What is the adjustable gastric band and how does it work?

The gastric band is an inflatable silicone prosthetic device that reduces the stomach capacity to hold food in less than 50cc which gives a sensation of fullness and facilitates following a diet program.

 

In which cases is this procedure advised?

Adjustable gastric banding is indicated for patients with morbid obesity (BMI >40) or patients with severe obesity (BMI between 35 and 39) when there are associated diseases that will improve with the expected weight loss.

Recently the procedure is approved in cases of patients with BMI between 37 and 39, when there are not any associated diseases and no contraindications. The above is due to low frequency of complications and fast recovery time of this procedure.

The patient must understand that the adjustable gastric banding is an extraordinarily efficient and safe weight loss procedure when it goes hand to hand with a modified diet controlled by our team. The key for the adjustable gastric banding success is the follow up program after surgery.

What tests do I need before the surgery?

Before the surgery the patient is studied in detail by the team of specialists

• SURGEON - TEAM COORDINATOR: complete lab work is done and therapy options and adjustable gastric banding are discussed.
• PSYCHOLOGIST: performs tests to identify psychological profile of the patient and approves the patient entering the program.
• DIETITIAN: explains in detail what and how much to eat after the placement of the adjustable gastric band.
• ENDOCRINOLOGIST: will see the patient in case of unstable endocrinopathy and might recommend delaying the surgery.
• PRE ANESTHESIC STUDY:  includes lab work with coagulation, electrocardiogram and thoracic Rx. A gastro duodenal transit test is performed to eliminate the risk of hiatus hernias and other alterations of the gastric morphology. Patients with a medical history of lung pathology will take a Spirometry test. Patients with specific symptoms will be advised to take an abdominal ultrasound and/or gastroscopy.
• ANESTHESIOLOGIST: With the test results and a visitation the anesthesiologist will evaluate what the anesthetic risk is (ASA score) and the intubation risk is (MALAMPATI).

With all the above mentioned test results, the team of specialists will approve the admission of the patient into the program or they will recommend another treatment prior to the surgery.

 

 In what cases I would not be able to have surgery?

• When the patient has a BMI of extreme obesity (> 50), we will recommend an initial treatment with the Intragastric Balloon.

• When the patient’s characteristics (dietetic habits or psychological profile) are not appropriate for this treatment it is possible that we will ask to re-evaluate his/her ability to respond to the adjustable gastric banding and recommend an initial Intragastric Balloon.

 

How is the surgery performed?

• The procedure usually takes between 60 and 90 minutes. It is performed via laparoscopic surgery, without opening the abdomen.

• The adjustable gastric band is placed under general anesthesia through small incisions in the abdomen (4 incisions of 10 mm and 1 incision of 18 mm). The band is placed around the stomach. Without cutting or stapling any tissue the band creates an artificial, small stomach (with capacity of less than 50 cc) that has functionally limits the amount of food that the patient can consume.

The food goes progressively into the rest of the stomach, where the nutrients are normally absorbed since the digestive physiology remains unaltered.

 

How does the adjustable gastric banding work?

• The adjustable gastric banding is a treatment that can be adapted to every patient’s therapeutic needs. The band is connected to a small box implanted in the abdominal wall- which is not bothersome even after weight loss.

• Filling the box with physiologic serum the band can be constricted. This has a restrictive effect on gastric filling capacity.

•  The band filling is done in the radiology room:

• In a few minutes.
• Without hospital admission.
• Without anesthesia.
• Without pain.

• With this simple method we can modify the feeling of fullness and adapt the treatment to each case.

• Usually the patients needs from 2 to 5 band fillings over the whole treatment.

• The band is designed to stay in place for life. It is a reversible treatment and the patient can have the band removed with a surgical procedure similar to its placement . 

X-ray of the gastric band.

 

Will I be in pain after the surgery?

After the surgery, the patient:

• Stands and walks around the room 3-4 hours after the procedure.
• Can drink cold liquids 4 hours after surgery.
• The patient is released from the hospital the day after the surgery. The suture is removed 10 days after surgery.
• It is recommended that patients restrict themselves to light activity  over the next 7 days; it is recommended that patients do go outdoors and exercise lightly.
• It is appropriate to avoid intense physical exercise over the next 4 weeks after the surgery.
• The timeframe for going back to work or back to your life depends on the type of work and should be between 1 and 4 weeks.
• It is a procedure with a fast recovery time and that adds very few changes to your lifestyle.

 

What are the surgery’s risks?

• The surgical procedure is considered to be “low risk” or “minimal risk”. Nevertheless in every surgery there is some risk. The mortality rate in the adjustable gastric banding is less than 1.5 per 1000 patients, the same as an appendicitis or gallstone surgery. This is because the major risk of the procedure is using anesthesia with obesity and not in the surgical technique itself.

• The factors that make the adjustable gastric banding risk so low compared to the risk of the gastric bypass (with a mortality rate of 3%) are:

• Its technical simplicity.
• The shorter time the patient needs to be under anesthesia and in surgery.
• The minimal bed rest time and quick hospital release.
• The fast recovery time.

 

What will I be able to eat with the adjustable gastric band?

• During the first 4-6 weeks the patient needs a liquid and soft diet. After this time the diet is normal with some limitations.

• In general it is recommended to have 5 meals per day, to eat slowly, to chew well and to drink only a little during meals. Eventually the patient will be able to eat prepared food and cooked meals without any problem.

 • Occasionally it might be necessary to avoid some food like raw meats or tough meats.

 

Will I be able to have a normal life with the adjustable gastric band?

• The patient can go back to have a normal life a few weeks after the surgery.

• In our support program, the patient has his/her first consultation with the Sports medicine specialist about 6 weeks after the surgery. The patient must exercise regularly according to his/her weight, age and possible musculoskeletal limitations.

• Moreover the patient needs to follow the advice on modifying dietetic habits and lifestyle.

• The patient must change his/her mindset to “cure” the obesity. 

 

How much weight will I lose with the adjustable gastric band?

• From 55 to 60% of the excess weight or more depending on each case.

• Half of this weight loss happens over the first 6 months. The rest takes the following 12 to 18 months.

• The weight loss is permanent when the patient maintains the dietetic changes made.

 

How does Clínica Obésitas treat patients who have an adjustable gastric banding procedure?

• Clínica Obésitas has a full team support treatment that consists of:

• Dietetic education and treatment.
• Lifestyle changes –physical exercise according to the needs and limitations of each patient-.
• Psychological treatment- behavioral therapy-.

• For all the above, Clínica Obésitas sets up a consultation and follow up visitation protocol that lasts over 24 MONTHS.

 

See details of the evaluation and organization of the adjustable gastric banding procedure

See results from Adjustable Gastric Banding: Presentation at Congreso Nacional Sociedad Española de Cirugía de la Obesidad SECO-2007