Laparoscopic Adjustable Gastric Banding involves placing a silicon band lined with a balloon around the upper stomach to create a small pouch of about 30mls. The band is connected by plastic tubing to a port placed under the skin. By injecting fluid into or removing it from the port the opening in the band can be adjusted regulating how fast the food empties.
Advantages:
- Keyhole surgery, usually takes about 1 hour and requires 1-2 days in hospital
- Safe initial procedure
- Adjustable – restriction can be tailored to each individual patient
- Removable – the band can be removed at any time although weight regain is very likely to occur
- No malabsorption
Disadvantages:
- Difficulty swallowing – many foods can get stuck eg steak, white breast meat and white bread and need to be avoided.
- Reflux, vomiting and regurgitation of food are common and occur frequently.
- Maladaptive diet – it is usually harder to eat healthy foods and easier to eat high Calorie energy dense foods.
- Doesn’t restrict fluids – must avoid high calorie liquids.
- Doesn’t limit the amount of food you can eat – whilst it does limit the speed of eating, the size of each mouthful and the consistency of food, you will still have a normal full capacity stomach.
- Adjustable – requires many ongoing follow up visits which costs you time and money and in practice it can be difficult to achieve the right balance between restriction and obstruction.
- Least effective procedure – weight loss is slow and often inadequate
- Mechanical problems including infection, blockage or leakage of the port, tubing or band, slippage or migration of the band, pouch dilatation, damage to the gastro-oesophageal junction and dilatation of the oesophagus.
- Major complications are uncommon (1-2%) and include strangulation of the stomach if a large slip occurs and erosion where the band wears a hole into the stomach.
- High rates of revisional surgery (20%) required for mechanical problems and complications.
- Not fully reversible – the band always causes scarring of the upper stomach as it becomes encased in a capsule of fibrous tissue. This increases the difficulty, the risks and the effectiveness of any subsequent operations.
- High rates of removal (>10%) for complications and intolerance.
- Limited access to healthcare including emergency surgery outside major metropolitan centres especially if you live, work or travel to regional areas or overseas.
Effectiveness:
- 50-60% average excess weight loss (EWL) at 3-5 years in those that have not had the band removed.
- put another way whilst there are many individual success stories approximately half of all patients lose less than half of their excess weight.
Current Status (2012):
- In view of the limited effectiveness, high rate of intolerance, high rate of removal and requirement for subsequent operations Upper GI West no longer recommends adjustable gastric banding.
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