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Weight Loss Surgery: Gastric BandingPhoto By: Tanvir Alam/ CC BY
Gastric banding or lap band surgery is one of the many types of weight loss surgery you can opt for. This type of surgery is called restrictive surgery and is one of the various techniques used to reduce stomach size. Once this type of surgery has been carried out, people will lose weight by feeling more satiated and eating less. The various kinds of restrictive surgery are laparoscopic adjustable gastric banding, sleeve gastrectomy, and vertical banded gastroplasty.
Lap band surgery or gastric banding is also called:
- Bariatric surgery- laparoscopic gastric banding
- Weight loss- gastric banding
- Laparoscopic adjustable gastric banding
- Obesity- gastric banding
How Gastric Banding Causes Weight Loss
Adjustable gastric banding or realize band surgery is held to be one of the least invasive and most pain-free procedures for weight loss. Placing a soft silicone ring with a balloon that can be expanded in the center divides the stomach into two compartments, with the top part that is smaller above the band. Only the top part of this stomach is the cavity where the food will go, so the person eats less. Over a period of time, the food then reaches the lower part of the stomach and digestion occurs naturally.
The band is connected to an injection port through soft tubing under the skin. This permits the band to adjust for the individual size and tightness by expanding or contracting the balloon. Adding saline to the band makes the opening between the stomach's 2 parts smaller and vice versa.
Adjustable gastric band surgery is a US FDA-approved procedure. It was first approved in 2001 and is currently permitted for those with body mass index of higher than 35. It is also recommended for those in the BMI range of 30-35 with comorbidities or obesity based medical conditions such as sleep apnea, hypertension, and diabetes, who have not lost weight using all other methods.
To be successful, the patient must make lifestyle changes as well as modifications in eating habits such as not mixing solid and liquid food at the meal time, chewing carefully and eating mindfully. Failure to do this will result in pain, acid reflux, nausea, and vomiting. Comprehensive follow-ups are also essential along with regular exercise for a healthy lifestyle.
Average weight loss following this surgery has been found to be in the range of forty to sixty percent. There is a wide variation in weight loss based on the motivation of patients and compliance with instructions following the surgery. In one such study of patients with BMI ranging from thirty to forty, 80 percent of the patients lost over thirty percent of their excess weight and remained trim for one year. The quality of life for patients also significantly improves following weight loss surgery.
What is Lap Band Surgery?
Also known as gastric banding, this surgical procedure involves the use of laparoscopy to implant adjustable silicone bands in the upper part of the stomach. Once the silicone band exerts pressure, the stomach is reduced to a pouch sized cavity with an inch long outlet. Once banding is done, only an ounce of food can be held in the stomach.
How It Works
A plastic tube is attached from the silicone band to a device placed under the skin. Saline or sterile salt water is injected or removed, flowing from the silicone band or into it. The saline causes the band to fill out and tightens it. The band can then be made tighter or looser depending upon the requirements to cope with side effects and encourage loss of weight.
The band restricts the food that can be eaten by ensuring the person feels full after eating even low amounts of food items. Once the surgery is done, the band can be adjusted to control the speed with which food passes through the stomach.
How is Lap Band Surgery Performed?
Once the patient is placed under anesthesia, he or she will remain unconscious and unable to feel pain. The procedure for the gastric banding surgery is as follows:
- A microscopic camera is placed within the belly of the patient.
- The camera is referred to as the laparoscope.
- It permits the surgeon to observe the inner portions of the belly.
- Around one to five surgical cut will be made to the abdominal region by the surgeon.
- The small cuts will accommodate the camera and tools for performing the surgery.
- A band will be placed around the upper part of the belly to separate it from the lower stomach area.
- The small pouch that is created has a narrow orifice going into the larger, lower part of the stomach.
- No cutting or staples are placed in the stomach during the course of the surgery.
- The entire procedure will take thirty to sixty minutes.
When you eat food after the surgical procedure, the small pouch will quickly fill up after small portions of food. It will then be released into the lower stomach through the opening gradually.
Precautions Regarding Surgery
There are certain restrictions on people who can be candidates for this surgery. Some of those exempted from this surgery include:
- Those with digestion problems
- Those with intestinal disorders
- Those on aspirin
- Those addicted to certain substances(drugs/alcohol etc)
- Those not willing to undertake post-operative care
- Those who cannot follow medical conditions post surgery such as dietary restrictions.
Why is Lap Band Surgery Performed?
Weight loss surgery such as gastric banding is only an option for those who are extremely obese and have been unable to lose weight via natural methods such as diet and exercise.
Laparoscopic band surgery is not a quick solution for weight loss, and if you do not follow the guidelines, you may have complications or lack of weight loss even after gastric banding.
Doctors use body mass index to ascertain which people would be likely to suffer from weight loss surgery. Normal BMI ranges between 18.5 and 25.
Those who are recommended this surgery include:
People with BMI 40 or more.
People with BMI 35 or more and a serious medical condition associated with obesity such as heart disease or hypertension.
Risks for lap band surgery include:
- Anesthesia maladministration
- Allergies to medications
- Breathing difficulties
- Blot clots reaching the lung
- Blood loss
- Infection in the lungs, bladder, kidney or site of surgery
- Heart attack/stroke following surgery
- Erosion of gastric band through the stomach
- The stomach can slip through the band (this requires critical surgery)
- Gastritis, heartburn, digestive ulcers in the stomach
- Damage, injury to stomach, or other organs such as the intestine.
