates a two-compartment stomach, with a much smaller top part above the band. A person eats enough food only to fill the top part of the stomach. Over time, after the meal, the food passes through the opening of the band into the remainder of the stomach, and digestion occurs normally.
The band is attached to an injection port under the skin via a soft tubing, which allows adjustment of the band’s tightness by inflating or deflating the balloon in the band. Adjustments to the band are easily performed in the office and require no special preparation. Adding saline to the band makes the orifice between the two parts of the stomach smaller, making the passage of food from the top of the stomach to the rest of the stomach slower. Removing saline from the band allows more rapid passage of larger particles of food to pass.
The adjustable gastric band procedure was first approved by the FDA for use in this country in 2001. It is currently approved for people with BMI of greater than 35 or 30 – 35 with comorbidities or obesity-related medical conditions (such as type II diabetes, hypertension, sleep apnea, etc.), who have failed to achieve sustained weight loss with non-surgical methods. In many cases the procedure can be performed as outpatient surgery, where a patient goes home the same day as the operation.
In order to succeed patients must be willing to make major changes in their eating habits and lifestyle. Mindful, planned eating with healthy food choices, careful chewing and not mixing solid food and liquid at a meal are critical to success. Inability to comply with these behaviors will result in adverse symptoms such as vomiting, reflux, or pain. In addition, a comprehensive follow-up program including dietary counseling and often monthly visits for weigh-ins and possible adjustments increase the chances of durable success. Regular exercise is also suggested for a healthy lifestyle.
Average excess weight loss has been reported in the 40 to 60% range, although there is a wide variance in weight loss depending on patient motivation and compliance. In a U.S. study of patients with a BMI between 30 and 40, 80% of patients lost at least 30% of their excess weight and kept it off for one year. There were some patients who lost no weight and others who lost over 80% of their excess weight. The quality of life for patients enrolled in the study improved significantly.
Although short-term complications of surgery are very rare, recent evidence suggests a significant long-term complication rate. Between 15 and 60% of patients need re-operation for implant malposition, erosion, frequent vomiting, or weight loss failure.
Recently the number of patients opting for the adjustable gastric band has declined sharply, likely due to the increasing knowledge of the higher long term complications, and many patients who have had a band are opting for other procedures. It is important to recognize that a different weight loss operation (such as the sleeve gastrectomy or gastric bypass) is more difficult and higher risk in a patient who has or has had a band in the past.
Adjustable gastric banding should not be used for someone who is a poor candidate for surgery, has certain stomach or intestinal disorders, has to take aspirin frequently, or is addicted to alcohol or drugs. It should not be used if someone is not able or willing to follow dietary and other recommendations, or for whom frequent visits to the office are prohibitive.