Adjustable Gastric Banding
At Upper GI West we recognised the importance the gastric band had in the history of bariatric surgery in Australia but we became aware of the limitations and drawbacks early and so did not put many bands in patients compared to the other bariatric procedures we performed.
How does the gastric band work?
The gastric band works by creating a narrowing of the upper stomach creating a small pouch about 30mls or so above it. As the band is in contact with the upper stomach it causes a reduction in appetite.
When food is then chewed well and slowly, then swallowed, it moves down the oesophagus (gullet) and then finds it difficult to pass through. On average the food bolus should bounce slightly two to three times before being squeezed through the narrowed area to the remainder of the stomach. This bouncing effect brings about satiety.
Just like any other procedure the gastric band can not prevent calories being consumed nor restrict volume being consumed. It can only bring about a reduction in hunger and earlier satiety.
Only you can reduce the total calories you consume making use of the cues from the band. Unlike the stapled bariatric procedures there are no profound hormonal, thermogenic or receptor changes with the band. Weight loss is thus by radical calorie restriction alone.
Adjustable Gastric Banding
Gastric banding is usually carried out using laparoscopy (keyhole surgery). Patients only require a short overnight stay in hospital. It is the simplest surgery to perform for weight loss. However, it is probably the hardest to maintain and has no direct hormonal effect. It is the least effective weight loss procedure on average. It is adjustable by means of fluid injected at visits to your surgeon's rooms. It is removable but not reversible.
What are the advantages of gastric band surgery?
- Safest bariatric procedure to perform
- Shortest stay in hospital
- Can be removed (not reversed)
"Gastric banding is a safe initial procedure. The gastric band can be adjusted, which means it is tailored to each patient. In addition, we can remove the band at any point if required. However, it should be noted that removing the band will likely lead to weight regain."
What are the disadvantages of gastric banding?
There are, however, drawbacks to gastric banding. Weight loss can be slower and can be inadequate. Medical complications can include:
- Obstructive system so tends to stop the healthier more solid or crunchy foods first, this can lead to maladaptive eating
- Reflux and vomiting are common and occur frequently with very little warning
- It is a foreign body and induces a foreign body reaction (scarring) around the stomach
- Device related issues occur:
- Infected band or port
- Blockage or leakage of tubing
- Port leak
- Band decay
- Erosion of band into stomach
- Stomach pouch dilation
- Oesophageal dilatation
- Damage to the gastro-oesophageal junction by higher pressure below
- Vagal nerve injury by compression by the band
- Aspiration into lungs at night
- High rates of revisional surgery (20%) needed for mechanical problems and complications
- Removal is common (greater than 30% and increasing rapidly) due to complications and poor tolerance. We believe the majority of bands will eventually be removed
- Regular and ongoing visits are needed as the band often needs to be adjusted to maintain effect. Adjustments often become less effective with time.
Key Points
What to expect from Upper GI West?
Gastric banding was very popular in Australia with over 97% of all bariatric procedures at one point being band insertions.
However Upper GI West surgeons do not recommend gastric banding for the vast majority of patients as there are more effective options which can be performed safely with fewer long term problems.
"In our early experience we realised that results were not as good as other procedures such as the sleeve gastrectomy and there were significant longer term issues. In fact, sleeve gastrectomy became our most common procedure for obesity management as far back as 2007. Whilst we would still perform gastric band insertion in certain scenarios these would be rare occurances."