Gastric band

The gastric band (or sometimes referred to more fully as laparoscopic adjustable gastric band – LAGB) is a really useful tool to help reduce the amount of food you eat. It simply acts like a belt around the top portion of your stomach, creating a small pouch. You will feel full after eating only a small quantity of food. This feeling of fullness will remain with you – a person working well with their band will feel satisfied eating three quite small meals a day.

The gastric band has been in use since the mid 1980s. It offers several major advantages:

  • It is adjustable - The adjustability of the band gives you and your doctor control to achieve weight loss without creating too many unpleasant symptoms due to the degree of restriction.
  • It is placed laparoscopically – for most people this means they can return to work soon after the operation with a minimal recovery period
  • It is reversible - Taking the band out would revert the stomach to its normal size and you would expect to gain weight again, so the plan at the outset is to leave it there permanently. However, if in the future your band needs to come out for any reason, this too can be done laparoscopically, leaving no permanent changes to your stomach.

There are a number of different bands available to your surgeon. They are all very similar and each comprises a silicone ring and a reservoir connected to the ring by a length of fine tubing.

The band is held closed by a locking device, so it will not come undone. It comprises an inner balloon which is connected by tubing to a reservoir (also called a port). The reservoir is usually anchored deep under your skin on one side of your abdomen below your ribs, or at the base of your breast bone.

Inflation of the balloon has the effect of making the band tighter – restricting the opening between the new small pouch that the band creates at the top of your stomach and the main part of your stomach. The opening between the two parts of your stomach is often referred to as a stoma.

By adjusting the amount of fluid in the balloon the amount of food you can eat and the rate at which it passes through the stoma is controlled.

How much weight will you lose with an adjustable gastric band?

The primary aim of weight loss surgery is to solve the problems caused by your obesity. This does not usually require you to get right down to your 'ideal' weight, but rather closer to it than you are now.

Studies show that on average, people lose between 50–65% of their excess weight in the two years after placement of a gastric band. The really good news is that long before you reach that stage, you will start to feel the benefits, especially if you also have any of the obesity–related diseases such as diabetes, heart disease or high blood pressure. You will also have a much greater capacity for physical activity and more self–confidence.

People who are motivated to follow the eating plan, increase their exercise, keep follow up appointments with the healthcare team and keep in touch with a patient support group, are more likely to achieve greater weight loss.

Like all medicines and procedures, the adjustable gastric band has been thoroughly tested in clinical trials and proven to be effective.

A review published in December 2002, looked at reports of 5,827 patients around the world who had adjustable gastric bands fitted. A pattern of a steady progressive weight loss was observed over a 2–3 year period followed by weight stabilisation for the next three years. On average, patients lost between 52 and 65% of their excess weight in the two years after surgery. (O'Brien PE, Dixon JB. Weight loss and early and late complications - the International experience. Am J Surg 2002; 184(6B): 42S–45S)

A study of 984 patients in Frankfurt (83% women, average age 40 years) who have had bands fitted since 1994 showed average excess weight loss has been 59.3% (average BMI reduced from 46.8 kg/m² to 32.3kg/m²). There was a very low rate of complications and importantly, 97% of patients attended the clinic for their follow up visits. (Weiner R, Blanco–Engert R, Weiner S, Matkowitz R, Schaefer L, Pomhoff I. Outcome after laparoscopic adjustable gastric banding – 8 years experience. Obes Surg. 2003 Jun;13(3):427–34)

1,120 patients had adjustable bands placed in Melbourne, Australia over 6 years ago now. The excess weight loss of these patients still averaged 54% five years and 57% six years after surgery, demonstrating the long term effect on weight loss of the gastric band. (O'Brien PE, Dixon JB. Weight loss and early and late complications - the International experience. Am J Surg 2002; 184(6B): 42S–45S)

The operation

You will be admitted to hospital either the night before, or the morning of your surgery. Most patients just stay in hospital for one night after their operation. You will have a general anaesthetic, and the operation takes about one hour. The surgery is done laparoscopically, (keyhole surgery) and your surgeon has done additional training to be able to operate this way. Through a series of small incisions across your upper abdomen he/she will use laparoscopic instruments and be guided by a special telescope with a camera, to place the band and secure it in place around your upper stomach. In the diagram above you can see how the outer tissue of the stomach is secured over the band to secure it in place.

