Generality
The gastric band is a surgical procedure indicated for the treatment of obesity. It is part, with its various techniques used, in restrictive bariatric surgery, intended to limit the consumption of food through the surgical reduction of the stomach volume; it follows, for obvious mechanical reasons, an "early onset of satiety and a reduced ability to eat food. Thanks to the gastric stenosis induced by the band, when the operated subject eats he feels full even after ingesting a small amount of food, to the point that if he continues to eat he is induced to vomit. Consequently, the quantity of food introduced will be obligatory. lower than what he was used to ingesting before the bandage: body weight will decrease accordingly.
The main gastrorestrictive interventions that make use of the gastric band are:
- Laparoscopic adjustable gastric band (LAGB or Lap-Band "®): currently, it is the most widespread method. It is performed laparoscopically, therefore it represents a minimally invasive operation, and is reversible: the gastric cavity is not sectioned and the band can be removed;
- Vertical gastroplasty (VBG): stomach volume reduction is ensured by a surgically implanted device. The surgeon creates a gastric pocket separating it from the rest of the stomach with cuts and sutures, which allow the positioning of a polypropylene band that will alter the anatomy of the stomach (the gastric cavity is dissected).
Like other methods designed to combat obesity, gastric banding requires high patient adherence to an appropriate diet after surgery.
Adjustable gastric band
The adjustable gastric band is one of the most common surgical interventions to treat obesity, surpassed in this sense only by gastric bypass.
The system consists of an inflatable bandage (silicone band), surgically implanted around the upper part of the stomach and fixed to the gastric fundus in order to avoid slipping of the device or stomach herniation.
The surface of the band is adjustable: its size depends on the amount of sterile saline solution that is inside the constricting bandage. Using a thin connecting catheter and a subcutaneous reservoir, the surgeon can adjust the diameter of the device around the stomach. adding or removing saline solution (inserts a needle at the level of the access tank, placed under the skin). This allows you to modulate the "throttling" amount to increase or reduce the level of passage of food, from the upper pocket to the body of the stomach. The achievement of the desired weight loss is in fact correlated to the degree of pressure exerted by the fascia, on which the width of the gastric pouch that is created depends.
The bandage limits the amount of food that can be ingested in a single meal and increases the time it takes to digest the food introduced. Laparoscopic Adjustable Gastric Band is indicated for obese patients with a body mass index (BMI) of at least 40, who have failed adopting non-surgical alternatives to lose weight, such as controlled diet, exercise medications, and behavior modification programs. food. In addition, it is also approved for patients with a BMI of 30-40, with one or more obesity-related conditions, such as high blood pressure, heart disease, diabetes or sleep apnea.
The adjustable gastric band leads, on average, to the loss of about 40% of excess weight. However, these results vary widely from subject to subject. If necessary, the procedure can be reversed, and, over time, the stomach returns to normal size. Weight loss is less and slower than with other surgical options, but the risks associated with surgery are also lower.
The most common problems after gastric band placement are:
- Nausea and vomit. These can generally be reduced by adjusting the band tightness.
- Secondary surgical complications, which include problems with the regulator or the onset of infections.
Unlike gastric bypass, the gastric band does not interfere with the absorption of food; for this reason, nutritional deficiencies are rare.
A gastric band is meant to be a long-term implant, but it is not a permanent device. Many people need additional operations to reposition, replace, or remove the gastric band due to complications.
Indications and Contraindications
The gastric band is indicated for patients with the following characteristics:
- 18 years of age or older;
- Failure of diet therapy under medical supervision (for about 6 months);
- Body mass index (BMI) greater than 40;
- BMI between 30 and 40, with one or more diseases related to obesity, such as diabetes, hypertension, heart disease or sleep apnea;
Before undergoing a gastric bandage, the patient must fully understand the risks and benefits of the procedure; furthermore, another very important aspect, must show the firm will to respect the post-intervention dietary restrictions required for long-term success.
Gastric banding is generally not recommended in the following cases:
- If surgery or therapy poses an unreasonable risk to the patient;
- Presence of inflammatory diseases of the gastrointestinal tract, such as ulcers, esophagitis or Crohn's disease;
- Current severe heart disease or other conditions that may increase the risk associated with the surgical procedure;
- Allergy to the materials contained in the bandage;
- Alcohol or drug addiction
- Presence of some eating disorders;
- Patients who are psychiatric, psychologically unstable or who have demonstrated pain intolerance to previous implanted devices.
Surgical intervention
The gastric band is usually applied by a laparoscopic surgical procedure. The surgery is performed while the patient is completely asleep (general anesthesia).
