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Gastric Banding For Weight Loss

Gastric banding involves placement of inflatable silicone ring around the proximal stomach. The band is attached to the reservoir system that allows adjustment of the tightness of band. This reservoir system is accessed through a subcutaneously placed port. Two major type of bands are used. The original Lap band is used more frequently. The Swedish band, remarketed as Realize band in United States is slightly wider and larger in circumference. Although use of adjustable gastric banding is declining, it did boost the popularity of bariatric surgery because of peri operative safety, lack of nutritional complications and relative ease and availability. The pars flaccida technique (through the window of the lesser omentum) is now the standard practice with a band placed just below the oesophago-gastric junction, making a small virtual gastric pouch. Once the band is passed around proximal stomach, it is locked into its ring configuration through its own self locking mechanism. The band is sutured into place anteriorly with gastro-gastric tunneling sutures to reduce slippage. The access port is routinely sutured to the rectus sheath in the upper abdomen for ease of access by a non-coring, Huber needle for band adjustments. The operation appears to work by reducing hunger, probably vagally mediated. The initial surgical placement is only the beginning of the treatment. Specialist nurses, physicians and surgeons do band consultations to assess eating habits and then perform an adjustment with injection or aspiration of saline, if indicated. The objective is to reach the so-called sweet spot of optimal appetite control. Follow-up should be monthly to begin with as needed during the first year, with full MDT support to help patients get the best use out of their bands. Lack of appropriate follow-up is the reason that results in the literature vary so much, with a consequent high band removal rate.