Gastric Banding Surgery: Full Expert's Guide

Gastric Banding Surgery, or adjustable gastric band surgery, is a very popular weight-loss surgery. With over hundreds of thousands of people already "banded," gastric banding surgery is the most well-known weight-loss surgery.

How Gastric Banding Surgery Works

Gastric Band

Gastric Banding Surgery works by restricting the upper portion of the stomach, ergo reducing the stomach's capacity. By reducing the stomach's capacity, people feel fuller faster helping them eat less food. Gastric Banding Surgery is typically done laparoscopically, or using many small incisions in the patient's stomach.

Placing the device, either Lap-Band or Realize Band, around the upper portion of the stomach, physicians can adjust the tightness around the stomach, thereby effectively managing weight-loss.

Gastric Banding Surgery, or adjustable gastric banding, is the most common form of bariatric surgery that utilizes a band that wraps the upper portion of the stomach to reduce the amount of food that you consume. This is a restrictive type of bariatric surgery that restricts food intake, thus helping the patient consume less food.

The adjustable part comes in when patients can adjust the band that affects the amount of restriction that is necessary. The physician usually changes the band based on your current weight loss, food cravings, and other physical reactions.

Gastric Banding uses a proprietary device that restricts the stomach; the two FDA approved “bands,” or implants are the: Lap-Band system and the Realize Band. The Lap-Band system is the most popular, with over 550,000 people undergoing the procedure and over 100,000 people undergoing the Realize procedure.

Cost of Gastric Banding Surgery

The cost of gastric banding surgery depends on the specific implant that will be used during the procedure. Average costs tend to hover around $20,000 to $25,000 in the United States. Costs can decrease with Medical Tourism, one study found that bariatric surgery in Mexico saved patient's 70%, from what they would have spent in the U.S.

Who is a Candidate for Mexico Gastric Banding Surgery?

Unlike RNY gastric bypass and sleeve gastrectomy surgery which typically require high BMIs, Mexico Lap-Band is least invasive and provides a short-term to mid-term tool for weight loss. Patients with body mass indexes of over 40 are good candidates, but patients with as low as 30 BMIs can also be a candidate.

Based on the manufacturer website, Lap-Band system is acceptable for patients with between 30 and 40 BMIs if they have a co-morbidity such as hypertension, diabetes, or high cholesterol. Realize Band is approved for patients who have BMIs of 35 to 45 and also with a co-morbidity.

The LAP-BAND System may be right for you if:

  • You are an adult (at least 18 years old).
  • Your BMI is 40 or higher or you weigh at least twice your ideal weight or you weigh at least 100 pounds (45 kilos) more than your ideal weight.
  • You have been overweight for more than 5 years.
  • Your serious attempts to lose weight have had only short-term success.
  • You do not have any other disease that may have caused you to be overweight.
  • You are prepared to make major changes in your eating habits and lifestyle.
  • You are willing to continue working with the specialist who is treating you.
  • You do not drink alcohol in excess.

If your BMI is less than 40, the LAP-BAND System may not be right for you. On the other hand, your surgeon may consider it if you have health problems that are related to obesity. Your surgeon may also have other criteria he or she uses. Ask him or her to discuss the criteria with you. See also the LAP BAND Contraindications.

Lap Band Around the Stomach

Before your surgery, you should talk about the procedure in detail with your surgeon. Your doctor may also want you to meet with other experts. They can help you understand what will happen during and after the operation. These experts might include process, the band part of the LAP-BAND System will be fastened around the upper part of your stomach. This will create a small stomach pouch. Part of the lower stomach will then be sutured to the band. The rest of the lower stomach will stay in its usual position. The reservoir for adjusting the band will be placed on your skin. To do this, the surgeon will slightly enlarge one of the incisions that he or she made for the laparoscopic tubes.

  • a dietitian
  • a physiotherapist
  • a psychologist
  • other specialists

Some examinations have to be carried out before a patient can undergo surgery The patient also needs to visit a dietitian. The dietitian may give him or her a food diary to obtain a comprehensive picture. The aim is that the patient should keep a detailed diary of what he or she eats for a week. This diary is used to assess whether surgery will be helpful. We can only decide to carry out the operation involving a band around the stomach once we have the green light from all quarters. The patient is usually admitted the day before the operation. The results of all the examinations are checked again. Then I again explain to the patient what the procedure involves, and the anesthesiologist talks to him or her about the anesthesia and the form of pain relief that will be used after the operation. When the patient has been admitted, he or she is also seen by a physiotherapist, with the emphasis being on respiratory therapy. After the operation, the patient may find it less comfortable to breathe deeply, and it may be painful to cough up mucus. So before the operation, the physiotherapist gives the patient instructions on the correct way to breathe and cough, so that post-operative treatment can be carried out efficiently and well.” (LAP-BAND System surgeon)

Open operation

Sometimes laparoscopic surgery can’t be done. Or sometimes, even after the laparoscopic surgery has started, the surgeon may switch to the “open” method. There could be some reasons for this. For instance, bleeding or problems placing the band could make the open method with the larger incision necessary. If this is the case, you will not be aware of it while you are under the anesthesia. The surgeon will make a larger incision in the abdomen to perform the operation. After this “open” surgery, you will most likely need to stay in the hospital longer. That’s because there could be more complications. It also may take more time for you to get back to your regular routine. In the U.S. study about 5% of the patients were converted to open procedures.

