Laparoscopic Adjustable Gastric Band

Also known as “the band”, “gastric band”, “banding”, “lap band”, “Swedish band”

You want to eat less, and must eat food more slowly, and therefore eat less.

A silicone band is placed around the upper stomach.

Gastric Banding

A soft, inflatable tube in the shape of a ring is placed surgically on the upper stomach. This is stitched in place and connected to a port under the skin. The port can be easily accessed with a needle and the amount of fluid in the band adjusted. Adding fluid makes the band squeeze on the stomach and stimulates fullness and decreases hunger. It also decreases the speed you can eat at. If this effect is too strong the fluid in the band can be removed a little.

The band has 3 components: The band, tubing and the port. The band is around the stomach, the tubing inside the abdomen connecting the band to the port, and the port is under the skin, attached to the outermost layer of muscle so it doesn’t move and is readily accessible.

Decreased drive to eat (less hunger), slow eating, smaller meals, longer sense of fullness

The band gently squeezes the upper stomach and this creates 2 effects: The stomach is narrow, and the Vagus nerve is squeezed. The stomach being narrow has the effect of allowing food to pass only very slowly, It is like blocking off a couple of lanes on a freeway: now the cars have to drive slower and they get to their destination slower. In fact, some people can’t get on the freeway, as there isn’t enough room. And so the food goes down slowly, you have to eat less food because thee is nowhere for it to go. You eat slowly and eat small meals. So you eat your meal slowly, because if you don’t things will block up and there may well be vomiting. The Vagus nerve is the nerve that (apart from many other functions) controls the stomach and also tells the stomach when you are full. As you eat, the Vagus nerve detects that the stomach is stretching and as this increases sends a message to the brain to stop eating, the stomach is full. With the band, this squeezes the vagus nerve all the time, and more so when you are eating. This effectively tells the brain that the stomach is always pretty full and to stop wanting to eat. In other words, you fell less or no hunger, and feel full very early in the meal, and this fullness then, coupled with the decreased hunger in the first place, results in long lasting, strong sense of fullness.

If you eat well and live well you lose weight

Healthy Eating to help weight loss

So you are not really hungry, you can’t eat much at a time and you feel a good strong sense of fullness after eating. But there is one more, very important aspect to eating that isn’t taken care of. It is what we eat. What we eat is critical to making our bodies work properly. With a band, you need to eat the food that your body needs, and avoid foods that slip past the band more easily such as soft foods and liquids. So the foods you should eat with a band are healthy, solid and textured foods. Foods that are not processed and have loads of calories added to them. Avoiding foods that are ridiculously high in calories and foods that turn into liquid when inside your body. Because all these things will clear the traffic jam and let the wrong amounts of the wrong foods down. So with a band, you still need to choose the right foods to eat or it won’t be as effective. So, for most people this means rethinking how they eat and changing a lot of habits. Even if you eat high calorie food, you eat less of it wit a Gastric Band and so this decreases the impact the naughty food has on your calorie balance. In other words, the gastric band flattens out the impact of imperfect food choices.

Requires effort But it is not as easy as that.

So, this requires effort obviously. Re-jigging your eating patterns takes a long time and you want to lose weight at the same time. Remember that you are not perfect and not expected to be and this is a long relearning process. Learn from your mistakes and keep trying to eat healthy food. In other words the band is a weight loss tool, you have to learn how to use it, become expert at using it and your weight loss will be even greater. We have a number of eating rules and tips to help you use this very powerful tool to its highest potential. But it all requires effort. You will probably need the support of those around you, keep reminding yourself of the bigger picture if ever you are finding it really challenging to change they way you eat.

Most people find a band is just a gentle reminder to eat slowly and eat less and because they are less hungry this is all quite easy. However, some people find the challenge to eat a certain way (see the eating rules) requires quite a lot of effort. You should assume it is going to take effort and then be pleasantly surprised perhaps. You are already quite familiar with making a big effort to lose weight. When you have a band, you need to put in the same effort as you usually do when you are losing weight. The difference being, that with a band the effort is very well rewarded with much higher weight loss and sustained weight loss. The weight loss is easier, but not automatic. In fact, you really should put more effort than ever before into losing weight, and get even more out of your band. After all, you have made a commitment to your self to get serious about your weight problem and have surgery. Now is the time to make sure you succeed.

