Adjustable Gastric Band
The laparoscopic adjustable gastric band (LAGB) is the most common weight loss procedure performed in Australia. It is regarded as the safest obesity operation currently available. It’s a great device, which many patients have used to reach a better weight and improve their health.
Who Qualifies for a Gastric band?
You may be eligible for a gastric band if you have a body mass index (BMI) that is greater than 40 (or greater than 35 with weight related illnesses) and you have tried other types of diets without long-term success. In certain circumstances patients with lower BMI may be candidates.
The gastric band operation is performed via laparoscopic (keyhole) technique, under general anaesthesia. Five small incisions are made in the abdomen where laparoscopic instruments are inserted. The adjustable silicone ring (gastric band) is fitted around the top of the stomach and then clipped into place. A fold of stomach is sewn over the band to reduce chance of the band slipping. The band is connected to a small tube and access reservoir (port), which is used to add or remove fluid from the band. The final step of the operation involves fixing the port to the muscle under the skin at one of the incision sites.
How does the surgery assist in weight loss?
The gastric band assists patients to lose weight in two ways:
- By restricting the amount of food you can eat at one sitting. The placement of the band creates a small pouch at the top of the stomach, smaller than a golf ball. This pouch holds less than 1/2 cup of food, whereas the typical stomach can hold up to 1 litre.
- By making you feel satisfied faster and for longer. The action of each bolus, or mouthful of food moving through the band stimulates the afferent nerve endings (nere endings around the band) to send a message to your brain indicating you are full.
It is important to remember that surgery is a TOOL for weight loss. It is vital that eating behaviours are modified to get the best result from the procedure. It is important to eat a variety of protein, vegetables and fruit, limit your intake of calorie dense foods and liquids and to slow your speed of eating. If eating behaviours are not adapted after surgery, weight loss will be limited or weight regain can be possible in the future. More detailed information about correct eating behaviours will be covered during your visit with the dietitian.
Expected weight loss
In general patients can lose up to half to two-thirds of their excess body weight. The time frame that this will take will vary from person to person, but an initial goal weight is usually reached approximately 18 to 24 months after surgery.
Regular band adjustments are vital to the success of the band. Achieving the correct amount of restriction to have good weight loss and good quality of life requires the band to be adjusted every 4 to 6 weeks for the first 12 to 18 months post placement. The frequency of these adjustments can vary from person to person. It is really important to adjust the band such that the restriction is not too loose and not too tight. You must work with your doctor to get this right as BOTH too loose and too tight can reduce your weight loss.
Advantages of a Gastric Banding
- This procedure does not require parts of the stomach to be removed or stapled as with other bariatric procedures. Therefore nutrients are absorbed from food in the same way that they were prior to surgery.
- It is the safest weight loss procedure.
Disadvantages of a Gastric Banding
- The intensity of follow up. Frequent band adjustment appointments, especially in the initial stages post-surgery, are required to achieve sufficient restriction.
- Weight loss results are often variable compared with more aggressive weight loss surgery, such as the gastric sleeve of bypass. Weight loss in the long term tends to be more difficult after gastric banding as opposed to other weight loss procedures.
- For safe and effective weight, substantial dietary and eating habit changes are necessary. It is important to take smaller mouthfuls, chew well and eat slower.
Risks of the Gastric Banding
As with any surgical procedure, the gastric banding operation has a risk profile which is important to understand before proceeding. The following is a comprehensive list of issues which can occur. This list is extensive and is not intended to worry you, but simply inform you about the range of possible complications, regardless of how rare the issue may be.
Possible Acute Complications
Acute surgical complications can include (but are not limited to):
- Infection – This may require treatment with antibiotics and occasionally reoperation.
- Damage to Organs – any keyhole procedure can be complicated by unintentional injury to the organs near the area of operation. This may require a repeat operation to repair of the damaged organs.
- Blood Clots – Deep Venous Thromboses (clots in the veins) and pulmonary embolus (clots in the lungs)
- Pneumonia/ chest infection
Possible Long-Term Complications
There are some possible long term surgical problems related to the device itself.
- The band can slip (move too high or too low on the stomach).
- The band can erode (appear within the stomach cavity) and this can require the band to be removed. This complication occurs in up to 1% of cases.
- Gastric pouch dilatation, or oesophageal dilatation, above the band can occur as a result of over eating on a regular basis. This increase the volume of food that can be consumed in one meal. This can result in weight regain, and a revision procedure might be required to modify or improve the band position. When this is recurrent or persistent, the band may need to be removed.
- Nutritional deficiencies. These are very rare after gastric banding. If they are found, they can usually be easily managed with vitamin and mineral supplementation and with regular review by your dietitian.
When you have a date for surgery, you will be advised to have a very low-calorie liquid meal replacement diet for 14 days prior to surgery. OptifastTM is the recommended meal replacement and is available from your local Chemist. The diet helps you to lose weight, particularly from the liver, and therefore optimizes the safety of the procedure. Your will receive more detailed information about this when you see you dietitian.
The hospital stay after surgery is generally three to five days. After the procedure you will start on clear fluids only (water, black tea, broth, juices). These will need to be sipped slowly in small amounts. Before going home you will have an x-ray to check the position of the band. You will then be able to have free fluids for the rest of your hospital stay. During the next 4 to 6 weeks, while your body heals, you will gradually increase the texture and volume of the food you take. Further information, including a dietary guidelines booklet, will be provided at your appointment with the dietitian.
The first post-operative clinic visit will be arranged about 1 to 3 weeks after surgery. At this appointment your wounds will be assessed, and any other issues will be discussed.
The dietitian will phone you within the first week following surgery to review your intake.
Your first post-operative clinic visit will be at 3 to 6 weeks following surgery and then 3 to 6 monthly for the first two years.