Gastric band surgery is one of the most common surgical weight loss procedures conducted in the United States. During the procedure, a band is implanted around the upper part of the stomach, creating a smaller pouch. It does not provoke weight loss alone, but helps in the process by restricting the capacity of the organ, which makes patients eat less and feel full faster. According to studies, gastric band surgery does not achieve the most weight loss on average compared to other procedure types, but it is the most simple, minimally invasive surgery type and the one with the lowest complication rates and highest safety ratings.
Why Are Gastric Band Adjustments Needed?
The band implanted around the stomach is a thin, hollow silicone rubber ring, which is accompanied by a small, thin tube. The band is inserted deflated to fit around the stomach and it is later filled with a saline solution to adjust the tightness of the band around the organ. This entire process is repeated several times during the treatment and it is known as a gastric band adjustment. The gastric banding procedure is the only adjustable weight-loss surgery available in the United States, making it customizable for each individual.
Approximately four to six weeks after the surgery, patients may undergo their first band adjustment. The American Society for Metabolic and Bariatric Surgery define adjustments as “the infusion of saline for device tightening or withdrawal of saline for device loosening via an access port to alter or adjust the size of the adjustable gastric restrictive device. The need for adjustments are based on clinical assessment of the patient’s hunger, satiety, dietary intake, portion size, weight loss/gain, and associated signs or symptoms of potential complications.”
How Are Gastric Band Adjustments Performed?
The adjustments are made without the need for surgery and are conducted in a process that takes about 10 minutes. The tube inserted alongside the rubber band also includes a small port positioned just below the skin that is used to fill the ring with saline and increase the amount of food and caloric restriction. The port is invisible from the outside and can only be felt when pushed by the physician. During the adjustment process, the physician will use a needle to inject or withdraw saline solution from the band.
To inflate the band and make it more tight, the medical professional will insert more solution, while if the band needs to be more loose, the professional will remove some saline to reduce the restriction. It is this system that allows the surgery to be adjustable to the patient’s individual needs, as well as to be reversible if needed. While right after the surgery there are standard adjustment schedules, as the patient loses weight, the gastric band adjustments can be made as needed, according to the physician’s recommendations.
Who Performs Gastric Band Adjustments?
According to The American Society for Metabolic and Bariatric Surgery, in order to fulfill the Global Credentialing Requirements and be authorized to conduct gastric band adjustments, a physician needs to have didactic training through a gastric band training course that at the very least includes patient selection criteria, surgical preparation, surgical procedure, early postoperative management, assessment of postoperative patient/band adjustment considerations, adjustment protocols, discharge instructions, long-term dietary and behavioral support, long-term complication recognition, assessment, and management as well as practice of access port adjustment.
In addition, physicians also need to participate in clinical training in a preceptor program if available, or, as substitute, in a preceptor program followed by supervised clinical training with an experienced provider. The society adds that for physician extenders currently performing gastric band adjustments, the guidelines that satisfy the credentialing requirements include having already performed adjustments in a bariatric surgery practice for a minimum of six months, having documentation of 50 adjustments performed, and documentation by an experienced provider of the physician extender’s ability to perform adjustments.