What is a Gastric Band?
Gastric Banding (also referred to as Lap Band surgery) is a purely restrictive type of weight-loss surgery (bariatric surgery). It involves in wrapping an adjustable silicon band around the upper part of the stomach to create a narrowing outlet effect and thereby limiting the capacity of food that can be stored in the stomach.
When the band is inflated with fluid, the stomach is effectively separated into 2 compartments: a small, upper pouch (above the band) which holds roughly 50-100ml and a much larger, lower stomach compartment (below the band). The upper pouch of stomach becomes the functional part in terms of storage and, as it is small, it fills up quickly with food giving a feeling of fullness or satiety. This helps to limit excessive intake of food and thus results in weight-loss. The restriction of outflow of food from the upper pouch to the lower part of stomach can be increased or decreased by the amount of fluid placed in the band through an access port under the skin of the abdomen.
Indications for Gastric Band
Lap-Band surgery is indicated for morbidly obese individuals with the following criteria:
- BMI is ≥ 40
- BMI is 35-39.9 with at least one or more associated co-morbidities such as type 2 diabetes, high blood pressure, high cholesterol level, heartburn, joint problems, breathing problems (obstructive sleep apnoea), etc…
- BMI is 30-34.9 with uncontrolled or poorly controlled type 2 diabetes with multiple anti-diabetic medications (including insulin)
Why choose to have this surgery?
Lap-Band surgery has the lowest risk of early/immediate post-operative complications compared to the other weight lost surgery on offer. It is therefore considered to be the safest by comparison. However, it requires a greater degree of commitment from patients in terms of adherence to dieting in order to achieve the desired/expected weight loss as it lacks the metabolic and malabsorptive mechanisms of the other weight loss operations. It also requires more frequent follow-up visits with your surgeon or bariatric physician in comparison.
It is a more appropriate procedure option for those who are disciplined and committed to dietary, exercise and behavioural modifications (and preferably in the lesser obesity severity category).
The excess weight loss is expected to be around 30-40%.
Advantages of Gastric Band
The main advantages of this procedure over other type of weight loss surgeries are:
- Shorter hospital stay and quicker recovery
- Lowest risk for immediate/early post-operative complications
- No resection of stomach or bowel and no alteration/re-routing of gut anatomy
- Low risk of malnutrition/vitamin deficiency
Disadvantages of Gastric Band
- Slower and less early weight loss than sleeve gastrectomy or gastric bypass
- Higher rate of inadequate weight loss compared to sleeve or bypass
- Risk of band slippage or erosion into stomach
- Risk of mechanical issues with band, tube or port
- Dilatation of the oesophagus can occur if patient overeats
- Foreign body (band, tubing and port) remain in the body
- Requires strict adherence to post-op diet and more frequent post-op follow-up visits
- High re-operation rate
Gastric Band Procedure
Lap-Band surgery is performed laparoscopically (key-hole surgery) under general anaesthesia. Your surgeon makes 4-5 small incisions in the abdominal wall through which a camera and surgical instruments can be inserted into.
The band is placed around the upper part of the stomach to divide it into two sections: a small, upper pouch and a large, lower compartment. The band is then fastened and secured to the stomach with sutures. In order to adjust the band, an access port is connected to the band and placed under the skin of the abdomen. This enables your surgeon to loosen (deflate) or tighten (inflate) the band by injecting or aspirating sterile water into the port as needed. Finally, the incisions are closed.
Post Gastric Band Care
After the surgery, you are required to stay in the hospital for about 1-2 days. You will be given pain medications to keep you comfortable. Your nurse will help you to move at the earliest after the surgery to prevent blood clots, respiratory problems and bedsores. To check if the lap band is in appropriate position, an X-ray of your stomach will be performed the day after your surgery. You will be kept on a liquid diet for the first 1-2 weeks. Your surgeon or dietician will give you a specific diet plan and instructions to follow after the surgery. It is important to drink plenty of fluids throughout the day to avoid dehydration.