Laparoscopic Adjustable Gastric Band

The laparoscopic adjustable gastric band has been used in other countries for more than six years and was approved for use in the U.S. by the FDA in 2001. Outside of this country, it is the single most performed procedure for weight loss.

Thelaparoscopic adjustable gastric band creates a smaller stomach pouch, slowing digestion and allowing the patient to feel full sooner and longer. Weight loss with the laparoscopic adjustable gastric band procedure is more gradual than other approaches and continues to increase over the years. It is ideal for patients who are highly motivated to succeed at weight loss. A study in Australia showed that on average, patients lose 56% of their excess weight and keep it off.

The benefits of thelaparoscopic adjustable gastric band include the reversibility of the procedure, the short hospital stay and a low risk profile for surgery. Thelaparoscopic adjustable gastric band can also be ideal for circumstances such as pregnancy, when weight loss must be adjusted or eliminated for a period of time. There are virtually no nutritional deficits associated with this procedure.

The Procedure
In alaparoscopic adjustable gastric band procedure, there is no stapling in the abdomen and no division of the intestinal tract. This minimally invasive approach involves laparoscopic entrance into the abdomen, after which the area behind the stomach in dissected for placement of the band.

The band is placed about one centimeter below the gastroesophageal junction and closed underneath a balloon, which creates a smaller stomach pouch. A port is placed under the skin to connect to the inside of the band and allow for the opening to be tightened. This port is secured with four stitches, which hold it in place.

After a laparoscopic adjustable gastric band procedure, the patient stays in the hospital for less than 24 hours. The morning after surgery they have a barium swallow procedure, which indicates the initial position of the band and confirms that there are no leaks in the stomach. The patient is then discharged to go home with instructions for a bariatric diet of liquids for seven days, gradually making the transition to solid foods. The initial filling of the band is done at about 3-4 weeks, once the swelling from surgery has subsided. The patient must begin eating solid foods for the band to work properly.

Why the Procedure Works
The laparoscopic adjustable gastric band system includes a silicone band that is surgically placed around the stomach and can be adjusted to limit food intake. This procedure is usually performed laparoscopically, making it much less invasive than other 'open' surgeries.

There is no cutting or stapling involved in thelaparoscopic adjustable gastric band procedure, because the band creates a 'pouch' in the upper stomach, dividing it from the lower stomach. This limits how much your stomach can hold. The band also controls the outlet, or stoma, between the two parts of the stomach. The size of the opening regulates the flow rate of food from the pouch to the lower part of the stomach. This allows you to feel full sooner and the feeling of fullness after eating lasts longer.

The laparoscopic adjustable gastric band system is adjustable, allowing for changes in the size of the stomach through the addition or removal of saline. Saline is a salty solution similar to fluids found naturally in your body. After surgery and recovery, your surgeon can later control the amount of saline in the band by piercing the reservoir through the skin with a fine needle. In this way, your rate of weight loss can potentially be adjusted without additional surgery.

Possible Risks and Complications
The risk profile for thelaparoscopic adjustable gastric band procedure is lower that that for any other type of bariatric surgery. In addition to general surgical risks, there are a few risks unique to the laparoscopic adjustable gastric band procedure. Removal of the band or conversion to another type of weight loss procedure occurs in about 3% of patients.

• Access Port Infections Access port infections occur in 10% of patients. The port may have to be removed and replaced. These infections may also be a sign of band erosion.
• Reservoir/Tubing Problems Complications with the reservoir/tubing occur in 5.8% of patients.
• Band Erosion Erosion of the band into the stomach 'flap' occurs in 3.4% of patients. This figure may be overestimated, because it is based on early studies. The 'buckle' on the band was later moved to reduce this problem. In large series studies conducted since then, only 1% of patients have experienced band erosion.
• Prolapse of the Stomach Prolapse or slippage of the stomach underneath the band occurs in 14% according to the early series studies reported prior to development of the Pars Flaccida technique. Scottsdale Bariatric Center uses this technique, in which the band is 'fixed' in place higher on the stomach and part of the stomach is sewn over the band. This technique drastically reduces the incidence of stomach prolapse.
• Re-Operations Re-operations occur in approximately 11% of patients, according to comprehensive worldwide studies. Re-operating may be required due to any of the complications above, or because the patient does not tolerate the band or does not lose an adequate amount of weight.
• Open Procedures Conversion to an 'open' (non-laparoscopic) procedure occur in 1.3% of patients. They occur when the band cannot be placed laparoscopically because of a very large liver or multiple adhesions from previous surgery.
• Mortality Death occurs in 0.1% of patients who have a LAP-BAND, usually from a perforation of the stomach during placement of the band. Other early complications that can potentially lead to death include perforation of another part of the intestine or bleeding.

Effect of Surgery on medical problems and weight loss

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