Treatments for Obesity
LAPAROSCOPIC GASTRIC BAND
Adjustable Gastric Banding System is designed to induce weight loss in obese patients by inducing early feeling of satiety and decreasing food intake, hence limiting food consumption.
The laparoscopic band (Gastric restrictive surgery) has evolved over the past decade as the treatment of choice for morbid obesity.
The LAP-BAND®
There are a number of bands available. The placement of the band is performed Laproscopically using keyhole surgery. The main difference between the adjustable gastric banding and other operations is that the gastric band can be adjusted to the patient’s needs and well being.
The Laparoscopic placement of this band combines the advantage of a non-invasive gastroplasty with the advantages of keyhole surgery. The band divides the stomach into a small proximal pouch and a large distal pouch. The inner surface of the band is inflatable and connected by tube to an access port, which is fixed to the abdominal wall. This should allow for an easy post-operative adjustment. The small proximal pouch acts as the new stomach and a feeling of satiety is reached after ingestion of only a small amount of food (15ml). It is important to point out that the stomach is not divided and the anatomy is not greatly altered after surgery. At any time, you can revert back to the normal anatomy by removing the band.
Patients who undergo this procedure must be very careful about chewing their food very slowly and thoroughly. After 5 years most patients can maintain 50% of targeted excess weight loss. However, like any other surgical procedure, the key to success is patient compliance with the dietary advice.
ADVANTAGES
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- Short Hospital stay and early return to normal activity. Most people can return to work within couple of weeks and they can resume strenuous exercise within 6 weeks.
- Surgery can be reversed
- Food consumed passes through the digestive tract in the usual order allowing it to be fully absorbed into the body
- Band can be adjusted to increase or decrease restriction
RISKS
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- Band slippage/migration
- Pouch dilatation
- Gastric perforation or tearing in the stomach wall may require additional operation
- Reservoir leakage or twisting may require additional operation
- May not provide the necessary feeling of satisfaction that one has had enough to eat.
The operation
The operation to insert the gastric band can usually be completed Laparoscopically. 4 to 5 small cuts in the abdominal wall are formed, the largest of which is about 4cm in diameter for the port which is used to inflate and deflate the band. The port is usually felt under the skin after the operation. Initially the balloon within the band is left completely deflated at the end of the operation.
Whilst the operation is not completely painless there is less pain following a laparoscopic procedure than one involving a large cut in the abdomen. Most patients are able to go home within 48 hours.
Click on the image below for a step by step Lap Band procedure video.
What would you expect after the procedure?
It is important to realize that the operation is the first step in a major life adjustment and not a quick fix. Motivation is the Key to Success
During the convalescence period, the small wounds will heal and you will have to adjust to a new eating behaviour as discussed with your surgeon and dietician prior to the operation.
The dietician will advise you on the diet after you surgery. For the first two weeks you will only be allowed liquid food. Then for the following two weeks you will have sloppy and mashed food. This is very important to allow proper settlement of the band in its position around the stomach without any displacement or slippage of the band down the stomach. During the healing process, tissue adhesions develop and help fix the band in the right place. Patients who eat solid food too soon after the operation stand a higher risk of displacing the band causing a stretch and enlargement of the new upper gastric pouch. This will lead to poor weight loss and, in some cases, the need to re-operate. (See Laparoscopic Gastric Banding – post-operative advice).
Band Adjustment
At 6-8 weeks after the surgery, the band may be tightened to increase the feeling of satiety. By then band will have settled and the swelling around the stomach has resolved.. Some weight loss will have occurred during the first few weeks. The adjustment is usually performed in the clinic and only occasionally under X-ray control. Occasionally, if the band is too tight {patients complain of having difficulty swallowing solid food} it will be necessary to remove some fluid. There is no need for sedation or anaesthesia during band adjustment; the only discomfort experienced being the passage of a fine needle through the skin into the reservoir. Thereafter, you will gradually be able to introduce normal food into your diet. Still you might find some difficulty with certain foods such as fresh white bread, red meat and vegetables that contain a lot of fibre which will need to be carefully chewed.
Complications of the gastric band
Like any operation, insertion of the gastric band does have risks associated with it, although every care is taken to reduce these to a minimum. Most problems are cause by pre-existing diseases such as heart disease or high blood pressure although wound and chest infections, clots in the legs and lungs, as well as other complications, can occur.
Complication specifically related to the gastric band also occur. These include slippage of the band, migration into the stomach, increase in the size of the stomach and gullet, rupture of the balloon and misplacement or infection of the port. These may lead to the need for the band or port to be removed, repositioned or replaced. One in 10 patients will need further surgery for these or other complications
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