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Zone 47, Building 412
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The Laparoscopic Adjustable Gastric Band (LAGB) was the first bariatric operation performed with small incisions. It was described in the early 1990’s and became quickly popular. Enthusiasm for the band has gradually waned because of disappointing long-term results and we rarely perform it these days.
The gastric band is made of silicon and is wrapped around the upper part of the stomach to restrict the passage of food from the esophagus down into the stomach. On the inside of the band there is a balloon that can be inflated to tighten the opening further and deflated to loosen it up. The adjustments are done by injecting a needle into a reservoir that is implanted under the skin. The reservoir and the band are connected via a long tube.
There are distinct advantages to the band including its simplicity as an operation, low immediate risks and the fact that it is adjustable. Unlike the gastric bypass and sleeve it may not necessarily decrease hunger or Ghrelin levels so in a way the struggle with fighting hunger persists. That is why results depend more on the patient’s commitment to dietary and lifestyle changes. Results vary a lot depending on how close and intense the follow-up is. Some patients achieve excellent results on follow-up of more than 10 years. However at least 50% of patients have poor weight loss or have to remove the band for reasons such as band malfunction, slippage and erosion.
Immediate risks following gastric band placement are uncommon but can include blood clots (DVT and PE), injury to the stomach and esophagus. The risk of mortality related to the operation is very low (less than 1 per 1000). Long-term problems though are common and present in more than 50% of patients. Most require band replacement, removal with alternated bariatric operation. Examples include acid reflux, dilation of the esophagus, band slippage, and band erosion inside the stomach, cracks in the band, tubing or reservoir.
The average operation takes about 60 minutes and the average stay in the hospital is around 1 day. Many patients go home the same day. Most patients return to work within 10 days of the operation and resume exercise three weeks later.
The phases of diet include fluids for three weeks. At week #4 we start adjusting the band and further tightening is done in clinic with follow-up depending on weight loss and food tolerability. Some adjustments will need X-ray guidance. Food intake after the band becomes more difficult because some foods such as bread and chicken become difficult to swallow. It is important for patients to chew well and take time during a meal. It is also important to avoid taking foods with high calorie content that are easy to swallow because that would defeat the purpose of the band. Long-term commitment to healthy eating habits and regular activity are important to guarantee the success of the operation.
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