- Lack of nutrition
- Scarring in the stomach leading to blockage of the bowel
- Access port becomes inaccessible so the band cannot be loosened or tightened
- Tubing near access port becomes punctured during access with a needle
- Vomiting from eating more than the pouch can accommodate
Before the Surgery
The surgeon will also ask for tests and visits to health care providers before surgery is performed. Blood tests and other assessments may need to be carried out to make sure you are healthy enough for surgery.
You will also have to undergo training about what will happen during the surgery, what post-operative care to undertake and risks or problems that may take place.
A detailed physical exam and nutritional counseling are also a must. Check with a healthcare provider about readiness for surgery and check other medical problems such as high BP, diabetes, and heart or lung problems are under regulation.
You need to tell the doctor about drugs, vitamins, supplements, and herbs taken and in case you are pregnant.
Before the surgery, you will be asked to stop taking medicines that make it hard for blood to clot such as aspirin. You cannot eat anything or drink beverages up to 6 hours before surgery.
Following the Surgery
Most patients go home on the day of the surgery once the operation is complete and take one to two days to resume normal activities. For two to three weeks after the surgery, only liquid or mashed food items are permitted. Soft and then regular food is added by the time six weeks is up.
As the band is made of silastic rubber with a balloon, your doctor may tighten or loosen it depending on the need. The band will have to be adjusted if:
- The patient is having problems in eating
- Weight loss is not enough
- Vomiting occurs after eating
Results and Prognosis
Final weight loss with lap band surgery is 1/3 to 1/2 of the excess weight being carried. Weight loss may take place for as long as 3 years from the surgery and is a gradual process. Losing weight after surgery can improve the following conditions:
This surgery alone is not a means of losing weight. You need to exercise discipline and control as well, following exercise and dietary restrictions keeping all this in mind. Gastric banding is the safest weight loss surgery. It also has another benefit– the procedure can be reversed anytime and the stomach returns to its normal size.
Who Should Opt for Gastric Band Surgery?
Only individuals with BMI of greater than 35 are slated for weight loss surgery. Only in the case of severe obesity where body mass index is 35 or greater, is gastric band placement recommended. When BMI is over 30 but the patient also suffers from other conditions like diabetes, sleep apnea and hypertension, gastric band surgery may also be considered. Surgery is considered only after treatment forms have failed, such as dietary lifestyle changes and activities as well as medications.
This form of weight loss surgery is not recommended for those with current alcohol or drug abuse, uncontrollable psychiatric conditions or even impairment in the capacity to understand lifestyle changes, risks, benefits, and alternatives demanded.
The Benefits of Gastric Banding
Advantages of this gastric banding include the chance of long-term weight loss for those facing obesity. Additionally, there's a chance for rapid recovery. Smaller chances of wound infections and hernia result post a surgery. Reduced risk of diabetes, urinary incontinence, high blood pressure and other conditions associated with more weight are also other benefits. No loss of nutrient absorption and improved life quality after surgery are some of the other benefits. Removing or adjusting the band is also possible. Adjustability means the band can be tightened or loosened. This is more so if not enough weight is lost or there is vomiting after food intake. On an average, anywhere from 40 to 60 percent of excessive weight loss may result, but this depends on the individual.
The Risks of Gastric Banding
There are risks associated with having a gastric band, too. Any weight loss surgery offers a lot of operation-linked issues such as general anesthetic. Individuals may also have an adverse reaction to anesthesia including breathing problems, allergic reactions, blood clots in legs traveling to the lungs, blood loss, infection, heart attacks or strokes pre or post the surgery.
Weight loss may be less rapid compared with other forms of surgery. The band can also slip post its insertion or erode into the stomach, requiring removal. The port shifts, making additional surgery required. Anywhere from 15 to 60 percent of people need to go in for follow-up surgery. Individuals need to follow the recommendations for the diet with care, as overeating leads to dilation of the esophagus or vomiting.
As with different types of weight-loss surgery, gastric banding comes with its fair share of risks. Injury during surgery to stomach, intestines or other abdominal organs or even hernia can be a byproduct of gastric banding. Inflammation of the stomach lining, heartburn, and ulceration in the stomach can also be a result. Then there's wound infection, gastrointestinal scarring leading to bowel blocking or lack of nutrition due to restrictions in food intake. If the person undergoes a procedure for sudden weight loss, there may be some issues such as a lack of quick weight loss.
A gastric band is not the only form of weight loss surgery. There's also Roux-en-Y or gastric bypass surgery. In this procedure, the surgeon staples the stomach to ensure it becomes smaller and then is affixed in the stomach straight into the smaller intestine. This reduces nutrient intake and absorption of other nutrients or calories. However, it does change the hormones in the stomach and reduces nutrient absorption. It is not easy to reverse.
Then, there's sleeve gastrectomy which involves removing a massive stomach portion and leaving the tube or banana-shaped sleeve closed with staples. This reduces the food needed to feel full, but it can also disrupt the metabolic rate. It is not possible to reverse this procedure.
Other options include the duodenal switch. Surgery involves dual procedures. First, the food is redirected to the small intestine by the surgeon. Next, the food is redirected into a bypass of the small intestine. Weight loss is quicker, but risks are far more. These include nutritional deficits and surgery-related issues.
Lap band surgery-gastric banding is a restrictive weight loss surgery with many benefits for the patient. Apart from weight loss, this surgery can also cure medical conditions resulting from obesity. Your doctor can guide you on more details about this weight loss surgery.