Laparoscopic gastric banding is a type of bariatric surgery that helps with weight loss by limiting the amount of food a person can eat. This procedure involves placing an adjustable silicone band around the upper part of the stomach. The band creates a small pouch at the top of the stomach, which fills quickly with food, promoting a feeling of fullness after consuming smaller portions. This reduces overall food intake, leading to sustained weight reduction.
The Surgical Procedure
Laparoscopic gastric banding is performed using a minimally invasive “keyhole” technique. Surgeons make several small incisions in the abdomen. Through these small openings, a laparoscope, a thin tube with a camera, and specialized surgical instruments are inserted.
The surgeon uses these instruments to position an inflatable silicone band around the upper portion of the stomach. This band divides the stomach into a small upper pouch and a larger lower section. Once positioned, the band is locked securely in place.
A thin tube extends from the band to an access port, placed just under the skin of the abdomen. This port remains accessible, allowing for future adjustments to the band without further surgery. The entire operation can take approximately 30 to 60 minutes.
Candidate Eligibility
Suitability for laparoscopic gastric banding involves specific medical guidelines. Generally, candidates have a Body Mass Index (BMI) of 40 kg/m² or greater. Individuals with a BMI between 35 and 39.9 kg/m² may also qualify if they have significant obesity-related health conditions.
These associated health conditions, or comorbidities, can include type 2 diabetes, severe sleep apnea, or hypertension. Other conditions like high cholesterol, gout, and joint diseases are also considered. Patients typically undergo this surgery only after conventional, medically-supervised weight loss methods, such as diet and exercise, have been unsuccessful.
Post-Surgery Lifestyle and Adjustments
Following laparoscopic gastric banding, patients undergo a structured dietary progression. Initially, a clear liquid diet is prescribed for about two weeks to allow the stomach to heal. This gradually transitions to puréed and soft foods, before solid foods are slowly reintroduced.
Adopting new eating habits is an ongoing requirement for successful weight management. Patients learn to consume small meals, chew their food thoroughly, and eat slowly to prevent discomfort or vomiting. The sensation of fullness is achieved with smaller food quantities, as the small upper pouch fills quickly, signaling satiety.
A unique aspect of gastric banding is its adjustability, often referred to as “fills” or “adjustments.” The inflatable silicone band can be tightened or loosened by adding or removing sterile saline solution through the access port located under the skin. These adjustments are performed during follow-up visits, typically starting around four to six weeks post-surgery, and are tailored to optimize restriction for effective weight loss and comfort.
Associated Complications and Side Effects
While laparoscopic gastric banding is considered a minimally invasive procedure, potential complications and side effects can arise. Some issues are directly related to the band itself, such as band slippage, where the band moves out of its proper position, causing severe pain or obstruction. Another serious complication is band erosion, where the band gradually wears into the stomach wall.
Problems can also occur with the access port or tubing. These include port infection due to bacteria, or mechanical issues like the port flipping or the tubing leaking, which prevent proper band adjustments. General digestive side effects include difficulty swallowing, persistent nausea and vomiting, or acid reflux (gastroesophageal reflux disease). Esophageal dilation, an expansion of the esophagus, can also develop over time due to pressure from food.
A significant long-term outcome for some patients is insufficient weight loss or weight regain. Studies indicate that a considerable percentage of gastric bands are removed within 7-10 years due to these complications or inadequate results. The risk of complications can increase over time, with some studies suggesting a 3-4% annual increase in complication rates.
Comparison with Other Bariatric Surgeries
Laparoscopic gastric banding differs from other common bariatric procedures like gastric sleeve and gastric bypass. Gastric banding is a purely restrictive procedure; it limits food intake by creating a smaller stomach pouch but does not alter nutrient absorption. In contrast, gastric sleeve surgery involves permanently removing a large portion of the stomach, which restricts food intake and can affect hunger-regulating hormones.
Gastric bypass surgery combines restriction with malabsorption. It reduces stomach size and reroutes the small intestine, bypassing a segment of the small intestine. This dual mechanism often leads to more significant weight loss than gastric banding.
Regarding invasiveness and permanence, gastric banding is generally considered the least invasive, adjustable, and reversible, meaning the band can be removed. Gastric sleeve surgery is permanent as it involves irreversible removal of stomach tissue. Gastric bypass also involves permanent alterations to the digestive tract, though reversal is a more involved process.