Gastric Band

Laparoscopic Bariatric Surgery

In laparoscopy, the surgeon makes one or more small incisions through which slender surgical instruments are passed. This technique eliminates the need for a large incision and creates less tissue damage. Patients who are super-obese (more than 350 pounds) or have had previous abdominal operations may not be good candidates for laparoscopy, however. Adjustable gastric banding is routinely performed via laparoscopy. This technique is often used for Roux-en-Y gastric bypass. The small incisions result in less blood loss, shorter
hospitalization, a faster recovery, and fewer complications than open operations. However, combined laparoscopic procedures are more difficult to perform than open procedures and can create serious problems if done incorrectly.

Laparascopic Gastric Band

The laparoscopic installation of an Adjustable Gastric Banding System is the most common form of bariatric surgery in Europe. It induces weight loss by reducing the capacity of the stomach, thus limiting the quantity of food that can be consumed at once. As there is no stapling, cutting or bypass involved, this procedure is thought to be the least traumatic kind of bariatric surgery.

How it’s done

This procedure is performed under a general anaesthetic, and lasts between 20 and 40 minutes. An adjustable silicone band is introduced laparoscopically through the abdomen, using several tiny incisions, and placed around the upper part of the stomach (figure 5). The risk of band slippage is reduced to 1% by taking precautions to fix the device and immobilise the stomach. The resulting pouch greatly reduces the working capacity of the stomach, making the patient feel full early during a meal.

The gastric band, which contains an inflatable balloon on its inner ring, connects to an access-port or reservoir beneath the skin by a thin, kink-resistant silicone
tube (figure 6). This port is generally placed in the upper left abdomen, and lets the surgeon adjust the size of the band, so as to control each patient's rate of weight loss. By adding saline through the port, the band's inner balloon is inflated, thereby decreasing the rate of food consumption—this is called a 'fill'. Similarly, the saline can be removed, causing an increase in the rate of food consumption.
This usually takes two adjustments to find the right level of restriction, but additional adjustments may be required. The first one is usually six weeks after surgery.

Adjusting The Band

By injecting fluid (saline) into the hollow adjustable gastric band, the size of the opening between the upper and lower parts of the stomach can be tightened to reduce the amount of food passing from the upper part of the stomach to the lower. Conversely, if fluid is removed the band is relaxed, the opening is larger and hence more food is allowed to pass from the small pouch above the band, into the main body of stomach below. The band is connected by a tube to a reservoir placed beneath the skin during surgery, usually at the lower end of the breast bone. The surgeon or Nurse Practitioner can later control the amount of saline in the band by piercing the reservoir through the skin with a fine needle.


figure 5	figure 6

Recovery

Hospital time lasts between one and two days. Some discomfort from the operation is common, but lasts only a week or less.

Dietary requirements

As the gastric band procedure is purely restrictive, the patient must not consume high-calorie liquids, which can ruin the process of weight loss. Besides this, the following guidelines are recommended:

Eat at least three times a day.
Eat only solid foods, as the band does not restrict liquids.
Chew thoroughly, as this makes the food less likely to damage the band, and causes an earlier feeling of fullness.
Do not drink liquids with your meals, as this can cause the food to be washed too quickly through the band.

A dietary consultant will provide personalised advice after the procedure.

Complications

Operative complications are very rare, as the stomach is not cut or stapled, but only mobilised. However, the following symptoms can occur after the operation.

Vomiting

Vomiting, while painful, can be productive; possible causes are eating too fast, eating too much and chewing too little. When vomiting is frequent the patient must adjust his or her eating behavior, or, if necessary, the band can be deflated a little.

Acid Reflux

Heartburn, the regurgitation of acid from the stomach into the oesophagus, is the most common symptom. It occurs when the band is too tight, or with the swelling of the stomach lining. Medical treatment or deflation of the band may be necessary if symptoms persist.

Slippage

This complication, which occurs less than 1 percent of the time, is when the upper stomach pulls the lower stomach through the band, thus pushing the band down on the stomach. This causes varying degrees of intolerance to solids or liquids, or even total obstruction. All slips require surgical repositioning, and sometimes the removal of the band as well.

Erosions

Although very rare, erosion does occur occasionally. The gastric band is subject to natural reactions, and can be dissolved. Every erosion requires surgical removal.

Port Problems

Rare complications include infection, seroma or hematoma. Breakage of the port can also occur, though the band itself is guaranteed not to break. Port leaks are rare and are usually related to the disconnection of the device or a sticking needle. A port replacement can be done under local anesthaetic as an ambulatory procedure.

Additional complications include tube rupture/disconnection, abscesses, pouch dilatation. However, in general the benefits greatly outweigh the relatively small risks involved

What Are The Benefits of Gastric Banding?

Because the stomach banding is adjustable, removable and does not require permanent alteration to the anatomy of the stomach or intestines, it provides an option for patients who may not otherwise consider surgery for treatment of their obesity. Other advantages include a shorter hospital stay and the surgery has no effect on food and nutrient absorption through the intestines.

Weight is lost during the first 2 to 3 years after gastric band surgery and follow-up data indicates 50-60% excess weight loss at 5 years. Importantly, this weight loss translates into dramatic improvements in weight-associated co-morbidities. Patients report improvements in mood, mobility, exercise capacity and sleeping patterns. Blood pressure and cholesterol levels are reduced and the majority of type 2 diabetes are cured.

Due to the relative safety of the procedure, the adjustability and reversibility of the band and the impressive health benefits, gastric band surgery is increasingly regarded as the optimal initial approach for the control of obesity and associated medical conditions.