Gastric banding is a surgical treatment method to suppress the natural sensation of hunger in overweight patients. During the surgery, a silicone band is wrapped around the upper part of the stomach. Thus a very small gastric pouch is created. When it is filled with food, the stomach signals satiety. Due to a fairly high complication rate, the method has become less popular.
What is a gastric banding?
The so-called gastric banding is a surgically placed silicone tube that is looped around the upper part of the stomach. It divides the stomach into a small "forestomach" (pouch) and a large remaining stomach. The pouch has the volume of only 20 to 30 milliliters. This is roughly the size of a table tennis ball. When the forestomach is stretched by food, it gives the brain the satiety signal. The gastric banding thus helps the patient to lose weight by suppressing the feeling of hunger.
The gastric banding is hollow inside and a small tube connects it with a so-called port system. The port is a small chamber, which is implanted under the skin during the gastric banding surgery. Using a special needle a physician can fill the the port chamber with liquid and thus filling the gastric banding, too. This allows the doctor to regulate the degree of gastric constriction: the more fluid is injected into the gastric band, the stronger the stomach restriction. By removing the liquid the specialist increases the inner diameter of the gastric band thus expanding the stomach.
A gastric banding surgery lasts for about 30-60 minutes and is performed under general anesthesia. The hospital stay usually lasts for one day before the surgery and three to five days after the operation. As a rule, it is performed using keyhole surgery (laparoscopy). With the keyhole technique, five small skin incisions (approximately two centimeters long) are made, through which the camera and the instruments are introduced. To implant the port a slightly larger skin incision at the lower edge of the sternum is made.
The silicone band is introduced via one of the operational channels. Using the instruments, the surgeon places the band around the upper part of the stomach (cardia) and tightens it similar to a cable tie. In order to estimate the size of the stomach pouch, the physician passes a gastric tube with a small expanding balloon through the mouth into the stomach. When expanded it is about as large as a table tennis ball (approx. volume 20 – 30 ml) and corresponds roughly to the final volume of the forestomach.
The gastric banding can be moved slightly upwards or downwards or locked slightly tighter after the stomach balloon has been placed. Once the perfect position for the gastric band has been reached, it is fixed with several seams to the surrounding tissue.
Finally, the tube going out from the gastric banding and the port chamber are passed outside through the cut in the abdominal area and placed under the skin at the lower end of the sternum and stitched down. The port is used to regulate the gastric band diameter at any time by removing or adding the fluid.
About a month after the gastric band surgery, the port is filled with a few milliliters of fluid for the first time. The liquid (the total maximum of 9 milliliters) usually used is the so-called X-ray contrast agent, which is visible on an X-ray image. For example, a leak in the gastric band can be identified using X-ray. The patient can usually return to work two to three weeks after the operation, depending on the profession.
The gastric banding is suitable for people with a body mass index (BMI) of ≥ 40 kg/m² (Obesity Grade III). If the obesity causes other metabolic diseases, such as diabetes mellitus, hypertension or sleep apnea, a gastric band may be applied already with the BMI of 35 kg/m².
However, it can be assigned only if all conservative (non-operational) measures have not achieved sufficient success over six to twelve months. These measures include, for example, nutritional advice, exercises and behavioral therapy (multimodal concept, MMC). To have a gastric banding installed you should be at least 18 and not more than 65 years old. However the intervention may be appointed for younger or older people in individual cases.
Certain physical and mental illnesses prohibit such an obesity operation as the gastric banding: in particular, previous surgeries or malformations of the stomach, gastric ulcers, addictions or untreated eating disorders (for example, binge eating or bulimia) are important contraindications for a gastric banding. Pregnant women and those who permanently take anticoagulants must also abstain from a gastric banding.
Compared with other surgical procedures, the weight loss achieved with the gastric banding is the lowest on average. Only few patients reach their normal weight (BMI ≤ 25 kg/m²) with the help of the gastric banding. Especially the patient eating soft, reach on calories and fats food or drinks, which can easily pass through the gastric banding should expect insufficient weight loss.
Studies suggest that gastric band worn for a prolonged time allows to achieve the loss of about 50 percent of the excess weight. This information is often misunderstood: this does not mean that the method will allow you to lose 50 percent of the initial weight. For example if a patient has a BMI of 45 kg/m² before the gastric banding surgery, then the EWL is 20 kg/m² above the normal weight (= a maximum of 25 kg/m²). If this patient wearing the gastric band reaches the reduction of their BMI by 10 kg/m² and achieves 35 kg/m², this corresponds to a weight loss of 50 percent of the excess weight.
The gastric banding surgery is a rather simple intervention and with the correct surgical technique carries only a minimal risk for the patient. One should not underestimate the comparatively low risk of the operation, especially due to obese people already having significantly increased surgical risks. Another great advantage of the gastric banding is that it can be removed relatively easily at any time which means that the intervention is completely reversible.
In principle, the usual surgical risks can be applied to the inserting of a gastric band. This includes bleeding, organ injuries, infections, wound healing disorders and anesthesia related complications. Finally, there is also the risk of a stomach injury during the operation.
Recent studies suggest, however, that the complication rate of the gastric bands (gastric banding) is relatively high. The problem is not the relatively low-risk operation itself, but the complications that can occur months or years later. The most common gastric banding specific complications are:
- Displacement of the gastric band (band slippage, in approximately 5.5 percent of all cases)
- The stomach pouch volume increase due to the gradual expansion of the stomach (pouch dilation, in approximately 5.5 percent of cases)
- Gastric band leakage or a the leakage of the hose connecting it to the port with the escape of liquids (in approximately 3.6 percent of cases)
- Expansion of the esophagus before the gastric band (esophagus dilation, in approximately 3 percent of the cases).
In very rare cases, even more serious complications may occur, such as stomach penetration by the gastric band through the stomach wall (gastric perforation) or port chamber pathogens infection. Some studies estimate the need for a revision surgery after a gastric banding to be around 30 to 50 percent. This may cause problems as abdominal intervention can induce adhesions and scarring, which will severely complicate any subsequent operations and also be the reason for serious complications up to an intestinal obstruction.
On the first postoperative day the transition to a normal diet begins with liquid. You should drink it slowly swallowing, spreading it over the day. The hospital will give you a nutrition plan for the next four weeks, which describes the nutritional structure in details. For about first two weeks you may eat only liquid food. The next two weeks only soft food is on the menu. About four weeks after the surgery, you may eat normal food again. But there are a few things to keep in mind:
- Gastric band wearers should not only eat less, they also have to eat differently than before. To make it possible for the food pulp to pass through the bottleneck, every bite must be chewed very thoroughly. Problems are often caused by long-fiber meat (beef, pork) or vegetables.
- Liquids also fill the forestomach at least for a short time, this is why you should take food and drink in separate time.
- Sweets, especially sweet drinks, but also alcohol, calories-rich soups and porridges should be avoided by gastric banding wearers. They pass freely through the bottleneck between the stomach pouch and the remaining stomach, are fattening and thus ruin all the weight loss effect.
The gastric banding costs are made up of different aspects: for one, of course, it is the operation itself. Additional costs for hospitalization and follow-up appointments after the gastric band surgery are also included. Gastric band costs vary considerably depending on the doctor and the treatment case. The price range is between 5000 and 10,000 euro.