Lap Band Surgery Risks

One of the benefits of choosing gastric banding surgery verse another bariatric surgery is because risks and complications are a lot lower. There is also the fact that since this surgery has been around a lot longer than the gastric sleeve, there are more known problems. Surgeons know what to expect 5, 10 or 15 years post-surgery.

Gastric banding surgery comes with many risks and possible complications, but so does any serious operation. One of the benefits of gastric banding is that since it’s less invasive than other bariatric surgeries, it holds fewer risks than, for example, gastric bypass. But that still doesn’t mean there are not risks. There is always the likelihood of death during or after surgery – as with all surgeries – but it occurs once about every 2,000 surgeries.

Specific risks from the implant itself include eroding implant, the implant can deflate, the band can make the stomach blocked and more. There is also infection risks with surgery, as well as bleeding. Side effects can include vomiting, nausea, and diarrhea. Your bariatric physician will tell you all the possible risks, and complications that can occur – it’s important to ask a lot of questions with your doctor before doing the surgery. For more information, please visit Bariatric Surgery in Mexico, a guide to weight loss surgery in Mexico.

Using the LAP-BAND System induces the same risks that come with all major surgeries. There are also added risks in any operation for patients who are seriously overweight.

Important

You should know that death is one of the risks. It can occur any time during the operation. It can also occur as a result of the operation. Death can occur despite all the precautions that are taken. There is a risk of gastric perforation (a tear in the stomach wall) during or after the procedure that might lead to the need for another surgery.

In the U.S. clinical study this happened in 1% of the patients. There were no deaths during or immediately after surgery in the U.S. study. Your age can increase your risk from surgery. So can excess weight. Certain diseases, whether they were caused by obesity or not, can increase your risk from surgery. There are also risks that come with the medications and the methods used in the surgical procedure. You also have risks that come from how your body responds to any foreign object implanted in it.

Published results from past surgeries, however, do show that LAP BAND System surgery may have fewer risks than other surgical treatments for obesity.

Lap-Band Surgery Side Effects and Complications:

Patients can experience complications after surgery. Most complications are not serious but some may require hospitalization and/or re-operation. In the United States dinical study, with 3-year follow-up reported, 88% of the 299 patients had one or more adverse events, ranging from mild, moderate, to severe. Nausea and vomiting (51%), gastroesophageal reflux (regurgitation) (34%), band slippage/pouch dilatation (24%) and stoma obstruction (stomach-band outlet blockage) (14%) were the most common post-operative complications. In the study, 25% of the patients had their band systems removed, two-thirds of which were following adverse events. Esophageal dilatation or dysmotility (poor esophageal function) occured in 11% of patients, the long-term effects of which are currently unknown. Constipation, diarrhea and dysphagia (difficulty swallowing) occurred in 9% of the patients. In 9% of the patients, a second surgery was needed to fix a problem with the band or initial surgery. In 9% of the patients, there was an additional procedure to fix a leaking or twisted access port. The access port design has been improved. Four out of 299 patients (1.3%) had their bands erode into their stomachs. These bands needed to be removed in a second operation. Surgical techniques have evolved to reduce slippage. Surgeons with more laparoscopic experience and more experience with these procedures report fewer complications.

Adverse events that were considered to be non-serious, and which occurred in less than 1% of the patients, included: esophagitis (inflammation of the esophagus), gastritis (inflammation of the stomach), hiatal hernia (some stomach above the diaphragm), pancreatitis (inflammation of the pancreas), abdominal pain, hernia, incisional hernia, infection, redundant skin, dehydration, diarrhea (frequent semi-solid bowel movements), abnormal stools, constipation, flatulence (gas), dyspepsia (upset stomach), eructation (belching), cardiospasm (an obstruction of passage of food through the bottom of the esophagus), hematemsis (vomiting of blood), asthenia (fatigue), fever, chest pain, incision pain, contact dermatitis (rash), abnormal healing, edema (swelling), paresthesia (abnormal sensation of burning, prickly, or tingling), dysmenorrhea (difficult periods), hypochromic anemia (low oxygen carrying part of blood), band system leak, cholecystitis (gall stones), esophageal ulcer (sore), port displacement, port site pain, spleen injury, and wound infection. Be sure to ask your surgeon about these possible complications and any of these medical terms that you don’t understand.

