Locate a Clinic
Facebook-f Twitter Linkedin Instagram Youtube
Facebook-f Twitter Linkedin Instagram Youtube
Locate a Clinic

Adjustable Gastric band

February 10, 2021

Obesity is defined as having a body mass index (BMI) of over 30 kg/m2. The BMI is the measure of the body fat based on an individual’s weight and height. Obese individuals are at higher risk for many serious diseases compared to those with healthy weight.

Though numerous therapeutic approaches and weight management programs have been advocated for obesity, many obese people are unable to lose enough weight or to prevent gaining back the weight. In such cases, surgical interventions may be recommended for effective long-term management of morbid obesity.
The procedure called gastric band, also called laparoscopic adjustable gastric banding (LAGB), is one of the safest and minimally invasive surgical procedure to treat obesity.

What is adjustable gastric banding?

Gastric band surgery, or lap banding, is a minimally invasive, quick, and reversible surgical procedure that decreases the size of the stomach, leading to reduced food intake. It is performed as a laparoscopic surgery by making small incisions in the upper abdomen. An adjustable band (soft silicone band equipped with a firmly attached inflatable balloon) is placed around the upper part of the stomach. This will create a small gastric pouch that can only hold a small amount of food, thus helps to control the portion size and also the hunger.

Who are eligible for gastric banding?

Adjustable gastric band surgery may be right for you if:

  • You are at least 18 years old.
  • Your BMI is 35 or above; or you have a BMI score 30 with one or more obesity-related comorbidities such as type 2 diabetes, high blood pressure, obstructive sleep apnea, polycystic ovary syndrome, etc.
  • You have a history of unsuccessful weight loss attempts.
  • You are prepared to make substantial changes in your lifestyle, including diet and exercise.

What are the pre-procedure work-ups?

Once you are eligible for a gastric banding, certain steps must be followed before the surgery to improve the results and avoid complications related to the surgery.

The pre-operative work-up consists of the following:

  • Pre-operative consultations : A complete physical examination is performed to make sure that you are healthy enough to undergo the surgery. This evaluation would include a detailed review of the past medical and surgical history, and a review of the psycho-social factors that could influence weight loss. The patient should also complete a screening for cardiac diseases, obstructive sleep apnea (OSA) and other obesity-related conditions.
  • Pre-operative lab tests: Routine tests, such as blood tests, x-rays, and several gastro-intestinal tests may be done prior to the surgery. These tests provide all the vital information about any pre-existing conditions that may need to be addressed before the surgery.
  • Psychological evaluation: A psychological evaluation is an important component in the preoperative care of the patient. Patients should undergo evaluation for a history of mental disorders, depression, eating disorders, prior weight loss attempts, and other habits. The patient should be encouraged for smoking cessation as smoking or use of tobacco products can adversely affect the healing process and successful outcome of your surgery. In addition, patients with alcohol dependence are referred for rehabilitation and detoxification before the procedure.
  • Nutritional evaluation and pre-operative diet: Nutritional evaluation is necessary to guide the patient towards dietary modifications that are necessary before and after the procedure. Based on the results, the dietician may plan a pre-operative diet that meets their caloric and nutrient needs. Following are the highlights of the new diet plan:
    • A high protein, very low-calorie diet is followed for 2-3 weeks prior to surgery. This helps to reduce the fat in and around the liver and will help to reduce the size of the liver prior to surgery.
    • You will be asked to begin a clear liquid diet the day before surgery. This will help the surgeons to handle the intestines and stomach easily during your operation.
    • You will be asked not to eat or drink anything after midnight the day of your surgery.
  • Medications : Based on your medical history, you will be advised to either gradually reduce or completely stop certain medications one to two weeks before your procedure. Drugs like aspirin, ibuprofen, vitamin E, warfarin etc. are often discontinued one week prior to surgery, as it may increase the risk of bleeding during the surgery.
  • Social and home planning : Your healthcare team will advise you to make necessary arrangements prior to the surgery, such as, having someone to drive you back home and to assist you at home during the recovery period.

