Gastric Band

What is a Gastric Band?

The gastric band is a surgical method for radical weight loss. The patient's stomach is divided into a smaller front stomach (pouch) with a filling volume of approx. 20-30ml and a larger rest stomach by an adjustable band. This limits the filling capacity of the stomach. A faster feeling of satiety limits food intake.

The food moves more slowly through the digestive tract, as it has to pass through the smaller opening, and thus the patient feels fuller more quickly. This slowing down of the digestive tract can be imagined like an hourglass through which the sand runs slowly. The gastric band acts as an eating brake.

When Can Gastric Banding Be Carried Out?

The requirement for obesity surgery is that conservative therapy for weight reduction has been completely exhausted. Conservative therapy means nutrition, exercise, and behavioral modification, and possibly psychological therapy.

Surgery-Indication as of a BMI of 40

The indication for surgical therapy is usually based on the patient’s BMI (body mass index). In case of failed conservative therapy and a BMI above 40 kg/m² or a BMI above 35 kg/m² with secondary diseases (e.g. diabetes, high blood pressure), surgical intervention should be discussed. There is no standard procedure that is suitable for every patient.

Therefore, it must always be individually examined which method (e.g. gastric banding, gastric bypass, sleeve gastrectomy, gastric balloon) is the best choice. The choice of procedure is influenced by the BMI, age, gender, and secondary diseases of the overweight patient.

The Procedure of Gastric Banding

The band is placed around the stomach just below the junction from the esophagus to the stomach. In this way, a partition into a front stomach (pouch) with a maximum volume of 20-30ml and a larger rest stomach is made. The gastric band is usually made of silicone and can be filled with a saline solution inside. The gastric band is inserted unblocked during the surgery it can be filled later as needed.

Filling of the Gastric Band is Carried Out from the Outside

The band is filled from the outside. A reservoir of the size of a 5-cent piece, which can be punctured through the skin, is under the patient’s abdominal wall. The amount of fluid in the band is variable. The more volume the band contains, the tighter it lies around the stomach and the weight loss increases proportionally. Changing the amount of fluid can be made in an outpatient setting.

Laparoscopic Surgery-Technique Reduced Late Complications

Implanting the gastric band should primarily be carried out laparoscopically ("keyhole technique"), as this results in fewer late complications, less pain, and a shorter inpatient stay., only a few small incisions are necessary for the laparoscopic procedure and the patient recovers more quickly.

Gastric Band Risk and Complications

Complications are generally quite rare. Of all surgical obesity treatments, the gastric band is the easiest method with the lowest risk of complications. Wound infections occur in about 1.4% of the patients. Pneumonia, lymphangitis (blood poisoning) or pulmonary embolism occurs in less than 0.5% of patients.

Most Common Gastric Band Complication is Slipping of the Gastric Band

The most common gastric band-specific complications are slippage of the band (5.5%), leakage of the gastric band (3.6%), or esophageal/stomach perforation (0.5%). These complications usually require further surgery and band removal.

What Are the Advantages of the Gastric Band?

An advantage of the gastric band is that normal food intake is still possible and digestion can proceed quite regularly. Vitamin or mineral deficiency usually does not occur due to the natural process of food digestion.

Gastric Banding is More Effective for Weight Reduction than Common Diets

The gastric band is clearly superior to conservative methods of weight loss in terms of weight reduction, reduction of secondary diseases caused by overweight (e.g. diabetes, high blood pressure), and reduction of mortality due to obesity. For example, 76.8% of gastric band implants cure type 2 diabetes caused by overweight.

After two years, the patients have lost an average of 62.5% of their overweight, while conservative diets only reduced 4.3% of the overweight. However, with other adiposity surgery, such as gastric bypass or biliopancreatic diversion, the antidiabetic effect occurs earlier.

The Gastric Band Can Be Removed

Another positive aspect of the gastric banding is that this procedure is reversible and modifiable, there are no permanent incisions or similar in the stomach. The natural structure of the stomach remains intact with this method and the surgery is therefore reversible. A gastroscopy is also still possible without any problems.

Disadvantages of the Gastric Band Surgery

The disadvantage of this method is that the surgery may not be successful if the patient eats many snacks or a high-calorie/rich in sugar diet. If the patient e.g. eats high-energy liquid food (for example high-calorie drinks), the possible weight loss will not occur. For this reason, each patient must carefully consider whether they can follow the recommended diet and whether the procedure is suitable for them.

This method tends to result in less weight loss than other stomach reduction surgeries. Good patient cooperation is essential for effective weight loss. The diet of the overweight person must be changed and the new body signals must be perceived. Therefore, precise information about the surgery and good nutritional advice is urgently required.

In the long term, complications such as an enlargement of the forestomach, changed mobility of the stomach, or slippage (dislocation) of the gastric band are possible.

Weight loss with the gastric banding method is usually 50-60% of the excess weight within the first 2 years. An accompanying nutritional therapy is recommended after the implantation of a gastric band. A low-fat, fiber and vitamin-rich diet must be learned and followed.

Which Doctors and Clinics Are Specialists in Gastric Banding Surgery?

Anyone thinking about a weight loss surgery wants the best medical care. Therefore, the patient is wondering where to find the best clinic for gastric banding.

As this question cannot be answered objectively and a reliable doctor would never claim to be the best one, we can only rely on the doctor’s experience. The more obesity surgeries a doctor carries out, the more experienced he becomes in his specialty.

Specialists in sleeve gastrectomy are abdominal surgeons who have specialized in the field of obesity surgery. They are the right contact person for carrying out a gastric banding surgery due to their experience and many years of medical practice as abdominal surgeons with a focus on bariatric surgery.

Sources:

• www.adipositas-zentrum-muenchen.eu/therapieoptionen/magenband/funktion.html
• www.aerzteblatt.de/archiv/89891
• Informationsbroschüre für Patienten über Adipositaschirurgie, Johnson&Johnson MEDICAL GmbH, Ethicon Endo-Surgery
• Adipositaschirurgie Indikation, Operationsverfahren und Erfolgsaussichten; Thomas P. Hüttl
• S3-Leitlinie, Chirurgie der Adipositas, 2010