Adjustable gastric band surgery is a weight loss method designed to decrease the size of the stomach. It is procedure indicated for obese patients, particularly for ones who have struggled and failed to lose weight through non-surgical medically supervised programs, including behavioral changes, pre-packaged meal replacement plans or pharmacotherapy. A device is placed around the stomach to limit food intake, and it is called adjustable because the thin silicone ring is filled with a saline solution, the amount of which can be adjusted by the physician to fit the patients’ dietary and weight loss needs.
There are currently two devices in the United States approved by the U.S. Food and Drug Administration (FDA). The Realize Gastric Band became available in 2007 and the Lap-Band System in 2011. Both of them include a silicone band, tubing, and an access port and work by connecting the inflatable inner surface of the silicone band to the access port through a thin tube. The systems are able to limit the amount of food and caloric intake, while they slow down the digestion time. Patients should discuss their options with a physician, as well as be aware of what this type of treatment involves.
Procedure For Adjustable Gastric Band Surgery
The adjustable gastric band is placed surgically during a procedure that can be performed either as open surgery or laparoscopically. Nowadays, it is more common to be submitted to a laparoscopic adjustable gastric band surgery, which is a much less invasive procedure. The surgeon makes five to six small incisions in the abdomen and inserts the surgical instruments as well as a small camera, called laparoscope, to increase visibility.
When the camera is placed, the surgeon uses the transmitted image to place the deflated silicone band around the upper part of the stomach, forming a ring. The band has a thin tube attached that connects it to the access port, which will remain under the skin. Following the surgery, the patient is required to visit their physician regularly, and a needle is inserted through the skin into the access port to add or remove saline solution, making the band tighter or looser. The first inflation of the band occurs after the patient recovers from the surgery, usually four to six weeks after.
Efficacy of Adjustable Gastric Band Surgery
The adjustable gastric band surgery has a high success rate and its safety has been widely studied. The efficacy of the treatment can’t be measured right after the procedure — the efficacy of the banding can only be assessed years after the surgery. However, adjustable gastric band surgery is known to be very safe and effective when combined with lifestyle alterations, including a healthy diet and regular exercise.
The study “Long-term efficacy of a low-pressure adjustable gastric band in the treatment of morbid obesity” focused on long-term efficacy and safety of a low-pressure adjustable gastric band in the treatment of morbid obesity, as well as the impact of age, gender, or preoperative body mass index (BMI). The researchers concluded that the procedure is “effective in achieving long-term sustainable weight loss with an acceptably low complication rate, (…) regardless of patients’ age and gender. Furthermore, preoperative BMI up to 60 kg/m2 does not influence the outcome.”
Adjustable Gastric Band Disadvantages and Risks
Despite the very low mortality rate associated to adjustable gastric band surgery — just 0.1% — there are some complications from Adjustable Gastric Band Surgery that may occur. In 19% of the cases, patients experience side effects that can result in additional surgeries to reposition or remove the band, in unsuccessful weight loss or in the development of other conditions. The main disadvantages of the treatment is that following the procedure, a serious, long-term commitment is needed on the part of the patient in order to continue a medically supervised weight loss program and assure safety and success.
According to the FDA, the main risks include allergic reactions to medicines, breathing problems, blood clots, blood loss, infection, heart attack or stroke during or after surgery, which are risks associated with the surgery itself. Additional problems related to the gastric band include erosion of the band through the stomach, partial slip of the band out of place, gastritis (inflamed stomach lining), heartburn, or stomach ulcers, infection in the port, injury to the stomach, intestines, or other organs, poor nutrition, scarring in the abdomen, difficulties in reaching the access port, flipping of the access port, accidental puncture of the tube during a needle access, and vomiting after trying to eat more than the stomach can handle.