How is adjustable gastric banding performed?

The gastric banding surgery usually requires a hospital stay, and you would be admitted to the hospital on the day of your surgery. The procedure typically takes about 45 minutes to an hour to perform.

A general anesthesia would be administered to put you to sleep and make you comfortable during the procedure. The insertion of the adjustable gastric band is usually done via a laparoscopic approach. It involves inserting a scope (flexible fibro optic video camera attached to a narrow tube) and other instruments needed to perform the surgery through small incisions in the abdomen.

The general steps involved in a gastric banding surgery are as follows:

  • A few, small incisions are made on the upper abdomen.
  • The scope and other surgery tools are inserted through these incisions.
  • An adjustable gastric band is placed around the upper stomach to separate it from the lower part. This will create a two-compartment stomach, with a much smaller top part above the band that can hold a small amount of food.
  • A small injection port is placed under the skin of your abdomen, along with a soft plastic tube which connects gastric band and injection port.
  • Some saline solution is injected into the band through this port to inflate the band and make it tighter.
  • Once the band is placed in position and secured to the upper abdominal wall, the scope and other tools are removed.
  • All incisions are finally closed using absorbable sutures.

Post-procedure care

Soon after the procedure, you would be moved to the recovery room and monitored until you recover from anesthesia. Once you wake up, you would be taken to your hospital room.

Hospital care

Intravenous (IV) fluids would be administered promote hydration. Along with IV fluids, antibiotics as well as pain medications are administered. Depending on the clinical conditions, you will be discharged in one or two days.

Post-operative diet

The post-surgery diet plan consists of several stages:
  • Stage one : Liquid diet (1-2 weeks post-op)
    The goal during this phase is to protect the small stomach pouch. Only few ounces of clear liquids are allowed during this time, to help the stomach heal without being stretched due to food intake.
  • Stage two : Pureed diet (3-4 weeks post op)
    During this phase, you may start having pureed food in the baby food consistency. You need to choose protein-rich foods at this stage.
  • Stage three: Soft diet (5 weeks post-op)
    During this phase, tender cooked foods are included, that do not require chewing or can be mashed with a fork. These foods should have no chunks and be soft and moist.
  • Stage four : Stabilization (6th week onwards)
    In this stage, normal food is re-introduced in small quantities. It is important to chew your food well and eat only small bites at a time.

In addition to this diet plan, you will be instructed to take multi-vitamin and B complex medications as absorption of vitamin would be affected by the weight loss surgery.

Post-operative exercise

You will be instructed to start off with 10-15 minutes of some form of exercise two to three days a week and increase to 30 to 45 minutes every day to achieve best results.

Post-operative follow-ups

You will be instructed to undergo frequent medical checkups at regular intervals for adjusting the band as per the weight loss and to monitor your health.

Outlook

Weight-loss with an adjustable gastric band is slow and steady with long term benefits. The results may vary from person to person. However, one can expect approximately 35 to 45 % loss in their excess body weight. If needed, the procedure can be reversed (i.e. the band can be removed), as the surgery does not alter the anatomy of the stomach. The gastric banding surgery also improves obesity associated comorbidities. It is essential to carefully follow diet and exercise guidelines provided by the healthcare team before surgery and after surgery to improve the outcomes.

Reference

  1. Laparoscopic Gastric Banding.
    https://columbiasurgery.org/conditions-and-treatments/laparoscopic-gastric-banding. 
  2. Laparoscopic gastric banding.
    https://medlineplus.gov/ency/article/007388.htm. .
  3. LAP-BAND- FAQs.
    https://4617c1smqldcqsat27z78x17-wpengine.netdna-ssl.com/wp-content/uploads/Lap-Band-FAQs.pdf. 
  4. Laparoscopic Adjustable Gastric Banding.
    https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/laparoscopic-adjustable-gastric-banding. 
  5. Laparoscopic Adjustable Gastric Banding.
    https://utswmed.org/conditions-treatments/laparoscopic-adjustable-gastric-banding/. 

