Gastric banding is a type of bariatric surgery in which a silicon strap is placed around the stomach to create a pouch that holds small amounts of food. The tightness of the band controls the passage of food into the lower stomach. Adding or removing saline through a port can adjust the band. Eligibility criteria for gastric banding includes persistent morbid obesity or obesity with serious conditions, such as sleep apnea, diabetes or hypertension, that can be treated through weight loss. Side effects may occur as a result of gastric band.
Gastroesophageal Reflux Disease
While weight loss goals can significantly reduce complications from obesity-related chronic disease conditions, banding can also produce additional discomfort and risks. Gastroesophageal reflux disease can lead to esophageal inflammation, scaring and an increased risk of cancer. In a follow-up on 90 cases at University Hospital in Uppsala, Sweden, Sven Gustavsson and A. Westling found that half the patients had complaints of heartburn or GERD within two years. Erosion and inflammation of the esophagus was discovered in 44 percent of cases. Within seven years after banding, 58 percent of patients underwent permanent bypass surgery for reasons including esophageal inflammation and stretching of the esophagus. The study was published in the June 2002 "Seminars in Laparoscopic Surgery."
Device Problems
Problems with the band or port used in the gastric band procedure are infrequent but can occur. The band may become migrate, resulting in pain and irritation. Slippage, erosion into the stomach and leakage are problems that may require surgery and could lead to internal bleeding or infection. Port flipping, tubing kinks or disconnection are other possible problems. In an eight year follow-up of 317 gastric band cases conducted by M. Suter and colleagues from Hospital du Chablais in Switzerland, 33 percent of patients developed late complications. Problems related to the device itself included band erosion in 9.5 percent of cases, tubing and port-related problems in 7.6 percent of cases, and slippage occurred in 6.3 percent of cases. The report was published in the July 2006 "Obesity Surgery."
Poor Long-Term Outcome
Gastric band procedure is promoted as a safe and reversible alternative to Roux-en-Y gastric bypass, the standard of care in bariatric surgery, according to J.A. Tice and colleagues at the University of California in San Francisco, who conducted a comparison study. Resolution of obesity-related diseases, percentage of weight loss, quality of life, operative complications, and long-term adverse events were assessed for at least one year after both surgeries. While gastric banding had shorter hospital stays, only 50 percent of weight-related disorders were resolved, compared to 78 percent after bypass. Gastric band achieved on average a 19 percent loss of excess weight in comparison to a 34 percent average loss of excess weight after bypass surgery. Patient satisfaction and long-term reoperation rates were also more favorable in bypass surgery. Researchers published the report in "The American Journal of Medicine" in October 2008.
References
- Pubmed.gov: Laparoscopic Adjustable Gastric Banding: Complications and Side Effects Responsible For the Poor Long-Term Outcome
- Pubmed.gov: A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates
- Pubmed.gov: Gastric Banding or Bypass? A Systematic Review Comparing the Two Most Popular Bariatric Procedures
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