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Laparoscopic Adjustable Gastric Banding |
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There are many different operations for weight loss, but all depend on restriction or malabsorption or a combination of the two. As is the case for the treatment of other conditions, the fact that there are several approaches indicates that no single option is ideally suited to deal with a diagnosis of severe obesity. |
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Restriction THe operations that work primarily by restriction are the adjustable gastric band procedure or the Roux-en-Y gastric bypass. These limit food intake to very small portions. They do this by constructing a very small stomach pouch. As a result, fewer calories can be consumed, negative energy balance is acheived and weight is lost. One aspect of restrictive operations is the feeling of fullness or satiety that results from small quantities of food. |
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Malabsorption Operations that work primarily by malabsorption, such as the duodenal switch procedure and the biliopancreatic diversion, reduce the opportunity for digested nutrients to come into contact with the absorptive surface in the lining of the intestine. This involves bypassing a large portion of the small intestine. Typically, patients may be able to eat relatively normal sized portions of food, but the process of digestion and absorption is compromised. |
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It is hard to believe the dramatic effects of successful bariatric surgery. All the patients pictured on this page had a laparoscopic adjustable gastric band.
The lady here took around 15 months to lose her weight. The man at the top left of the page had much more to lose and 23 months elapsed between the "before" and "after" photographs. Having reached his target weight he was involved as a subject in a postgraduate surgical examination - the examiners read the diagnosis and were convinced that the wrong patient was positioned beside the label! Frequently asked questions Here are the questions which people ask most often. How long does the operation take? Normally, a little less than an hour. Access and exposure varies from patient to patient and so there is some variation in operation times. How about the length of hospital stay? Usually an overnight stay is all that is required. Providing everything goes according to the script the complication rates are very low. What can go wrong? As with any operation, things can go awry. All technical complications are rare (e.g. bleeding, visceral damage or such difficulty with the dissection that conversion to an open operation is required). Infection rarely occurs but can be troublesome. In the longer term, bands can slip, migrate or even break (usually the tubing) but these problems can be tackled by means of band repositioning, replacement or occasionally by opting for a different or second line procedure. As a rule the band is an effective and safe technique in assisting weight control. When does the weight loss start? Most patients lose a modest amount (a few kg) as a result of the metabolic effects of the operation. The weight loss does not really begin until the band is tightened to the correct degree. That may take two or three adjustments at intervals of a week or two and may need subsequent "tweaking" to achieve the best control. Assuming the band can be tensioned within a couploe of months of the surgery patients can typically expect to lose around 3-4 kg per month. What about diet - are there major restrictions? There are certainly restrictions related to the physical presence of the band. However when the band is empty there is little if any restriction. Patients are always warned to avoid bulky or stodgy foods and to be particularly careful with bread or other starchy items. Small portion size is enforced by a correctly tightened band and any changes in the pattern should be investigated and treated promptly. Download a more detailed document which has been prepared for patients having bariatric surgery - click the link below. |
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 Advice for patients |
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For a summary of our West of Scotland experience - here is what we published in March 2006. Scottish Medical Journal 2006:50;37-41 Download a copy of a review paper on gastric banding which I put together with my colleague Mark Vella and published in the journal "Obesity Surgery." Obesity Surgery 2003:13(4);642-648.
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