Results of Gastric Banding, Efficacy

The official name for gastric banding is laparoscopic adjustable gastric banding or LAGB. This is one of several different types of weight loss operations that a patient may undergo in order to improve weight loss chances on a long term basis. One of the biggest questions that arise with this type of operation is whether or not it will provide patients with long-term weight loss effects rather than simply a short-term solution.

The laparoscopic adjustable gastric banding procedure is a type of restrictive surgery. What this means is that the size or capability of the stomach is restricted in order to benefit long term weight loss. After a restrictive operation, the patient is going to feel fuller much quicker while eating, allowing them to eat less which will lead to natural, long-term weight loss. The gastric banding surgery is the second most popular out of all the weight loss surgery options, second only to gastric bypass. One of the greatest benefits of this type of weight loss is that it is performed laparoscopically, and so it is a minimally invasive operation that provides for an adjustable weight loss effort.

Numerous studies have shown that there are positive, long-term results for this particular surgical procedure, namely:

  • According to the NCBI, 3227 patients having undergone laparoscopic adjustable gastric band placement between the years of 1994 and December 2011 were followed up with. 714 of those patients had gone through at least 10 years of follow-up. Among the patients who continued with follow-up care during this time, 47.1% of excess weight was lost within a period of 15 years and was kept off during this time.
  • Though some patients required revisionary operations during this time period to adjust bands or repair tubing or port problems, these revisionary surgeries did not impact weight loss in a negative way.
  • This study was conducted in 2013 by Monash University. Their 15-year follow-up study in Australia involved patients who underwent the lap-band surgery as many as 15 years prior to when the study began. This study, which is one of the longest and the most comprehensive to date, found that a significant number of patients who underwent the laparoscopic adjustable gastric band operation continued to maintain average weight loss of 26 kilograms as many as ten years after the operation.
  • The Centre for Obesity Research and Education, also known as CORE, in Australia at the Monash University analyzed 3,227 patients who had undergone the surgery. Some had experienced the operation the year it was introduced in 1994, while others had experienced the surgery more recently.
  • Gastric banding has proven to provide more than simply weight loss. Patients who were obese and suffered from type 2 diabetes prior to the surgery often found that they had greater control over their blood sugars, many no longer requiring the use of medication. According to Professor O’Brien who led the study, approximately 25% of all patients with type 2 diabetes no longer required insulin therapy or medications in order to control blood sugars following the gastric banding surgery.
  • As a result of these studies, it has been estimated that the average weight loss for patients undergoing a gastric banding procedure is 40% of excess weight. This is the typical or average result, however, and so some patients may lose more or less than 40% of their excess body weight. Results can vary widely regarding how much weight a patient may lose, though the results are positive for most patients following this operation.

As researchers continue to amass data about laparoscopic gastric banding surgeries and its success rate, physicians and surgeons will be better able to showcase the efficacy and results of this operation. Just like with any type of surgery, there are both positive and negative aspects that need to be considered before going through with gastric banding surgery.

After Gastric Banding

Once the anesthesia has worn off, you may feel some pain. This pain can usually be relieved with ordinary painkillers. The hospital staff will help you get out of bed and start moving as soon as possible. This will help prevent blood clots, respiratory problems, and bedsores.

On the day after the surgery, you will likely be given an X-ray. This is so your health team can see that the Lap Band is in the right place. It is also to see that the new stomach outlet is open. You may be asked to swallow a liquid that can be seen on X-ray.

After laparoscopic surgery, you will stay in the hospital for 1 to 3 days. The hospital stay may be longer after the open procedure or if there are complications. If there are no complications, you should be able to resume normal activities within a week or two after the surgery.

Overall, gastric banding surgery is the safest bariatric surgery today. It's the most common bariatric surgery in the World, and is offered in many different countries. Most notably, the United States, India, and Mexico.

Cost of Lap Band Surgery

Bariatric Surgery is a costly endeavor. Most of the time it’s not paid for by insurance and if insurance pays, it most likely doesn’t cover the full cost. Lap Band Surgery is the least costly of the various weight loss surgery options and is offered across the world.

LAP-BAND Cost Samples
United States: $15,000 to $30,000
Mexico: $4,000 to $10,000

LAP-BAND Surgery can be financed or can be paid with your own finances. There are numerous patient financing companies that allow people to pay for bariatric surgery.

Why Bariatric Surgery is an Investment in Your Future

Having LAP-BAND Surgery will change your life for the better. Though it’s one where you should consult a trained physician before deciding the risks and complications. Lap Band Surgery provides people a way of losing weight and handling obesity.

