Adjustable Gastric Banding
The adjustable gastric band is made of soft silicone and is equipped with a firmly attached inflatable balloon. This balloon is connected by a tube to an access port.
The band is positioned around the upper part of the stomach by keyhole (or laparoscopic) surgery so as to create a small pouch. This small pouch lies above the band and has a capacity of 15-20mL. The remaining stomach lies below the band. The band helps patients reduce weight by 2 mechanisms:
- By reducing the amount of food that an individual wants to eat by inducing a feeling of fullness after only half a cup of food; and
- By slowing down the emptying from the pouch above the band, thereby prolonging the feeling of fullness
The size of the pouch outlet is adjusted by adjusting the volume of fluid in the balloon through the access port. The access port is situated under the skin usually in the upper abdomen and is easily accessible by the treating doctor with a special needle.
Since the insertion of the adjustable gastric band does not involve any stapling, resection or shortening of any part of the stomach or intestines, the function of the digestive system remains intact. All ingested food will still be absorbed by the body the same way that it was before the operation. Weight loss is achieved by helping induce early feeling of satiety after eating considerably smaller amounts of food than before the surgery. It is most important to avoid foods of high caloric content, such as ice cream, custards and chocolates.
The Adjustable Gastric Band on the stomach
Insertion of the adjustable gastric band is usually done via laparoscopic approach. Five or six small incisions are made in the abdomen to introduce a camera and instruments and the adjustable gastric band is positioned at the upper end of the stomach.
Once the band is placed in position, the connecting tube and access port are inserted and secured to the upper abdominal wall. All incisions are finally closed using absorbable sutures which do not need to be removed.
How much weight can you expect to lose?
The weight will be lost gradually and should commence immediately after surgery. The amount of weight loss will depend partly on the amount of fluid injected into the balloon to provide a feeling of satiety. More importantly, the amount of weight loss in the long term will depend on the patient, i.e. on how carefully the patient follows the recommendations regarding eating habits, diet and exercise. The recommended rate of weight loss we would like to see is 0.5 – 1.0 kg per week. On average it is expected that 50-60% excess weight will be lost long term.
This also means a long term commitment to follow up by your bariatric clinic as data clearly shows the importance of follow up for successful weight loss.
We recommend that you follow the dietary instructions from our dietician and if necessary take a multivitamin supplement
Weight-related co-morbidities such as diabetes, obstructive sleep apnoea and hypertension resolve along with successful weight loss.
What are the risks involved in having gastric banding for weight reduction?
Whilst the laparoscopic approach has helped decrease the length of hospital stay by decreasing the postoperative recovery period, the insertion of the gastric band is not without complications because of the weight of the patient and his/her premorbid condition.
As with any surgical procedure, there are associated risks to the patient. Whilst your surgeon will endeavor to minimize risks, complications may occur which may have permanent effects.
Specific Risks Associated With Laparoscopic Surgery Include:
- Whilst your surgeon may have recommended laparoscopy to insert the gastric band, he/she may find that, after starting the procedure, this approach is not safe due to unexpected findings or events. If this is the case, then your surgeon may insert the gastric band through a large incision (approximately 10 to 15cm in length) in the abdomen. This is known as open surgery or "laparotomy".
- Converting from a laparoscopic to an open approach is not a complication of the procedure but rather to protect the interest of the patient’s safety and wellbeing. A potential complication to an open incision is the possibility of an incisional hernia in the long term. The likelihood of this is higher in obese patients compared to those with normal weight & is approximately 1-2%.
- Excessive bleeding
- Injury to organs near the stomach
- Injury to the stomach wall
- Injury to major blood vessels
- Gas embolism from the gas used in the abdominal cavity
The Gastric Band operation very safe but complications occur in a small number of patients and it is important that you fully understand the risks and discuss this matter with your surgeon before you decide to have this operation. There is no guarantee that the gastric band will work without fault for the rest of your life. However, extensive use of the gastric band since 1985 demonstrates that it works well and can be complication free with long term weight loss. This complication-free and successful weight loss is more likely to occur in patients who have a clear understanding of the potential benefits and risks of having a gastric band and have a realistic responsibility towards their eating habits and exercise. Furthermore regular follow up will ensure early recognition and possibly prevention of major complications
What problems can occur after the gastric band operation?
