Gastric Banding Surgery
Treatment of morbid obesity has been gradually shifted from non-surgical management to the more effective bariatric (weight loss) surgeries. This is due to the poor result associated with the former and high incidence of weight regain. Because of poor weight loss, the resolution of obesity-associated disease conditions following non-surgical management is also not as significant as that obtained with surgical management.

These surgeries are of various types ranging from those that limit the capacity of the stomach (restrictive) to those that reduce the absorptive capacity of the intestine and those that offer both. Gastric banding is a common bariatric surgery which limits the amount of food the stomach can take and thus reduce the individual’s calorie intake. It is one of the options available for morbidly obese individual or those that desire resolution of obesity-associated disease conditions.

The laparoscopic approach has taken over from the open surgical approach as the former is associated with reduced complications and early post-operative recovery. Laparoscopic adjustable gastric banding has the added advantage of being reversible. It can be converted to other bariatric surgical procedures in the event of failure or complication.

This surgery involves the compartmentalization of the stomach into a smaller upper and a larger lower portion. This division is an incomplete one as the upper portion still communicates with the lower one as against gastric bypass where there is no communication between the two. As the smaller upper pouch gets filled, there is a feeling of early satiety and thus, reduction in calorie intake. After a little time, the partially digested food then moves gradually into the lower pouch and subsequently into the small intestine and digestion continues.

This compartmentalization is achieved with the use of a silicone band. The silicone band is inflated with sterile water via a plastic tube that extends from the band to an area under the skin of the abdomen. This tube allows for adjustment of the band; addition of more water makes it tighter and vice versa. Hence, the name “laparoscopic adjustable gastric banding”

Indications and Contraindications

Eligibility for this procedure is similar to that of other bariatric surgeries. A body mass index of ≥40 or >35 in the presence of one or more obesity-associated disease condition necessitates a gastric banding. A physical problem due to obesity with interference with daily activities is also an indication to undergo a gastric banding procedure.

Care should however be exercised in a patient with any of the following conditions: Chronic liver disease, Inflammatory bowel diseases e.g. Crohn disease, Congenital malformations of the digestive tract, Chronic pancreatitis, Previous gastric perforation , Severe cardiac and respiratory disease, Autoimmune connective tissue diseases such as SLE, Prolong use of steroids/immunosuppressant, etc.

Effectiveness

An average body mass index reduction from 44.3kg/m 2 to 34.2, 32.8, and 31.9, at 1year, 2year and 3years after the surgery respectively was reported in over 500 cases of gastric banding surgery.1

In another study 2,815 patients with an average body mass index of 44.6 kg/m2 had laparoscopic gastric banding and were followed-up for 5years. The average percentage weight loss (%WL) and percentage excess weight loss (%EWL) progressively increased over the first 2.5 years post-surgery and reached a plateau at 20% and 49 %, respectively, for up to 5 years of follow up.2

Similar result was obtained in 178 patients who had laparoscopic gastric banding.  The average percentage total body weight loss at 1, 2 and 3 years after surgery was 15.8%, 20.7% and 20.3%, respectively.3

Complications

The procedure is relatively safer as compared to other bariatric surgeries. The commonest early post-operative complication is nausea (19%). The intermediate complications are band migration (5.6%) and port site complications (1%), band leakage (1%) and incisional hernia (1%). The rate of reoperation after the initial surgery is 4.5%. The average length of hospital stay is 1.4 days. The average numbers of clinic visits and band adjustments were highest in the first year.3

Safety

In terms of safety, laparoscopic adjustable gastric banding  was associated with an average short-term death rate of approximately 0.05% and an overall median morbidity rate of 11.3%, as against Laparoscopic Roux-en-Y gastric bypass  with 0.50% and 23.6% and vertical banded gastroplasty with  0.31% and 25.7% death and morbidity rate respectively.4

  1. Costs of Gastric Bypass Surgery
  2. Life and Recovery of Gastric Bypass Surgery
  3. Pre-Operative Gastric Bypass Diet
  4. Post-Operative Gastric Bypass Diet

References

  1. Zinzindohoue F, Chevallier J, Douard R et al. Laparoscopic Gastric Banding: A Minimally Invasive Surgical Treatment for Morbid Obesity. Annals of Surgery. 2003;237(1):1-9. doi:10.1097/00000658-200301000-00001.
  2. Cobourn C, Chapman MA, Ali A, Amrhein J. Five-Year Weight Loss Experience of Outpatients Receiving Laparoscopic Adjustable Gastric Band Surgery. Obesity Surgery. 2013;23(7):903-910. doi:10.1007/s11695-013-0881-7.
  3. Chiu CJ, Birch DW, Shi X, Karmali S. Outcomes of the adjustable gastric band in a publicly funded obesity program. Canadian Journal of Surgery. 2013;56(4):233-236. doi:10.1503/cjs.002712.
  4. Chapman A, Kiroff G, Game P et al. Laparoscopic adjustable gastric banding in the treatment of obesity: A systematic literature review. Surgery. 2004;135(3):326-351. doi:10.1016/s0039-6060(03)00392-1.