Adjustable Gastric Band Treatment

The obesity, or bariatric, surgical procedure known as laparoscopic gastric band involves reducing the size of a patient's stomach by placing an adjustable belt around one part the stomach. While the procedure carries some risk of fatality and other serious consequence, gastric bands have generally strong safety and success records. The greatest difficulty patients may have with gastric banding may be committing to lifestyle changes such as eating much less and exercising.

Who Is Eligible?

• People with a body mass index greater than 40 who have tried and failed to lose significant weight by dieting and exercising make the best candidates for laparoscopic gastric banding surgery. People with lower BMIs may also be considered for gastric banding if they have other serious health problems such as advanced diabetes or cardiovascular disease. A factsheet written for Medline Plus notes that people who are dependent on or addicted to illegal drugs or alcohol cannot get a gastric band.

Procedure

• A surgeon places a gastric band while a patient is under general anesthesia. Using a camera called a laparoscope to guide the positioning of the band--usually a Lap Band from Allergan--and the application of surgical instruments, the surgeon inserts the band through a 1 centimeter incision and wraps the band around the uppermost part of the patient's stomach. Cinching the band creates a small pouch of about 15 cubic centimeters. The procedure takes between 30 to 60 minutes, and the pouch formed by the procedure permits patients to eat only very small amounts of food at any one time. The band contains an embedded saline-filled balloon that doctors can inflate or deflate to shrink or expand the newly created smaller stomach. Adjustments get made as patients gain or lose weight, and the balloon is accessed via a tube that sits just under a patient's skin.

Serious Risks

• All forms of bariatric surgery, including gastric banding, put patients at risk for dying from a heart attack or stroke, bleeding internally or developing blood clots. Once quite high, these risks have decreased over the years as surgeons have gained expertise and patients have been better identified as appropriate candidates. An article published in the July 30, 2009, New England Journal of Medicine reports that only 0.3 percent of bariatric surgery patients died with 30 days of undergoing the procedure and just 4.3 percent of patients experienced a serious problem during the first month post surgery.

Potential Complications

• Patients who undergo bariatric surgery can vomit if they eat more their new stomach can hold, suffer chronic dehydration and become deficient in iron and fat-soluble vitamins B12 and D. The surgery also raises a patients' risk of developing kidney stones, gallstones, low blood sugar and bleeding stomach ulcers. For unknown reasons, patients can develop aversions to certain foods, with the particular foods varying from person to person. Complications specific to gastric banding include band slippage, swelling of the stomach lining (i.e., gastritis), chronic heartburn, scarring inside the stomach and injury to the stomach or nearby organs.

Lifestyle Adjustments

• Physicians from the Mayo Clinic caution patients that adjusting to having a substantially smaller stomach and being unable to eat as usual can take as long as six months. During this adjustment period, patients may experience flu-like symptoms, constant fatigue, chills, hair loss, mood swings and dry skin. To guarantee weight loss, patients who have a gastric band implanted will also have to exercise regularly and adhere to a strict reduced-calorie and low-volume diet.

Prognosis

• Patients can lose up to half of their excess bodyweight following laparoscopic gastric banding, but this total weight loss can take two years or more. Losing weight can lessen or eliminate the symptoms of asthma, gastro esophageal reflux disease, sleep apnea, type 2 diabetes and high blood pressure. Patients who had suffered joint problems before undergoing laparoscopic gastric banding may also find it easier to move around and exercise after they lose weight.