Obesity Surgery

Description:

This restrictive procedure is based on reducing the size of the stomach, by placing an adjustable band around its upper part, in order to create a small gastric pouch of 15-30 ml capacity. This band is related to a port site that is fixed under the skin of the anterior abdominal wall. The adjustment of the band is done by serum injection inside the port site, upon demand. This will give the patient a feeling of an early satiety. The operative time varies between 45 – 60 minutes. This intervention will achieve 60% Excess Weight Loss (EWL) during the following 2 years.

Advantages/Disadvantages/Complications

Advantages of adjustable gastric band:

• Simple, relatively safe procedure
• Short recovery period
• Low short term complication rate
• No malabsorption and no anemia
• No dumpimg syndrome
• Reversible
• Very Low mortality rate : 0.05-0.4%
• Low morbidity

Disadvantages of adjustable gastric band are:

• High dietary and exercise compliance is required
• High failure rate
• Band erosion
• Band slippage
• Esophageal dilatation
• High reoperation rate of another restrictive or mixed bariatric procedure (gastric placation, sleeve gastrectomy, mini gastric bypass or Roux en Y gastric bypass, )

Complications of adjustable gastric band are:

• Deep venous thrombosis (clots of blood in the leg veins) and pulmonary emboli (blood clot in the lung).
• Damage or bleeding from adjacent organ (liver, spleen, aorta, pancreas…)
• Gastric or esophageal leak
• Port site infection
• Pouch dilatation
• Gastric erosion
• Other general complications (allergy to medication, heart problems, problems from anesthesia, organ failure that may rarely lead to death (0.05-0.4%)

Our experience

More than 352 Laparoscopic Gastric Banding procedures were done since 2004. This purely restrictive procedure lost its popularity due to the emerging results of Laparoscopic Sleeve Gastrectomy. This procedure is still performed in our institution, in really rare selected cases. The majority of our patients still have the adjustable band without any complications and in others, the band was removed and replaced by a Sleeve or a Bypass mainly due to weight regain