Adjustable Gastric Banding Surgery
Laparoscopic adjustable gastric banding is surgery to make the stomach smaller. It is done to help people lose weight. The surgery limits the amount of food the stomach can hold. This helps you eat less and feel full more quickly.
Adjustable gastric banding is done through several small cuts, called incisions, in the belly. The doctor will place small surgical tools and a camera through the incisions. The doctor will then wrap a device around the upper part of your stomach to form a ring. Attached to the ring is a thin tube leading to an access port that is left under the skin. The access port is the place where the doctor puts in a needle to add or take away saline. Adding saline tightens the band and makes the stomach smaller. The doctor can take away saline if the ring is too tight.
During surgery, the band is not inflated. You will need to recover from surgery before the band is adjusted for weight loss. This is usually 4 to 6 weeks after surgery.
Another name for this surgery is gastric banding. Sometimes people refer to it by brand names, for example the Lap-Band System or the Realize Band.
What To Expect After Surgery
After surgery, you may need pain medicine to help with discomfort and soreness. You'll be encouraged to start moving around to help your body heal. You may have an X-ray the day after surgery to see that everything is working correctly.
Your doctor will give you specific instructions about what to eat after the surgery. For the first 2 weeks, your stomach can only handle small amounts of liquids while you are healing. Some people feel full after just a few sips of water or other liquid. Other people won't notice much difference. It is important to try to sip water throughout the day to avoid becoming dehydrated. You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements.
Bit by bit, you will be able to add solid foods back into your diet. You must be careful to chew food well and to stop eating when you feel full. This can take some getting used to, because you will feel full after eating much less food than you are used to eating. If you do not chew your food well or do not stop eating soon enough, you may feel discomfort or nausea and may sometimes vomit.
Your doctor may recommend that you work with a dietitian to plan healthy meals that give you enough protein, vitamins, and minerals while you are losing weight. Even with a healthy diet, you probably will need to take vitamin and mineral supplements for the rest of your life.
After you can eat solid food again, your doctor will adjust the band around your stomach by inserting saline into your port, which will inflate the band and cause it to tighten. You will probably have many adjustments to the band in the first year to find the right size that helps you lose weight, feel full at the right time, and not vomit. You'll need to visit doctor each time you need the band adjusted.
After this surgery, weight loss is usually gradual but steady. You will have regular visits with your doctor to check how you are doing. The doctor can adjust the band if you are not losing weight as expected or if you have problems with the band. Some people continue to lose weight for up to 3 years after surgery.
It is common to have many emotions after this surgery. You may feel happy or excited as you begin to lose weight. But you may also feel overwhelmed or frustrated by the changes that you have to make in your diet, activity, and lifestyle. Talk with your doctor if you have concerns or questions.
Why It Is Done
Weight-loss surgery is suitable for people who are severely overweight and who have not been able to lose weight with diet, exercise, or medicine.
Surgery is typically considered when your body mass index (BMI) is 40 or higher. Surgery may also be an option when your BMI is 35 or higher and you have a life-threatening or disabling problem that is related to your weight.
It is important to think of this surgery as a tool to help you lose weight. It is not an instant fix. You will still need to eat a healthy diet and get regular exercise. This will help you reach your weight goal and avoid regaining the weight you lose.
How Well It Works
Studies have shown that people can lose weight as successfully with adjustable gastric banding as they do with other weight-loss methods or surgeries, although in general the weight loss is slower and less than with gastric bypass.
Risks common to all surgeries for weight loss include an infection in the incision, bleeding, and a blood clot in the legs (deep vein thrombosis, or DVT) or lung (pulmonary embolism). Some people develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis.
Although adjustable gastric banding is considered the least invasive of the weight-loss surgeries, problems can occur. They include:
- Obstruction. The band can cause something (usually food) to block the opening from the upper part of the stomach to the lower part of the stomach. This can cause pain, nausea, and vomiting.
- Band slippage. The band can slip out of place. Symptoms might include belly pain or heartburn (acid reflux). This may be treated by removing the fluid from the band. Or you may need a second operation.
- Access port problems. You could get an infection around the access port, or the access port could disconnect or leak. The tube that leads from the band to the access port could also become blocked.
- GERD. You could develop esophagitis or gastroesophageal reflux disease (GERD).
- Esophageal dilation. If the band is too tight, or if you eat too much, your esophagus could expand. This can make it hard for you to swallow, which could cause food to get stuck in your throat. If it is not fixed, you could get pneumonia.
- Poor nutrition. Eating less may mean that you are not getting enough nutrients, which can cause health problems. You will probably have to take vitamin supplements for the rest of your life.
What To Think About
Weight-loss surgery does not remove fatty tissue. It is not cosmetic surgery.
Some studies show that people who have weight-loss surgery are less likely to die from heart problems, diabetes, or cancer compared to obese people who did not have the surgery.1
- Adams TD, et al. (2007). Long-term mortality after gastric bypass surgery. New England Journal of Medicine, 357(8): 753–761.
Other Works Consulted
- Colquitt JL, et al. (2009) Surgery for Obesity. Cochrane Database of Systematic Reviews (2).
- Heber D, et al. (2010). Endocrine and nutritional management of the post-bariatric surgery patient: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 95(11): 4823–4843. Available online: http://www.endo-society.org/guidelines/final/upload/FINAL-Standalone-Post-Bariatric-Surgery-Guideline-Color.pdf.
- Pories WJ (2008). Bariatric surgery: Risks and rewards. Journal of Clinical Endocrinology and Metabolism, 93(11, Suppl 1): S89–S96. Available online: http://jcem.endojournals.org/cgi/reprint/93/11_Supplement_1/s89.pdf.
Last Revised: April 5, 2013
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