Laparoscopic Gastric Band

Morbid obesity is a disease that often has multiple associated medical illnesses and is associated with a significant decrease in life expectancy. Many of these can be reversed with significant long term weight loss. Evidence demonstrates that for the great majority of the morbidly obese, diet/exercise/medications including medically supervised medications/diets have a high failure rate and that bariatric surgery is the most effective long term way to achieve significant weight loss in these patients. The risks of a non-surgical approach to your morbid obesity is a very high failure rate with increased weight gain in the longer term leading to higher risk of obesity-related medical illness and decreased life expectancy.

The Laparoscopic Gastric Band

The laparoscopic gastric band is performed by making several small incisions through which the surgeon inserts laparoscopic instruments to perform the surgery. The surgery consists of placing a silicone band around the inlet of your stomach to reduce your ability to eat. This silicone band is then connected by tubing to a port that sits underneath the skin, just below your breastbone.

The port allows access to the band for adjustments over the weeks and months after the procedure.

The adjustments allow the tightness of the band to be tailored to your weight loss. Patients usually go home the day after surgery. A laparoscopic band is purely a restrictive procedure, i.e. it limits the amount of food you can eat at any one time.

The laparoscopic gastric band is the commonest procedure performed for weight loss in Australia and it is the safest. The risk of mortality from the gastric band in Australia is currently 1:1000.

The weight loss with the gastric band is gradual, averaging approximately half a kilogram per week, with the aim of losing on average 65% of your excess body weight by two years. The band does require a change in your dietary habits and as it is a purely restrictive procedure, it can be circumvented by eating high calorie liquids or high calorie soft foods. The band does require a number of adjustments post operatively to achieve the optimum setting, or 'sweet spot' for each individual patient. The average number of adjustments required to reach this point is approximately five.

After gastric band surgery, some patients experience intolerance to certain types of foods. These are typically breads, nuts and tough fibrous meat. Other food intolerances can occur with high fibre foods and fruit peels. If food becomes stuck, typically patients will vomit and significant discomfort can occur until the food passes, either one way or another. Rarely an endoscopy is required to remove the stuck food.

Alternative procedures for weight loss available in this practice include the laparoscopic sleeve gastrectomy and the laparoscopic Roux-en-Y bypass. All of these procedures are designed as tools to help you to lose your excess weight, making you healthier and hopefully improving your quality of life.

The laparoscopic Roux-en-Y gastric bypass procedure is designed to make a small reservoir or pouch for food at the upper end of your stomach with the capacity of about 30 mL. This pouch is connected to the small intestine by a new anastomosis, or join. The outlet of this join is about 4 cm in diameter. Ingested food therefore bypasses the majority of your stomach which remains alive and undisturbed in the abdominal cavity. The gastric bypass has certain advantages for diabetic patients. The laparoscopic Roux-en-Y gastric bypass has the highest mortality and complication risk of the bariatric procedures performed in this practice. The laparoscopic sleeve gastrectomy is a restrictive procedure that involves removing the majorityof the stomach, turning the stomach into a thin tube-like structure, thus reducing the capacity of your stomach to approximately 50 mL initially and later to approximately 100 mL. The safety profile of the sleeve gastrectomy lies between the gastric band, which is the safest, and the laparoscopic gastric bypass. Like the gastric band, the sleeve gastrectomy works as a restrictive procedure. Your anatomy is not altered and therefore there is less requirement for you to take any vitamin supplements. However there is not as much long term data with the sleeve gastrectomy as the other two procedures and there is some suggestion that there can be some weight gain at ten years.

Please carefully weigh up the advantages and disadvantages of each bariatric procedure before you decide which one is your procedure of choice. Where appropriate your surgeon will make a recommendation of which procedure you should consider as being the most appropriate for your medical condition.