Share on Social Platforms :

Related Articles

Ask an

Expert

We are here to provide you the best service, to help you with all our expertise….
Please leave a message and we will try to reach you very soon

Adjustable Gastric Band

Obesity is defined as having a body mass index (BMI) of over 30 kg/m2. The BMI is the measure of the body fat based on an individual’s weight and height. Obese individuals are at higher risk for many serious diseases compared to those with healthy weight. Though numerous therapeutic approaches and weight management programs have been advocated for obesity, many obese people are unable to lose enough weight or to prevent gaining back the weight. In such cases, surgical interventions may be recommended for effective long-term management of morbid obesity.
The procedure called gastric band, also called laparoscopic adjustable gastric banding (LAGB), is one of the safest and minimally invasive surgical procedure to treat obesity.

What is adjustable gastric banding?

Gastric band surgery, or lap banding, is a minimally invasive, quick, and reversible surgical procedure that decreases the size of the stomach, leading to reduced food intake. It is performed as a laparoscopic surgery by making small incisions in the upper abdomen. An adjustable band (soft silicone band equipped with a firmly attached inflatable balloon) is placed around the upper part of the stomach. This will create a small gastric pouch that can only hold a small amount of food, thus helps to control the portion size and also the hunger.

Who are eligible for gastric banding?

Adjustable gastric band surgery may be right for you if: • You are at least 18 years old. • Your BMI is 35 or above; or you have a BMI score 30 with one or more obesity-related comorbidities such as type 2 diabetes, high blood pressure, obstructive sleep apnea, polycystic ovary syndrome, etc. • You have a history of unsuccessful weight loss attempts. • You are prepared to make substantial changes in your lifestyle, including diet and exercise.

What are the pre-procedure work-ups?

Once you are eligible for a gastric banding, certain steps must be followed before the surgery to improve the results and avoid complications related to the surgery. The pre-operative work-up consists of the following:
  • Pre-operative consultations:
A complete physical examination is performed to make sure that you are healthy enough to undergo the surgery. This evaluation would include a detailed review of the past medical and surgical history, and a review of the psycho-social factors that could influence weight loss. The patient should also complete a screening for cardiac diseases, obstructive sleep apnea (OSA) and other obesity-related conditions.
  • Pre-operative lab tests:
Routine tests, such as blood tests, x-rays, and several gastro-intestinal tests may be done prior to the surgery. These tests provide all the vital information about any pre-existing conditions that may need to be addressed before the surgery.
  • Psychological evaluation:
  A psychological evaluation is an important component in the preoperative care of the patient. Patients should undergo evaluation for a history of mental disorders, depression, eating disorders, prior weight loss attempts, and other habits. The patient should be encouraged for smoking cessation as smoking or use of tobacco products can adversely affect the healing process and successful outcome of your surgery. In addition, patients with alcohol dependence are referred for rehabilitation and detoxification before the procedure.
  • Nutritional evaluation and pre-operative diet:
Nutritional evaluation is necessary to guide the patient towards dietary modifications that are necessary before and after the procedure. Based on the results, the dietician may plan a pre-operative diet that meets their caloric and nutrient needs. Following are the highlights of the new diet plan:
  • A high protein, very low-calorie diet is followed for 2-3 weeks prior to surgery. This helps to reduce the fat in and around the liver and will help to reduce the size of the liver prior to surgery.
  • You will be asked to begin a clear liquid diet the day before surgery. This will help the surgeons to handle the intestines and stomach easily during your operation.
  • You will be asked not to eat or drink anything after midnight the day of your surgery.
 
  • Medications
Based on your medical history, you will be advised to either gradually reduce or completely stop certain medications one to two weeks before your procedure. Drugs like aspirin, ibuprofen, vitamin E, warfarin etc. are often discontinued one week prior to surgery, as it may increase the risk of bleeding during the surgery.
  • Social and home planning
Your healthcare team will advise you to make necessary arrangements prior to the surgery, such as, having someone to drive you back home and to assist you at home during the recovery period.

How is adjustable gastric banding performed?