While the cost of the surgery is an important factor, it shouldn’t be paramount. If you’re an ideal candidate for Lap Band Surgery, than there are more pressing issues to consider. If you are significantly overweight there are health issues that may increase your chance of getting or developing a serious disease or condition. By going through Lap Band Surgery one can decrease their health risks, increase their life-span, and live a happier life.

FAQs on Gastric Banding

Q: Will I be sick a lot after the operation?

A: The LAP-BAND System limits food intake. If you feel nauseous or sick on a regular basis, it may mean you are not chewing your food well. It could also mean you are not following the diet rules properly. Another reason you would feel sick may be that there is a problem with the placement of the band. So you should contact your doctor. Vomiting should be avoided as much as possible. It can cause the small stomach pouch to stretch. It can also lead to slippage of part of the stomach through the band. That would reduce the success of the operation. In some cases, it would also require another operation.

Q: Will I suffer from constipation?

A: There may be some reduction in the volume of your stools. That’s normal after a decrease in food intake, because you eat less fiber. This should not cause severe problems. If difficulties do arise, check with your doctor. He or she may suggest you take a mild laxative and drink plenty of water for a while. Drinking plenty of water is a good idea, anyway. Your needs will vary, but you should drink at least 6-8 glasses of water a day.

Q: Will I need to take vitamin supplements?

A: You may. It’s possible you may not get enough vitamins from three small meals a day. At your regular check-ups, your specialist will evaluate whether you are getting enough vitamin B12, folic acid, and iron. Your surgeon may advise you to take supplements.

Q: What about other medication?

A: You should be able to take prescribed medication. You may need to use capsules or break big tablets in half or dissolve them in water so they do not get stuck in the stoma and make you sick. You should always ask the doctor who prescribes the drugs about this. Your surgeon may tell you to avoid taking aspirin or other non-steroidal anti-inflammatory pain relievers. That’s because they may irritate the stomach. The problems these drugs may cause could mean the band would need to be removed.

Q: What about pregnancy?

A: Becoming pregnant can be easier as you lose weight. Your menstrual cycle may become more regular. If you need to eat more while you are pregnant, the band can be loosened. After the pregnancy, the band may be made tighter again. Then you can go back to losing weight.

Q: Can the band be removed?

A: Although the LAP BAND System is not meant to be removed, it can be. In some cases this can be done laparoscopically. Surgeons report that the stomach generally returns to its original shape once the band is removed. After the removal, though, you may soon go back up to your original weight. You may also gain more.

Q: What if I go out to eat?

A: Order only a small amount of food, such as an appetizer. Eat slowly. Finish at the same time as your table companions. You might want to let your host or hostess know in advance that you cannot eat very much.

Q: What about alcohol?

A: Alcohol has a high number of calories. It also breaks down vitamins. An occasional glass of wine or other alcoholic beverage, though, is not considered harmful to weight loss.

Q: Will I need plastic surgery for the surplus skin when I have lost a lot of weight?

A: That is not always the case. As a rule, plastic surgery will not be considered for at least a year or two after the operation. Sometimes the skin will mold itself around the new body tissue. You should give the skin the time it needs to adjust before you decide to have more surgery.

Q: What will happen if I become ill?

A: One of the major advantages of the LAP-BAND System is that it can be adjusted. If your illness requires you to eat more, the band can be loosened. This can be done by removing saline from it. When you have recovered from your illness and want to lose weight again, the band can be tightened. This can be done by increasing the amount of saline. If the band cannot be loosened enough, it may have to be removed.

Q: How is the band adjusted?

A: Adjustments are often carried out in the X-ray department. They are done there so the reservoir can be clearly seen. When X-rays are used, your reproductive organs should be shielded. Sometimes adjustments can be done in an outpatient clinic or office. Local anesthesia may or may not be needed. A fine needle is passed through the skin into the reservoir to add or subtract saline. This process most often takes only a few minutes. Most patients say it is nearly painless.

Q: How much weight will I lose?

A: The amount of weight you may lose depends on several things. The band needs to be in the right position. And you need to be committed to your new lifestyle and eating habits. In the U.S. clinical trial, 2% of patients gained some weight. 5% neither gained, nor lost weight (t5%). 61% of the patients lost at least 25% of their excess weight. 52% of the patients lost at least 33% of their excess weight. 22% lost at least 50% of their excess weight, and 10% lost at least 75% of their excess weight.

You should lose weight gradually. Losing weight too fast creates a health risk and can lead to a number of problems. Nausea and vomiting are only the most minor examples. A weight loss of 2 to 3 pounds a week in the first year after the operation is possible, but one pound a week is more likely. Twelve to 18 months after the operation, weekly weight loss is usually less. Remember that your main goal is to have a weight loss that prevents, improves, or resolves health problems connected with severe obesity.

Gastric Banding (Lap-Band) in Mexico