How Laparoscopic Adjustable Gastric Banding works

The procedure
The gastric band procedure, like the other procedures that we perform here at Texas Health Center for Diagnostics & Surgery, is performed laparoscopically, or in a minimally invasive manner. This means that rather than the single large incision that is used during open surgery, five small incisions are made in the abdomen through which small medical devices called trocars are passed. The trocars serve as passageways for the various medical devices that will be used to perform surgery.

During the surgery, the gastric band is placed around the upper portion of the stomach. The band is then tightened, resulting in the formation of two distinct stomach chambers. The smaller upper chamber becomes the primary receptacle for the food that is consumed by the patient. Its small size means that the patient will feel full sooner. The restriction provided by the band means that the food will not pass into the lower stomach as quickly, allowing for prolonged satiety. Once the food drops into lower stomach, it is processed and digested by the gastrointestinal system much in the way that it was before surgery.

Adjustments to the band
The band can also be adjusted. The band is attached to an access port via tubing beneath the skin. While the port can be felt by touch, it is invisible from the outside. After surgery, we will use a specially made needle to adjust the band. These are called “band fills” or “adjustments” and are routine. By injecting or removing saline from the band, the inner tube of the band is inflated or deflated. This tightens or loosens the band respectively, based on need.

Post-surgical care
The first fill or adjustment is usually performed 5 weeks after surgery. It is common to take several adjustments, with an average three, to reach your initial “sweet spot” where the band is just right, providing portion control and prolonged fullness. From that point forward, fills are needed based on increasing portions of food, slowing of weight loss and frequently after 20-30 pounds of weight loss. Once your goal weight is achieved plan on annual assessments. Adjustments occur under radiology imaging called fluoroscopy, conducted with your surgeon, your nurse and a radiology tech.

Considerations and Risks

• Despite its track record, gastric banding surgery is still major surgery and comes with the risks of any other procedure, which may be exacerbated by a patient’s poor health due to obesity.
• Weight loss with the gastric banding is usually slow and steady compared to other choices.
• Complications may include band slippage and erosion, or injection port flippage or separation from band component.
• If the band is removed, most patients will regain all of their weight.
• Banding patients will have a greater degree of follow-up because of the adjustability of the procedure, meaning that they will have to visit our office several times over the first two years, and periodically thereafter, for adjustments and valuations.
• A medical device will be placed in the abdomen.
• Potential gastric banding patients should note that losing weight requires a great degree of self-control after surgery. This means changing their lifestyle, including significant diet and exercise modifications. The willingness and ability of the patient to change their lifestyle is fundamental in the success of the procedure over the long-term.