Gastric Banding

Another way to limit food intake is to place a constricting ring completely around the top end (fundus) of the stomach, creating an hour-glass effect, just like your Microsoft cursor! Except that the ring has to be placed near the upper end of the stomach, just below the junction of stomach and esophagus. This idea of gastric banding has been around for quite a number of years, and was pursued in Europe and Scandinavia particularly. Initially, readily available materials such as an arterial graft was used for the band. The results, however, were not as good as RGB or VBG and the concept has only become popular with the development of modern bands designed for the task and techniques to measure the size of the “stoma” created under the band and associated pressures. An ingenious variant, the inflatable band was developed by Dr. Kuzmak (Kuzmak, Yap et al. 1990) who devised a band with an inflatable balloon as its lining. This balloon was connected to a small reservoir which is placed under the skin of the abdomen, through which the balloon can be inflated, thus reducing the size of the stoma. It can also be deflated, thus enlarging the stoma. Even more ingenious has been the development of models which can be inserted laparoscopically, thus saving the patient the discomfort of a large incision. Since the hour glass configuration only constricts the upper stomach, with no malabsorptive effect, it acts as a pure restrictive operation. Like VBG, the favorable consequences are absence of anemia, dumping and malabsorption, while the disadvantages include the need for strict patient compliance. Long term results of this device are not yet available, but logic would suggest they are likely to be comparable to VBG results with an unknown additional effect due to manipulation of the inflatable balloon. At the present time there are two devices on the world market. The LAP-BAND manufactured by Bioenterics, Carpenteria, California and the Obtech device produced in Sweden by Obtech Medical AG. At this time only the LAP-BAND is freely available in the USA, having completed U.S. trials and been approved for use by the FDA. It is now produced by a company named Inamed. The REALIZE Band, which is the newest version of the Adjustable Gastric Band, varies from the LAP-BAND in that there is a built in website community to help keep you involved with your Band and grow a relationship with it. This community can be found at www.realizemysuccess.com.

Listing of Complications Following Gastric Banding

Operative:

• Splenic Injury
• Esophageal Injury
• Conversion to Open Procedure
• Wound Infection

Late:

• Band slippage
• Reservoir deflation/leak
• Failure to lose weight
• Persistent vomiting
• Acid reflux

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How is the Band Performed
Laparoscopic Adjustable Gastric Banding: A Restrictive Procedure

The Laparoscopic Adjustable Gastric Banding procedure is a purely restrictive surgical procedure in which a band is placed around the uppermost part of the stomach. This band divides the stomach into two portions: one small and one larger portion. Since the stomach is divided into smaller parts, most patients feel full faster. As the name indicates, the band is adjustable. So if the rate of weight loss is not acceptable, the band can be adjusted. Food digestion happens normally.

Advantages

• A 2004 meta-analysis of more than 22,000 patients showed that those who underwent a bariatric surgical procedure experienced complete resolution or improvement of their co-morbid conditions including diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea.
• 47.9 percent of type 2 diabetes cases were resolved.
• Significant improvements in overall cholesterol occurred, including a boost in HDL levels.
• 70.8 percent of hypertension cases were resolved or improved.
• Patients lost roughly 47 percent of their excess weight.
• The amount of food that could be consumed at a meal was restricted.
• Food passed through the digestive tract in the usual order, allowing it to be absorbed fully by the body.
• In studies involving more than 3,000 patients, excess weight loss ranged from 28 to 87 percent, with a minimum of two-year postoperative follow-up.
• Band can be adjusted to increase or decrease restriction via an access port.
• Surgery can be reversed.

Risks and Disadvantages

• The access port may leak or twist, which can require an operation to correct the problem.
• Surgery may not provide the necessary feeling of satisfaction that one has had enough to eat.
• Dumping syndrome, which may provide important warning signs, does not occur.
• Band may erode into the stomach wall.
• Band may move or slip.
• Weight loss is slower than that following Roux-en-Y gastric bypass surgery.
• The procedure, like any surgical procedure, could result in death.