Gastric Band: One of the Safest and Most Effective Weight Loss Procedures

Placement of an adjustable gastric band is a fairly straightforward procedure that is accomplished by placing the band, which is a belt-like section of plastic, around the upper stomach to create a tiny stomach pouch. The band creates a calibrated narrowing at the bottom of this tiny new stomach, so that the pouch is easily filled up with small amounts of food. This good sensation of fullness with the band is called “satiety.” The tiny stomach pouch gradually empties through the restricted outlet, somewhat like the flow of sand out of the top section of an hourglass.

The band’s distinguishing feature is that it’s adjustable. Adjustments are made by filling (tightening) or emptying (loosening) the balloon that lines the inside of the gastric band.

On the day of surgery, when the band is placed, the balloon is empty and this provides only a slight restriction to eating. For most patients, the minor trauma of band placement on the stomach causes suppression of hunger for several weeks. Over the weeks and months following surgery, the balloon within the band is gradually filled – thus the outlet is tightened, to provide progressively increasing restriction that is matched or tuned individually to each patient. The balloon adjustment is accomplished using an access port, buried under the skin, to increase or decrease the amount of saline fluid contained in the balloon.

The Gastric Band presents several key features that make the technique attractive.

• no division or anastomosis of stomach or bowel – low impact operation
• removable
• adjustable

The fact that there is no cutting or repositioning of any intestine brings the risk of leaks or obstruction to very low levels, but a leak is still possible.

It should be noted that some patients who undergo gastric banding may require other procedures at the time of the operation.

The gastric band tends to create slower and steadier weight loss than the results seen after most other surgical procedures. Most weight loss operations create very rapid weight loss in the first few months, which then slows and stabilizes at 10 to 18 months after surgery. On the other hand, gastric band patients begin with a relatively loose band that allows ongoing intake of nutrition, and the band is gradually tightened according to the patient’s weight progress and satiety symptoms. The approach achieves a weight loss of one to two pounds per week that continues up to or beyond 30 months after surgery, with proper follow-up. Gastric band advocates promote this difference as gentler, safer or more physiologic, but truthfully, our surgeons have seen very few nutritional problems in our many patients who have undergone other procedures with more rapid weight loss.

There does seem to be some variability in the weight loss after gastric banding. About 20% of patients lose all the weight that we would hope, about 50% lose substantial weight and have substantial medical benefit, and about 30% lose less than 40 pounds.

Gastric banding does not cause any absorption abnormality, in comparison to more complex operations that involve re-routing the intestines. Nevertheless, band patients can become deficient in a variety of nutrients due to decreased intake. For the time being, Acadiana Weight Loss Surgery recommends exactly the same supplements after any of its weight loss surgical procedures.

The band can erode through the wall of the stomach. This results in a loss of restriction to eating, or band infection caused by leakage of stomach juices onto the band. Such erosion rarely results in a sudden life-threatening situation for the patient. Erosion of the band requires removal of the band, with plans for a later conversion to a different weight loss procedure. All surgeons who perform gastric band surgery have found erosion of the band into the patient’s stomach in a small percentage of cases. It appears that this event (which requires removal of the band) occurs most frequently in the first year or so after surgery, but can occur at any time after band placement. The rate of band erosion is less than 1% in our practice, which matches national results.

The band must remain in the correct position on the upper stomach in order to function properly. If it slips out of place or twists, it is likely to cause obstruction of the stomach. If the band slips it is usually necessary to re-operate to reposition the band. In the past, about 3% of band patients experienced a slip some time after their surgery, but our preliminary experience with the REALIZE™ Band seems to be lower than the previous standard.

As mentioned above, the function of the band as a partial blockage against outflow from the stomach pouch may cause the esophagus to become fatigued or damaged, and fail to conduct its normal swallowing function of pushing food down in a coordinated way. The rate of occurrence of this problem varies widely among published reports.

The band, the connection tubing and the port are designed to last for life. In fact, the band itself is almost never reported to break or leak. However, the tubing and the port definitely can become twisted, kinked or broken. Such events usually require minor re-operations for repair or repositioning of the problem spot.

Even in capable hands, the maneuvers involved in placing the band may sometimes create injury to the stomach, esophagus, spleen or liver – or to the tissues involved in placement of the trocars. Sometimes such injuries can be addressed at the time of surgery and the band can still be placed, but sometimes the nature of the injury means it is most reasonable to abandon the operation.

Early studies from Europe reported weight loss results that were less substantial than the gastric bypass; however, more recent studies from Australia – especially from Dr. Paul O’Brien and Dr. George Fielding – have put out reliable-appearing results in which weight loss after gastric band is essentially equivalent to gastric bypass. Comparative studies done between gastric bypass and gastric band by surgeons in the U.S. have shown somewhat less weight loss with the gastric band, and have shown that weight loss after banding is more variable than other available procedures. The course of weight over many years after gastric banding points in the direction of long-term maintenance of weight, but the actual long-term results do not match more invasive procedures.

Some patients have experienced failure of normal esophageal peristalsis (swallowing function) after gastric banding. If this occurs, it causes painful swallowing, reflux or regurgitation. Band deflation or removal is required. More recent studies suggest that the occurrence of esophageal failure arises from tightening the band too aggressively, and that this complication can be almost completely avoided. We also work to minimize the chance of this problem by checking on the swallowing function of every band candidate during the testing phase prior to surgery.

It is possible that the material of the band could create some type of body immune reaction that stimulates a separate disease process, such as arthritis or Systemic Lupus Erythematosis (SLE). However, the band is made of a silicone elastomer which is completely non-reactive to the body tissues, as far as it has been possible to determine. The same type of material has been in use in a number of implanted medical devices over time, and no problems with tissue reaction have been demonstrated. Here again, the early data is reassuring but no true long-term information exists.