The laparoscopic installation of an Adjustable Gastric Banding System is the most common form of bariatric surgery in Europe. It induces weight loss by reducing the capacity of the stomach, thus limiting the quantity of food that can be consumed at once. As there is no stapling, cutting or bypass involved, this procedure is thought to be the least traumatic kind of bariatric surgery.
How it’s done
This procedure is performed under a general anaesthetic, and lasts between 20 and 40 minutes. An adjustable silicone band is introduced laparoscopically through the abdomen, using several tiny incisions, and placed around the upper part of the stomach (figure 1). The risk of band slippage is reduced to 1% by taking precautions to fix the device and immobilise the stomach. The resulting pouch greatly reduces the working capacity of the stomach, making the patient feel full early during a meal.
The gastric band, which contains an inflatable balloon on its inner ring, connects to an access-port or reservoir beneath the skin by a thin, kink-resistant silicone tube (figure 2). This port is generally placed in the upper left abdomen, and lets the surgeon adjust the size of the band, so as to control each patient’s rate of weight loss. By adding saline through the port, the band’s inner balloon is inflated, thereby decreasing the rate of food consumption—this is called a ‘fill’. Similarly, the saline can be removed, causing an increase in the rate of food consumption.
Recovery
Hospital time lasts between one and two days. Some discomfort from the operation is common, but lasts only a week or less.
Dietary requirements
As the gastric band procedure is purely restrictive, the patient must not consume high-calorie liquids, which can ruin the process of weight loss. Besides this, the following guidelines are recommended:
- Eat at least three times a day.
- Eat only solid foods, as the band does not restrict liquids.
- Chew thoroughly, as this makes the food less likely to damage the band, and causes an earlier feeling of fullness.
- Do not drink liquids with your meals, as this can cause the food to be washed too quickly through the band.
A dietary consultant will provide personalised advice after the procedure.
Complications
Operative complications are very rare, as the stomach is not cut or stapled, but only mobilised. However, the following symptoms can occur after the operation.
Vomiting
Vomiting, while painful, can be productive; possible causes are eating too fast, eating too much and chewing too little. When vomiting is frequent the patient must adjust his or her eating behaviour, or, if necessary, the band can be deflated a little.
Acid Reflux
Heartburn, the regurgitation of acid from the stomach into the oesophagus, is the most common symptom. It occurs when the band is too tight, or with the swelling of the stomach lining. Medical treatment or deflation of the band may be necessary if symptoms persist.
Slippage
This complication, which occurs less than 1 percent of the time, is when the upper stomach pulls the lower stomach through the band, thus pushing the band down on the stomach. This causes varying degrees of intolerance to solids or liquids, or even total obstruction. All slips require surgical repositioning, and sometimes the removal of the band as well.
Erosions
Although very rare, erosion does occur occasionally. The gastric band is subject to natural reactions, and can be dissolved. Every erosion requires surgical removal.
Port Problems
Rare complications include infection, seroma or hematoma. Breakage of the port can also occur, though the band itself is guaranteed not to break. Port leaks are rare and are usually related to the disconnection of the device or a sticking needle. A port replacement can be done under local anesthaetic as an ambulatory procedure.