By Dr. Mustafa Ahmed
Weight loss surgery is not a quick fix for weight loss and it is not for everyone. But for those who are obese and suffer from obesity-related conditions and who have been unsuccessful at sustaining weight loss by other means, weight loss surgery (or bariatric surgery) might be the solution that finally enables them to lose weight permanently and dramatically improve their health. Eligibility for surgery is determined by a combination of medical and psychological factors. Those who are eligible and make the decision for surgery must make a life-long commitment to maintaining healthy diet and exercise habits. But first they must decide – along with the help of their doctor – which surgery is right for them.
There are several types of surgery that make changes to the stomach or intestines that induce weight loss. Some procedures achieve that goal by restricting the amount of food the stomach can hold, some by restricting the nutrients than can be absorbed, some by a combination of the two. One option is the adjustable gastric band or LAP-BAND® procedure, which restricts the amount of food by promoting a feeling of fullness after eating just a small amount.
How does the adjustable gastric band work?
The surgeon places a soft silicone band around the top part of the stomach to create a small pouch to hold food, effectively creating a two-compartment stomach. The patient feels full after eating enough food to fill only the small, top part of the stomach. After the meal, the food passes through the opening of the band into the remainder of the stomach, and digestion occurs normally. The band has an expandable balloon in its center, which is what makes it adjustable. We can adjust the amount of food the upper part of the stomach can hold by inflating or deflating the balloon – tightening or loosening the band – via injections of saline solution through a tiny port under the skin. By promoting a feeling of fullness after eating just a small amount of food, the band reduces hunger and the patient consumes fewer calories.
What are the advantages of the adjustable gastric band?
The band is the only bariatric surgical solution that is both adjustable and reversible. It is also the least invasive of the surgical options for weight loss. The surgery requires no permanent changes to the stomach or rerouting of the intestines. It is simpler and safer, with the lowest rate of post-surgical complications. The procedure is performed laparoscopically, requiring only a few very small incisions and enabling a rapid recovery. Patients are generally in the hospital for no more than 24 hours, often go home the same day, and are back to regular activities within a week. Adjustments to the band are made in the doctor’s office.
What are its disadvantages?
Weight usually comes off more slowly with the gastric band than with other weight loss procedures and the final weight loss may not be as great, averaging about one-third to one-half of the patient’s excess weight. The band requires strict adherence to the post-operative diet and may induce vomiting if the patient eats too much or too quickly. And while the gastric band has the lowest rate of surgical complications, it has the highest rate of long-term complications due to mechanical problems with the band or the port, such as slippage or erosion, which may need minor surgery to correct. Patients who opt for the gastric band must feel comfortable with the idea that they will have a foreign device in their bodies.
As with many decisions, there are trade-offs in choosing a weight loss solution. The gastric band is adjustable and reversible as well as safer and less invasive than other options but the weight loss may be less dramatic and over the long term, it may pose a higher risk of complications. But whichever option is chosen, the most important factor for success is the patient’s ability and willingness to stick to the lifestyle and follow-up regimen necessary to sustain weight loss. For those who make that commitment, the improvement to their health and well-being can be life-changing.
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