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, some studies have found that LAGB patients will have the same percentage of excess weight loss and comparable ability to keep it off after only a couple of years. The procedure tends to encourage better eating habits which, in turn, helps in producing long term weight stability. However, with greater experience and longer patient follow up, several studies have found suboptimal weight loss and high complication rates for the gastric band.
A systematic review concluded LAGB has been shown to produce a significant loss of excess weight while maintaining low rates of short-term complications and reducing obesity-related comorbidities. LAGB may not result in the most weight loss but it may be an option for bariatric patients who prefer or who are better suited to undergo less invasive and reversible surgery with lower perioperative complication rates.
Band adjustments and weight loss
Correct and sensitive adjustment of the band is imperative for weight loss and the long term success of the procedure. Adjustments may be performed using an X-ray fluoroscope so that the radiologist can assess the placement of the band, the port, and the tubing that runs between the port and the band. The patient is given a small cup of liquid containing a clear or white radio-opaque fluid similar to barium. When swallowed, the fluid is clearly shown on X–ray and is watched as it travels down the esophagus and through the restriction caused by the band. The radiologist is then able to see the level of restriction in the band and to assess if there are potential or developing issues of concern. These may include dilation of the esophagus, an enlarged pouch, prolapsed stomach, when part of the stomach moves into the band where it does not belong, erosion or migration. Reflux type symptoms may indicate too great a restriction and further assessment may be required.
Under some circumstances, fluid is removed from the band prior to further investigation and re-evaluation. In other cases further surgery may be required e.g. removal of the band, should gastric erosion or a similar complication be detected. Some health practitioners adjust the band without the use of X-ray control. In these cases, the doctor assesses the patient’s weight loss and potential reflex symptoms described by the patient, such as heartburn, regurgitation, or chest pain. From this information, the doctor decides whether a band adjustment is necessary. Adjustments are often indicated if a patient has regained weight, if their weight loss has leveled off, or if the patient has a distinct feeling that food is difficult to move through the stomach.
During a clinical visit, patients visiting for a regular fill adjustment will typically find they will spend more time talking about the adjustment and their progress than the actual fill itself, which generally will take only about one to two minutes. However, for some patients, this type of fill is not possible, due to issues such as partial rotation of the port, or excess tissue above the port making it difficult to determine its precise location. In these cases, a fluoroscope will generally be used. It is more common practice for the band not to be filled at surgery—although some surgeons choose to place a small amount in the band at the time of surgery. The stomach tends to swell following surgery and it is possible that too great a restriction would be achieved if filled at that time.
Many health practitioners make the first adjustment between 4 and 6 weeks post operatively to allow the stomach time to heal. After that, fills are performed as needed.
No accurate number of adjustments required can be given. The amount of saline/isotonic solution needed in the band varies from patient to patient. There are a small number of people who find they do not need a fill at all and have sufficient restriction immediately following surgery. Others may need significant adjustments to the maximum the band is able to hold.
Post-surgical diet and care
The patient may be prescribed a liquid-only diet, followed by mushy foods and then solids. This is prescribed for a varied length of time and each surgeon and manufacturer varies. Some may find that before their first fill, they are still able to eat fairly large portions. This is not surprising since before the fill there is little or no restriction in the band. This is why a proper post-op diet and a good after-care plan are essential to success. A recent study found that patients who did not change their eating habits were 2.2 times more likely to be unsuccessful than those who did, and that patients who had not increased their physical activity were 2.3 times more likely to be unsuccessful than those who did.
A long-term, post-gastric-band surgery diet should consist of normal healthy food that is solid in nature and requires ample chewing to achieve a paste consistency prior to swallowing. This texture will maximize the effect of the band, rather than choosing easier wet foods, such as soups, casseroles and smoothies, which pass through the band quickly and easily resulting in greater caloric intake.
All these early attempts at restriction using meshes, bands and clips showed a high failure rate due to difficulty in achieving correct stomal diameter, stomach slippage, erosion, food intolerance, intractable vomiting and pouch dilatation. Despite these difficulties, an important ancillary observation was that silicone was identified as the best tolerated material for a gastric device, with far fewer adhesions and tissue reactions than other materials.
The development of the modern adjustable gastric band is a tribute both to the vision and persistence of the early pioneers, particularly Lubomyr Kuzmak and a sustained collaborative effort on the part of bio-engineers, surgeons and scientists.
The laparoscopic era
The advent of surgical laparoscopy has transformed the field of bariatric surgery and made the gastric band a more appealing option for the surgical management of obesity.
Single port laparoscopy (SPL) is an advanced, minimally invasive procedure in which the surgeon operates almost exclusively through a single entry point, typically the navel. Special articulating instruments and access ports make it unnecessary to place trocars externally for triangulation, thus allowing the creation of a small, solitary portal of entry into the abdomen. The SPL technique has been used to perform many types of surgery, including adjustable gastric banding and sleeve gastrectomy.