Laparoscopic Gastric Banding

Introduction

Laparoscopic Gastric Banding, also referred to as 'Laparoscopic Adjustable Gastric Banding' (LAGB), is a weight loss or 'bariatric' procedure which can help patients who are significantly obese*.

The problem with obesity is its association with a range of serious metabolic conditions, including...

  • Diabetes.
  • High blood pressure.
  • Obstructive sleep apnoea.
  • High cholesterol / high triglycerides.
  • Infertility.
  • Polycystic ovarian syndrome.

Surgery however is generally only recommended where other non-surgical weight loss methods have not worked.

Laparoscopic Gastric Banding induces weight loss by reducing the capacity of the stomach, which in turn restricts the amount of food that can be consumed. It has been highly successful in the treatment for morbid obesity.

Laparoscopic surgery is commonly known as keyhole surgery or 'minimally invasive' surgery. Laparoscopic gastric banding is reversible, however as with all surgical procedures it should not be undertaken lightly.

While the Gastric Band System is an effective treatment for morbid obesity, the kilos do not come off by themselves. The Gastric Band System is an aid to support you in achieving lasting results by limiting food intake, reducing appetite and slowing digestion. However, your motivation and commitment to adopt a new lifestyle are extremely important for long-term weight loss. New eating habits must be adhered to for the rest of your life. Exercise is an equally important component of a changed lifestyle.

Indications

The Gastric Band System is suitable for use in weight reduction for severely obese patients with a Body Mass Index (BMI) of at least 40 or a BMI of at least 35 with one or more severe co-morbid conditions, or those who are 45kg or more over their estimated ideal weight.

The Gastric Band System may be right for you if:

  • You are at least 18 years old.
  • Your BMI is 30 or higher – View our interactive BMI Calculator.
  • 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 your obesity.
  • You are prepared to make substantial changes in your eating habits and lifestyle.
  • You are willing to continue being monitored by the specialist who is treating you.
  • You do not drink alcohol in excess.
  • If you do not meet the BMI or weight criteria, you still may be considered for surgery if your BMI is over 35 and you are suffering from serious health problems related to obesity.

Contraindications

The Gastric Band System is not recommended for non-adult patients, patients with conditions that may make them poor surgical candidates or increase the risk of poor results, who are unwilling or unable to comply with the required dietary restrictions, or who currently are or may be pregnant.

The Gastric Band System is not right for you if:

  • You have an inflammatory disease or condition of the gastrointestinal tract, such as ulcers, severe oesophagitis, or Crohn's disease.
  • You have severe heart or lung disease that makes you a poor candidate for surgery.
  • You have another disease that makes you a poor candidate for surgery.
  • You have a problem that could cause bleeding in the oesophagus or stomach. This might include oesophageal or gastric varices (a dilated vein). It might also be something such as congenital or acquired intestinal telangiectasia (dilation of a small blood vessel).
  • You have portal hypertension.
  • Your oesophagus, stomach, or intestine is not normal (congenital or acquired). For instance, you might have a narrowed opening.
  • You have or have experienced an intra-operative gastric injury, such as a gastric perforation at or near the location of the intended band placement.
  • You have cirrhosis.
  • You have chronic pancreatitis.
  • You are pregnant. If you become pregnant after the Gastric Band has been placed, the band may need to be deflated. The same is true if you need more nutrition for any other reason, such as becoming seriously ill. In rare cases, removal may be needed.
  • You are addicted to alcohol or drugs.
  • You are under 18 years of age.
  • You have an infection anywhere in your body or one that could contaminate the surgical area.
  • You are on chronic, long-term steroid treatment.
  • You cannot or do not want to follow the dietary rules that come with this procedure.
  • You might be allergic to materials in the device.
  • You cannot tolerate pain from an implanted device.
  • You or someone in your family has an autoimmune connective tissue disease. That might be a disease such as systemic lupus erythematosus or scleroderma. The same is true if you have symptoms of one of these diseases.

Preoperative Instructions

Food intake

It is strongly recommended that the patient start to adjust to smaller and more frequent meals before the procedure itself.