The operation will cause you discomfort, rather than severe pain, and this can usually be managed with pain relief tablets. Initially you will have an intravenous drip but you will be able to start drinking sips of water quite soon after the operation. You will also be encouraged to get up out of bed the same day and the majority of people are well enough to be discharged from hospital 1–2 days following the operation.

In rare cases, the surgeon will encounter an unexpected difficulty as he/she operates and will decide to continue the operation with a bigger incision. If this happens, you will take a little longer to recover, but it should not adversely affect the band or your subsequent weight loss progress.

About two weeks after the laparoscopic operation you should have fully recovered, back to normal activities and possibly already seeing some weight loss.

About two weeks after the laparoscopic operation you should have fully recovered, back to your normal activities and possibly already seeing some weight loss.

Risks and Side Effects

Fortunately, complications are rare but it is important you learn about the potential problems before you decide to proceed with the surgery.

Firstly, being obese makes any surgery more risky. Anaesthetics are more difficult, and obesity–related diseases that you may have can add further complications. Statistics show the death rate associated with gastric band insertion to be about 1 in 2,000 operations. The most common cause of death is the development of a blood clot in the lungs (pulmonary embolism).

Occasionally patients may develop other complications at the time of operation such as an infection in the lungs, stomach or at the site where the reservoir is placed under the skin, which may delay recovery.

The placement of the gastric band laparoscopically helps to reduce the risk of complications, and the team who manage your surgery and anaesthetic are specially trained in the treatment of obese patients. They will monitor you closely in the period immediately following your surgery, and take a range of measures to prevent complications from arising, including giving you medications to help prevent vomiting (and dislodging the band) and blood clots and getting you up and about soon after the operation.

Overall, international studies suggest that 1 in 10 people with a gastric band will need a further operation at some time in the future. This may be due to:

  • Slippage. Months or even years after the operation, there is always the risk that the stomach will move up through the band and the upper pouch will become enlarged. The band can be re–fixed in the correct position.
  • Erosion. Very slowly, and particularly if the balloon is tightly inflated, the band can work its way into or through the wall of the stomach and cease to be effective. In this case the band would be removed and and replaced if possible.
  • Leakage. This may be due to damage of the reservoir or tubing if fills are not carried out with extreme care or if two of the band components come apart. Again, this would necessitate replacement of the damaged component.
  • Infection of the reservoir/port or tubing. It may need to be resited or replaced if the infection persists and in the case of severe infections which have been resistant to antibiotic treatment, the band may have to be removed.

The band itself is made of silicone and there are no known side effects to this material inside the body. However, you do have to bear in mind the possibility that some time in the future your band may need to be replaced simply because it has worn out or newer, better bands have been developed to replace current ones (hip replacement prostheses are replaced for these reasons). If you have a lesser known brand of gastric band from a small company, they may not be around in 20 years time when you need your band replacing.

Some people will fail (lose less than 25% of the excess weight) with a gastric band and in these cases, the surgeon may advise that a gastric bypass operation is performed. However, don’t give up too soon on your band if you are one of these people – experience in Australia shows that it can take a full 2 years for people to get their heads around how to live effectively with their gastric band, and when they do, they start to lose weight.

Medical Follow Up After Surgery

A multidisciplinary healthcare team, headed by your surgeon and comprising a mix of professionals such as other physicians, dietitians, nurses, exercise specialists and a psychologist, will work together to help you get the best results from your gastric band surgery. This means resolution or improvement in obesity–related diseases as well as weight loss. Remember, the band is simply a tool to help you eat less and there is a lot required from you in following the eating and exercise guidelines.

In the early months, your band will be adjusted (usually two to three times) until the setting is optimal for your weight loss progress. Once the setting is correct, the degree of restriction created by your band is generally maintained at that level until you reach your weight loss target.

Adjustments to the band take only a few minutes and are done in the clinic without any need for anaesthetic. Sometimes these are performed under x-ray control - this depends on the standard procedures of your local bariatric surgery centre.

Even when you have reached your weight loss target, the healthcare team will want you to attend annual appointments so that they can check that the band is still in place and functioning as it should.