GASTRIC BANDING

The development of the modern adjustable gastric band was the vision an early pioneer, Kuzmak in 1983 and was optimized in the last decade. The greatest advantage of this procedure is that is considered by many, to be the least invasive surgery for weight loss.

The procedure involves placing an implant, a soft silicone ring with an expandable balloon in the center, around the top part of the stomach. It effectively creates a two-compartment stomach, with a much smaller top part above the band. A person eats enough food only to fill the top part of the stomach. Over time, after the meal, the food passes through the opening of the band into the remainder of the stomach, and digestion occurs normally. The band is attached to an injection port under the skin via a soft tubing, which allows adjustment of the band’s tightness by inflating or deflating the balloon in the band. Adjustments to the band are easily performed in the office and require no special preparation.  Adding saline to the band makes the orifice between the two parts of the stomach smaller, making the passage of food from the top of the stomach to the rest of the stomach slower. Removing saline from the band allows more rapid passage of larger particles of food to pass. Most of the times, the band is adjusted periodically.

WHO SHOULD HAVE A GASTRIC BANDING SURGERY?

The indications are the same as in the sleeve gastrectomy. Contraindications include: scarring inside your belly which could lead to a blockage in your bowel, existence of hiatus hernia, vomiting from eating more than your stomach pouch can hold, a previous surgery to the stomach area and hepatomegaly that can sometimes prevent a laparoscopic surgery.

RESULTS

In order to succeed patients must be willing to make major changes in their eating habits and lifestyle.  Mindful, planned eating with healthy food choices (no food high in fat and sugar, soft calorie syndrome), careful chewing and not mixing solid food and liquid at a meal are critical to success. Inability to comply with these behaviors will result in adverse symptoms such as vomiting, reflux, or pain. In addition, a comprehensive follow-up program including dietary counseling and often monthly visits for weigh-ins and possible adjustments increase the chances of durable success.

The adjustable gastric band procedure was first approved by the FDA for use in the US in 2001 but the long-term results and the complications of this method have not been estimated in full. Short-term post-surgical risks are minimal (<1%). There might be bleeding, stomach perforation and/or the gastric band might erode through the stomach. Most complications appear several months, or even years after the surgery (usually after 2 years).  Most often complications are: Stomach may slip up through the band, stomach perforation, gastroesophageal reflux disease and/or band erosion.  No one can foresee if the band might be problematic since we do not know the life expectancy of the band. Complication percentages are between 15-45% at about 5 to 8 years, after the surgery.

BENEFITS

The only benefits of this specific surgical method is that is the least invasive surgery for weight loss and that the band can be adjusted. It is performed laparoscopically, after surgery pain in minimal and the hospital stay is up to 24 hours (a day). The patient can eat right after the surgery is performed. Since there is not a big surgical incision, there are no typical open surgery complications, like hernias. The band can be easily removed, in case there are complications.

RISKS

Adjustable gastric banding should not be used for someone who is a poor candidate for surgery, has a BMI>55, has certain stomach or intestinal disorders, has to take aspirin frequently, or is addicted to alcohol or drugs. It should not be used if someone is not able or willing to follow dietary and other recommendations, or for whom frequent visits to the office are prohibitive. The cost of the band in the Greek market is high (about 3,000€). The “life expectancy” of the device is not yet known and has no guarantee coverage.

WARNING

The number of laparoscopic gastric banding performed worldwide as a bariatric procedure has grown exponentially in recent years, given the simplicity of the technique, the low complication rate and the good short- and mid-term results regarding weight loss and the resolution of co-morbidities. However, there are a limited data from long-term studies. In this study, a standardized LSG proved to be safe (no mortality and a leakage rate of 1.2%) and highly effective in terms of weight loss after 5-year of follow-up, particularly in patients with a low preoperative body mass index. This manuscript provides additional evidence supporting the role of laparoscopic sleeve gastrectomy as a stand-alone procedure for selected morbidly obese patients. Adjustable gastric banding should not be used for someone who is a poor candidate for surgery, has certain stomach or intestinal disorders, has to take aspirin frequently, or is addicted to alcohol or drugs. It should not be used if someone is not able or willing to follow dietary and other recommendations, or for whom frequent visits to the office are prohibitive.

  • Complications are increasing each year that passes by (4-5%/year). Also, they can happen at any time. In some clinics, the total percentage of minimal or maximal surgeries due to complications is over 20%, after only 3 years.
  • Mortality due to complications of a second surgery is up to 5-8 times higher than those of the primary surgery.
  • Success is not a given. Only 35- 40% without any complications show a stable weight loss in 8 years after the surgery.
  • Removing the band means gaining back the lost weight, up to 90% of the cases.

TODAY

After more than 200,000 cases of gastric banding surgeries in bariatric clinic in Europe, the surgeons tend to prefer other methods such as sleeve gastrectomy and gastric by-pass. Most commonly, due to the fact that has limited benefits, a high cost of postsurgical care and many complications. Indications of the gastric banding surgery, tend to be minimized to those that have a BMI<35-40.

 

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