Overview of Adjustable Gastric Banding Procedure or Lap-Band Surgery

What is an adjustable gastric banding surgery?
Approved by the FDA, Adjustable Gastric Banding is a minimally invasive surgery that involves applying prosthesis (the lap-band) around the stomach – creating a small gastric pouch – and a calibrated opening to the rest of the stomach.

It is a form of restrictive weight loss surgery (bariatrics) designed for obesity patients with a body mass index (BMI) of 40 or greater, or for those with a BMI between 35 and 40 and who have co-morbidities that are known to improve with weight loss. The gastric band is an inflatable silicone prosthetic device which is placed around the top portion of the stomach via surgery.

Adjusting the size of the opening between the two parts of the stomach controls how much food passes from the upper to the lower part of the stomach. This opening (stoma) between the two parts of the stomach can easily be decreased or increased, by injecting or removing saline from the band. The band is connected by a tube to a reservoir placed beneath the skin during surgery. The surgeon can later control the amount of saline in the band by piercing the reservoir through the skin with a fine needle. This adjustment is done to achieve the right weight loss for one’s individual needs.

How does gastric banding help a person to lose weight?
The placement of the band creates a small pouch at the top of the stomach that holds approximately 2 ounces of food. The inflatable ring controls the flow of food from this smaller pouch to the rest of the digestive tract. This pouch fills with food quickly and the passage of food from the top to the bottom of the stomach is slowed. As the upper part of the stomach believes it is ‘full’, the message to the brain is that the stomach is full and this sensation helps the person to eat smaller portions. And because of the slow emptying, the patient will continue to feel full for several hours reducing the urge to eat between meals thereby helping them to lose weight over time.

Adjustable gastric banding helps you achieve long-lasting weight loss by:
•    limiting the amount of food you intake
•    reducing your appetite
•    slowing the digestion process

Who is a candidate for gastric banding surgery?
In general, gastric banding is indicated for people for whom all of the following apply:
•    Body Mass Index above 40, or those who are overweight by a 100 pounds (45 kg) or more, or those between 35 and 40 with co-morbidities which may improve with weight loss (high blood pressure, diabetes, sleep apnea, and arthritis)
•    If you are an adult between 18 and 55 years of age
•    Serious attempts to lose weight through changes in the diet or weight-loss drug therapy have failed for more than one year
•    You have been overweight for more than 5 years
•    You are willing to comply with major lifelong changes in your eating habits and lifestyle
•    You do not drink alcohol in excess

The above are general guidelines and the individual must discuss their suitability for the gastric banding procedure with their surgeon.

What are the different types of gastric banding surgeries?
There are two types of gastric banding surgery: open and laparoscopic.
Open gastric banding surgery is the traditional way of carrying out the procedure.
Laparoscopic gastric banding is a minimally invasive way of doing the surgery involving a few small incisions, shortened hospital stay, and quicker recovery.

Details of Gastric Banding Surgery

What type of anesthesia will be used?
The operation is performed under general anesthesia.

What happens during the surgery, and how is it performed?
During the procedure, surgeons usually use laparoscopic techniques (making tiny incisions rather than a large incision and inserting long-shafted instruments through “ports”), to wrap the gastric band system around the patient’s stomach. A narrow camera is passed through a port so the surgeon can view the operative site on a nearby video monitor. Like a wristwatch, the band is fastened around the upper stomach to create the new stomach pouch that limits and controls the amount of food you eat. The band is then locked securely in a ring around the stomach. The tube that comes off of the band leads to a port which is placed under the skin in the wall of the stomach. This port is later used to adjust the diameter of the band to control the flow of food from the small pouch to the rest of the digestive tract.

The gastric banding operation lasts between 30 minutes and 1 hour.

How long will I be in the hospital?
You are released from the hospital either the same day or within 24 hours of the surgery.

What are the risks/complications associated with this procedure?
This surgery involves the same risks that come with all major surgeries like bleeding and infection. The risks specific to this surgery are:
•    Ulceration
•    Gastritis (irritated stomach tissue)
•    Gastroesophageal reflux (regurgitation)
•    Heartburn or vomiting due to the slippage of the band
•    Dehydration
•    Leakage from the band, the reservoir or the tubing that connects them
•    Enlargement of the stomach pouch
•    Blockage of the stoma (stomach outlet)
•    Thrombosis (blood clots)
•    Rupture of the wound
•    Perforation of the stomach or esophagus during surgery

Rapid weight loss may lead to symptoms of:
•    Malnutrition
•    Anemia
•    Related complications

You must discuss the possible risks and complications with your surgeon prior to the surgery.

