Laparoscopic gastric banding

Description

You will receive general anesthesia before this surgery. You will be asleep and unable to feel pain.

The surgery is done using a tiny camera that is placed in your belly. This type of surgery is called laparoscopy. The camera is called a laparoscope. It allows your surgeon to see inside your belly. In this surgery:

• Your surgeon will make 1 - 5 small surgical cuts in your abdomen. Through these small cuts, the surgeon will place a camera and the instruments needed to perform the surgery.
• Your surgeon will place a band around the upper part of your stomach to separate it from the lower part. This creates a small pouch that has a narrow opening that goes into the larger, lower part of your stomach.
• The surgery does not involve any cutting or stapling inside your belly.
• Your surgery may take only 30 - 60 minutes if your surgeon has done a lot of these procedures.

When you eat after having this surgery, the small pouch will fill up quickly. You will feel full after eating just a small amount of food. The food in the small upper pouch will slowly empty into the main part of your stomach.

Weight-loss surgery may increase your risk for gallstones. Your doctor may recommend having a cholecystectomy (surgery to remove your gallbladder) before your surgery.

Why the Procedure is Performed

Weight-loss surgery may be an option if you have been severely obese for 5 years or more and have not been able to lose weight through diet and exercise.

Laparoscopic gastric banding is not a "quick fix" for obesity. It will greatly change your lifestyle. You must diet and exercise after this surgery. You may have complications from the surgery and poor weight loss if you don't.

People who have this surgery should be mentally stable and not be dependent on alcohol or illegal drugs.

Doctors often use the following body mass index (BMI) measures to identify patients who may be most likely to benefit from weight-loss surgery. A normal BMI is between 18.5 and 25. This procedure may be recommended for you if you have:

• A (BMI) of 40 or more. This usually means that men are 100 pounds overweight and women are 80 pounds over their ideal weight.
• A BMI of 35 or more and a serious medical condition that might improve with weight loss. Some of these conditions are sleep apnea, type 2 diabetes, high blood pressure, and heart disease.

Risks

Risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

Risks for any surgery are:

• Blood clots in the legs that may travel to your lungs
• Blood loss
• Infection, including in the surgery site, lungs (pneumonia), or bladder or kidney
• Heart attack or stroke during surgery

Risks for gastric banding are:

• Gastric band erodes through the stomach (if this happens, it must be removed)
• Gastric band may slip partly out of place
• Gastritis (inflamed stomach lining), heartburn, or stomach ulcers
• Infection in the port, which may need antibiotics or surgery
• Injury to your stomach, intestines, or other organs during surgery
• Poor nutrition
• Scarring inside your belly, which could lead to a blockage in your bowel
• Your surgeon may not be able to reach the access port to tighten or loosen the band (you would need minor surgery to fix this problem)
• Vomiting from eating more than your stomach pouch can hold

Before the Procedure

Your surgeon will ask you to have tests and visits with your other health care providers before you have this surgery. Some of these are:

• Blood tests, ultrasound of your gallbladder, and other tests to make sure you are healthy enough to have surgery
• Classes to help you learn what happens during the surgery, what you should expect afterward, and what risks or problems may occur
• Complete physical exam
• Nutritional counseling
• Visit with a mental health provider to make sure you are emotionally ready for major surgery. You must be able to make major changes in your lifestyle after surgery.
• Visits with your doctor to make sure other medical problems you may have -- such as diabetes, high blood pressure, and heart or lung problems -- are under control

If you are a smoker, you should stop smoking several weeks before surgery and not start smoking again after surgery. Smoking slows recovery and increases the risk of problems. Tell your doctor or nurse if you need help quitting.

Always tell your doctor or nurse:

• If you are or might be pregnant
• What drugs, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription

During the week before your surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery:

• Do not eat or drink anything after midnight the night before your surgery.
• Take the drugs your doctor told you to take with a small sip of water.

Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will probably go home the day after your surgery. Many patients are able to begin their normal activities 1 or 2 days after going home. Most people take 1 week off from work.

You will stay on liquids or mashed-up foods for 2 or 3 weeks after surgery. You will slowly add soft foods, then regular foods, to your diet. By 6 weeks after surgery, you will probably be able to eat regular foods.

The band is made of a special rubber (silastic rubber). The inside of the band has an inflatable balloon. This allows the band to be adjusted. You and your doctor can decide to loosen or tighten it in the future so you can eat more or less food.

The band is connected to an access port that is under the skin on your belly. The band can be tightened by placing a needle into the port and filling the balloon (band) with water.

Your surgeon can make the band tighter or looser any time after you have this surgery. It may be tightened or loosened if you are:

• Having problems eating
• Not losing enough weight
• Vomiting after you eat

Outlook (Prognosis)

The final weight loss with gastric banding is not as large as with gastric bypass. The average weight loss is about one-third to one-half of the extra weight you are carrying. This may be enough for many patients. Talk with your doctor about which procedure is best for you.

The weight will usually come off more slowly than with gastric bypass. You should keep losing weight for up to 3 years.

Losing enough weight after surgery can improve many medical conditions you might also have, such as:

• Asthma
• Gastroesophageal reflux disease (GERD)
• High blood pressure
• High cholesterol
• Sleep apnea
• Type 2 diabetes

Weighing less should also make it much easier for you to move around and do your everyday activities.

This surgery alone is not a solution to losing weight. It can train you to eat less, but you still have to do much of the work. To lose weight and avoid complications from the procedure, you will need to follow the exercise and eating guidelines that your doctor and dietitian gave you.

Alternative Names

Lap-Band; LAGB; Laparoscopic adjustable gastric banding; Bariatric surgery - laparoscopic gastric banding

References

Blackburn GL, Hutter MM, Harvey AM, Apovian CM, Boulton HR, et al. Expert panel on weight loss surgery: executive report update. Obesity. 2009;17:842-862.

Garb J, Welch G, Zagarins S, Kuhn J, Romanelli J. Bariatric surgery for the treatment of morbid obesity: a meta-analysis of weight loss outcomes for laparascopic adjustable gastric banding and laparoscopic gastric bypass. Obes Surg. 2009;19:1447-1455.

Leslie D, Kellogg TA, Ikramuddin S. Bariatric surgery primer for the internist: keys to the surgical consultation. Med Clin North Am. 2007;91:353-381.

Townsend Jr. CM, Beauchamp RD, Evers BM, Mattox KL. Townsend: Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders; 2008.

Update Date: 11/29/2010

Updated by: Ann Rogers, MD, Associate Professor of Surgery; Director, Penn State Surgical Weight Loss Program, Penn State Milton S. Hershey Medical Center. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.