Medications

Any anti-inflammatory medication, Plavix, Aspirin and Warfarin must be stopped seven days before surgery. If you are regularly taking any other medication or supplements please contact Dr Watson and he will be able to advise accordingly.

Smoking

If you smoke, this significantly increases the risks of certain complications, such as wound healing. Our recommendation is that you not smoke in the six-week period before the procedure and consider giving up smoking permanently. You must not smoke at all in the week before surgery.

Procedure

The silicon 'band' is placed around the upper part of the stomach and then is tightened by adding saline solution inside the band. This has the effect of reducing the usable stomach size which in turn reduces appetite.

The surgical procedure is conducted under a general anaesthetic and takes around two hours to complete. Using laparoscopic ('keyhole') techniques three to five 2.5cm incisions are made to the abdomen to allow access for the laparoscopic surgical instruments. The surgeon views the procedure via a small video camera inserted into the abdominal cavity.

The band is fitted in place using sutures and a 'gastric band port' is created under the skin to allow the band to be easily adjusted if necessary, by adding or removing saline solution inside the band.

Postoperative Instructions

Once surgery is complete patients are normally able to get up and walk around and drink liquids two to three hours later. The patient normally stays in hospital overnight after the procedure and can return home the next day.

A few days after discharge normal non-strenuous day-to-day activities can be resumed. Anything more strenuous such as lifting heavy weights or sports/more intense exercise should be avoided for a little longer - Dr Watson will be able to advise you on this. Total recovery generally takes up to six weeks. Most patients are able to return to work seven days after the procedure.

Around 6-8 weeks after surgery the band may need to be adjusted (this is referred to as a 'lap band fill'). In some cases, the effect of the gastric band may not be felt until after this adjustment.

Procedure Costs

The costs of Gastric Band/Sleeve Surgery and BIB Procedure relate to:

  • Surgeon.
  • Anaesthetist.
  • Hospital.
  • Ancillary charge (pharmacy, etc).
  • Purchase of Gastric Band / Sleeve or BIB system.

The total out of pocket expense for surgery and anaesthetic varies on the health fund, costing from approximately $2,800. There may be increased costs with super obese patients and those who have had major previous abdominal surgery. Sleeve surgery out of pocket expenses range from $3,300 to $3,900 depending on previous surgeries.

Anaesthetic Costs

See the website of Dr Greg Lumsden - Specialist Anaesthetist for more information on anaesthetic fees and charges.

Risks

The Gastric Band System is a long-term implant. Explant and replacement surgery may be required at some time. Patients who become pregnant or severely ill, or who require more extensive nutrition may require deflation of their bands. Patients should not expect to lose weight as fast as gastric bypass patients, and band inflation should proceed in small increments. Anti-inflammatory agents, such as aspirin, should be used with caution and may contribute to an increased risk of band erosion.

Adverse Events

Placement of the Gastric Band System is major surgery and, like any surgery, death can occur. Possible complications include the risks associated with the medications and methods used during surgery, the risks associated with any surgical procedure, and the patient's ability to tolerate a foreign object implanted in the body.

Band slippage, erosion and deflation, obstruction of the stomach, dilation of the oesophagus, infection, or nausea and vomiting may occur. Reoperation may be required.

Rapid weight loss may result in complications that can require additional surgery. Deflation of the band may alleviate excessively rapid weight loss or oesophageal dilation.

Not all contraindications, warnings or adverse events are included in this brief description. More detailed risk information is available at www.lapband.com.au.

Treatment Alternatives

Read about other weight loss procedures, including:

Laparoscopic Gastric Bypass

Laparoscopic Sleeve Gastrectomy

Intragastric Balloon

Related Information

Gastric Band VS Gastric Sleeve Surgery (PDF Document)

* obesity is most commonly measured as Body Mass Index (BMI) - this is the weight in kilograms divided by the height squared - for example a person weighing 120kg and 1.6m tall has a BMI of 47. Obesity is defined as a BMI reading over 30.


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