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Single-port laparoscopy

Single-port-surgery-laparoscopicSingle-port laparoscopy (SPL), is a recently developed technique in laparoscopic surgery. It is a minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient’s navel. Unlike a traditional multi-port laparoscopic approach, SPL leaves only a single small scar.

Technique & equipment

SPL is accomplished through a single 20 mm incision in the navel (umbilicus or belly button), or through only an 11 mm incision in the navel, minimizing the scarring and incisional pain associated with the multiple points of entry used during traditional laparoscopic surgery.

Specialized equipment for SPL surgery falls into two broad categories; access ports and hand instruments. There are a number of different access ports, including GelPOINT system from Applied Medical, the SILS device from Covidien, the TriPort+, TriPort15 and QuadPort+ a from Advanced Surgical Concepts and the Uni-X from Pnavel. Hand instruments come in three configurations – standard, articulating, and pre-bent rigid. A number of factors influence a surgeon’s decision to use standard or articulating hand instruments, including which access port they use, their own surgical skills and cost as articulating instruments are significantly more expensive than standard instruments. SPL is enhanced by the use of specialized medical devices such as the SILS Multiple Instrument Access Port manufactured by Covidien and Laparo-Angle Articulating Instruments made by Cambridge Endoscopic Devices, Inc. The flexible port that can be fitted through a small incision in the navel to allow surgeons to use up to three laparoscopic devices simultaneously. Certain articulating instruments can be inserted through such specialized ports, providing surgeons with maneuverability and access to the target tissue from a single access point. However single port laparoscopic appendectomy has also been performed using a single standard 10 mm “Y” shaped operating telescope having a 5 mm instruments channel also.

Although awareness of single-port surgery is high amongst surgeons, the use of specialized instruments through such limited access requires considerable skill and training. This operative training and experience is currently limited and some negative perceptions regarding increased operating time and complications with this type of surgery remain.

Risks and benefits

When compared with traditional multi-port laparoscopic techniques, benefits of SPL techniques include less postoperative pain, less blood loss, faster recovery time, and better cosmetic results.[citation needed] Despite the potential advantages of SPL techniques, there may also be complications. Potential complications include significant postoperative pain, injury to organs, bleeding, infection, incisional hernia, intestinal adhesions and scarring.

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Is The Laparoscopic Adjusted Gastric Bands Safe?

Laparoscopic-Adjusted-Gastric-Bands
Laparoscopic-Adjusted-Gastric-Bands

Lap-Band surgery is one of several surgical procedures to treat obesity. Surgery is an option for patients who previously tried and failed to lose weight with other medically supervised weight loss programs, such as behavioral alterations, pre-packed meals and pharmacotherapy. To qualify for Lap-Band surgery, patients need to have a Body Mass Index (BMI) higher than 40 or higher than 30 and suffer from a comorbidity, like high blood pressure, diabetes or heart disease.

While weight loss surgery is often a “last resort” for patients who need to lose weight, an increasing body of research evidence is revealing that bariatric surgery procedures such as Lap-Band surgery may in fact offer patients the best option for losing weight, since the procedures are proving to be both safe and effective.

For Lap-Band surgery, treatment includes the placement of a silicone band around the stomach to reduce its size, as well as the connection to the band’s inflatable inner surface to an access port using a thin tube. The device, which is usually placed in the patient’s body through a minimally invasive laparoscopic surgery, limits food intake based on the tightness of the band, which can be adjusted by regulating the amount of fluid injected into the band by a physician.

Is the Lap-Band Safe? Lap-Band Safety Procedures

The Laparoscopic Adjusted Gastric Bands surgery is a proven safe procedure, with a very low 0.1% mortality rate.

Obese patients often favor the Lap-Band because it is:

Minimally invasive — the surgery can be conducted by making only a few small incisions.

Not permanent — the gastric band can be removed at any time, unlike other weight loss surgeries, such as sleeve gastrectomy, which permanently change the digestive tract.

Proven safe — most weight loss surgeries are safe and have low mortality rates, but the gastric band’s .1% mortality rate is compelling for patients.

Proven effective — numerous clinical trials have demonstrated that the Lap-Band helps patients achieve weight loss and can also improve comorbidities, such as type 2 diabetes.

Is The Lap-Band Safe? It Depends on Patient Compliance

In order to ensure the safety and success of the Lap-Band procedure, there are some lifestyle changes that have to be made on the part of the patient. The eligibility of the patients for a Laparoscopic Adjusted Gastric Bands surgery is very specific and should be discussed with a physician. The system is not recommended for patients younger than 18 years old, patients with conditions that may make them poor surgical candidates or increase the risk of poor results, including inflammatory or cardiopulmonary diseases, gastrointestinal conditions, symptoms or family history of autoimmune disease, and cirrhosis.

