The Gastric Band Unveiled
Exploring the mechanics, indications, and patient journey of the adjustable gastric band for sustainable weight management.
What is it? 👇 Understand Risks 🚨Dive in with Flashcard Learning!
🎮 Play the Wiki2Web Clarity Challenge Game🎮
Introduction
A Device for Weight Management
The laparoscopic adjustable gastric band (LAGB), commonly known as a lap-band or A band, is an inflatable silicone device surgically placed around the upper part of the stomach. Its primary function is to reduce food consumption, thereby aiding in the treatment of obesity. This procedure falls under the umbrella of bariatric surgery, a field dedicated to surgical interventions for weight loss.
Who is it For?
Initially, adjustable gastric band surgery was designed for individuals with a Body Mass Index (BMI) of 40 or greater. It also served patients with a BMI between 35 and 40 who presented with significant comorbidities known to improve with weight loss. These conditions include sleep apnea, diabetes, osteoarthritis, gastroesophageal reflux disease (GERD), hypertension, and metabolic syndrome. In February 2011, the U.S. Food and Drug Administration (FDA) expanded its approval to include patients with a BMI between 30 and 40, provided they had at least one weight-related medical condition like diabetes or high blood pressure. Crucially, this intervention is considered only after conventional methods such as diet and exercise have proven insufficient.
ICD-9-CM Code
For medical classification and billing purposes, the adjustable gastric band procedure is identified under the ICD-9-CM code 44.95. This standardized code helps healthcare providers and insurers accurately track and categorize the surgical intervention.
Working Principle
Creating a Smaller Pouch
The adjustable gastric band functions by creating a small stomach pouch at the top of the stomach, typically holding about 1/2 cup (approximately 120 mL) of food, significantly less than the average stomach's capacity of 6 cups (around 1,440 mL). This smaller pouch fills quickly, and the band itself slows the passage of food to the lower stomach. This mechanism helps individuals feel full sooner and for longer periods, reducing hunger frequency and promoting smaller portion sizes. It's important to note that the band does not decrease gastric emptying time, but rather restricts intake and encourages satiety through hormonal signals like peptide YY (PYY).
Laparoscopic Placement
The surgical insertion of an adjustable gastric band, often called a lap band procedure, is typically performed using laparoscopic ("keyhole") surgery. This minimally invasive approach involves small incisions, usually less than 1.25 cm (0.5 in), near the belly button. Carbon dioxide gas is introduced into the abdomen to create a working space, allowing the surgeon to use a small camera and long-handled instruments to perform the procedure. This technique generally leads to shorter hospital stays, faster recovery, smaller scars, and less pain compared to open surgical procedures. While less invasive, not all patients are suitable for laparoscopy; those with extreme obesity, prior abdominal surgeries, or complex medical conditions may require an open approach.
Adjustable and Reversible
A key advantage of gastric banding is its adjustability and reversibility. The band can be adjusted by injecting or removing saline solution through a small access port placed under the skin. This allows for fine-tuning the level of restriction to ensure comfort and effectiveness as the patient loses weight. While the procedure is reversible through another laparoscopic operation, it's not entirely without consequence, as adhesions and tissue scarring are inevitable. However, unlike other bariatric surgeries, gastric banding does not involve cutting or removing any part of the digestive system, preserving normal nutrient absorption and avoiding issues like gastric dumping syndrome.
Surgical Criteria
Indications for Surgery
Gastric banding is generally indicated for individuals who meet specific health and lifestyle criteria. These typically include:
- A Body Mass Index (BMI) above 40, or being 100 pounds (45 kilograms) or more over their estimated ideal weight.
- Alternatively, a BMI between 30 and 40 with co-morbidities such as type 2 diabetes, hypertension, high cholesterol, non-alcoholic fatty liver disease, or obstructive sleep apnea, which are expected to improve with weight loss.
- Age typically between 18 and 55 years, though some medical professionals may consider patients as young as 12.
- Documented failure of medically supervised dietary therapy, usually for at least six months.
- A history of obesity, often for up to five years.
