Laparoscopic Adjustable gastric banding, , is a form of restrictive weight loss surgery (bariatrics) designed for obesity patients with a (BMI) of 38 or greater - or 33.5 with those who have comorbidities that are known to improve with weight loss. The gastric band is an inflatable silicone prosthetic device which is placed around the top portion of the stomach via keyhole laparoscopic surgery.

   Procedure:

The idea behind the operation is to create a small pouch in the upper part of the stomach with a controlled and adjustable stoma thus limiting food intake.

A gastric band device is introduced through tiny (key hole) incisions in the abdomen and is placed around the upper part of the stomach. The resulting pouch (or the "new stomach") dramatically reduces the functional capacity of the stomach. The band has a balloon from the inside that is adjustable and can reduce stoma size, thus prolonging the period of fullness.

The operation is performed under general anesthesia and can last between 30 minutes and 1 hour. The Band is fitted around the uppermost part of the stomach, forming a 15-20 cc small pouch. It band is designed so that it can be inflated or deflated at any time after the operation. This helps the patient continually lose weight until they reach their goals. The restriction takes place in the radiology suite and normally takes 15 minutes. This simple procedure is painless.

Band Adjustment:

Adjusting the size of the stoma (opening between the two parts of the stomach) controls how much food passes from the upper to the lower part of the stomach. This opening (stoma) between the two parts of the stomach can easily be decreased or increased, by injecting or removing saline/ radio-opaque dye from the band. The band is connected by a tube to a reservoir placed beneath the skin during surgery. The surgeon can later control the amount of saline in the band by piercing the reservoir through the skin with a fine needle.

Advantages:

Keyhole approach …. Less scarring or wound problems Short hospital stay (does not  exceed 48 hours) Earlier return to work (1-2 weeks)

Adjustable : by filling port the outlet (stoma) size can be increased or decreased to  patient's needs

Reversible: If the band is removed , patient’s anatomy is resumed like before.

No malabsorbtion / Low malnutrition risk

Lower risk - Relatively safe operation

 Limitations :

Weight loss is upto 60% -70% of Extra Weight Loss ( sometimes exceeds upt 90%)

In sweet eaters the weight loss may not be good

Snackers the weight loss is limited.

If the Band is removed , the weight regain is possible

Short-term side effects:

1. Vomiting

Sometimes patients will once or twice feel pain or vomit after intake of food. It may be caused by eating too much …too fast. Regular and persistent vomiting is either be caused by incorrect eating behavior or by the stoma of the gastric pouch becoming too narrow

2. Constipation

Constipation is mainly caused by the fact that the reduced food intake leads to less feces and it is thus normal with fewer bowel movements. If laxatives become necessary one can use liquid laxative such as lactulose

3. Hair loss

Some patients will experience temporary hair loss during the first six months after surgery. This is also caused by the relative starvation. This does not lead to baldness. Normal hair growth will eventually return.

Complications:

Complication rates are low but this does not mean that complications are nonexistent. The following is list of the complications that have been seen following this operation;

2. Leakage of the band – very uncommon and will require replacement of the band.

3. Band Migration – very uncommon and will require an operation to remove and re-adjust the band

4. Band Slippage ; The gastric band get slipped from it’s position upward or down wards. The down ward slippage causes pouch dilatation and weight regain.

5. Oesophageal Dilatation : If there is oesophageal dysmotility then it gets dilated after the band surgery. The band may have to be removed or kept loose all the time.

6. Port mal-position – occurs sometimes after patient lost a lot of weight or the anchoring stitches came loose. This will require a simple local procedure to fix.

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