Until 2007, the implantation of an adjustable gastric band was one of the most common bariatric surgical procedures. Nowadays, gastric banding is rarely performed and represents only 3% of all procedures.
The principle of gastric banding
Like all bariatric procedures, gastric banding is performed laparoscopically. The principle of the procedure is that a silicone band is wrapped around the stomach below the entrance to the stomach. At this point, the stomach receives a constriction comparable to a "waist", resulting in a small pre-stomach. In order to prevent the slipping of the silicone band, it is fixed to the stomach with a few sutures.
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Starting from the silicone band, a flexible tube is inserted into the abdominal wall and connected to a small port. The port can be punctured through the skin with a needle, comparable to a cannula, which is used to draw blood. If a saline solution is injected through the port, it reaches the silicone band, which then expands depending on the amount of fluid and tightens the waist. Adjustable therefore means that the width of the band can be individually adjusted depending on the amount of saline.
Mechanism of action of gastric banding
The principle of gastric banding is based on restriction. The stretching of the small pre-stomach leads to a feeling of satiety even when small amounts of food are ingested; later the mechanical narrowness predominates. The disadvantage is that calorie-rich liquid food can easily pass through the disfigurement. If there is no lasting change in eating habits, satisfactory weight reduction cannot be achieved.
The silicone band should be filled with saline solution at the earliest 4 - 5 weeks after the procedure. Until then, the patient should eat small amounts of liquid food and take his time. It is important that the patient - even after filling the band - consumes sufficient liquid, 1.5 - 2 litres daily are recommended.
For the filling of the band with saline solution, 2 - 3 sessions at intervals of several weeks may be necessary in order to achieve a satisfactory band setting for the patient. Afterwards, annual controls are necessary to recognize complications in time.
Complications after gastric banding
Gastric banding can lead to injuries of the stomach wall and the oesophagus. The injuries are extremely rare, but not harmless and can put the patient in a threatening situation, which is why immediate surgical intervention is required. The same applies to bleeding - rare, but dangerous.
Malpositions of the silicone band also can occur. If its position is too high, not the stomach, but the lower part of the oesophagus is constricted. The patient can then no longer swallow without problems, and saliva and food also accumulate in the oesophagus, which dilates over time. If the position of the gastro-intestinal band is too low, the pre-stomach becomes too large, which undermines the principle of restriction and the patient loses insufficient weight. In these cases, surgical repositioning of the silicone band is necessary.
Late complications include slipping of the silicone band, which is observed in around 6% of patients who have undergone surgery. The symptoms include swallowing disorders, frequent burping, pain in the stomach area and burning in the oesophagus. In these cases, emptying the port system, i.e. aspirating the saline solution, can bring relief. If not, the silicone band must be surgically repositioned or removed.
Extremely rarely, slipping can lead to bruising the stomach wall, whereby the band can migrate into the stomach. This means that the silicone band has to be removed.
Results after gastric banding
The weight loss due to gastric banding is between 35 and 57 % after 5 years, only 14 % after 10 years and 13 % after 15 years. The achieved weight reduction of gastric banding is therefore inferior to that of other obesity or metabolic surgery. A positive effect on diabetes mellitus type 2 can also be demonstrated. The remission rate for diabetes is between 62 and 82 % in the short term, but only 25% after 5 years.
Gastric banding has the lowest rate of early complications around the time of surgery of all obesity and metabolic surgery, but relatively often late complications such as slipping.
Due to the relatively high rate of late complications with less weight reduction, gastric banding is performed less and less today.
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