- A thorough understanding of the risks and benefits of the procedure, coupled with a willingness to adhere to substantial lifelong dietary restrictions and follow-up care for long-term success.
Contraindications
Certain conditions may render gastric banding unsuitable or pose an unreasonable risk to the patient. These contraindications include:
- Any medical condition where the surgery or treatment presents an unreasonable risk.
- Untreated endocrine diseases, such as hypothyroidism.
- Inflammatory diseases of the gastrointestinal tract, including ulcers, esophagitis, or Crohn's disease.
- Severe cardiopulmonary diseases or other conditions that make a patient a poor surgical candidate in general.
- Known allergic reactions to materials used in the band or a history of pain intolerance to implanted devices.
- Dependency on alcohol or illicit drugs.
- Individuals with severe learning or cognitive disabilities, or those deemed emotionally unstable, who may struggle with the rigorous post-operative compliance required.
Pregnancy Considerations
For patients considering pregnancy, careful management of the gastric band is essential. Ideally, the patient should be in optimal nutritional condition before or immediately after conception. Deflation of the band may be necessary prior to a planned conception or if the patient experiences morning sickness. The band can remain deflated throughout pregnancy and during breastfeeding. Once breastfeeding is completed, or if bottle-feeding, the band can be gradually re-inflated to support postpartum weight loss as needed. It is also important to note that rapid weight loss can increase fertility, particularly by reversing conditions like Polycystic Ovary Syndrome (PCOS) and reducing excess estrogen produced by fat cells. Therefore, effective birth control methods are strongly advised after surgery to prevent unintended pregnancies.
Comparison
Benefits Over Other Surgeries
When compared to more invasive bariatric procedures like Roux-en-Y gastric bypass (RNY), biliopancreatic diversion (BPD), or duodenal switch (DS), adjustable gastric banding offers several distinct advantages:
- Lower Mortality Rate: Studies suggest a significantly lower mortality rate, approximately 1 in 1000, compared to 1 in 250 for RNY gastric bypass surgery.
- No Anatomical Alteration: The procedure does not involve cutting or stapling the stomach, nor does it re-route the intestines. This means the digestive system remains intact.
- Shorter Recovery: Patients typically experience a shorter hospital stay and a quicker recovery period.
- Adjustable: The band can be adjusted non-surgically to optimize restriction and weight loss.
- No Malabsorption: Since no intestines are bypassed, patients generally do not experience nutritional deficiencies or malabsorption of micronutrients, eliminating the routine need for calcium supplements or Vitamin B12 injections.
- No Dumping Syndrome: Gastric dumping syndrome, a common issue with procedures that alter intestinal routing, does not occur with gastric banding.
- Fewer Life-Threatening Complications: Generally associated with fewer severe complications compared to more radical surgeries.
Weight Loss Trajectory
While other bariatric procedures like RNY often result in faster initial weight loss, studies indicate that the difference in excess weight loss between adjustable gastric banding and these procedures can decrease significantly over time. Gastric banding patients typically lose an average of 47.5% of their excess weight. The procedure encourages the adoption of better eating habits, which is crucial for long-term weight stability. However, maintaining weight reduction requires strict adherence to post-operative dietary guidelines, exercise, and consistent band maintenance. Weight regain is possible with any weight loss procedure if these guidelines are not followed.
Reoperation Risk
Despite its benefits, some studies indicate a decrease in adjustable gastric banding surgeries due to an increased risk of reoperation compared to Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). This highlights the importance of patient selection, meticulous surgical technique, and comprehensive long-term follow-up to mitigate potential complications that may necessitate further surgical intervention.
Potential Risks
Common Patient Experiences
One frequently reported occurrence for patients with a gastric band is the regurgitation of non-acidic swallowed food from the upper pouch, often referred to as "Productive Burping" (PBing). This is not considered normal and typically indicates that the patient should eat less, eat more slowly, and chew food more thoroughly. Occasionally, the narrow passage created by the band can become blocked by a large portion of unchewed or unsuitable food, leading to discomfort or obstruction.
Surgical Complications
Beyond common patient experiences, several surgical complications can arise:
- Ulceration and Gastritis: Irritation or inflammation of the stomach tissue.