Can be sabotaged by eating high calorie foods or liquids

If you don’t make much of an effort to change your eating style etc to get the most out of the band the weight loss will be less. Some people, unfortunately, will not change their eating habits enough and struggle with the band, the weight loss will be poor and their food will get blocked all too often etc. Some people will from time to time eat foods that go down easily for whatever reason, and some will do this all the time. And then there are people who will intentionally make themselves and the band fail by eating the wrong foods. It can be quite difficult to understand why people do this sometimes, and it isn’t very common, but it is certainly easy to do. To sabotage a band all you need to do is eat high calorie foods that are soft or liquid so they can slide past the band and you can eat at the same speed as without the band and fill up your whole stomach before feeling full. In other words, put a whole heap of motorcycles on the freeway with 3 or 4 per lane and more passengers will get through even with a blocked lane. More calories get through faster and easier, just like you don’t have a band at all.

In the end, a very small number of people with a band find themselves saying “it made me eat the wrong foods”. This is something we can try to fix if you come to talk to us. Honestly telling us what is going on so we can help you. So if you do find yourself sabotaging your weight loss with the band, please don’t let yourself down, don’t give up on yourself, try and get some assistance and get back on track.

Difficult for sweet tooths and emotional eaters.

Weight loss with the band requires using this tool to maximise its usefulness, but you still need to ride out the weaknesses. The bands weaknesses are that it doesn’t slow down liquids and it doesn’t choose your food for you and so you can still eat high calorie foods, even though of course you shouldn’t. When you are making your food choices and you are not hungry, feeling nice and calm, have plenty of time to prepare your food, and everything in the world is good, it is easier to make good judgements about what you should eat. But when you are in a hurry, have only a few choices available to you and you are madly craving a chocolate, your judgement is not so good. If you use food to comfort you or distract you from stress, boredom, sadness, loneliness etc then it gets even harder to choose food for the right reason. Because it is hard for at that time to know which is more important for you: healthy food so I feel better later, or comfort food so I feel better now. Most people who eat for emotional reasons prefer to feel better now of course. And most people who feel comforted by food at these times choose chocolates etc and not broccoli etc. And so people who get the majority of the excess calories from food choices made for emotional reasons or for a craving for certain foods struggle with the band.

We choose food to meet one or more of 3 needs: pragmatism, pleasure, and emotional. If you choose food on the basis of what is healthy and what your body needs to run itself and what you haven’t had enough of lately, you will control your weight more easily (Pragmatic Eating). But if you choose food on the basis of what is yum, looks delicious and smells amazing (Pleasure Eating) you will not necessarily supply your body with the right ingredients to run it well. Pleasure eaters and “Sweet tooths” find eating certain foods so irresistible they give in regularly and so find it hard to keep their calorie balance in check. If you choose food that comforts you (Emotional Eating), it will generally be higher in calories than your body needs. Most people mostly eat food with a combination of all 3 styles, and so it becomes a balancing act to eat the right amount of food for the various roles food has in your life. The challenge is to also get the balance right for your body, metabolism, lifestyle etc. A Gastric Band helps flatten out any eating errors and so sweet tooths and emotional eaters still usually do very well with a band. In fact studies have shown little difference in the weight loss with a Gastric Band for sweet tooths, emotional eaters and pragmatic eaters.

However, in the experience of Melbourne Bariatrics Peninsula, sweet tooths and emotional eaters do find the whole process more difficult, and although they seem to achieve good weight loss, the journey is harder. And it is sometimes quite a battle if in particular the majority of un-required calories come from emotional eating or eating sweets. Oddly, a large number of sweet tooths in our experience are no longer sweet eaters after the Gastric band, they just say the sweets no longer do it for them! We don’t know why this should happen but it does.

Keyhole surgery, 5 incisions, or SILS

Laparoscopic surgery is where small incisions are used to perform the operation. Long instruments are inserted along with a camera and the operation viewed on a large screen. It decrease pain and recovery time and there is less blood loss, infections and is better tolerated by patients in general when compared to open surgery which is done through large incisions. Also known as keyhole surgery, it really perhaps should be called keyholes surgery. Most weight loss surgery is done laparoscopically including Gastric band surgery. Five incisions are used for a gastric band: 5mm by 3, 12mm by 1, and 45mm by 1. The larger incision is where the port is inserted and it has a 45mm radius so this incision cant be any smaller. At Melbourne Bariatrics Peninsula this incision and the port are located 12 to 15cm below the junction of the ribs, just to the left of the midline.

