About gastric banding

What is gastric banding?

Obesity is a growing concern. By medical standards, obesity is defined as having a body mass index (BMI) of over 30 kg/m2. While lifestyle modification remains the cornerstone for treatment, surgical options are becoming more popular. One of the surgical treatments for obesity is called gastric banding, commonly known as lap-band surgery. Some of the specifics of gastric banding will be addressed in this article.

What is gastric banding?

Laparoscopic adjustable gastric banding (LAGB) is a surgical procedure that involves the placement of an adjustable belt around the upper portion of the stomach using a laparascope. The band is made of silicone and can be tightened by adding saline to fill the band (like blowing air into a doughnut-shaped balloon). The band is connected to a port that is placed under the skin of the abdomen. This port is used to introduce or remove saline into the band.

LAGB ultimately restricts the size of the stomach and the amount of food it can hold. It also slows the passage of food to the intestine. By doing so, signals to the brain from the gut allow for a sensation of fullness and satiety with the consumption of less food. This signal is sent from a small pouch created by the band in the upper stomach. When the pouch fills, the same signal is sent to the brain that occurred previously when the entire stomach filled.

What is a lap band?

The LAP BAND® is a specific device brand name and is made by Allergan Inc. The term is often used in the lay community interchangeable with gastric banding (similar to the way we interchange the brand name Kleenex for facial tissue). There are different sizes and models of the LAP BAND. There are also other companies that make gastric banding devices such as the REALIZE® adjustable gastric band (by Ethicon), the MIDBAND®, and the Heliogast® gastric band (which are not available in the US).

Who are candidates for the lap band system?

Generally, candidates for LAGB have a body mass index over 40 kg/m2, or are more than 45 kilograms over their ideal body weight. LAGB can be performed on a person with a BMI of 35-40 kg/m2 if there are problematic medical conditions that are weight-related, such as high blood pressure (hypertension) ordiabetes.

Most surgeons and programs will want to note a history of failed weight loss in the past using more conventional approaches. The procedure is indicated for adults only, and is not to be performed on those less than 18 years old. All patients must demonstrate an understanding of the procedure, and be willing to adhere to the lifestyle changes that are needed to make this procedure successful. Most large centers have a psychological assessment to assure that this last criteria is met.

LAGB is usually contraindicated if the potential patient has difficulty understanding the procedure, is emotionally unstable, or is dependent on drugs or alcohol. Those potential cases with a history of gastrointestinal problems such as ulcers need to be reviewed carefully. Similarly, those that have underlying medical conditions that make them high risk for surgery- such as heart or lung conditions- may be refused the procedure. Associated with these risks is a BMI of greater than 50kg/m2. In this group, there may be a request to lose weight prior to the procedure (although this seems paradoxical). Again, the risks of the procedure in this subgroup of obese patients may outweigh the benefits of surgery. By dropping the BMI under 50 kg.m2, outcomes may be better.

While there is growing discussion about offering LAGB to those with a BMI of 30-35 who have diabetes, there are no current guidelines to allow for this.

How is the lap band (LAGB) procedure performed?

Lap band or LAGB is a surgical procedure done under full general anesthesia and takes about 1 to 2 hours to perform. It is done using a laparoscopic technique. This involves making 3 to 5 small incisions, each about 1 inch in length. The surgeon inserts a small camera attached to a tube into one of these incisions and views the procedure on a screen. The other incisions allow for the use of surgical instruments and placement of the band. The gastric band is placed around the upper part of the stomach and set into position with sutures. The port is then placed in the wall of the abdomen and sutured in place.

How do I prepare for lap band surgery?

Depending on the surgeon or the program, the preparation for surgery will vary. Many centers like to see a commitment from the patient to the necessary lifestyle changes even before surgery. It may be suggested that the patient start eating 5 to 6 small meals a day to prepare for the changes ahead. It may be recommended to wean off "slippery" high calorie foods such as ice cream or milk shakes (since these will continue to be easily absorbed after the procedure).

If the BMI is greater than 50, or if there are other medical issues, medical risk reduction may be needed preoperatively and should be discussed in detail. In addition, a weight loss of 5% to 10% prior to surgery has been shown to improved post operative outcomes, and may be a goal that your surgeon or preoperative care team will discuss with you.

How long is the recovery after lap band surgery?

Recovery varies with each individual. However, in general, LAGB offers a shorter hospitalization and quicker recovery than gastric bypass procedures. In general, most people can return to work 1 week after surgery (if their job is not too physically demanding). Normal activity can usually resume after 6 weeks.

What is a lap band fill?

A lap band "fill" is the common term for gastric band adjustments. Once surgery is performed, there is a period of healing that must take place before the first adjustment. Usually, the first fill takes place around 6 to 8 weeks. It involves injecting saline into the port just under the skin which is connected to the band. Prior to this, there may be little change in appetite. Fills are painless and are usually performed by the surgeon who performed the procedure. These adjustments may take place to enhance weight loss, especially if there is a plateau phase in weight loss, and they may to performed to overcome side effects such as nausea and vomiting (in this latter case, the band is loosened).