- Erosion: The band may slowly migrate through the stomach wall, moving from the outside to the inside. This can occur silently but may lead to severe problems, including internal leaks of gastric contents or bleeding, requiring urgent treatment.
- Slippage: An uncommon event where the lower part of the stomach prolapses through the band, causing an enlarged upper pouch. Severe cases can lead to obstruction and necessitate urgent surgical correction.
- Malposition: If the band is not correctly positioned around the vertical axis of the stomach, restriction may be inadequate, leading to reduced weight loss or a painful kink in the stomach. In rare instances, the band may not enclose the stomach at all, encircling only perigastric fat, resulting in no food restriction.
- Port and Tubing Issues: Problems can include the access port flipping over (making it inaccessible), disconnection of the port from the tube, or perforation of the tube during an access attempt. These issues can lead to a loss of band fill fluid and restriction, often requiring minor surgical repair.
- Internal Bleeding and Infection: As with any surgical procedure, there is a risk of internal bleeding or infection at the surgical site.
Documented Adverse Effects (FDA)
The U.S. Food and Drug Administration (FDA) has documented a comprehensive list of adverse effects associated with gastric banding, categorized as follows:
Band- and Port-Specific
- Band slippage/pouch dilation
- Esophageal dilatation/dysmotility
- Erosion of the band into the gastric lumen
- Mechanical malfunctions (port leakage, tubing cracks, connection disruption)
- Port site pain
- Port displacement
- Infection of the fluid within the band
- Bulging of the port through the skin
Digestive
- Nausea and/or vomiting
- Gastroesophageal reflux
- Stoma obstruction
- Dysphagia (difficulty swallowing)
- Diarrhea
- Abnormal stools
- Constipation
- Diverticulosis
Body as a Whole
- Abdominal pain
- Asthenia (weakness)
- Death
- Infection
- Fever
- Hernia
- Pain (general, chest, incisional)
- Blood clots
- Hair loss
- Gallstones
- Pancreatitis
Miscellaneous
- Abnormal healing
- Alopecia (hair loss)
- Band intolerance
- Inability to maintain proper restriction
Post-Surgery Journey
Effectiveness and Weight Loss
On average, gastric banding patients can expect to lose 500 grams to 1 kilogram (1–2 pounds) per week consistently, though heavier individuals may experience faster initial weight loss. While some studies suggest that Roux-en-Y gastric bypass patients may lose weight more rapidly at first, long-term data indicates that LAGB patients can achieve a comparable percentage of excess weight loss and maintain it over several years. This procedure fosters improved eating habits, which are critical for sustained weight stability. However, it is crucial to recognize that suboptimal weight loss and high complication rates have been observed in some studies with greater experience and longer patient follow-up, underscoring the importance of diligent post-operative care and patient compliance.
Band Adjustments (Fills)
Precise and careful adjustment of the band, known as "fills," is paramount for effective weight loss and the long-term success of the procedure. These adjustments involve introducing saline solution into the band via a subcutaneous access port. Fluoroscopy (X-ray guidance) may be used to visualize the band and port placement, and to observe the passage of a radio-opaque fluid through the esophagus and the restricted area. This helps the radiologist assess the level of restriction and identify potential issues like esophageal dilation, an enlarged pouch, or band migration. Alternatively, some practitioners perform adjustments based on the patient's weight loss progress and reported symptoms such as heartburn, regurgitation, or chest pain, which might indicate excessive restriction. The first adjustment is typically made four to six weeks post-operatively to allow for stomach healing, with subsequent fills performed as needed. The optimal fill volume varies significantly among individuals.