The latest advancement in laparoscopic surgery is SILS. This is Single Incision Laparoscopic Surgery. This is available at Melbourne Bariatrics Peninsula and involves inserting the gastric Band through a single incision, which is slightly larger at 55mm. It is placed in either the umbilicus or in the upper abdomen. It has the advantage of less scars, but no other benefits have been proven. Most people having SILS Gastric Band choose this for cosmetic reasons alone.

Overnight stay in hospital

Most people go home the day after surgery for a Gastric Band.

Sometimes people stay dor another night for any of number of reasons such as not walking around steadily enough to be safe at home. Some even go home on the day of the operation.
 

Time off Work

Most people return to work after 2 weeks. Occasionally only 1 week off is needed. Even people with physically demanding jobs tend to back in this time but longer full recovery is usual.

Complications

Complications are very uncommon with Gastric Band Surgery. Out of over 800 Gastric band cases performed by Dr Draper we have had only 2 complications, and this is better than or about the same as most studies. Dr Draper has not had a complication in the past 700 cases. Complications occur that can be predicted from the nature of the operation. Bleeding can occur and structures can be injured, and numerous undesired consequences can then develop. Being obese poses a significantly increased risk for surgery. To address this at Melbourne Bariatrics Peninsula we do a thorough preoperative work up, and help you to get your weight down prior to surgery.

Adjustments

• Adjustments done in the rooms take 5 minutes

• Slow eating, small meals, less hunger, lose weight

This is the central idea to effective weight loss with a Gastric band. If the band is tight enough but not too tight then you should be finding yourself eating slowly, putting a small meal in front of yourself and stopping eating after only a small amount, you should be feeling less hunger than usual or no hunger at all and you should therefore be losing weight. And if not, why not? Will adjusting the band make it easier or more likely you will be doing all these things? If you are experiencing all these things but not losing weight then you are not choosing the right foods for the balance of calories in and calories out to favour weight loss. So changing the food choices is what to change, not the band tightness. If the patient thinks that changing the band tightness might help with food choices then it is adjusted.

• No vomiting, broad range of food

If the Gastric band is too tight then you will find yourself getting heartburn, regurgitating foods, pain with eating, coughing at night, frequently belching, finding the restriction unpredictable and vomiting. Or just some of these, of course. Vomiting should only occur very occasionally, when you are rushed, distracted, very stressed or eating a small range of foods. If you are vomiting more than once per week, the band is either too tight or is malfunctioning for some reason. In other words, vomiting tells us the band is not set correctly. Another indication, apart from the list of symptoms above, that the band is malfunctioning is the range of food you can tolerate. You should be able to eat all foods, all types, cooking styles, anything you want, red meat, bread, anything. The trouble is that for some people with the Gastric Band adjusted to the tightness that makes them eat slowly and not feel hungry is also nearly the same as the tightness that makes them vomit if they eat certain foods. If this happens, the band must be loosened a little so you are still not hungry, but also able to eat all foods. It can take a few adjustments to get this sweet spot, the just right spot, right in between too tight and too loose.

• Aim for 0.5kg weight loss per week.

This guideline is hardly ever the reason to adjust or not to adjust the Gastric Band. The biggest determiner of weight loss is food choices, and so this is just a guide to the amount of weight loss we believe is safe and achievable.

• The band decreases your drive to eat and helps you feel full, the rest is up to you…

People don’t only eat because they are hungry, and so a well adjusted band is not the only thing required for success. You need to change your approach to food, and this can take some effort. We can help you with the challenges you are facing and therefore achieve your weight loss goals. But it is all ultimately up to you to succeed. The big thing to remember is that the Gastric Band will every day, every meal, always be there reminding you to eat less. A gentle tap on the shoulder perhaps reminding you of what you are trying to achieve. And so it becomes easier to avoid eating too much, and lose weight

• Watch a video of adjustments on the media page

Simplest and Safest

The adjustable Gastric Band is the safest weight loss operation. It is also the simplest to perform. This gives gastric Band surgery a self-explanatory advantage over other operations, and partly explains why so many people are having Gastric Band surgery.