In addition, to ensure the safety of the patients, they need to be willing and able to commit to required dietary restrictions, as well as giving up alcohol and addressing drug addictions. Pregnant women are also not candidates for the Lap-Band surgery.

However, the Lap-Band is indeed a long-term weight loss treatment and additional surgeries may be needed to enhance the results, correct potential problems and ensure the safety of the patient.

Potential Problems Associated with the Lap-Band

Despite the safety of the treatment, there are potential problems that can occur. The possible side effects associated with the Lap-Band include:

  • band problems
  • blood clots
  • bowel function changes
  • bowel perforations
  • esophageal dilation
  • food trapping
  • gallstones
  • Gastroesophageal Reflux Disease
  • hiatal hernia
  • indigestion (Dyspepsia)
  • food intolerance, nausea
  • vomiting
  • pneumonia
  • port problems
  • pouch dilation

Based on the study cited above, the most common adverse events caused by the Lap-Band were vomiting, indigestion, acid reflux, and nausea. Specialists argue that these adverse events can be mitigated by adhering to the best practices of the device.

Gastric banding requires a drastic diet change—you need to eat small portions frequently to prevent complications and ensure weight loss, if you eat or drink more than your stomach pouch can hold, the pouch will stretch and food may back up into the esophagus. You may have nausea and vomiting, and require an adjustment of the band.

And if patients eat a lot of fattening foods or drink milkshakes or other high-calorie liquids, they may not lose a lot of weight.

when it comes to complications and adverse events associated with the device, it is primarily up to the patient to ensure that they eat right in order to continue to lose weight and feel good.

Losing weight after surgery

Effectiveness

adjustable-gastric-banding

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.

Non-adjustable bands

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.

Adjustable bands

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.

Gastric band Mechanics & Types of Band

laparoscopic-adjusted-gastric-bandsThe 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 surgerieslaparoscopic-adjusted-gastric-bandsUnlike 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:

  • Ulceration
  • 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).

Effectiveness

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.

Laparoscopic adjustable gastric band

laparoscopic-adjusted-gastric-bandsA laparoscopic adjustable gastric band, commonly called a lap-band, a band, or LAGB, is an inflatable silicone device placed around the top portion of the stomach to treat obesity, intended to decrease food consumption.

Adjustable gastric band surgery is an example of bariatric surgery designed for obese patients with a body mass index (BMI) of 40 or greater—or between 35 and 40 in cases of patients with certain comorbidities that are known to improve with weight loss, such as sleep apnea, diabetes, osteoarthritis, hypertension (high blood pressure), or metabolic syndrome, among others.

However, an adjustable gastric band may be used only after other methods such as diet and exercise have been tried.

The inflatable band is placed around the upper part of the stomach to create a smaller stomach pouch. This slows and limits the amount of food that can be consumed at one time, thus giving the opportunity for the sense of satiety to be met with the release of peptide YY. It does not decrease gastric emptying time. The individual achieves sustained weight loss by choosing healthy food options, limiting food intake and volume, reducing appetite, and progress of food from the top portion of the stomach to the lower portion digestion.

However, gastric banding is the least invasive surgery of its kind and is completely reversible, with another “keyhole” operation. Gastric banding is performed using laparoscopic surgery and usually results in a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures. Because no part of the stomach is stapled or removed, and the patient’s intestines are not re-routed, he or she can continue to absorb nutrients from food normally. Gastric bands are made entirely of biocompatible materials, so they are able to stay in the patient’s body without causing harm.

However, not all patients are suitable for laparoscopy. Patients who are extremely obese, who have had previous abdominal surgery, or have complicating medical problems may require the open approach.

Placement via laparoscopic surgeryAdjustable-Gastric-Band

The surgical insertion of an adjustable gastric band is often referred to as a lap band procedure or band placement. First, a small incision (typically less than 1.25 cm or 0.5 in.) is made near the belly button. Carbon dioxide (a gas that occurs naturally in the body) is introduced into the abdomen to create a work space for the surgeon. Then a small laparoscopic camera is placed through the incision into the abdomen. The camera sends a picture of the stomach and abdominal cavity to a video monitor. It gives the surgeon a good view of the key structures in the abdominal cavity. A few additional small incisions are made in the abdomen. The surgeon watches the video monitor and works through these small incisions using instruments with long handles to complete the procedure. The surgeon creates a small, circular tunnel behind the stomach, inserts the gastric band through the tunnel, and locks the band around the stomach.

Surgical indications

In general, gastric banding is indicated for people for whom all of the following apply:

Body Mass Index above 40, or those who are 100 pounds (7 stone/45 kilograms) or more over their estimated ideal weight, according to the National Institutes of Health, or those with a BMI between 30 and 40 with co-morbidities that may improve with weight loss (type 2 diabetes, hypertension, high cholesterol, non-alcoholic fatty liver disease and obstructive sleep apnea.)