Diet and Aftercare
Following surgery, patients are typically prescribed a phased diet, starting with liquids, progressing to mushy foods, and then to solids. The duration of each phase varies by surgeon and manufacturer. Initially, before the first band fill, patients may still be able to consume relatively large portions due to minimal restriction. Therefore, a structured post-operative diet and a robust after-care plan are essential for success. A recent study highlighted that patients who did not alter their eating habits were 2.2 times more likely to be unsuccessful, and those who did not increase physical activity were 2.3 times more likely to fail. A long-term diet should consist of solid, healthy foods that require thorough chewing to a paste-like consistency before swallowing. This texture maximizes the band's effect, whereas softer, wet foods like soups or smoothies pass through easily, potentially leading to higher caloric intake. Support groups can be beneficial, though some patients find groups mixing different bariatric surgery types less helpful due to differing needs and initial weight loss rates.
Procedure Cost
Financial Considerations
The cost of adjustable gastric band surgery in the United States typically averages around $15,000. However, this figure can vary significantly by state, ranging from approximately $10,500 in states like Colorado and Texas to over $33,000 in Alaska. The services included in these quoted costs also differ among surgical clinics and hospitals.
Most practices generally include the essential services required for the procedure, such as the surgeon's fee, surgical assistant fee, hospital/operating room fee, anesthesiologist fee, and the cost of the gastric band device itself. Some clinics may also bundle a specified duration of post-operative follow-up visits for band adjustments (fills and un-fills), which can range from three to thirteen months post-surgery. As a standalone service, each office visit for a band adjustment can cost between $15 and $300.
It is important for prospective patients to note that most quoted fees typically do not cover the cost of preoperative care and testing, nor do they include expenses for any potential complications that may arise after the surgery. Therefore, a comprehensive understanding of all potential costs is crucial when considering this procedure.
History
Early Non-Adjustable Bands
The concept of limiting food intake without altering the gastrointestinal tract's continuity dates back to the late 1970s. Wilkinson pioneered several surgical approaches, and in 1978, he and Peloso were the first to place a non-adjustable band (a 2 cm Marlex mesh) around the upper stomach via open surgery. The early 1980s saw further innovations from researchers like Kolle, Molina & Oria, Naslund, Frydenberg, and Kuzmack, who experimented with various materials including marlex mesh, dacron vascular prosthesis, silicone-covered mesh, and Gore-Tex. Bashour also developed the "gastro-clip," a polypropylene clip, which was later abandoned due to high rates of gastric erosion. These early attempts faced challenges such as difficulty in achieving the correct stomal diameter, stomach slippage, erosion, food intolerance, intractable vomiting, and pouch dilatation. Despite these hurdles, silicone emerged as the best-tolerated material, exhibiting fewer adhesions and tissue reactions.
The Advent of Adjustable Bands
The development of the modern adjustable gastric band is a testament to the vision and collaborative efforts of bio-engineers, surgeons, and scientists. Early research into "adjustability" can be traced to G. Szinicz in Austria, who experimented with adjustable bands connected to a subcutaneous port in animals. In 1986, Lubomyr Kuzmak, a Ukrainian surgeon, reported on the clinical use of the "adjustable silicone gastric band" (ASGB) through open surgery. Kuzmak's contributions included applying Mason's principles of VBG to gastric banding, defining pouch volume, addressing staple line disruption, validating silicone use, and introducing adjustability. Concurrently, Hallberg and Forsell in Stockholm, Sweden, developed what became known as the Swedish Adjustable Gastric Band (SAGB), which was patented in Scandinavian countries in 1985 and later implanted using the open technique.
The Laparoscopic Era
The introduction of surgical laparoscopy revolutionized bariatric surgery, making the gastric band a more attractive option. In 1992, Prof. Guy-Bernard Cadière was the first to apply an adjustable band (the Kuzmak ASGB device) using a laparoscopic approach. Over the next few years, the Kuzmak ASGB was refined for laparoscopic implantation, leading to the modern lap band, driven by Belachew, Cadière, Favretti, and O'Brien, with engineering support from Inamed Development Company. The first human laparoscopic implantation of this new lap band occurred in Belgium in September 1993, followed shortly by a similar procedure in Italy. In 1994, the first international laparoscopic-band workshop was held in Belgium, and another for the SAGB in Sweden. Further advancements included single-port laparoscopy (SPL), a highly minimally invasive technique where surgeons operate through a single entry point, typically the navel. In 2003, the American Institute of Gastric Banding (AIGB) True Results opened the first accredited outpatient bariatric center in the U.S., performing over 30,000 outpatient lap-band procedures since then.
