The placement of the band creates a small pouch at the top of the stomach. This pouch holds approximately ½ cup of food, whereas the typical stomach holds about 6 cups of food. The pouch fills with food quickly, and the band slows the passage of food from the pouch to the lower part of the stomach. As the upper part of the stomach registers as full, the message to the brain is that the entire stomach is full, and this sensation helps the person to be hungry less often, feel full more quickly and for a longer period of time, eat smaller portions, and lose weight over time.
As patients lose weight, their bands will need adjustments, or fills to ensure comfort and effectiveness. The gastric band is adjusted by introducing a saline solution into a small access port placed just under the skin. A specialized non-coring needle is used to avoid damage to the port membrane and prevent leakage.There are many port designs such as high profile and low profile, and they may be placed in varying positions based on the surgeon’s preference, but are always attached through sutures, staples, or another method to the muscle wall in and around the diaphragm.
Adjustable gastric bands hold between 4 and 12 cc of saline solution, depending on their design.When the band is inflated with saline solution, it places pressure around the outside of the stomach. This decreases the size of the passage between the pouch created from the upper part of the stomach and the lower stomach and further restricts the movement of food. Over the course of several visits to the doctor, the band is filled until the optimal restriction has been achieved – neither so loose that hunger is not controlled, nor so tight that food cannot move through the digestive system. The number of adjustments required is an individual experience and cannot be accurately predicted.
Types of adjustable bands
Realize and Lap-Band
The device comes in five different sizes and has undergone modification over the years. The latest models, the Lap-Band AP-L and Lap-Band AP-S, feature a standardized injection port sutured into the skin and fill volumes of 14 mL and 10 mL respectively.
Realize Band-C has a 14% greater adjustment range than the Realize Band. Both the Realize Band and Realize Band-C, however, are one-size-fits-all. The device differentiates itself from the Lap-Band AP series through its sutureless injection port installation and larger range of isostatic adjustments. The maximum fill volume for the Realize Band is 9 ml, while the newer Realize Band-C has a fill volume of 11 ml. Both fill volumes fall within a low pressure range to prevent discomfort or strain to the band.
Special considerations for pregnancy
If considering pregnancy, ideally the patient should be in optimum nutritional condition prior to, or immediately following, conception; deflation of the band may be required prior to a planned conception. Deflation should also be considered should the patient experience morning sickness. The band may remain deflated during pregnancy and once breast feeding is completed, or if bottle feeding, the band may be gradually re-inflated to aid postpartum weight loss as needed.
It is highly advised to take extra precautions during intercourse after surgery, as rapid weight loss increases fertility. Effective birth control methods must be used at all times to avoid unwanted pregnancies. Two factors have been pointed out by experts that may help explain this increase in fertility: reversal of PCOS (polycystic ovary syndrome) and reduction in the excess of estrogen, which is produced by fat cells.
Comparison with other bariatric surgeriesUnlike more open forms of weight loss surgery, gastric banding does not require cutting or removing any part of the digestive system. It is removable, requiring only a laparoscopic procedure to remove the band, after which the stomach usually returns to its normal pre-banded size so it is not unusual for a person to gain weight after having a band removed. However, it is not entirely reversible as adhesions and tissue scarring are inevitable. Unlike those who have procedures such as RNY, DS, or BPD, it is unusual for gastric band patients to experience any nutritional deficiencies or malabsorption of micro-nutrients. Calcium supplements and Vitamin B12 injections are not routinely required following gastric banding (as is often the case with RNY, for example). Gastric dumping syndrome issues also do not occur since intestines are not removed or re-routed.
Although other procedures appear to result in greater weight loss than adjustable gastric banding in the short term, results from the study by Maggard suggest that this difference decreases significantly over time. Gastric banding patients lose an average[clarification needed] of 47.5% of their excess weight, according to a meta analysis by Buchwald.
Benefits of gastric banding when compared to other bariatric surgeries
- No cutting or stapling of the stomach
- Short hospital stay
- Quick recovery
- Adjustable without additional surgery
- No malabsorption issues
- Fewer life-threatening complications
- Potential complications
A commonly reported occurrence for banded patients is regurgitation of non-acidic swallowed food from the upper pouch, commonly known as Productive Burping . Productive Burping is not to be considered normal. The patient should consider eating less, eating more slowly and chewing food more thoroughly. Occasionally, the narrow passage into the larger, lower part of the stomach might also become blocked by a large portion of unchewed or unsuitable food.
Other complications include:
- Gastritis (irritated stomach tissue)
- Erosion – The band may slowly migrate through the stomach wall. This will result in the band moving from the outside of the stomach to the inside. This may occur silently but can cause severe problems. Urgent treatment may be required if there is any internal leak of gastric contents or bleeding.
- Slippage – An unusual occurrence in which the lower part of the stomach may prolapse through the band causing an enlarged upper pouch. In severe instances this can cause an obstruction and require an urgent operation to fix.
Malposition of the band (rare with experienced practitioners):
If the band does not surround the vertical (esophagus-to-duodenum) axis of the stomach but instead surrounds only a non-vertical (horizontal or diagonal) axis of the stomach, as by encircling only a side or portion of a side of the stomach, then the restriction on food passage will be less, weight loss will be reduced, and a painful kink in the stomach may result.
Problems with the port and/or the tube connecting port and band – The port can “flip over” so that the membrane can no longer be accessed with a needle from the outside. The port may get disconnected from the tube or the tube may be perforated in the course of a port access attempt (both would result in loss of fill fluid and restriction, and likewise require a minor operation).
The average gastric banding patient loses 500 grams to a kilogram (1–2 pounds) per week consistently, but heavier patients often lose faster in the beginning. This comes to roughly 22 to 45 kilograms (49 to 99 pounds) the first year for most band patients. It is important to keep in mind that while most of the RNY patients drop the weight faster in the beginning, the procedure tends to encourage better eating habits which, in turn, helps in producing long term weight stability.
It is important to note that, in order to maintain their weight reduction, patients must carefully follow post-operative guidelines relating to diet, exercise, and band maintenance. Weight regain is possible with any weight loss procedure, including the more radical procedures that initially result in rapid weight loss.