Only adjustable operation

Gastric Bands are readily adjustable. The older bands, going back 20 years or so, were not adjustable and this meant that some people were not hungry and ate small meals and lost weight, while others did not get these effects. Now that we can adjust the band tightness so easily, most people get the desired effects.

We don’t need to do an operation to adjust the band to achieve the desired weight loss. We do, however, need to reoperate on people with a Sleeve Gastrectomy or bypass if the effect of the operation is weak or the weight loss is inadequate. Fortunately, it is very rare to need to reoperate for this reason.

Reversible

The Gastric Band is the only reversible operation. This does not mean you should think of it as a temporary weight loss method. On the contrary, it is very important to take up the gastric band with the intention that it will not be reversed. Weight loss surgery is your second chance at a healthy weight and life. Revision surgery including reversal is not without risk.
The other operations are not reversible, but can be modified surgically if required. This is rarely required.

Extensive follow up required

To get the most out of your adjustable gastric band you will be attending follow up appointments with the weight loss surgery team. The number of appointments you will have is more for the band than any other operation. On average this is 8 for the first year, and then less for the years that follow. All weight loss surgery operations require follow up on an annual basis to ensure good results. .

Smallest amount of weight loss: 50 to 60% excess weight loss

You can expect on average 50 to 60% of your excess weight to be lost with a Gastric Band, as long as you use it as a tool and follow the guidelines to get the most out of the band. People who follow the guidelines very closely tend to lose very big amounts of weight and can become quite thin. People who don’t follow the eating rules properly, and for other reasons sometimes out of their control, some people lose only very small amounts of weight. So the average weight loss is just that, average. It is not an indication of the weight you will lose. You need to ask yourself how well you think you can work with the band to maximise your success. Even so, the average weight loss we see with the Gastric Band is less than for the Sleeve Gastrectomy and Gastric Bypass.

Sabotage

Sabotage is breaking the eating rules, working against the design of the operation and making the weight loss less. This is covered elsewhere on this website. Basically it is easier to sabotage the Gastric Band compared with the other operations. All weight loss surgery operations require effort and can be sabotaged. It is just easiest to do this with the band. This is because the Gastric Band is decreasing your food intake by a method that relies on you eating a certain way. Eat a different way, and the weight loss may be affected. The key to beating the band, cheating, or sabotaging with the band is to eat high calorie liquids. To achieve good weight loss, you need to do the opposite. You need to eat low calorie, textured solid food. Eat a different way with a Sleeve Gastrectomy or a bypass and the operation itself will encourage you to eat properly again. With the Sleeve, it will stop you eating big amounts of food, no matter what the food choices are, and a Bypass you will make you feel unwell if you break the eating rules.

High Reoperation Rate

The reoperation rate in Australia varies from place to place. At Melbourne Bariatrics, Mr Geoffrey Draper has a reoperation rate of only 2%, and there have been no reoperations required for slippage in the past 500 cases. However, in Australia overall, reoperation on Gastric Bands is being done at somewhere between 10 and 25%. You should assume that there is a significant chance that you might require a reoperation for a Gastric Band. The most common reasons for requiring reoperation are slippage, erosion, dilatation and inadequate weight loss.

Eating Rules

Band Eating Rules
20 minute meals
Small plate
Small mouthfuls
Cut food into small pieces
Chew well
Separate liquids and solids
Avoid liquid calories
Solid textured nutritious foods
Keep trying challenging foods
All these eating rules are explained in detail by our team and can be read about in our patient information brochures. More details on this website soon.

Weight loss takes 6 to 24 months

All weight loss operations achieve the majority of the weight loss in the first 2 years.

1 to 2 weeks off work

Gastric Band patients are usually able to return to work after only a few days convalescence. It takes longer to return to physically demanding jobs of course.

1 night stay in hospital, Peninsula Private Hospital

Nearly all our Gastric Band patients stay one night in hospital after the surgery, which is just about always done at Peninsula Private Hospital in Langwarrin on the Mornington Peninsula. Some patients are have their Gastric band surgery at Epworth Eastern in Box Hill.

 

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Please Contact Melbourne Bariatrics on  03  9770  7189  for more information or to make an appointment
Royal Australasian College of SurgeonsAMA - Australian Medical AssociationFRACS - Fellow of the Royal Australasian College of Surgeonsmattu - Minimal Access Therapy Training Unit GuildfordIFSO - International Federation for the Surgery of Obesity and Metabolic DisordersMonash University
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