  • Age between 18 and 55 years (although there are doctors who will work outside these ages, some as young as 12).
  • Failure of medically supervised dietary therapy (for about 6 months).
  • History of obesity (up to 5 years).
  • Comprehension of the risks and benefits of the procedure and willingness to comply with the substantial lifelong dietary restrictions required for long term success.
  • Gastric banding is usually not recommended for people with any of the following:
  • If the surgery or treatment represents an unreasonable risk to the patient
  • Untreated endocrine diseases such as hypothyroidism
  • Inflammatory diseases of the gastrointestinal tract such as ulcers, esophagitis or Crohn’s disease.
  • Severe cardiopulmonary diseases or other conditions which may make them poor surgical candidates in general.
  • An allergic reaction to materials contained in the band or who have exhibited a pain intolerance to implanted devices
  • Dependency on alcohol or drugs
  • People with severe learning or cognitive disabilities or emotionally unstable people

Clinical studies of laparoscopic bariatric surgery patients found that they felt better, spent more time doing recreational and physical activities, benefited from enhanced productivity and economic opportunities, and had more self-confidence than they did prior to surgery.

Intragastric balloon

gastric_balloonAn intragastric balloon is a newer kind of weight-loss procedure. A saline-filled silicone balloon is placed in your stomach, which helps you lose weight by limiting how much you can eat. It also makes you feel fuller faster.

This procedure is an option if you’re overweight or obese, and diet and exercise haven’t worked for you.

Like other weight-loss procedures, an intragastric balloon requires commitment to a healthier lifestyle. You need to make permanent healthy changes to your diet and get regular exercise to help ensure the long-term success of the intragastric balloon procedure.

Why it’s done

The placement of an intragastric balloon helps you lose weight. Weight loss can lower your risk of weight-related health problems, such as:

  • Heart disease and stroke
  • High blood pressure
  • Sleep apnea
  • Type 2 diabetes

An intragastric balloon and other weight-loss procedures or surgeries are typically done only after you’ve tried to lose weight by improving your diet and exercise habits.

An intragastric balloon may be an option for you if:

  • Your body mass index (BMI) is between 30 and 40.
  • You’re willing to commit to healthy lifestyle changes and regular medical follow-up, as well as to participate in behavioral therapy.
  • You have not had any previous stomach or esophageal surgery.
  • Intragastric balloons aren’t the right choice for everyone who is overweight. A screening process will help your doctor see if the procedure might be beneficial for you.

Risks

Pain and nausea affect about one-third of people soon after insertion of an intragastric balloon. However, these symptoms usually only last for a few days after balloon placement. And they can be treated with oral medication.

Serious risks after intragastric balloon placement and removal are rare. It’s possible that the balloon could deflate. If the balloon deflates, there’s also a risk that it could move through your digestive system. This can cause a blockage that may require a further procedure.

Other possible risks include ulcers or a hole (perforation) in the stomach, which might require surgery to fix.

How you prepare

If you’re going to have an intragastric balloon placed in your stomach, your health care team will give you specific instructions on how to prepare for your procedure. You may need to have various lab tests and exams before your procedure.

You may need to restrict what you eat and drink, as well as which medications you take, in the time leading up to the procedure. You also may be required to start a physical activity program.

What you can expect

The intragastric balloon procedure is done in the endoscopy unit as an outpatient procedure. You’ll be sedated for the procedure.

During the procedure, the doctor advances a thin tube loaded with the intragastric balloon down your throat into your stomach. Next, the doctor advances an endoscope-a flexible tube with a camera attached down your throat into your stomach. The tiny camera allows your doctor to see the balloon as he or she fills it with saline.

The procedure takes about a half-hour. You can normally go home several hours after the procedure.

After intragastric balloon insertiongastric-balloon

You can have small amounts of liquid starting about six hours after the procedure. The liquid diet generally continues until the start of the second week, when you can start eating soft foods. You’ll probably be able to start eating regular food around three weeks after the insertion of the intragastric balloon.

Intragastric balloons are left in place for up to 6 months, and are then removed using an endoscope.

You’ll also have frequent meetings with members of your medical team, such as your nutritionist and psychologist, after your procedure.

Intragastric Balloon: Non-Surgical Procedure

An intragastric balloon can make you feel fuller faster than you normally would, which often means you’ll eat less. One reason why may be that the intragastric balloon slows down the time it takes to empty the stomach. Another reason may be that the balloon seems to change levels of hormones that control appetite.

The amount of weight you lose also depends on how much you can change your lifestyle habits.

Loss of about 10 to 15 percent of body weight is typical during the six months following intragastric balloon placement. In a randomized clinical trial with 255 adults with a BMI between 30 and 40, people who had the intragastric balloon procedure along with behavioral therapy lost 29 percent of their excess weight, compared to 14 percent in a group that received behavioral therapy alone.

