Laparoscopic adjustable gastric banding offers a simpler and safer option for patients interested weight loss surgery but concerned about the potential consequences of the gastric bypass and sleeve gastrectomy. The banding operation involves the placement of an inflatable adjustable silicone band around the top of the stomach pinching off a small gastric pouch of approximately half an ounce.
Watch Bariatric Surgery: Laparoscopic Adjustable Gastric Banding Weight Loss video with Malcom K. Robinson, MD, Center for Metabolic and Bariatric Surgery at BWH.
Only a small amount of food can be eaten at one time as the small pouch fills up very fast. After reaching the pouch, the food slowing leaves the pouch through a narrow stomach channel created by the band and then into the big part of the stomach below the band and beyond. Digestion is normal after banding. The band can be easily adjusted (tightened or loosened) in the office to regulate the passage of food from the pouch and in doing so, the amount of food that can be eaten.
Connected to the band is a hollow tube that is attached to a hollow metal disc called a port. The port is placed on the muscle layer of the abdominal wall under the skin. Saline fluid is injected from a skinny needle into the port to tighten the band and removed from it to loosen it. When the band is first placed in the body, it is empty of fluid and too loose to be effective. Most patients typically require 3 to 5 fills to achieve ideal tightness.
Compared to the other weight loss operations, band placement is simpler and safer. The surgery takes only 1 hour or less and the patient generally stays no more than 1 day in the hospital. There is no cutting of the stomach, stapling or manipulating the intestines. Complication rates are low. The most common complications include band erosion into the lumen of the stomach (2%) and band slippage (3-4%). However, of the 3 commonly performed operations for weight loss, the band requires the highest level of patient compliance and the one most likely to fail. Patients unable to restrict their intake of candy, liquid calories, or fast food, or unable to control grazing habits, are more likely to fail. In addition, patients whose bands are not properly tightened will not do very well.