ADJUSTABLE GASTRIC BANDING

 

          Adjustable gastric banding is a purely restrictive operation.  There is no malabsorption associated with this procedure, which means that there is no long term requirement for taking vitamin or mineral supplements as is necessary with the gastric bypass or duodenal switch.  Also, there is no associated “dumping syndrome”, which means there is no punishment for eating foods with high sugar or fat content.

 

 

                                

 

(fig. 1)

         

          The components of the adjustable gastric band are depicted in fig. 1.  The “Gastric band” consists of an outer silicone ring and an inner balloon.  This balloon is attached to tubing which connects it to the “Access port”, containing a tiny chamber allowing it to be accessed via a special needle to “adjust” the band.  The operation to place the band takes approximately one hour to perform and is accomplished via the Laparoscopic approach.  A schematic view of the band in place can be seen in fig. 2.  The band is placed in the abdominal cavity open, passed around the upper part of the stomach, and then locked in position during the procedure.  The port is attached to the fascia, beneath the skin and fat but outside the abdominal cavity.

 

 

                                                

 

(Fig. 2)

 

          The primary purpose of the band is to change one’s eating habits by limiting portion size (forcing one to eat slowly and chew well), inhibiting intake of simple carbs (bread, pasta, and rice), and decreasing appetite slowly.  This leads to a relatively slow, but progressive weight loss of approximately 1-6 pounds per month.  The small pouch of stomach above the band, created by progressively inflating the balloon with saline (adjustment), becomes distended after eating small portions of food leading to fullness (satiety).

 

 

 

ADVANTAGES

 

          ► REVERSIBLE

          ► ADJUSTABLE

          ► LEAST INVASIVE PROCEDURE

          ► NO NEED TO TAKE MULTIPLE VITAMINS AND SUPPLEMENTS LONG TERM

          ► NO MALABSORPTION

          ► LESS SERIOUS COMPLICATIONS

          ► SLOWER WEIGHT LOSS

 

DISADVANTAGES

 

          ► SLOWER WEIGHT LOSS

          ► NO “DUMPING SYNDROME”

          ► LESS LIKELY AND LONGER TIME TO RESOLVE DIABETES (TYPE II) THAN GASTRIC BYPASS

          ► LESS APPETITE SUPPRESSION THAN GASTRIC BYPASS

 

          The adjustable gastric band is an excellent alternative to the Roux-Y gastric bypass for patients with BMI < 55, younger patients, patients over 65 years of age, and patients with contraindications to the gastric bypass.  The band patient does require closer follow-up (for ideal adjustment) than the gastric bypass patient and, probably, more effort to stay on track but, in the end, all bariatric procedures are tools to help one change his/her eating habits and lifestyle long term.