Adjustable Gastric Banding
The Adjustable Gastric Banding is considered to be a safe operation and considered to be less invasive than either the gastric bypass or the sleeve gastrectomy. The Lap-Band was introduced in the United States in 2001; Gastric Banding was available in other countries prior to this. There are two types of gastric band: the Realize Band and the Lap-Band. Adjustable Gastric Banding is considered to be a purely restrictive procedure which you will recall means that the amount of food that can be consumed is dramatically reduced. The operation works solely by restricting food intake. There is no re-routing or re-wiring of any of your intestines. There is NO METABOLIC EFFECT with band surgery. The band is a small device that goes around the top part of the stomach. It contains a balloon which is slowly inflated over time resulting in a “tightening” of the band around the stomach. This in turn leads to greater restriction and ultimately more weight loss. Initially, when the band is placed in the operating room, the balloon is left empty in order to give the area time to heal. Beginning one month after surgery, your physician will gradually start to inflate the balloon by using a needle to inject a safe, sterile fluid called “saline” into a port that is connected to your band. Band adjustments are performed in the office setting, using a radiologic device called Fluoroscopy.
It is very important for patients to understand that the band is somewhat of a “higher maintenance” operation in that it often requires many follow-up appointments after surgery in order to have your band tightened to the restriction that your body requires in order to maximize your weight loss. Tightening the band too much too soon often results in symptoms of nausea, vomiting, and pain. Conversely, if a patient does not come into clinic for band adjustments, he/she will expectedly not lose weight. In most cases, the Band procedure is performed in an out-patient setting, with the patient leaving the hospital a few hours after surgery.
The patient must be comfortable having a medical device implanted in his/her body and be comfortable living with this implant. Additionally, it is important to understand that a needle must be inserted into the upper abdomen to access the “port” each time an adjustment is made. That being said, patients generally tolerate the procedure very well, requiring no anesthesia, nor any recovery time. It is important that you do not have the expectation that once you lose weight or get down to your ‘goal weight’, you will have the Band removed. You need to be emotionally prepared to have the Band remain in your body forever. For many people, the Band may not be the best option due to the inconvenience of needing more routine follow-up visits. Patients can expect to have anywhere from 8 to 12 postoperative office visits in the first year in order to have their band adjusted.It is important to note, that this operation is not a metabolic surgery and does not influence Ghrelin (hunger hormone) or Leptin (satiety hormone) favorably as in the case with the gastric bypass and sleeve gastrectomy. Some patients will remain feeling hungry after the band is placed.
Risk of Adjustable Gastric Banding
Despite the Band being a very safe procedure, there are still some complications that can occur which are mostly equipment related. It is important to think of the Band as an implant and in many ways it is no different than the hardware used in a hip replacement. Unfortunately, just like having a new hip reconstruction, occasionally these things do not last forever or they do not work, or you can develop equipment related problems, which require repair. These devices are intended to be permanent, but if we had to remove them for any reason, there is usually no significant damage or side effects to the stomach afterwards.
Bands can also sometimes slip – this is when the band migrates either up or down on the stomach and causes problems swallowing.Pouch enlargements can occur without a slip and can cause lack of feeling full. These patients will no longer feel restriction with a small portion of food. It is important to follow the eating guidelines and eat small portions to not stretch your stomach out. Erosions are when the band erodes through to the inner lining of the stomach. These occur in about 1/300 cases. It is not clear how erosions occur. When these do occur, the Band must be removed.Also as with any surgery or procedure there are risks, albeit small or severe, like allergic reactions, infections, heart attacks, pneumonia, and rarely death.
Follow-up Appointment / Band Fills
- Patients who have had the lap band surgery initially need to be seen 2 weeks after
- After that, patients are seen every 2-4 weeks for the next 6 months
- These patients then follow our normal Grayson Surgical Follow-Up schedule like the rest of our
- After every lap band adjustment, we do require patients to stay on liquid diet for at least 48 hours and then progress slowly to soft