Bariatric surgery: Gastric banding

Gastric banding is a type of bariatric surgery initially developed as a presumably safer alternative to gastric bypass. The key drawbacks of gastric bypass result from the structural redesign of the GI tract it imposes and may include severe nutritional deficiencies (causing anemia, osteroporosis, etc.) as well as ulcers, stenosis, dumping syndrome and other problems. Since gastric bypass is largely irreversible, many of its complications may be difficult to treat.

Gastric banding avoids many of these problems by obviating the need to irreversibly restructure the GI tract. As a result, it became the weight loss surgery of choice in many parts of the world, including Europe and Australia. The most popular version of this procedure, called adjustable gastric banding, involves placing a hollow silastic band around the upper part of the stomach. The band divides the stomach into a small upper pouch above the band and a larger one below the band. This small gastric pouch limits the amount of food that a patient can eat at any one time, and tends to produce a feeling of fullness even after a relatively small meal.

The procedure is usually performed laparoscopically. The band can be later adjusted, making it tighter or laxer, by injecting saline into the band via a reservoir implanted under the skin. The adjustment does not require another operation -- only a saline injection through the skin into the reservoir.

The overall complication rates for gastric banding are lower than for gastric bypass and include the following:

Slippage or pouch enlargement: 1.8%

Erosion: .6%

Wound Infection: 2.2%

Infection (band or port): 3.2%

Obstruction: 2.2%

Mortality: .05%

Despite the growing popularity, reversibility and better safety profile, gastric banding and other so-called restrictive operations have failed to replace more dangerous malabsorptive operations, such as gastric bypass. While restrictive operations lead to weight loss in almost all patients, they are less successful than malabsorptive operations in achieving substantial, long-term weight loss. About 30 percent of those who undergo gastric banding achieve normal weight, and about 80 percent achieve some degree of weight loss. Some patients regain all of the weight they lost. Others fail to lose all the weight they intended. While healthy eating habits and active lifestyle is important for long-term success of any weight loss surgery, they play a comparatively greater role after gastric banding.

See also the index of studies related to gastric banding.

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