What can I expect my lifestyle to be after lap band surgery (LAGB)?

Immediately after surgery, there will be some pain and discomfort that can be controlled with medications. This is part of the normal recovery phase after any surgical procedure. After 6 to 8 weeks, one can generally return to normal activities. Weight loss with LAGB is a gradual process. Initially, the weight loss may be more dramatic- say 2 to 3 pounds per week. However, this generally slows to a pound or so weekly over the long-term. Naturally, the food choices made will govern this weight loss rate. After about 18 months, the weight loss tends to slow significantly. The average weight loss for this procedure is 40% of excess body weight in the first year, with an additional 10% to 20% in the second year. Patients are usually asked to keep in contact with their surgeon regularly during this time period as further band adjustments may be needed.

How is the lap band (LAGB) procedure performed?

Lap band or LAGB is a surgical procedure done under full general anesthesia and takes about 1 to 2 hours to perform. It is done using a laparoscopic technique. This involves making 3 to 5 small incisions, each about 1 inch in length. The surgeon inserts a small camera attached to a tube into one of these incisions and views the procedure on a screen. The other incisions allow for the use of surgical instruments and placement of the band. The gastric band is placed around the upper part of the stomach and set into position with sutures. The port is then placed in the wall of the abdomen and sutured in place.

How do I prepare for lap band surgery?

Depending on the surgeon or the program, the preparation for surgery will vary. Many centers like to see a commitment from the patient to the necessary lifestyle changes even before surgery. It may be suggested that the patient start eating 5 to 6 small meals a day to prepare for the changes ahead. It may be recommended to wean off "slippery" high calorie foods such as ice cream or milk shakes (since these will continue to be easily absorbed after the procedure).

If the BMI is greater than 50, or if there are other medical issues, medical risk reduction may be needed preoperatively and should be discussed in detail. In addition, a weight loss of 5% to 10% prior to surgery has been shown to improved post operative outcomes, and may be a goal that your surgeon or preoperative care team will discuss with you.

How long is the recovery after lap band surgery?

Recovery varies with each individual. However, in general, LAGB offers a shorter hospitalization and quicker recovery than gastric bypass procedures. In general, most people can return to work 1 week after surgery (if their job is not too physically demanding). Normal activity can usually resume after 6 weeks.

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What are the symptoms for gastric banding?

Gastric banding is a laparoscopic surgery which is recommended in Weight loss. It is recommended hyper obese patients. The surgeon places a band around the upper part of your stomach to create a small pouch to hold food. The band limits the amount of food you can eat by making you feel full after eating small amounts of food. , guidelines recommended gastric band placement only if a person’s body mass index35 or above. Some people with a BMI of 30–34.9 had surgery if there were other obesity-related problems, such as diabetes, , or sleep apnea. This was because of the high risk of complications. It is a minimally invasive, quick, reversible and adjustable surgical procedure that decreases the size of the stomach to reduce food intake. It involves placing an inflatable band around the top of the stomach, which results in a person feels fuller with less food. After surgery, it is necessary to follow a strict liquids-only diet with gradual reintroduction of soft foods for up to 6 weeks. Banding can result in significant Weight loss and improve diabetes, but Weight loss varies greatly.

What are the causes for gastric banding?

Gastric banding is a surgical procedure where a plastic ring is placed around the top of the stomach to restrict the amount of food that can pass through. •There are two types of Gastric Banding: Laparoscopic and Open Surgery, both take about 30 minutes. •After the surgery, patients are given a liquid diet for several days before allowing solid foods. •There are many reasons someone would go for Gastric Banding. •One of the main causes is losing weight. The surgery is performed on people who are morbidly obese. •The goal of this procedure is to reduce the size of the stomach and limit food intake, thereby reducing the number of calories consumed. •Another reason is to help control diabetes. Gastric banding helps control blood glucose levels by limiting the amount of food ingested at once. •High cholesterol can lead to cardiovascular disease in most cases. Gastric banding reduces the amount of food consumed daily. As a result, cholesterol levels decrease over time. •High blood pressure or hypertension is a medical condition caused by increased pressure in the arteries. •Gastric banding lowers blood pressure by decreasing the amount of food ingested daily. •Type 2 diabetes is a chronic disease that occurs when the body becomes resistant to insulin. •Gastric banding prevents the development of type 2 diabetes by restricting the amount of food ingested.

What are the risk factors for gastric banding?

People tend to have few problems as a result of gastric banding surgery. The risk of death due to gastric banding surgery is less than one in 3,000. The most common problems after gastric banding surgery include:

  • Nausea and vomiting. These can often be reduced by adjusting the tightness of the band.
  • Minor surgical complications. These include problems with the adjustment device, wound infections, or minor bleeding, and they occur less than 10% of the time.

Unlike gastric bypass surgery, gastric banding does not interfere with food absorption. For this reason, vitamin deficiencies are rare after gastric banding.

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