The gastric banding surgery usually requires a hospital stay, and you would be admitted to the hospital on the day of your surgery. The procedure typically takes about 45 minutes to an hour to perform. A general anesthesia would be administered to put you to sleep and make you comfortable during the procedure. The insertion of the adjustable gastric band is usually done via a laparoscopic approach. It involves inserting a scope (flexible fibro optic video camera attached to a narrow tube) and other instruments needed to perform the surgery through small incisions in the abdomen. The general steps involved in a gastric banding surgery are as follows:
  • A few, small incisions are made on the upper abdomen.
  • The scope and other surgery tools are inserted through these incisions.
  • An adjustable gastric band is placed around the upper stomach to separate it from the lower part. This will create a two-compartment stomach, with a much smaller top part above the band that can hold a small amount of food.
  • A small injection port is placed under the skin of your abdomen, along with a soft plastic tube which connects gastric band and injection port.
  • Some saline solution is injected into the band through this port to inflate the band and make it tighter.
  • Once the band is placed in position and secured to the upper abdominal wall, the scope and other tools are removed.
  • All incisions are finally closed using absorbable sutures.
  Post-procedure care Soon after the procedure, you would be moved to the recovery room and monitored until you recover from anesthesia. Once you wake up, you would be taken to your hospital room. Hospital care: Intravenous (IV) fluids would be administered promote hydration. Along with IV fluids, antibiotics as well as pain medications are administered. Depending on the clinical conditions, you will be discharged in one or two days. Post-operative diet: The post-surgery diet plan consists of several stages:
  • Stage one: Liquid diet (1-2 weeks post-op)
The goal during this phase is to protect the small stomach pouch. Only few ounces of clear liquids are allowed during this time, to help the stomach heal without being stretched due to food intake.
  • Stage two: Pureed diet (3-4 weeks post op)
During this phase, you may start having pureed food in the baby food consistency. You need to choose protein-rich foods at this stage.
  • Stage three: Soft diet (5 weeks post-op)
During this phase, tender cooked foods are included, that do not require chewing or can be mashed with a fork. These foods should have no chunks and be soft and moist.
  • Stage four: Stabilization (6th week onwards)
In this stage, normal food is re-introduced in small quantities. It is important to chew your food well and eat only small bites at a time. In addition to this diet plan, you will be instructed to take multi-vitamin and B complex medications as absorption of vitamin would be affected by the weight loss surgery. Post-operative exercise You will be instructed to start off with 10-15 minutes of some form of exercise two to three days a week and increase to 30 to 45 minutes every day to achieve best results. Post-operative follow-ups You will be instructed to undergo frequent medical checkups at regular intervals for adjusting the band as per the weight loss and to monitor your health. Outlook: Weight-loss with an adjustable gastric band is slow and steady with long term benefits. The results may vary from person to person. However, one can expect approximately 35 to 45 % loss in their excess body weight. If needed, the procedure can be reversed (i.e. the band can be removed), as the surgery does not alter the anatomy of the stomach. The gastric banding surgery also improves obesity associated comorbidities. It is essential to carefully follow diet and exercise guidelines provided by the healthcare team before surgery and after surgery to improve the outcomes. Reference:
  1. Laparoscopic Gastric Banding. https://columbiasurgery.org/conditions-and-treatments/laparoscopic-gastric-banding. Accessed on: 12-05-2020.
  2. Laparoscopic gastric banding. https://medlineplus.gov/ency/article/007388.htm. Accessed on: 12-05-2020.
  3. LAP-BAND- FAQs. https://4617c1smqldcqsat27z78x17-wpengine.netdna-ssl.com/wp-content/uploads/Lap-Band-FAQs.pdf. Accessed on: 12-05-2020.
  4. Laparoscopic Adjustable Gastric Banding. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/laparoscopic-adjustable-gastric-banding. Accessed on: 12-05-2020.
  5. Laparoscopic Adjustable Gastric Banding. https://utswmed.org/conditions-treatments/laparoscopic-adjustable-gastric-banding/. Accessed on: 12-05-2020.