A gastric band is an implantable device which is wrapped around the top part of your stomach. This creates a small pouch at the top of your stomach which is about 1 or 2 ounces in size. After having a gastric banding procedure all the food you eat after having a band first enters this small pouch and then must filter through the band. This means that the band is simply a restrictive procedure. You can imagine how this works by picturing an hour glass, everything poured into an hour glass must filter through the narrow portion in the middle of the hour glass.
The band creates that narrow portion near the top of your stomach and since everything you eat must filter through it you will have to eat much slower and much smaller portions. The gastric banding procedure is therefore ideal for a patient who needs portion control (simply eats too much food), however for a patient who eats a great many sweets or junk food the band may not be as effective. The band is then connected to a small port under the skin of the abdominal wall. A small amount of saline solution can be injected into the port which tightens the band; this is known as an adjustment.
The band typically requires adjustments every several months (generally when a patient has stopped losing weight). We perform the adjustments at an outpatient facility under x-ray guidance which reduces the number of adjustments that the average patient will require. The adjustment is not an operation and only local anesthesia is used, you can drive yourself home after the adjustment and if you choose even go to work that day.
Advantages of Band Surgery
- Can be done as same day surgery or overnight stay
- Reversible – nothing is removed when placing the gastric band
- Restrictive only; no chemical/hormonal changes
- Loss of 40-50 percent of excess weight in average patient
- Slower weight loss than other surgeries – compliance critical
- Easy to “out-eat” the band, particularly for patients who eat a great deal of junk food or sweets; “grazers’ or drink their calories – Portion Control Only
- Exercise is critical
- 1st year follow-up with surgeon/adjustments 5-9 times
- Compliance with follow up is crucial; a typical patient will require an adjustment every three to four months. Lack of timely follow up will absolutely decrease the chances of succeeding with gastric banding
FDA announcement on the “Lap Band”
In early 2011 the FDA announced that it had approved the “Lap Band” (but not the Realize band) for insertion into patients with BMI’s as low as 30. This generated a great deal of interest, and some controversy. Many patients have called expecting that they can now have the “Lap Band” even though they have a BMI of 31 or 32. The insurance companies however still follow the guidelines of the National Institutes of Health (NIH) which state that bariatric surgery (including the “Lap Band”) are only indicated for patients with a BMI of 40 or higher (regardless of medical problems), or patients with a BMI of 35 or higher if they have significant medical problems such as: diabetes, hypertension, sleep apnea, heart disease etc. So, if you have a BMI less than 35 the insurance companies will not cover the “Lap Band”, or any other bariatric procedure.