Weight loss surgery isn’t new. With older techniques however, a traditional open procedure is required. The different types of surgery involve (partial) removal or stapling of the stomach or bypassing the digestive system. These traditional bariatric surgeries are often irreversible and no circumstantial adjustment is possible. On top of that, these traditional procedures are known to lead to nutritional deficiencies when good follow-up fails to occur.

Benefits of gastric banding

• Placement is performed using the laparoscopic technique which allows quicker recovery and leaves almost no scars;
• Stomach remains intact;
• Surgery is completely reversible where available;
• Gastric band adjustment is performed with a simple injection;
• Results are at least as satisfactory as the those attained with traditional weight loss surgeries.

Gastric Banding candidates

Since length and we ight are considered to be determining factors, the BODY-MASS Index is used as indicator for obesity. The BMI is calculated as follows: weight in kilograms divided by the square of length in meters. A BMI of more than 40 means severely overweight (morbid obesity) and is a medical ground for surgery. If BMI situates between 35 and 40, surgery is recommended if related health problems, e.g. high blood pressure or complaints about joints (knees, back,…) occur. With a BMI of less than 35 there is no need for surgery.

Type of Eater

Obesity, to a great extent, depends on the type of eater the patient is. The idea behind gastric banding is narrowing down the stomach content. Therefore, gastric banding is very effective for so-called volume-eaters (people who eat big portions). Beverages and sweets contain a large amount of calories where only a small amount of the product itself is needed and slip easily through the gastric band. This means that gastric banding will be ineffective for people who crave for cola and sweets (sweet-eaters).

State-of-mind

Success of the procedure depends greatly on the will and discipline of the patient. The gastric band only functions as an aid. Therefore, a low-calorie diet must be followed. If not, no good results will be attained, since the gastric band does not cause weight loss.

Gastric banding is not suitable for

• pregnant women or women planning pregnancy;
• mentally and emotionally unstable people;
• alcohol abusive people;
• people with severe hart, vascular or long deseases;
• severe infection of the bowel
• gastroesophageal reflux (backflow from the stomach)
• people with a genetic disorder of the gullet or the stomach;
• Adolescents under 18;
• people with silicone allergies.

Necessary preoperative examination

First of all, underlying causes for obesity need to be excluded. For this, the advice of an endocrinologist is called in. Endocrinology specialises in disorders of the thyroid gland, adrenal glands, diabetes,…

• A dietitian will discuss eating habits and will evaluate the patient’s state-of-mind.
• A routine blood test.
• Examination of the heart and lungs.

How does Gastric Banding work?

The gastric band is fitted around the upper part of the stomach, dividing it in a small stomach pouch and a larger section below the band. The pouch only allows a smaller amount of food and induces therefore an earlier feeling of satiety and hunger for food diminishes.

The Gastric Band

The system is consists of:

An adjustable gastric band made out of silicone with an inflatable inner side. Inflating causes the band to narrow in diameter.

A silicone tube that connects the gastric band with an access port. The latter is made out of silicone and titanium. The injection port is placed under the skin. With a simple injection in the port, the band can then be inflated.

Procedure

After extensive examination, hospital admission and surgery will be scheduled if patient is found to be a good candidate.

Hospitalisation can occur on the day of the surgery.

Surgery is performed under general anaesthesia using the laparoscopic (“keyhole”) technique. First, the abdomen are inflated with gas (CO2) through a needle. After that, five small incisions are made through which the instruments are inserted. The entire operation is monitored on a TV screen.

The gastric band is fitted around the uppermost part of the stomach just below the gullet. No cutting of the stomach is required.

Via a tube that runs through the abdominal wall, the gastric band is connected to a reservoir (port). The latter is placed just underneath the skin.

Surgery takes about 60 to 90 minutes.

Complications

During surgery

• haemorrhage or piercing of an organ; conversion to traditional open surgery is required
• pneumonia
• clot formation in the legs
• collapsed lung
• wound infections

Post operative

• leakage or tumbling of the band
• stomach slipping
• infection caused by the band
• stomach dilatation
• vomiting
• infection of the gullet due to stomach backflow (occurs when band is to narrow)
• erosion of the band due to pressure on the abdominal wall

Hospitalisation

After the operation, the patient will remain in the recovery room until fully awake. If the patient’s situation is stable, s/he will be transferred to his room.

The day after surgery the gastrostomy route, which was inserted during surgery, will be removed and a check-up x-ray will be taken. For this, the patient needs to drink a liquid substance. The substance makes it possible to check on food-flow and leakage. If no problems occur, the patient can start drinking water. If water intake is without any problems, patient is allowed to eat yoghurt and mashed or shredded food.

In most cases the patient is discharged from the hospital the day after surgery. At home, for a period of about ten days, patient needs injections to prevent formation of thrombosis in the veins.

Follow-up

If no complications are accounted for, a first check-up will take place four weeks after placement of the gastric band. Because the band is not inflated during surgery, initially the patient will experience few problems during nourishment.

The patient will be questioned about eating habits and weight loss. Depending on the food volume the patient has eaten during that period, the gastric band will be adjusted. This procedure takes place at the radiology department of the hospital and is performed under sedation. It takes about 15 minutes and the patient can go home afterwards. Additional advice from a dietitian can be obtained.

It is very important that the patient adheres to diet restrictions, because even after placement of the gastric band, a low calorie diet is essential to obtain good weight loss results. This requires a lot of discipline from the patient.

Weight loss estimation

The estimated weight loss after four weeks is five to ten kilograms. From that point onwards weight loss will continue gradually, up to 35 kilograms over a period of six to twelve months.

Insufficient weight loss can attributed to:

• lack of patient motivation to follow diet restrictions
• too fast and too much food intake. This causes the stomach pouch to expand and allows larger amounts of food to be eaten. This, of course, annuls the effect of the gastric band. To avoid expansion of the pouch, patient should restrict to shredded or mashed foods.

Pregnancy

The gastric band should be loosened during pregnancy, since a stable weight is recommendatory.

Need to know more about gastrick banding ?