ADJUSTABLE GASTRIC BAND

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[ General Information About Bariatric Surgery ]

The adjustable gastric band (AGB) operation (also known as Lap Band) is a weight loss surgical procedure in which an adjustable band is placed around the upper portion of the stomach using a minimally invasive, laparoscopic procedure. The decreased size of the stomach and narrowed outlet limits the food intake and an increases the feeling of fullness. Both effects result in a drop of body weight. The procedure is usually done under general anesthesia and requires one or two nights stay in the hospital. A special diet will follow the first two weeks after the procedure. It is considered  one of the safest bariatric procedures performed today. (8)

Mechanism of weight loss

An inflatable silastic band is placed around the stomach creating an hour-glass shape. Food enters the upper part of the stomach, then trickles slowly down through the band-controlled opening into the lower part and then passes normally into the small intestine. The small pouch at the top of the stomach holds about 50ml of food. This pouch normally fills up with food very quickly and sends signal to the brain that the stomach is full. This signal helps the patient to eat smaller portions and therefore consume fewer calories. Even if the patient wishes to eat more, the small size of the upper stomach pouch will accommodate a very small amount of food, and excess food swallowed will be vomited.

Mode of Inflation of the band

The silastic band is inflated and adjusted by introducing isotonic saline via a needle through a small access port positioned under the skin. As the fluid reaches the gastric band, the band swells thus increasing the pressure around the stomach. This decreases the size of the passage between the upper and lower pouches and further restricts the movement of food. Conversely, by removing fluid from the gastric band, pressure is decreased, permitting faster gastric emptying and a greater food intake. Usually, the stomach band is not inflated or "filled" during the actual operation. Most Lap Band surgeons choose to introduce only a small amount of fluid into the band at the time of placement. This is because the stomach tends to expand immediately after surgery.

Positioning of the band

It's vital for the silastic band to be correctly positioned, which typically requires a number of adjustments after the bariatric surgery. Such adjustments (AKA "fills") can be performed by using X-ray fluoroscope techniques, to enable the radiologist to view and assess the placement of the band, as well as the tube which connects the port and the band. This technique is always used if the port has partially rotated or if there is excess tissue above the port. The fluoroscopic process involves the patient swallowing a small amount of radio-opaque fluid called a 'barium meal', which shows up on the X–ray as it passes through the esophagus and through the small passageway between the upper and lower stomach pouches. This allows the radiologist to view the level of restriction to judge if there are any potential or developing health complications. These health problems include: dilation of the esophagus, an enlarged pouch, prolapsed stomach, erosion or migration of the band. Gastric Band patients need to regularly visit a bariatric center to evaluate the position of the band. In some circumstances revision bariatric surgery may be necessary to remove the band.

Comparison with gastric bypass surgery or vertical sleeve gastrectomy

Stomach banding does not involve any form of gastrectomy (as in Biliopancreatic Diversion or Sleeve Gastrectomy with or without bypass), nor does it entail any change in the passage of food through the duodenum or jejunum. Unlike gastric bypass, stomach banding is fully reversible. Such revision is typically done laparoscopically by, whereupon the stomach reverts to its regular pre-banded shape and function. These patients have a much reduced health risk of nutritional deficiencies or malabsorption of vitamins/minerals. Thus calcium and vitamin B12 supplementation is not mandatory, as it is after bypass surgeries such as Roux-en-Y or Duodenal Switch. Also, there is no risk of gastric dumping syndrome, because the intestinal tract is left intact.

Effectiveness

In general, the typical gastric banding patient loses 1-2 pounds per week, but weight reduction is faster immediately after surgery. This weekly weight loss adds up to roughly 50 to 100 pounds the first year.(8) Weight loss results for gastric banding are typically less impressive than for bypass surgery, although some evidence suggests that long term weight reduction is not that different. American experience indicates that early weight loss is slower for banding patients than for bypass patients. However, in Australia, where Lap Banding accounts for the majority of bariatric operations performed, long term weight loss results (after 5 years) for stomach band patients are close to those achieved by Roux-en-Y patients (50-60 percent loss of initial excess weight), although early weight reduction remains slower.(8)

Indications

In general, stomach banding is indicated for people who conform to all the following criteria:

• Have a Body Mass Index above 40, or those with a BMI >35 with severe co-morbidities, like high blood pressure, diabetes, sleep apnoea, arthritis, or mobility problems.
• Are aged 18-55 years.
• Have tried and failed to lose weight using diets and/or weight-loss drug therapy for more than 12 months.
• Have a minimum 5 year history of obesity.
• Who understand the risks and benefits of the procedure and are strongly motivated to comply with the post-op diet and fitness guidelines necessary for long term weight control.

Contraindications

In general, stomach banding is contraindicated if the surgery represents an unreasonable risk to the patient, or in the following cases: If the patient has any inflammatory diseases of the gastrointestinal passage, such as ulcers, esophagitis or Crohn’s disease, or any other health conditions which render them poor candidates for general surgery. Gastric banding is also not suitable for anyone with an allergic reaction to materials contained in the band.

Adjustable Gastric Band in Germany

Or center for bariatric surgery is a leading institution with an established track record with this procedure. The bariatric surgeons are able to assess the risks and benefits of each procedure together with you and will, based on your personal requirements, suggest a procedure that is most suitable for you. Please contact us for more information.