Laparoscopic gastric banding

Definition

Laparoscopic gastric banding is surgery to help with weight loss. The surgeon places a band around the upper part of your stomach to create a small pouch to hold food. The band limits the amount of food you can eat by making you feel full after eating small amounts of food.

After surgery, your doctor can adjust the band to make food pass more slowly or quickly through your digestive system.

See also: Gastric bypass surgery

Alternative Names

Lap-Band; LAGB; Laparoscopic adjustable gastric banding; Bariatric surgery - laparoscopic gastric banding

Description

You will receive general anesthesia before this surgery. This will make you unconscious and unable to feel pain.

The surgery is done using a tiny camera that is placed in your belly. This type of surgery is called laparoscopy. The camera is called a laparoscope. It allows your surgeon to see inside your belly. In this surgery:

• Your surgeon will make 2 to 5 small incisions (cuts) in your abdomen. The surgeon will pass the laparoscope through one of these openings. It will be connected to a video monitor in the operating room. Your surgeon will look at the monitor to see inside your belly. Your surgeon will insert thin surgical instruments through the other openings.
• Your surgeon will place a band around the upper part of your stomach to separate it from the lower part. This creates a small pouch that has a narrow opening that goes into the larger, lower part of your stomach.
• The surgery does not involve any cutting or stapling inside your belly.
• Your surgery may take only 30 to 60 minutes if your surgeon has done a lot of these procedures.

When you eat after having this surgery, the small pouch will fill up quickly. You will feel full after eating just a small amount of food. The food in the small upper pouch will slowly empty into the main part of your stomach.

Weight-loss surgery may increase your risk for gallstones. Your doctor may recommend having a cholecystectomy (surgery to remove your gallbladder) before your surgery.

Why the Procedure Is Performed

Weight-loss surgery may be an option if you are very obese and have not been able to lose weight through diet and exercise.

Laparoscopic gastric banding is not a “quick fix” for obesity. It will greatly change your lifestyle. You must diet and exercise after this surgery. You may have complications from the surgery and poor weight loss if you don’t.

People who have this surgery should be mentally stable and not be dependent on alcohol or illegal drugs.

This procedure may be recommended for you if you have:

• A body mass index (BMI) of 40 or more. Someone with a BMI of 40 or more is at least 100 pounds over their recommended weight. A normal BMI is between 18.5 and 25.
• A BMI of 35 or more and a serious medical condition that might improve with weight loss. Some of these conditions are sleep apnea, type 2 diabetes, and heart disease.

Risks

Risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

Risks for any surgery are:

• Blood clots in the legs that may travel to your lungs
• Infection, including in the incision, lungs (pneumonia), or bladder or kidney
• Blood loss
• Heart attack or stroke during surgery

Risks for gastric banding are:

• Injury to your stomach, intestines, or other organs during surgery.
• The gastric band may slip partly out of place
• Scarring inside your belly. This could lead to an obstruction (blockage) in your bowel in the future.
• Your surgeon may not be able to reach the access port to tighten or loosen the band. Fixing this problem would require a minor operation.
• Gastritis (inflamed stomach lining), heartburn, or stomach ulcers
• Poor nutrition
• Vomiting from eating more than your stomach pouch can hold

Before the Procedure

Your surgeon will ask you to have tests and visits with your other health care providers before you have this surgery. Some of these are:

• A complete physical exam
• Blood tests, ultrasound of your gallbladder, and other tests to make sure you are healthy enough to have surgery
• Visits with your doctor to make sure other medical problems you may have, such as diabetes, high blood pressure, and heart or lung problems, are under control
• Nutritional counseling
• Classes to help you learn what happens during the surgery, what you should expect afterward, and what risks or problems may occur afterward
• Visit with a mental health provider to make sure you are emotionally ready for major surgery. You must be able to make major changes in your lifestyle after surgery.

If you are a smoker, you should stop smoking several weeks before surgery and not start smoking again after surgery. Smoking slows recovery and increases the risks of problems. Tell your doctor or nurse if you need help quitting.

Always tell your doctor or nurse:

• If you are or might be pregnant
• What drugs, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription

During the week before your surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery:

• Do not eat or drink anything after midnight the night before your surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will probably go home the day after your surgery. Many patients are able to return to work and begin their normal activities 1 or 2 days after going home.

The band around your stomach is filled with saline (saltwater). It is connected to a container that is placed under your skin in your upper belly. Your surgeon can make the band tighter or looser by increasing or decreasing the amount of saline in the band. To do this, your surgeon will insert a needle through your skin into an “access port” in the container.

Your surgeon can make the band tighter or looser any time after you have this surgery. It may be tightened or loosened if you are:

• Not losing enough weight
• Having problems eating
• Vomiting after you eat

Outlook (Prognosis)

The final weight loss with gastric banding is not as large as with gastric bypass. The average weight loss is about one-third to half of the extra weight that you are carrying. This may be enough for many patients. Talk with your doctor about which procedure is best for you.

The weight will usually come off more slowly than with gastric bypass. You should keep losing weight for up to 3 years.

Losing enough weight after surgery can improve many medical conditions you might also have. Conditions that may improve are asthma, type 2 diabetes, high blood pressure, obstructive sleep apnea, high cholesterol, and gastroesophageal disease (GERD).

Weighing less should also make it much easier for you to move around and do your everyday activities.

This surgery alone is not a solution to losing weight. It can train you to eat less, but you still have to do much of the work. To lose weight and avoid complications from the procedure, you will need to follow the exercise and eating guidelines that your doctor and dietitian gave you.

References

Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery, 2007;142:621-632.

Leslie D, Kellogg TA, Ikramuddin S. Bariatric surgery primer for the internist: keys to the surgical consultation. Med Clin North Am. 2007;91:353-381.

Townsend Jr. CM, Beauchamp RD, Evers BM, Mattox KL. Townsend: Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders; 2008.