Catherine Spader, RN
What is gastric banding?
Gastric banding is a surgery that can help adults and some adolescents who are very obese (morbidly obese) achieve significant weight loss. Gastric banding reduces the size of the stomach and restricts the amount of food you can eat. It involves attaching an inflatable band around the top portion of the stomach and tightening it like a belt. This forms a small pouch that functions as a smaller stomach. The band is attached to a port that is implanted in your abdominal wall under the skin.
Gastric banding can be a life-saving treatment option for people whose obesity seriously threatens their health. It can help resolve diseases associated with obesity, including type 2 diabetes, and can lower the risk of heart disease.
Candidates for gastric banding include those who have tried unsuccessfully to lose weight using diet, exercise, behavioral and nutritional counseling, and medication.
Gastric banding is only one part of a complete plan that includes a lifelong commitment to healthy dietary and exercise habits, vitamin supplementation, and regular follow-up care. You may have less invasive treatment options with less risk of complications. Ask your doctor about all your treatment options and consider getting a second opinion before having gastric banding.
Types of gastric banding
Gastric banding is commonly known by many names, including adjustable gastric banding, AGB, LAP-BAND® surgery, and gastric band surgery. Brand names of gastric banding products include:
- Realize™ Band
- Swedish Adjustable Gastric Band (SAGB)
Other procedures that may be performed
Your doctor may perform other procedures in addition to gastric banding, such as vertical banded gastroplasty (VBG).
VBG is a major surgical procedure that combines gastric banding with stomach stapling. A small stomach pouch is created with surgical staples, leaving a dime-sized opening at the bottom. A band of plastic tissue or mesh is wrapped around the opening to help prevent the opening from stretching. This helps you feel fuller longer by allowing food to stay in the stomach longer.
VBG is generally not as effective as other weight loss surgeries. It also has a higher rate of complications compared to adjustable gastric banding (AGB).
Why is gastric banding performed?
Your doctor may recommend gastric banding to treat obesity and reduce the risk of life-threatening complications of obesity. These include diabetes, heart disease, and severe sleep apnea.
Gastric banding is not a treatment option for people who are mildly overweight. It is generally considered for adults with a body mass index (BMI) of 40 or more. This means being approximately 100 pounds overweight for men and 80 pounds overweight for women. Some people who are less obese with a BMI of about 35 to 39.9 and have serious weight-related health problems may have gastric banding.
Gastric banding may be an option when treatments that involve less risk and fewer complications have not worked to achieve and maintain a healthy weight. Other treatments include diet, exercise, behavioral and nutritional counseling, and medication. People typically need a psychological evaluation prior to the surgery.
Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on gastric banding.
Who performs gastric banding?
A general surgeon or bariatric surgeon performs gastric banding. General surgeons specialize in the surgical treatment of a variety of diseases and conditions, including those of the stomach and intestines. Bariatric surgeons are usually general surgeons who further specialize in weight-loss surgery.
How is gastric banding performed?
Your gastric banding will be performed in a hospital or surgery clinic. It is usually an outpatient laparoscopic surgery. Laparoscopic surgery is a minimally invasive technique that uses small incisions instead of a large incision made in open surgery.
A small camera attached to the laparoscope sends pictures of the inside of the body to a video screen. Your surgeon sees the pictures while performing the surgery.
Laparoscopic gastric banding generally has a faster recovery time and less pain than an open gastric banding procedure. This is because it causes less trauma to tissues. Surgical tools are threaded around structures and organs instead of cutting through and displacing them as in open surgery.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different gastric banding and bariatric (weight loss) surgeries and ask why your surgeon will use a particular type for you.
Surgical approach for gastric banding
Your surgeon will insert laparoscopic surgical tools through several small incisions and place the gastric banding device around the upper part of the stomach. The surgeon then tightens the band like a belt to form a small pouch that serves as a new, much smaller stomach.
Your surgeon adjusts the diameter of the inflatable band and size of the stomach after four to six weeks by adding or removing saline (salt water) through a small port. The port is located under the skin of your abdomen.
Types of anesthesia that may be used
General anesthesia is used for gastric banding. General anesthesia is a combination of intravenous (IV) medications and gases that put you in deep sleep. You are unaware of the surgery and do not feel any pain.
What to expect the day of your gastric banding
The day of your surgery, you can generally expect to:
- Talk with your nurse who will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
- Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
- Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
- A surgical team member will start an IV.