Band Types
FDA-Approved Bands
In the United States market, the Lap-Band system is currently the only adjustable gastric band approved by the FDA, having received approval in 2001. The device has undergone several modifications over the years and is available in five different sizes. The latest models, the Lap-Band AP-L and Lap-Band AP-S, feature a standardized injection port that is sutured into the skin, with fill volumes of 14 mL and 10 mL respectively. The Realize Band, another adjustable gastric band, lost its FDA approval in 2016.
International Bands
Outside of the United States, two other adjustable gastric bands are in use: Heliogast and Midband. Neither of these devices has received FDA approval for use in the U.S. The Midband was introduced to the market in 2000. It is designed with smooth contours, devoid of sharp edges or irregularities, to protect the gastric wall from rubbing. Additionally, it is opaque to X-rays, which facilitates easy localization and adjustment during follow-up procedures. The Heliogast band, which entered the market in 2003, features a streamlined design intended to ease its insertion during the surgical operation.
Safety Concerns
Congressional Scrutiny
In 2012, members of the U.S. Congress initiated a request for a congressional investigation into the safety of lap-band procedures. This inquiry was prompted by a series of patient deaths reported after lap-band surgeries performed at clinics associated with the "1-800-GET-THIN" advertising campaign in Southern California. Such investigations underscore the critical importance of patient safety, ethical marketing practices, and rigorous oversight in the field of bariatric surgery.
Public Awareness
Influential Figures
As with many medical advancements and weight loss approaches, public figures have played a role in increasing awareness and shaping public opinion regarding gastric banding. Notable individuals who have undergone or spoken about lap-band surgery include:
- Khaliah Ali: Daughter of the legendary boxer Muhammad Ali.
- Fern Britton: A well-known television presenter.
- Professor Chris Oliver: A surgeon and professor of physical activity, who initially had a LapBand but later underwent gastric bypass surgery in 2020 after the band failed.
- Sharon Osbourne: A prominent television personality and music manager.
- Chris Christie: Former Governor of New Jersey, who underwent lap-band stomach surgery in February 2013.
The experiences of these public figures often bring both positive and negative aspects of the procedure into the public discourse, influencing perceptions and discussions around bariatric surgery.
Teacher's Corner
Edit and Print this course in the Wiki2Web Teacher Studio
Click here to open the "Adjustable Gastric Band" Wiki2Web Studio curriculum kit
Use the free Wiki2web Studio to generate printable flashcards, worksheets, exams, and export your materials as a web page or an interactive game.
True or False?
Test Your Knowledge!
Gamer's Corner
Are you ready for the Wiki2Web Clarity Challenge?
Unlock the mystery image and prove your knowledge by earning trophies. This simple game is addictively fun and is a great way to learn!
Play now
References
References
- Laparoscopic Adjustable Gastric Banding: Surgical Technique, thinforlife.med.nyu.edu
- Dr. Jacob Haiavy and Dr. John Olsofka (25 May 2021). Lap band surgery Healthroid.
- Surgical procedures and innovations. Columbia University Center for Metabolic and Weight Loss Surgery. Retrieved 2010-10-01.
- "She floats like a butterfly, too", thinforlife.med.nyu.edu
- Sharon Osbourne candid about colorectal cancer, USA Today, 2003-11-14. Retrieved on May 30, 2007
Feedback & Support
To report an issue with this page, or to find out ways to support the mission, please click here.
Disclaimer
Important Notice
This page was generated by an Artificial Intelligence and is intended for informational and educational purposes only. The content is based on a snapshot of publicly available data from Wikipedia and may not be entirely accurate, complete, or up-to-date.
This is not medical advice. The information provided on this website is not a substitute for professional medical consultation, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider, such as a bariatric surgeon, endocrinologist, or general practitioner, with any questions you may have regarding a medical condition, obesity, or surgical interventions like the adjustable gastric band. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
The creators of this page are not responsible for any errors or omissions, or for any actions taken based on the information provided herein.