Laparoscopic Gastric Banding

Written by Shabir

What is laparoscopic gastric banding?

Gastric banding is a surgical procedure which basically involved placing an inflatable silicon band around the upper part of the stomach. A reservoir is also placed under the abdominal skin and is used to inflate the balloon and adjust the gastric band. When the band is inflated, the gastric band tightens and decreases the upper part of the stomach- which ultimately decreases the amount of food passing through. When the balloon is deflated, the band deflates and loosens and the stomach regains its original shape and size

Weight reduction occurs because the food is unable to get to the stomach and even small amounts of food make the stomach full and thus decreasing the desire to eat.

What does gastric banding involve?

Gastric banding is always done in a hospital and requires general anesthesia. After the anesthesia is induced, a tube is placed via the nose into the stomach. The surgery is then done using five very small holes in the abdomen, through which are placed the essential instruments and a camera. The entire surgery is done through these 5 mm holes and an inflatable band is placed around the stomach. The inflating and deflating device is then secured just below the skin above the belly button. The band is left deflated at the end of the procedure.

What risks are associated with the procedure?

Like any surgery, complications can occur with the procedure. However, most laparoscopic surgeons are very adept at this new technique and serious complications are rare.

Complications which may occur include:

1. damage to the abdominal organs during placement of the instruments
2. bowel injury may occur with the instruments
3. bleeding may occur but this is usually identified at the time of the surgery
4. infection
5. Have to convert this to an open surgical procedure (this does happen in 1-3% of cases). This is most common in individuals who have had prior abdominal surgery and the surgeon is unable to insert his instruments safely
6. Perforation of the esophagus or stomach. Both of these are serious and if not identified early, serious complications can occur- which require surgery
7. Migration of band. Even though the band is secured on to the stomach, it can slip and make the surgery completely ineffective.

What happens soon after surgery?

After the surgery, you will be allowed to recover in the recovery room for a few hours. Most individuals have minimal pain. You will not be allowed to eat for the first 24 hours and an intravenous will be started to give you fluids. The following day, an x ray with a dye is done to ensure that the surgery is fine and no damage to the stomach or esophagus has occurred. If everything is fine, you will be allowed to drink some fluids and eat.

When do I go home?

After the first day, you will be encouraged to start walking and take in fluids. For those who have minimal pain and are able to take fluids, discharge is done on the 2^nd or 3^rd day after surgery

When do you inflate the band?

After surgery, you will be allowed to recover for 1-2 weeks. When all the incisions have healed, you will be seen in the weight loss clinic and taken to the radiology department. The small pocket with the plastic cup placed underneath your skin will be filled with water or saline. The band will be inflated under X ray to determine exactly how much tightening is required.

Will I be seen again by the surgeon?

Yes, you will have period clinic appointments to ensure that you are losing weight and that there are no complications

Is any part of my stomach cut or removed?

No, in laparoscopic gastric banding, no part of the stomach or any other organ is cut or removed

What are advantages of gastric banding?

When the procedure is successful, the following can occur:

• Once the weight loss occurs, control of diabetes improves
• Most individuals start to show a decrease in the blood cholesterol
• The control of blood pressure improves
• On average there is loss of 20-50% of the weight
• The procedure can be reversed

What are the complications of laparoscopic gastric banding?

Risks of a laparoscopic gastric band procedure include:

• The port to inflate the band may leak or not work at all and another surgery may be required
• The band may erode and perforate the stomach
• The band may slip and be ineffective
• Weight loss may not occur as much as one expected

How long does the procedure take?

Laparoscopic gastric banding takes about 1-2 hrs. All patients have to stay in the hospital overnight

How is the band adjusted?

Band Adjustments are done in the x ray department.  A fine needle is aced into the pocket created near the abdomen. Water is the injected into this pocket and the band starts to inflate. The procedure is not painful and takes about 10-20 minutes.

When can I return to work?

The majority of individual will be able to return to work in 7-10 days

How much weight will I lose?

At the very best, most individuals will lose anywhere from 20-50% of excess weight. This weight loss is gradual and may not become fully apparent until 2-3 years. Initially most individual lose weight fast and then the weight loss becomes gradual.

Will I have a lot of excess skin after losing weight?

Yes, once you lose weight, excess skin will appear. Once all the desired weight loss has occurred and you are satisfied, a plastic surgeon can easily remove the excess skin. This is normally done at the end of 2-3 years since one is still losing weight.

When can I resume exercise?

The surgery does not affect one’s ability to exercise. Once the incisions are healed, exercise can be resumed in 7-10 days.

Can the band be removed?

Yes, the band can be removed anytime. Because of scars, the abdomen may have to be opened up with a small incision

Once the band is inflated, what will I feel?

Some individuals may feel full but the majority will not have any symptoms. However, a significant number of individuals will complain of nausea, vomiting or a bloated feeling in the initial period when food is eaten. This feeling subsides with time as the individual gets adjusted to the band and the need to eat less.

What happens if am unable to eat all?

In some cases, the band may be too tight and needs to be deflated. This is the chief advantage of the adjustable band. Once the band is adjusted, the symptoms subside. In some rare cases, the patient is just unable to tolerate the band and thus the band has to be removed

What if I get pregnant after the procedure?

There is no problem and it is best to deflate the band so you can eat and nourish your baby. The band can always be tightened after delivery.

Can I take my medications and vitamins?

Sure, the banding procedure does not affect the ability to swallow a pill. Remember swallow the pills with a lot of water.

Can I drink alcohol after the surgery?

Yes, as long as it is in moderation, alcohol is fine and does not affect weight loss.

What can I eat after surgery?

Once the recovery phase of surgery is over, one can eat anything. However, the banding will make you feel full with small amounts of food. It is important to eat a wholesome diet with all the necessary nutrients because one only eats a little food on a daily basis.

How much does the procedure cost?

The cost is variable and includes the fee for the surgeon and the hospital. The average cost ranges from $ 15-30,000.

Is the procedure covered by medical insurance?

Many insurance companies do not cover this procedure but attitudes have been changing since the cost of caring for a thinner patient is much less than that of an obese patient. So phone your insurance company before you embark on this expensive undertaking

Who does this procedure?

The procedure is generally done by general surgeons who have additional training in laparoscopic surgery. Because of the lure of easy money, there is a bandwagon of surgeons who are clamoring for the business of obesity surgery. So ask if your surgeon is board certified, has additional training in laparoscopic procedures and talk to people who have had the procedure. Remember, if in doubt, go seek a second opinion.