Laparoscopic Adjustable Gastric Banding
The body’s natural reaction is to vigorously defend against weight loss through compensation in energy intake and expenditure. Surgical manipulation to induce weight loss appears to be more sustainable. The band is a purely restrictive procedure.
Laparoscopic adjustable gastric banding is considered the safest, least invasive, and only adjustable surgical treatment for morbid obesity. It induces weight loss by reducing the capacity of the stomach, which restricts the amount of food that can be consumed.
The band (figure 1) is placed around the stomach just below the gastro-oesophageal junction. The varieties of band all observe the same general principles: A soft, flexible, and adjustable balloon or cushion against the stomach, connected by a tube to a reservoir port system which is accessible from outside and allows adjustment of the band (figure 2). The band probably acts to enhance a sensation of fullness.
This procedure involves placing an inflatable silicone band into the patient's abdomen. Like a wristwatch, the band is placed around the upper stomach to create a new, 15 – 30 cc stomach pouch that limits and controls the amount of food eaten. It also creates a small outlet that slows the emptying process into the stomach and the intestines. To modify the size of the band, its inner surface can be inflated or deflated with a saline solution. After the operation, the surgeon can control the amount of saline in the band by entering the port with a fine needle through the skin. As a result, patients experience an earlier sensation of fullness and are satisfied with smaller amounts of food. This restriction with adjustable control enables a slow but consistent weight loss.
Since there is no cutting, stapling or stomach re-routing involved in the adjustable band procedure, it is considered the safest and least traumatic compared to other weight-loss surgeries.
If for any reason the adjustable band needs to be removed, the stomach generally returns to its original form, but most patients will likely regain their weight..
Adjustability: The diameter of the band is adjustable for a customized weight-loss rate. Your individual needs can change as you lose weight. For example, pregnant patients can expand their band to accommodate a growing foetus, while patients who aren't experiencing significant weight loss can have their bands tightened.
Weight-loss results vary from patient to patient, and the amount of weight you lose depends on several things. The band needs to be in the right position, and you need to be committed to your new lifestyle and eating habits.
Obesity surgery is a tool to aid weight loss – not a cure.
Surgery is not a miracle cure for obesity - the pounds won’t come off by themselves.
It is very important to set achievable weight-loss goals from the beginning. A weight loss of 2 to 3 pounds a week in the first 6 months after the operation is possible, but one pound a week is more likely.
Twelve to 18 months after the operation, weekly weight loss is usually less. Gastric bypass patients lose weight faster in the first year.
The average EXCESS weight loss achieved after adjustable banding is in the range of 40% to 60% 18 months to 2 years. At 5 years, some adjustable banding patients may have achieved weight loss comparable to bypass patients.
Aftercare
Patients can drink straight away upon recovery from the anaesthetic. ITU admission following bariatric procedures is rare and if needed is ideally planned. One could expect older, heavier patients and those suffering from complications or undergoing redo procedures to require ITU admission. Patients are put on a liquid diet for 2 weeks then a soft diet for 2 weeks before resuming a diet of more normal consistency.
Follow Up
Adjustability is a key feature of the band systems and knowing when and how much to adjust requires careful judgment. A properly placed and adjusted band helps to enhance satiety after a small meal.
Band Adjustment Schedule
This is tailored to the individual patient. The first injection or band fill is done 4 -6 weeks after surgery. The band is filled through the reservoir port in the out patients clinic. X-rays are rarely required to do this. The band has a capacity of 5-9mls but many patients only require 3-5mls to achieve the required restriction.
Advantages of Lap-band surgery:
- Lowest mortality and complication rate
- Least invasive surgical approach
- No stapling, cutting, or intestinal re-routing
- Adjustable
Disadvantages of Lap-band surgery:
- Initially, weight loss is slower compared to the gastric bypass procedure.
- Weight loss with adjustable banding is quite variable. While some patients have excellent weight loss with the device, others have less.
- It is not an effective treatment for sweet-eaters.
- Regular follow-up appointments are recommended for optimal results.
- Everyone requires multiple band adjustments (at least 3 or 4). Some people require substantially more adjustments. For some people, it may be difficult to find the "sweet spot" where the band is tight enough for good weight loss but not so tight that it causes vomiting.
- The surgery requires implanting a foreign body. Late complications such as erosion of the band into the stomach, or slippage may occur