Vomiting / Regurgitation
Some patients have trouble adjusting to their new eating habits, they repeatedly eat too quickly or too much and then regurgitate. Repeated vomiting can result in a band slipping (see below) and patients should contact the clinic if frequent vomiting occurs.
Infection of the Port
An infection may develop in the port area or in the abdomen and in some instances the infection may involve the band. In such a case, re-operation may be necessary. It is very important that you do not let anyone apart from your surgeon or a bariatric practitioner inject or remove fluid from your port as infection can occur if the proper aseptic technique is not complied.
Infection of the wound and/or band
This is uncommon (approximately 1-2%) and may need treatment via drainage of the infection, antibiotics or removal of the band, catheter and port.
Leakage from the gastric band or from the connecting tube between the balloon and the port may occur. The gastric balloon is made of fragile material and, if too much fluid is injected, leakage may occur. Leakage from the connecting tube can occur if the injecting needle is inserted incorrectly. Leakage from the port can occur if the incorrect needle is used for injecting or removing fluid from the port. Hence it is important that only an experienced person such as your surgeon or bariatric practitioner be allowed to manipulate the amount of fluid in your band. In the event of leakage, the gastric band can normally be replaced with a new one, but this will require re-operation.
Slippage of the band and pouch enlargement
This is a major long-term concern that occurs in approximately 3% of people. The band may slip and the pouch (the part of the stomach above the band) may become too large. This problem can arise months or years after the procedure. This is a rare complication as, at operation, the band is placed in a special tunnel and special measures to fix the band securely are performed. However, it can occur if the rules of eating and ignoring the signs of fullness are not adhered to. If this occurs, a re-operation may be necessary.
This is an uncommon (approximately 2%) but major complication which may occur some months or years after the operation. The band may erode from the outside of the stomach into the stomach. It is more common in patients in whom the band is over inflated but may also occur in bands that have an acceptable volume of fluid. It again emphasizes the need for appropriate follow up by the team in our clinic. If this complication were to occur the band needs to be removed by either endoscopy or reoperation.
This symptom of heartburn plus regurgitation arises when the opening or outlet from the small pouch is too tight causing food or liquid ingested to spill up or back into the oesophagus. This can be prevented by not eating or drinking for 2-3 hours before lying down or going to bed. The reflux symptoms can also be alleviated by having some fluid removed from the gastric band.
Acid Erosion of Teeth
The tooth surface is composed of mineral (calcium)which is susceptible to acid attack. If the fluid around the tooth changes such as constant sugar ingestion, ingestion of acidic foods, poor cleaning technique or stomach acids from gastric reflux/regurgitation, calcium will be dissolved from the tooth. The end result is tooth decay. This can be prevented quite easily by good dental hygiene practice (eg simply brushing your teeth well after reflux or regurgitation occurs and at least three times a day after meals).
Gallstones often occur in obese patients. You may be asked to have an ultrasound before your operation to determine whether you have any stones. If there are any present, then your surgeon may recommend removal of your gallbladder. If no stones are present, you may still develop stones as a result of the weight loss after surgery. Removal of the gallbladder and gallstones can be done via keyhole surgery. It is recommended that your team at our clinic be involved in this treatment as adjustments will need to be made to the band during such surgery.
Hernia in the Incision
Sometimes a hernia can form along the scar line. A hernia is basically a weakness in the abdominal wall allowing the abdominal organs to herniate. This can be corrected by surgery.
This can occur especially if you have lost a lot of weight or lose it very quickly. It usually occurs on the arms, breasts, abdomen and thighs. Exercise during weight loss can reduce the amount of flabby skin and help tone up your body. About 20% of patients have surgery for this condition.
Excessive skin folds can become a problem, especially in summer. Rashes and other skin conditions can be of great concern especially under the breasts and abdomen.
Some of these late complications can occur so it is important that you are aware of them. Iron, Folic Acid and B12 Deficiencies – These deficiencies may occur in many patients after surgery for weight reduction. They are usually a result of an imbalanced diet due to the small amount of food being consumed. We recommend that you follow the dietary instructions from our dietician and if necessary take a multivitamin supplement. Levels of vitamin B12, folate and iron should be checked annually.