Gastric Banding (Lap-Band®) Surgery
Gastric banding is commonly known and referred to by its trade name, Lap-Band®, representing the laparoscopic (minimally invasive) implantation of an adjustable band around the upper portion of the stomach to restrict food intake. The gastric banding system is currently the third most commonly performed weight loss surgery procedure in the United States and offers an adjustable and reversible option for those that have a relatively lower BMI. The first gastric banding system was approved in the United States decades ago, and since then, hundreds of thousands of bands have been placed in patients throughout the US and the world.
How it Works:
The gastric band procedure, like the other procedures that we perform here at Texas Health Rockwall, is performed laparoscopically, or in a minimally invasive manner. This means that rather than the single large incision that is used during open surgery, five small incisions are made in the abdomen through which small medical devices, called trocars, are passed. The trocars serve as passageways for the various medical devices, including a high-definition camera, that will be used to perform surgery.
During the surgery, the gastric band is placed around the upper portion of the stomach. The band is then tightened, resulting in the formation of two distinct stomach chambers. The smaller, upper chamber becomes the primary receptacle for food and its small size means that the patient will feel full sooner. The restriction provided by the band means that the food will not pass into the lower stomach as quickly, allowing for prolonged satiety. Once the food drops into lower stomach, it is processed and digested by the gastrointestinal system the same way that it was before surgery.
The band can also be adjusted via an access port beneath the skin, which is, in turn, connected to the band by thin tubing. While the port can be felt by touch, it is invisible from the outside. After surgery, we will use a specially-made needle to adjust the band. These are called “band fills” or “adjustments” and are routine. By injecting or removing saline from the band, the inner tube of the band is inflated or deflated. This tightens or loosens the band respectively, based on need.
VIDEO PROVIDED COURTESY OF ETHICON
The first fill or adjustment is usually performed 5 weeks after surgery. It is common to take several adjustments, with an average of three, to reach your initial “sweet spot” where the band is just right, providing portion control and prolonged fullness. From that point forward, fills are needed based on increasing portions of food, slowing of weight loss, and frequently after 20-30 pounds of weight loss. Once your goal weight is achieved, plan on annual assessments. Adjustments occur under radiology imaging called fluoroscopy, conducted with your surgeon, your nurse and a radiology tech.
Results of Gastric Banding:
The gastric band offers good results (albeit significantly lower potential excess weight loss than stapled procedures) and a lower risk of perioperative complications. While every patient will see different results, largely due to their willingness and ability to change their lifestyle after surgery, the average gastric banding patient will lose between 45 and 60% of their excess body weight. Those successful patients will see an improvement or elimination of the diseases associated with morbid obesity including type II diabetes, sleep apnea, high cholesterol and high blood pressure.
Advantages of the Gastric Band:
- The gastric band is adjustable and, in case of need, removable, offering patients the ultimate in flexibility. It should be noted, however, that the gastric band is intended to be a permanent solution.
- The gastric band does not involve the cutting away or rerouting of any portion of the gastrointestinal system, meaning that major complications and risk of mortality are reduced significantly.
- The band provides safe and measured weight loss at approximately a half a pound to 1 pound per week.
- Banding is performed laparoscopically and on an outpatient basis, meaning that pain and blood loss are reduced significantly and hospital stays and recovery times are minimized.
Considerations and Risks:
- Despite its excellent track record, gastric banding surgery is still major surgery and comes with the risks of any other procedure, which may be exacerbated by a patient’s poor health due to obesity.
- Weight loss with gastric banding is usually slow and steady compared to other procedures.
- Complications may include band slippage and erosion, or injection port flippage or separation from the band component. Each of these require follow-up surgery. These complications are more common than the complications associated with stapled procedures.
- If the band is removed, most patients will regain all of their weight.
- Banding patients will have a greater degree of follow-up because of the adjustability of the procedure – meaning that they will have to visit our office several times over the first two years, and periodically thereafter, for adjustments and valuations.
- A medical device will be placed in the abdomen and remain there indefinitely.
- Potential gastric banding patients should note that losing weight requires a great degree of self-control after surgery. This means changing their lifestyle, including significant diet and exercise modifications. The willingness and ability of the patient to change their lifestyle is fundamental to the success of the procedure over the long-term.
After Gastric Banding Surgery
The typical recovery time after a gastric banding procedure is just a few hours. In very few cases, a patient may have to spend a night in the hospital for further observation. Once home, patients will practice appropriate wound care and limit strenuous activities according to their postoperative guidelines. Return to work and normal activity will be based on a patient’s unique circumstance, but a return after banding is generally faster than after stapled procedures (gastric bypass and gastric sleeve).
Like other bariatric surgeries, gastric banding patients will take a multi-vitamin supplement, however banding patients have fewer dietary restriction than gastric bypass patients. Periodic blood tests will ensure that any nutritional deficiencies (unlikely common if post-operative instructions are followed) are found and addressed appropriately. As with any bariatric post-op program, patients will follow a diet and exercise program that combines moderation and nutritional balance.
Our program’s approach to food budgeting, exercise, vitamins, portion control, speed at which one eats, and behavior modification such as refraining from drinking while eating is exactly the same regardless which procedure is chosen.
In order to learn more about the gastric banding system, we invite you to a consultation with one of our surgeons who will explain the advantages and risks of the procedure and help determine if it is the best course of action for you.
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