When weight-loss procedures don’t work

It’s possible to not lose significant weight or to regain weight after any type of weight-loss procedure or surgery, even if the procedure itself works correctly. This weight gain can happen if you don’t follow the recommended lifestyle changes. Permanent healthy changes in your diet, along with regular physical activity and exercise, are necessary to avoid regaining weight.

Visit HOPE OBESITY CENTRE for testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Gastric Balloon (endoscopic intragastric balloon) – 14 Ways It Will Affect You

gastric-balloonThe gastric balloon procedure leaves 1 to 3 inflated silicon balloons in the stomach for 6 months, making less room for food. As a result:

  • You will feel full sooner while eating, so you will eat less and lose weight
  • You will lose about 30% of their excess weight in 6 months (when the balloon(s) are removed)
  • A patient who is 100 pounds overweight will lose 30 pounds in six months
  • Your health will improve, including improvement for diabetes, joint/bone disease, and heart-related issues

How the Balloon Works

  • A deflated balloon is inserted through your mouth and down the esophagus
  • The balloon is expanded in your stomach
  • The expanded balloon causes you to feel full sooner while eating, so you eat less and lose weight

Why the Gastric Balloon Works

Between 1 and 3 inflated balloons in the stomach leave less room for food and cause patients to feel full sooner and eat less.

How the Gastric Balloon Procedure Is Performed

The gastric balloon procedure is performed differently depending on which balloon type you choose:

Once you are set up in the treatment room, following are the steps:

  • Your throat will be numbed with a special spray. The numbing sensation may feel strange, but it will help your throat tolerate the instruments used in the procedure. If you wish, you can also ask for an injection to make you feel sleepy, but these options will be discussed with you beforehand.
  • After you are comfortable, the nurse will insert a plastic mouth guard between your teeth to keep your mouth open for the scope.
  • The scope will be passed through your mouth and into your stomach. This will not be painful, and you will be able to breath without worry. The doctor may also need to pass some air down the scope to have a clear view. This too can be a strange feeling, and it may make you want to belch.
  • The scope will be removed.
  • The deflated balloon will be passed into your stomach and inflated with either air or saline solution.
  • The scope will be passed into your stomach one final time to double check that the balloon is in the right position and properly inflated.

Weight Loss

  • You will lose up to one-third of your excess weight in 6 months
  • For example, if you are 5’4″ and weigh 220 lbs, you will lose about 25 lbs. in 6 months
  • If you are 5’9″ and weigh 300 lbs, you will lose about 40 lbs. in 6 months

The average gastric balloon patient loses a moderate amount of weight very quickly after the procedure:

  • Month 3: Approximately 15% of excess weight
  • Month 6: Approximately 30% of excess weight
  • Actual weight loss could be higher or lower.

The most popular types of balloon must be removed after 6 months, so long-term weight loss depends entirely on the patient’s diet and lifestyle choices. In other words, gastric balloon should not be viewed as a “long-term fix.”

In fact, some patients use the balloon to lose weight before having a more involved procedure like gastric sleeve. More involved procedures have a lower complication rate when patients weigh less before surgery, so you may want to discuss this option with your surgeon.

Health Benefits

  • A gastric balloon may improve your diabetes, cardiac health & joint/bone issues
  • Gastric balloon patients are more likely to see health improvements than people of similar weight who do not have the procedure.

Qualify

  • A body mass index (BMI) of 30 – 40 is required

For some types of balloons, such as the ReShape Balloon, you must have a health risk associated with obesity like diabetes, high blood pressure or sleep apnea. For other balloon types, like the Orbera balloon, no comorbidities are required.

For a list of frequently asked questions about qualifying, see our “Do I Qualify For Weight Loss Surgery?” page.

The procedure takes 20 to 30 minutes

Preparing for the Procedure

Gastric-Ballon-surgery

Take the proper steps to improve your outcome

Your doctor and their office will work closely with you to prepare for your gastric balloon procedure, including:

Conduct a pre-procedure health assessment, where you will be asked questions about your medical history and medications.

Review your surgical history, as some complications can arise if you’ve had prior procedures on your stomach.

Order certain tests like an ECG, x-ray, and blood tests.

Recovery

  • You will leave the hospital on the same day (outpatient)
  • 3 days until you are “fully recovered”

After the procedure, gastric balloon patients usually:

  • Leave the hospital and return home the same day.
  • Have someone who is willing and able to drive them home and take care of them for at least 24 hours. The patient’s throat will probably be sore following the procedure since the balloon was inserted through the mouth.
  • Have fully recovered and are back to work within 3 days.

Instruct you to fast (no food) for at least 24 hours before surgery, with nothing to eat or drink 12 hours before surgery.