Gastric Banding is a treatment for obesity, a growing in India. A person is officially obese when he or she attains a Body Mass Index (BMI) of more than 30 kg/m2. Lifestyle alterations remain the main forms of treating obesity, but in an ‘instant results’ world, more and people are opting for surgery to battle their body mass. Gastric banding or lap-band surgery is one such surgical technique to treat obesity.
Lap-Banding is short for Laparoscopic Adjustable Gastric Banding (LAGB). This surgery uses a laparoscope to place an adjustable silicone doughnut-shaped belt or band around the upper part of the stomach. The band can be tightened from the outside by filling it with saline. The silicone band is connected to a port, which is placed just under the skin of the abdomen. The saline is passed into or removed from the band through this port.
LAGB works on the psychiatric side. The idea is to restrict the size of the stomach and limit the amount of food it can hold, while simultaneously slowing the passage of food to the intestines. This results in the gut sending signals to the brain of satiety even with the consumption of less food. The signal is actually sent from a small pouch created by the band on the upper stomach. When the pouch is filled with saline, the same signal is sent to the brain with still less food in the stomach.
Who needs a Lap-Band?
The Lap-Band is an actual brand name, which has now become generic like Kleenex. Lap-bands come in different sizes and models manufactured by various companies. People with a BMI of 40 kg/m2 or who are 45 kgs. above their ideal body weight qualify for LAGB. LAGB can also be performed on people with a BMI of 35-40 kg/m2 if the patient suffers from weight-related medical conditions like high blood pressure, diabetes or hypertension.
Most surgeons will only recommend gastric banding if the patient has a history of failed attempts at weight loss with lifestyle changes. The procedure is off limits for children or teenagers below 18. Everyone undergoing the procedure must display a full understanding of the technique and must be willing to adopt the lifestyle changes that are associated with the procedure. This is where our center helps with counseling and assessment of psychology to assure the patient meets these criteria.
LAGB is not recommended for people who have difficulty understanding the technique, are emotionally unstable or are addicted to drugs or alcohol. Patients with a history of gastrointestinal problems like ulcers need to be evaluated carefully before LAGB can be prescribed for them. Some underlying medical conditions like those of the heart and lungs can put patients at a high-risk for surgery and will not undergo the procedure.
People with a BMI of over 50 kg/m2, will be asked to reduce before undergoing LAGB. The risks of the procedure in such patients may outweigh the benefits of the surgery. There is a growing discussion about providing LAGB to diabetics with a BMI of 35-40 kg/m2, but there is no consensus or any surgical guidelines for this group, which makes them ineligible.
LAGB Surgery Procedure
The surgery is performed under general anesthesia and lasts between 1 and 2 hours. Again, the surgeon makes several small incisions in the abdomen. The surgeon inserts a port into one of the incisions through which a tiny telescopic camera is inserted into the abdominal cavity. The camera transmits the internal images on a television screen. Surgical instruments are inserted through the other incisions. These instruments place the band in its identified location and perform other aspects of the operation guided by the surgeon. The gastric band and the port are set into their place with sutures.
Preparing for LAGB
Proceedings before the surgery vary from center to center. Many medical centers insist on a commitment from patients to make the mandatory alterations to their lifestyle and eating habits before scheduling the procedure. Patients may be recommended to alter their eating habits before the surgery itself by eating 5 to 6 small meals a day to prepare them mentally for the challenges post-LAGB. Doctors may also wean the patient off high-calorie snack desserts like ice-cream and milkshakes. These desserts may be highly restricted after surgery since they can be easily absorbed despite the stomach tightness after surgery.
If there are other medical complications, doctors may put patients under preoperative risk-reduction programs. Furthermore, a weight reduction of 5% to 10% before the surgery has been shown to produce better post-operative results.
Recovery after Lap-Band Surgery
LAGB generally requires shorter hospitalization and faster recovery than gastric bypass operations, recovery varies between patients. Most people are able to resume work a week after the procedure and it might take up to six weeks before they can return to pre-operative levels of activity.
Gastric Band Adjustments
The gastric band adjustment is commonly called the lap-band ‘fill’. After LAGB, there is a convalescence period of 6 to 8 weeks, after which the first ‘fill’ of the lap-band. It involves infusing a saline solution into the lap-band through the port that was left under the skin, which is connected to the band. There may be a change in appetite before the first fill. Fills are painless and usually conducted by the same surgeon who performed your operation. These adjustments are made to augment weight loss, particularly if it has reached a plateau. Loosening the band may a good way to adjust to managing nausea and vomiting.
Life after Lap-Band Surgery
Weight reduction after LAGB is a gradual process; initially, the loss of weight may be faster-1 or 2 kilos per week. However, this would eventually level up to a more modest weight loss of half a kilo per week. Now is the time to stick to your pre-surgery commitment because foods you eat will directly decide how much and how fast you will lose weight. The weight loss tends to become significantly slower after about 18 months. Average weight reduction in the first year is 40% of the excess body weight with a 10% to 20% weight loss in the following year. Patients are advised to keep in regular touch with their surgeons during this time because further band adjustments may be required
Side Effects and Complications
Common side effects of lap-band surgery include nausea, vomiting, development of ulcers at the site of the band, indigestion, constipation, dehydration and also regaining of weight. Since LAGB is a stomach-restricting technique, which does not interfere with the absorption of nutrients, there are no vitamin deficiencies generally. Still, many centers recommend multivitamin supplements.
LAGB has a relatively low risk of complications as compared to other surgical weight reduction surgeries. There is a possibility of the band malfunctioning, slipping or dissolving into the stomach. Other complications may include but are not limited to, infection, bleeding and abdominal pain.
It is important that the surgeon who is to perform lap-band surgery on you is a qualified bariatric surgeon, preferably with a good track record. You can also ask how frequently he or she conducts LAGB procedures; a count of about 100 or more procedures annually indicates popularity and he or she is more likely to give you a good result. A surgeon who is part of a multi-specialist team of nurses, nutritionists, pre-and post-operative counseling who also meets the criteria above should be your preferred surgeon.