The surgeon makes a few small incisions in the abdomen to insert a laparoscope and other surgical instruments into the abdominal cavity. During the surgery, the surgeon applies an adjustable (hollow) silicone band around the upper part of the stomach; a gastric pouch is thus created which communicates with the lower part of the stomach by means of a narrow opening regulated by the "ring." The operation does not involve any cutting or pinching of the stomach; therefore, the LAGB gastric banding procedure is completely reversible.
Once the device is in place, the surgical instruments are removed and the incisions are closed with sutures. The intervention usually takes about an hour to complete. After the procedure, the doctor can tighten or loosen the band, adapting it to the stomach, without the need to subject the patient to further interventions; it is in fact sufficient to add or remove the fluid through the reservoir implanted in the subcutis by accessing it through a thin needle.
Typically, patients are discharged after a short hospital stay (usually 48 hours). For the first two weeks, the stomach can only handle small amounts of fluid. Some people feel completely full after a few sips of water, while others won't feel much of a difference. Gradually, the patient will be able to add solid foods back to the diet. The doctor will provide specific instructions on what and how to eat after surgery. In particular, the patient must be careful to chew food well and stop eating as soon as he feels satiety. The adjustable gastric band does not provide for any alteration of the " absorption of food and it is very important that the patient takes the various foods according to the food instructions received from the doctor.
Weight loss after surgery
After the surgery, following the ingestion of food, the patient feels a premature and prolonged satiety, therefore the food volume ingested is lower and the weight is consequently reduced.
With the gastric band the patient loses on average from 500 grams to one kilogram of weight per week. During the first year, most patients can lose around 22-45 kilograms. The procedure tends to encourage better eating habits which, in turn, help produce weight stability over the long term.
Proper and sensitive adjustment of the elastic bandage is critical for the long-term success of the procedure. Often, the first adjustment is made 4 to 6 weeks after surgery to provide the stomach with adequate time to heal. Thereafter, adjustments are made as needed, based on individual needs. In the first period after surgery. "surgery (1-2 months), the patient will be able to eat very little and foods will have to be added gradually.
The gastric band requires a constant commitment to eat less, following medical recommendations, otherwise serious complications may arise (dilation of the esophagus, pneumonia ab-ingestis, etc.). People who are unable to adapt to the band may not achieving or maintaining weight loss.
Risks
In addition to the possible occurrence of complications related to the surgical procedure, the following complications may occur:
- Nausea and vomit;
- Difficulty swallowing
- Gastroesophageal reflux disease (GERD);
- Stomach ache;
- Abdominal pain;
- Constipation;
- Intolerance to the device;
- Dilation or herniation of the gastric pouch
- Possible damage to the stomach, due to erosion of the fascia through the stomach walls, which can be resolved with further surgery;
- Stretching of the esophagus: If the band is too narrow, or if you eat too much, the esophagus may expand. This can make swallowing difficult.
Other specific postoperative complications include:
- Obstruction of the passage of solid foods and liquids;
- Fluid loss from the gastric band
- Fluid injection port problems: an infection may arise around the subcutaneous access reservoir or it may dislodge. The catheter connecting the bandage to the subcutaneous reservoir may also become blocked, ruptured, or cause the regulation fluid to leak of the gastric band;
- Displacement of the gastric band from its original position: Symptoms can include stomach pain or acid reflux. It can be treated by removing fluid from the band or through another surgery to reposition it.
The risks are greater when a patient is obese or has other serious health conditions. If any of these complications occur, you should speak to your doctor.
Benefits
The gastric band has the following advantages:
- Guarantees a moderate weight loss;
- Compared to other bariatric surgery, the mortality rate associated with the operation is lower: only 1 in 1000;
- No stomach cutting or stapling is required;
- Short hospital stay;
- Fast recovery and fewer life-threatening complications;
- Adjustable without further surgery;
- The absorption of food remains unchanged (malabsorption problems do not occur).
Gastric banding has shown benefits for people who have not achieved satisfactory weight loss through non-surgical methods. In addition, some patients also reported an improvement in general health conditions and obesity-related disorders, such as diabetes, hypertension and sleep apnea.
Another plus of the gastric band lies in the low invasiveness of the surgical procedure, performed laparoscopically. Compared to other interventions used to treat obesity, laparoscopic gastric banding is less painful and usually requires less recovery time than other gastrorestrictive surgical procedures.Weight loss is usually gradual, but constant: some people experience weight loss for up to 3 years after surgery. To achieve the best weight loss outcome from gastric band treatment, it is essential that the patient has an adequate dietary regimen by making appropriate changes in their eating habits, and engages in regular physical activity. In addition to making changes to the diet in the long term, it is necessary to have regular follow-up visits with the competent surgeon, to monitor progress and make any changes to the gastric band.
