Adjustable Gastric Banding


Adjustable gastric bands are prosthetic devices that are placed around the upper part of the stomach.  The band acts as a “govener” to regulate how fast healthy foods flow into the stomach.  Older banding devices (vertical banded gastroplasty) were not adjustable and patients had difficulty swallowing healthy food.  By adjusting the tightness of the band, you can control the amount of healthy food you eat at one time.  By reducing the volume and calories of food ingested, patients experience weight loss.

Procedure

The operation is performed laparoscopically with a small camera and light source.  The band is placed around the stomach just below where it attaches to the esophagus using long, thin instruments inserted through small incisions.

The band has an inflatable bladder that is used to make the band tighter or looser around the stomach, controlling the amount of food allowed to pass through the band.

Adjustments are made in our Band Evaluation Clinic at the office.  All adjustments (or “fills”) are made under x-ray guidance allowing more precise filling of the band.  The clinic affords a unique educational opportunity to our band patients because of the immediate visual feedback they get when viewing the adjustment results on the x-ray monitor themselves. The frequency and timing of adjustments depends on each individual. Adjustable Gastric Band (AGB) patients periodically require upper endoscopy to rule out erosion of the band.

The Lap-Band® is now FDA approved to be performed in patients with a body mass index (BMI) of 30 or more with at least one obesity-related comorbidity condition such as high blood pressure, heart disease, sleep apnea, Type-2 diabetes, or other conditions.

Advantages of Adjustable Gastric Banding
  • It is minimally invasive.
  • Laparoscopic placement.
  • It is adjustable.
  • It is removable.
  • It is reversible.
  • There is no stomach stapling, cutting or intestinal re-routing involved.
  • There is no dumping syndrome.
  • No division.
  • The patient experiences slower and steadier weight loss.
  • This procedure allows for ongoing absorption of nutrients such as Iron, Calcium, and B12.
  • It is a low risk procedure.
Risks
  • The Band may erode through the wall of the stomach causing loss of restriction to eating or Band infection.
  • The Band may shift or slip likely causing obstruction of the stomach, in which urgent re-operation is necessary.
  • This procedure may cause problems swallowing due to fatigue or damage of the esophagus.
  • The tubing and the port of the Band may become kinked, twisted, or broken, which would require re-operation.
  • There is a possibility that the surgery, since dealing with sensitive locations within the body, may cause damage to the stomach or other nearby organs or tissues. This may be addressed during surgery or may result in aborting the operation.
Contraindications

Some conditions preclude the insertion of an adjustable gastric band. If the patient has an autoimmune disease, severe heart or lung disease, cirrhosis or severe gastrointestinal disease they are not a candidate for adjustable gastric banding.

Recovery

Patients undergo laparoscopic adjustable gastric banding as an outpatient or as a 23 hour hospitalization depending on their health issues. Post-operative pain is normally well managed with oral pain medicine only.  An x-ray study will be performed to evaluate the band and a lower extremity venous ultrasound is routinely obtained to rule out blood clot formation in the legs before discharge.

Most patients are able to return to office style work in about a week, and unrestricted activity is allowed after one month.

Long term, patients need to follow up regularly in the Band Evaluation Clinic to monitor for band slips and esophageal dysfunction that can occur in some patients.  On average expected excess weight loss is about 40-50% for most patients.