When can I expect to return to work and/or resume normal activities?
Although most gastric band patients feel quite well after two or three weeks, full recovery takes six weeks after which they can resume strenuous exercising. In the case of open surgery or if there are complications, recovery may take longer.

How can the band be adjusted?
Correct and sensitive adjustment of the band is imperative to weight loss and the long term success of the procedure. Adjustments are simple office visits that only take 10 or 15 minutes. They are performed without surgery using a thin needle to inject or withdraw saline from the band via the access port. This widens or narrows the band opening to control the rate of your weight loss. The most common reasons for adjustments are that you are not able to eat much of anything without feeling uncomfortable and vomiting (your band is too tight) or that you are not losing weight (your band is too loose).

What should I expect after the surgery?
The success of gastric band surgery depends both upon the band as well as your motivation and commitment to a new lifestyle and eating habits. The estimated weight loss after the surgery is approximately 40 - 60% of one’s excess weight to be achieved over 2 years.

The average gastric band patient loses 1 to 2 pounds (500 grams to a kilogram) per week consistently, but heavier patients often lose faster in the beginning. This comes to roughly 50 to 100 pounds the first year for most patients.

After surgery, you will need a new nutrition plan. Your surgeon and/or dietitian can help you learn about and get used to the changes in lifestyle and eating habits you need to make. It is very important to follow the eating and drinking instructions beginning immediately after the operation.

Eating after your adjustable gastric lap band surgery means taking tiny bites, and eating very slowly. After a lap-band surgery the stomach will never hold more than 4 to 6 ounces per meal, so making every bite count is essential for healthy and nutritionally rounded weight loss success. You should think of your new stomach as a ‘baby’ stomach. You’ll be drinking protein shakes and re-learning eating skills much the same way as a new baby drinks formula (or breast milk), and slowly adds new foods from blended baby foods to chunkier baby foods.

In general, most patients find they are unable to easily tolerate red meat, pasta, rice, fresh bread and fibrous foods. You will be asked to eat three meals a day with one planned snack, chew your food very well and swallow slowly. You will need to make good food choices and learn to avoid problem foods, such as high-fiber, high-fat, and dry foods, since these are more difficult for the small stomach pouch to digest.

Good food choices include fruit and vegetables, lean protein, some bread and cereal, and some dairy products. Foods that have a concentrated supply of calories with little nutritional value, such as milkshakes, syrups, jam, and pastries, should be avoided as much as possible. You must only drink either no or low caloric beverages and wait at least one hour between eating and drinking.

The first 3 to 4 days following the surgery patients must follow a clear liquid diet. Failure to follow the prescribed diet can cause complications such as band erosion or slippage that require additional surgery.

If you are a regular coffee, tea, or soda drinker you should be aware that no caffeine is permitted for the first three months after surgery. Carbonated beverages; both diet and regular may cause gas, bloating, and an increase in stomach size due to the carbonation and are not recommended at any time for gastric band patients.

Protein is especially important following Lap-Band surgery. Patients are advised to consume fifty to sixty grams of protein daily to avoid protein deficiency. Protein deficiency causes hair loss, fatigue, edema, muscle weakness, and a delay in wound healing.

Any medicine you take may need to be adjusted following gastric banding surgery since you will not be able to swallow pills that are aspirin-size or larger, or capsules or irregular-shaped pills.

Incorporating regular physical activity into your daily routine is as important as following your nutrition plan. After lap band surgery, aerobic activities – particularly walking and swimming – are generally best tolerated. You will need to consult with your surgeon and weight-management team to find out which activity is right for you.


Cost and availability of Gastric Band Surgery

How much does it cost?
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Which countries/hospitals is it available in?
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Note: All information presented here has been obtained from publicly available medical resources and is here for reference purposes only. Healthbase does not claim to be a medical professional and does not provide any advice on any issues relating to medical treatment.