Adjustable Gastric Banding

Background

The laparoscopic adjustable gastric band (LAGB) is the most common weight loss procedure performed in Australia. It is regarded as the safest obesity operation currently available. It’s a great device, which many patients have used to reach a better weight and improve their health.

Who Qualifies for A Gastric Band?

You may be eligible for an adjustable gastric band if you have a body mass index (BMI) that is greater than 40 (or greater than 35 with weight related illnesses) and you have tried multiple other types of diets without long-term success.

Surgery

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The operation of gastric banding is performed with laparoscopic (keyhole) technique under general anaesthesia. Five small incisions are made in the abdomen where laparoscopic instruments are inserted. The adjustable silicon ring (gastric band) is fitted around the top of the stomach and then clipped into place. A fold of stomach is sewn over the band to reduce the chance of a slippage. The band is connected to a small tube and access reservoir (port) which is used to add or remove fluid from the band. The final step of the operation involves fixing the port to muscle under the skin at one of the incision sites.

Expected weight loss

In general patients can lose up to half to two-thirds of their excess body weight. The time frame that this will take will vary from person to person, but an initial goal weight is usually reached approximately 18 to 24 months after surgery.

Regular band adjustments are vital to the success of the band. Achieving the correct amount of restriction to have good weight loss and good quality of life requires the band to be adjusted every 4-6 weeks for the first 12-18 months post placement. The frequency of these adjustments can vary from person to person. It is really important to adjust the band such that the restriction is not too loose and not too tight. You must work with your doctor to get this right as both too loose and too tight can reduce your weight loss.

Gastric Banding Procedure – Green Zone

A ‘Green Zone’ diagram is used to help you to identify when you need an adjustment. This concept, displayed as a colour spectrum, is used to describe where you are in regards to your hunger and eating regime. Yellow represents caution and indicates you are ‘not quite there yet’. Red indicates it is time to stop and that the band is too tight. Green means ‘go’ and is the ultimate zone where you are fully satisfied after modest meals, eating the right kinds of foods and losing weight. The following video describes this concept in more detail.

Advantages of Gastric Banding

  • This procedure does not require parts of the stomach to be removed or stapled as with other bariatric procedures. Nutrients are therefore absorbed from food in the same way that they were prior to surgery.
  • It is the safest of the weight loss procedures.

Disadvantages of Gastric Banding

  • The intensity of follow up. Frequent band adjustment appointments, especially in the initial stages post-surgery, are required to achieve sufficient restriction.
  • For safe and effective weight loss with the band, the dietary and eating habit changes are radical and difficult for some patients to achieve (such as eating small mouthfuls, chewing well and eating slower)
  • Weight loss results are often variable compared with more aggressive weight loss surgery, such as the gastric sleeve or bypass. Weight loss in the long term also tends to be more difficult after gastric banding as opposed to other weight loss procedures
  • The gastric band is a mechanical device and therefore there can be issues in the long term. Some patients may need further surgery in the future to revise, read just or modify the band in some way.

Risks of the Gastric Banding

As with any surgical procedure, the gastric banding operation has a risk profile which is important to understand before proceeding. The following is a comprehensive list of issues which can occur. This list is extensive and is not intended to worry you, but simply inform you about the range of possible complications, regardless of how rare the issue may be.

Possible Acute Complications

Acute complications are very rare after gastric banding, but can include:

    • Infection of tissues around the port site or the band. This can require treatment with antibiotics and in exceptional circumstances removal of the band.
    • Damage to organs – Any keyhole procedure can be complicated by unintentional injury to the organs near the area of operation. This may require a repeat operation, removal of the band and repair of the damaged organs.
    • Deep Venous Thrombosis (clots in the veins) and pulmonary embolus (clots in the lungs).
    • Pneumonia/chest infection

Your surgical team will take all possible measures to reduce these risks, but if these complications occur, treatment may be necessary.

Possible Long Term Complications

There are some possible long term surgical problems related to the device itself:

  • The band can slip (move too high or too low on the stomach)
  • The band can erode (appear within the stomach cavity) and this can require the band to be removed. This complication is up to 1%.
  • Long term complications with adhesions (scar tissue) formation.
  • Gastric pouch dilatation, or oesophageal dilatation, above the band can occur as a result of over eating on a regular basis. This increases the volume of food that can be taken at one time which can lead to weight regain. If this occurs, a revision procedure might be required to modify or improve the band position. When this is recurrent or persistent, the band may need to be removed.
  • Nutritional deficiencies. These are very rare after gastric banding. If they are found, they can usually be easily managed with vitamin and mineral supplementation and with regular review by your dietitian.

Occasionally these issues require urgent medical and surgical intervention.

The band is simply a mechanical device, and like all devices can require maintenance long term. Some people may require some sort of revision surgery in the future to improve the position of the band.

Pre-Operative Diet

When you have a date for surgery, you will be advised to have a very low calorie liquid meal replacement diet for 14 days prior to surgery. OptifastTM is the recommended meal replacement and is available from your local Chemist. The diet helps you to lose weight, particularly from the liver, and therefore optimizes the safety of the procedure. You will receive more detailed information about this when you see your dietitian.

Post-Operative Care

The hospital stay after surgery is generally one night. After the procedure you will start on clear fluids only (water, black tea, broth, juices). These will need to be sipped slowly in small amounts. Before going home you will have an x-ray to check the position of the band. You will then be able to have free fluids for the rest of your hospital stay. During the next 4 to 6 weeks, while your body heals, you will gradually increase the texture and volume of the food you take. Further information, including a dietary guidelines booklet, will be provided at your appointment with your dietitian.

Appointments

Surgeon

  • The first post-operative clinic visit will be arranged about 1 to 3 weeks after surgery. At this appointment your wounds will be assessed and any other issues will be discussed.
  • Your first band adjustment appointment will generally take place 4 to 6 weeks following surgery. You will then see the surgeon 2 to 4 weekly initially to achieve an appropriate band fluid volume, then decrease frequency of surgical consultations thereafter.

Dietitian

The MHNS dietitian will phone you within the first week following surgery to review your intake.

Your first post-operative clinic visit will be at 3 to 6 weeks following surgery and then 3 to 6 monthly thereafter.

Gastric Banding Procedure – Health Benefits

It is important that you maintain regular contact with the MGOS/ MHNS team following the insertion of your gastric band. This will help you to achieve all of the health benefits of the gastric banding procedure.

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