Adjustable gastric banding is a surgical procedure designed to assist individuals with obesity in weight management. This bariatric operation involves placing an inflatable silicone band around the upper part of the stomach. The band creates a small pouch at the top of the stomach, limiting the amount of food that can be consumed at one time. This mechanism promotes weight loss by inducing an earlier sensation of fullness, leading to reduced food intake.
The Gastric Banding Procedure
The adjustable gastric banding procedure is performed using a minimally invasive laparoscopic approach. This involves a surgeon making several small incisions in the abdomen, through which a camera and specialized instruments are inserted. The silicone band is then positioned around the upper portion of the stomach, creating a small stomach pouch above the band and a narrower passage into the larger, lower part of the stomach.
Once the band is in place, a small access port is connected to it via a tube. This port is positioned just under the skin of the abdomen, making it easily accessible after the surgery. The port allows medical professionals to inflate or deflate the band by injecting or withdrawing a saline solution, adjusting the size of the opening between the stomach pouch and the rest of the stomach. The entire operation takes about 30 to 60 minutes.
Candidacy for the Procedure
Individuals considered for adjustable gastric banding meet specific health criteria. A common guideline includes a Body Mass Index (BMI) of 40 or higher. Patients with a BMI between 35 and 39.9 may also be candidates if they have at least one obesity-related health condition, such as type 2 diabetes, high blood pressure, or sleep apnea.
Recent approvals have extended candidacy to some patients with a BMI of at least 30 who have one or more obesity-related comorbidities. Beyond BMI, a history of unsuccessful attempts at weight loss through conventional methods like diet and exercise is required. The decision for surgery also involves an evaluation of a patient’s readiness to commit to long-term lifestyle changes.
Life After Gastric Banding
Following adjustable gastric banding, patients embark on a structured dietary progression to accommodate their altered stomach capacity. Initially, a liquid-only diet is prescribed for about two weeks, followed by two to four weeks of pureed foods. This gradual introduction allows the stomach to heal and adapt to the band.
Soft foods are then introduced, eventually transitioning to a long-term diet of solid, protein-rich, low-calorie meals. Patients learn to eat smaller portions and chew food thoroughly to ensure smooth passage. Meals should be consumed slowly, over 20 to 30 minutes, and patients are encouraged to stop eating as soon as they feel satisfied, rather than full.
The adjustable nature of gastric banding is managed through band adjustments, often called “fills.” Initially, the band contains no fluid, and adjustments begin around four to six weeks post-surgery. During an adjustment, saline is injected into the access port under the skin, tightening the band and restricting the stomach opening.
These adjustments are performed in a clinical setting and help optimize weight loss by customizing the level of restriction. Patients require regular follow-up appointments to monitor progress and perform further adjustments as needed. Lifelong commitment to dietary guidelines, including vitamin and mineral supplementation, and regular physical activity are also important for long-term success.
Potential Complications and Removal
While adjustable gastric banding is considered a less invasive bariatric procedure, complications related to the device can occur. One issue is band slippage, where the band migrates from its intended position, causing symptoms like pain, nausea, or difficulty swallowing. This can lead to the stomach prolapsing above or below the band.
Another complication is band erosion, an uncommon but serious event where the band erodes through the stomach wall into the gastric lumen. This can result in abdominal pain, weight gain, or infection. Issues with the access port or tubing, such as leaks, infection at the port site, or the port flipping over, can also arise, affecting the band’s functionality.
The gastric band may require removal, making it a reversible procedure. Reasons for removal include complications that cannot be managed, such as persistent erosion, slippage, or chronic pain. Inadequate weight loss or weight regain despite adherence to post-operative guidelines can also lead to band removal.