- The anesthesiologist or nurse anesthetist will start your anesthesia.
- A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
- The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the surgery and recovery until you are alert, breathing effectively, and vital signs are stable.
What are the risks and potential complications of gastric banding?
As with all surgeries, gastric banding involves risks and possible complications. Gastric banding generally has fewer risks than other types of bariatric (weight loss) surgery, complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
- Anesthesia reaction, such as an allergic reaction and problems with breathing
- Bleeding or hemorrhage (heavy bleeding), which can lead to shock
- Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can move to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
- Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of gastric banding
Complications of gastric banding include:
- Damage to abdominal organs or major blood vessels
- Difficulty swallowing (dysphagia)
- Gastritis (irritated stomach tissue)
- Gastroesophageal reflux (regurgitation)
- Inability to maintain long-term weight loss
- Nausea, vomiting, gas and bloating
- Obstruction of the stomach opening created by the gastric band
- Slippage, deflation or erosion of the gastric band
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
- Following activity, dietary and lifestyle restrictions and recommendations
- Notifying your surgeon immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
- Taking your medications and vitamin and mineral supplements exactly as directed
- Telling all members of your care team if you have any allergies
How do I prepare for gastric banding?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a gastric banding by:
- Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
- Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
- Losing some weight as directed by your surgeon. Even losing a small amount of weight can help reduce the risks of bariatric surgery.
- Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
- Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
- Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before gastric banding and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
- Why do I need gastric banding? Are there any other options for treating my condition?
- How long will the surgery take? When can I go home?
- What restrictions will I have after the surgery? When can I return to work and other activities?
- What kind of assistance will I need at home?
- How should I take my medications?
- How will you treat my pain?
- When should I follow up with you?
- When and how should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after gastric banding?
Knowing what to expect can help make your road to recovery after gastric banding surgery as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and vital signs are stable.
You may have a tube that was passed through your nose into your stomach during surgery. This tube is used to keep your stomach empty and is removed when your stomach has recovered from the effects of surgery. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
Gastric banding is often done on an outpatient basis. Some patients stay in the hospital for a couple of days, depending on their condition.
Full recovery is a gradual process. Recovery time varies depending on the procedure, your general health, age, and other factors.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
You will likely have narcotics for pain. These medications make you drowsy. You should not drive while taking this medication.
When should I call my doctor?
It is important to keep your follow-up appointments after gastric banding. Contact your doctor for questions and concerns between appointments. Call your surgeon right away or seek immediate medical care if you have:
- Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
- Change in alertness, such as passing out, unresponsiveness, or confusion
- Chest pain, chest tightness, chest pressure, or palpitations
- Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
- Inability to urinate or have a bowel movement
- Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
- Nausea and vomiting
- Pain that is not controlled by your pain medication or severe abdominal pain
- Uncontrolled or heavy bleeding (hemorrhage)
- Unexpected drainage, pus, redness or swelling of your incision
How might gastric banding affect my everyday life?
Gastric banding is not a quick or easy fix for obesity. It is only one part of a complete obesity treatment plan. Treatment plans include a lifelong commitment to healthy dietary and exercise habits, possibly vitamin supplementation, and regular follow-up care for band adjustments.
Adjustable gastric banding generally has a high weight-loss success rate initially. Some people are not able to maintain that weight loss on a long-term basis.
Your diet will change drastically after your gastric banding. Your surgeon will give you specific instructions about your diet and activity restrictions. Diets after gastric banding generally start with very small amounts of liquids and then gradually progress to small amounts of pureed and soft foods. You will eventually transition to solid foods about 10 to 12 weeks after your surgery.
The stomach and small intestine still function normally after gastric banding, reducing the risk of poor nutrition that can occur with gastric bypass procedures. Gastric banding does cause significant changes that may affect your everyday life including:
- Change of body image
- Changes in social, work and family relationships. As you lose weight, you will probably have an increase in energy and ability to participate in everyday activities, sports, exercise, social activities, and work.
- Chronic diarrhea may occur in some cases
- Decreased risk of developing heart disease and its complications
- Improved quality of life
- Improvement or resolution of many diseases and conditions. These include migraines, depression, type 2 diabetes, metabolic syndrome, polycystic ovarian syndrome, venous stasis disease, gastroesophageal reflux disease (GERD), hypertension, stress urinary incontinence, gout, and high cholesterol.
- Reduced need for medications that treat chronic conditions related to obesity. You will need to see your primary care provider regularly to adjust your adjustments.
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