Laparoscopic Gastric Banding

How is it done?

Gastric banding involves placing an adjustable silicone band at the upper part of the stomach connected through a narrow tube to a small access port that is placed under the skin. The size of the outlet of the upper stomach can be adjusted by adding or removing fluid through the access port. The band allows people to feel full after eating only a small amount of food.

Advantages:

1. Minimal vitamin deficiencies as there is no bypass of any part of the intestine
2. Safe operation as the procedure does not involve cutting or joining any part of the intestine or stomach.
3. Shortest inpatient stay (one night)
4. Relatively reversible. See below from futher explanation.

Disadvantages:

1. Obstructive eating: patients feel obstructed rather than full after eating with pain on swallowing, regurgitation, heartburn and vomiting. This is seen even in patients who succeed in losing weight.
2. Very restrictive diet: most patients cannot eat rice, pasta, white bread, red meat and chicken (unless minced) and many fruits. Patients quickly discover that soft sloppy food such as chocolate, milk shakes and ice cream readily passes through the band. Thus the band tends to teach patients to eat the wrong diet (rich in sugar and fat).
3. The band requires the highest self discipline from patients to stick to the prescribed diet despite difficulties.
4. Ongoing failure rate due to band slip, band erosion, and tubing and access port troubles. On average 4-5% of bands need to be removed per year. When the band is removed for any reason patients will quickly regain back any weight they might have lost.
5. Intensive follow up is needed to adjust the amount of fluid in the band. Studies have shown that the success of the band is very dependent on the intensity and duration of the follow-up.
6. Variable weight loss: the average excess weight loss is around 45%. Many patients fail to lose half their excess leading to a higher rate of dissatisfaction.
7. The band does not work so well for older and larger patients.
8. Compromising further weight loss operations: Though gastric banding does not involve removing or joining any part of the stomach or intestine, the band leaves a band of scar and a folded stomach after removing the band. This scaring interfere with the safety and success of other weight loss operations like sleeve gastrectomy and gastric bypass.