Laparoscopic Adjustable Gastric Banding

“When you feel like quitting, think about why you started.”

Morbid Obesity or Clinically Severe Obesity has emerged as one of the most dreaded diseases of this century. People who have attempted to lose weight, know how difficult it is to not only lose weight but also to maintain the weight loss. On a daily basis, we see patients who put their heart and soul into their efforts to lose weight. They have been to every weight loss clinic, celebrity Dieticians, gyms, yoga gurus and weight loss retreats. Unfortunately, more often than not, they meet with disappointment and tend to yo-yo between weight loss and weight gain. This entire process is extremely disheartening and demotivating.

So, if you have tried hard to lose weight without success and the weight is bearing you down, you have come to the right place because Bariatric Surgery is the only way at the moment that can lead to sustained weight loss in Morbidly Obese patients.

Laparoscopic Adjustable Gastric Banding

Laparoscopic Adjustable Gastric Banding was one of the most popular Weight Loss Bariatric Procedures till about a decade ago. Unfortunately, it did not yield very good results in terms of weight-loss outcomes and went out of favour, especially in India. In the last 10 years, more bands have been removed than those that have been inserted.

Yet it still has its place in the treatment of Obesity for young adolescents. One of the biggest advantages of Adjustable Gastric Banding is that it does not lead to any permanent change in anatomy and is fully reversible.

Am I the right candidate for undergoing Laparoscopic Adjustable Gastric Banding

The IFSO- APC (International Federation for Surgery for Obesity and Metabolic Disorders - Asia Pacific Chapter) guidelines for weight loss surgery are as under:

• Bariatric Surgery/Obesity Surgery/Weight loss Surgery must be considered for the treatment of Obesity for acceptable Asian candidates with BMI ≥ 35 Kg/m2 with or without any associated diseases.
• Bariatric Surgery/Metabolic Surgery must be considered for the treatment of Type 2 Diabetes or Metabolic Syndrome for patients who are inadequately controlled by lifestyle alterations and medical treatment for acceptable Asian candidates with BMI ≥ 30 Kg/m2.
• Bariatric Surgery/Metabolic Surgery may also be considered as a non-primary alternative to treat inadequately controlled Type 2 Diabetes or Metabolic Syndrome for suitable Asian candidates with BMI ≥ 27.5 Kg/m2.

Laparoscopic Adjustable Gastric Banding has its place in the treatment of Adolescent Obesity. There is no permanent alteration in anatomy and it is fully reversible. It gives them a decent chance at weight loss. At a later stage, it can be easily converted to another weight loss surgery such as Roux-en-Y Gastric Bypass or Sleeve Gastrectomy.

How is it done?

• As the name suggests, this surgery is performed by Laparoscopic technique. In this technique, 4 to 5 tiny 0.5 to 1 cm cuts are made on your tummy and the entire surgery is performed using a camera and instruments. This is minimally invasive and there is no big cut like the surgeries of the past. All the stitches are absorbable and no sutures are to be removed later. Laparoscopy enables the patient to have less pain, recover faster and return to work much earlier. Most patients are discharged from the hospital one day after their operation. Of course, this depends on their clinical status as well.
• During the surgery, a silicon band is placed around the Stomach, dividing it into a smaller upper pouch and a larger greater pouch. The band is attached to a connecting tube and adjustment port which is fixed under the skin. Through this port, distilled water can be injected into the band and it can tightened or loosened.
• No filling is done at the time of surgery. The first adjustment is made after 6 weeks and then the adjustments are titrated as per the patient’s weight loss.
• Though perceived as an easy operation, banding is an intricate procedure. As it went out of fashion many years ago, most Bariatric surgeons today do not have enough experience in dealing with the band.

How does it lead to weight loss?

The following mechanisms lead to weight loss after Laparoscopic Adjustable Gastric Banding.

• Adjustable Gastric Banding is primarily a restrictive procedure. It limits food intake and causes early satiety. Patients feel full despite eating smaller quantities of food.

Results of Laparoscopic Adjustable Gastric Banding

• Patients lose up to 45 to 50 % of their excess weight over a period of 12 to 18 months after this surgery. This can be better if the patient embraces lifestyle modification and follows a strict diet and exercise program as guided by the Bariatric Surgery team.
• This surgery also leads to a significant improvement in associated diseases such as Type 2 Diabetes, High Blood Pressure, risk of Heart Disease, risk of Venous Thromboembolism, Gout and so on.

Long-term weight loss goals

• Bariatric Surgery must not be perceived as a shortcut to weight loss. The patient and the doctor work as a team to achieve the best results in the long term. It is extremely important to be diligent with your follow-up to get optimum results.
• Long-term weight loss goals can be achieved with the help of a team that consists of a doctor, an Endocrinologist, a Nutritionist and a Psychologist. This support team of experts will keep you motivated, provide advice and help you to work through weight loss barriers.

Who is not eligible for weight loss surgery

• Pregnant women
• Patient with Acid Reflux Disease and Hiatus Hernia
• Patient with Gastric Outlet Obstruction
• Patients with severe psychiatric disorders
• Smokers
• Patients who are medically unfit for surgery and Anaesthesia

Complications

• Laparoscopic Adjustable Gastric Banding is as safe as any other surgery like a Knee Replacement or Gall Bladder Surgery. In fact, the complication rate is much lower than Cancer Surgery or Surgery for Oesophagus, Valve Replacement etc.
• It is important to follow the protocols set by the team and to take nutritional supplements as advised. Failure to do so may result in nutritional deficiencies in future.
• Smokers must strictly stop smoking. Smoking can lead to complications that can be life-threatening. If you are not confident about giving up smoking after this surgery, our advice is that you must not undergo the surgery at all.
• The team will discuss the pros and cons in detail with you during your consultation.

Dr Aparna Govil Bhasker has been practising Bariatric Surgery for over a decade now and is one of the few surgeons in the country with experience in dealing with Gastric Banding. The biggest plus of coming to us for your surgery is our personalized care. Every patient is a VIP for us and we assure you that your smallest queries will be addressed at the earliest.

It is extremely important for the patient to be mentally prepared and in a positive frame of mind before undergoing any kind of surgery. Positive thoughts go a long way in getting good results after surgery. So, be positive and we wish you all the best for your weight-loss journey to being a different you.