What is a gastric band? How does gastric banding help weight loss?

Over the course of the last decade and more, the surgical treatment of obese people with bariatric procedures such as gastric banding has gained acceptance and popularity.¹

Figures from 2006 suggest that around 113,000 weight loss procedures are performed in the US every year, with gastric banding being performed laparoscopically as a day procedure for 37% of all bariatric surgery cases.¹

The estimated total cost of bariatric surgical procedures to the US health economy is estimated to be at least $1.5 billion each year.¹

This page offers more information about what gastric banding involves, who can benefit, what the risks and advantages are, and also what other weight loss surgical procedures are available.

You will see introductions at the end of some sections to recent developments covered by MNT's 

Fast facts on gastric band surgery

Here are some key points about gastric band surgery. More detail and supporting information is in the body of this article.

• Gastric band surgery is a type of weight loss, or bariatric, surgery.
• It is an adjustable and reversible way of restricting the size of the stomach and therefore the food intake.
• A band with an inflatable balloon creates a small pouch out of the stomach above, with the greater part of the stomach below. This is usually fitted in a short operation that is often completed as a day-procedure.
• The operation is done under general anesthetic via small incisions in the abdomen, with the surgeon guided by laparoscope (keyhole surgery).
• Diet is altered for up to six weeks following the surgery, and there is a strict diet regime to maintain.
• Banding can result in the loss of over half the excess weight and improve or resolve diabetes.
• Risks include those involved with any general surgery as well as complications specific to the procedure, such as potential slippage of the band.

How does a gastric band work?

Gastric banding is a type of weight loss (bariatric) surgery that involves placing a silicone band around the upper part of the stomach.^2-4 It has been approved by the FDA in the US since 2001.⁵

Weight loss surgery targets the gut, the stomach in particular.

The band has a balloon that is inflatable with saline solution, which can be injected via a port attached under the skin of the abdomen for adjustment after the surgery. The band creates a small stomach pouch above it, with the rest of the stomach below.^2-4,6

The smaller stomach pouch reduces the amount of food that can be held. The band produces fullness after eating a smaller amount of food and reduces feelings of hunger, and so lowers food intake, although the exact way in which it works is not clear.^2-4

This form of bariatric procedure does not create any malabsorption - all food consumed is digested and absorbed normally.^2-4

Other names for the procedure are Lap-Band (the name of the commercial device), laparoscopic adjustable gastric banding (LAGB), bariatric surgery, laparoscopic gastric banding and, simply, the band.

How is gastric band surgery performed?

A gastric band is fitted under general anesthesia, usually in an outpatients department as a day procedure - often going home on the same day.^2,4

The procedure is minimally invasive, being performed laparoscopically using a camera through keyhole incisions - 1-5 small surgical cuts in the abdomen.^2,4

Surgeons experienced in the procedure will take between 30 minutes and an hour to complete it.^2,4

Because of the general anesthesia, patients should not eat on the day of the surgery (from midnight the night before). Most people undergoing it have a week off work and can begin normal activities within a day or two.^2,4

For the first 2-3 weeks after the procedure, diet is restricted to liquids and liquidized foods, after which soft foods are introduced until diet is along a normal regime after around 6 weeks.^2,4

Who is a suitable candidate for gastric banding?

Eligibility for a gastric band placement is restricted to people who are severely obese, with a body-mass index (BMI) of 40 or over.

Only severely obese people are eligible for weight loss surgery - with a BMI of 40 or more.

A smaller person may be eligible if there are other obesity-related problems such as diabetes, hypertension or sleep apnea.^7,8

Other treatment options for obesity need to have been exhausted before surgery is considered - patients must first try lifestyle changes to diet and activity, and medications.^7,8

Some research recommends bariatric surgery is done sooner rather than later in obese patients with type 2 diabetes - recommending the intervention in people with pre-diabetes or with a high diabetic risk.⁹

Some people cannot be considered for weight loss surgery - absolute contraindications include:⁸

• Current drug or alcohol abuse
• Uncontrolled psychiatric illness
• Inability to understand the risks and benefits, outcomes, alternatives, and lifestyle changes demanded.

Benefits of gastric banding

A review of the research studies, for all the weight loss surgeries overall, found that the average result was excess body weight loss of 38.5 kilograms or 55.9%, along with complete resolution of diabetes among 78.1% of relevant patients.¹⁰

Having a gastric band comes with some risks, but there are advantages in addition to the weight loss:^{1-4,6,9,11,12}

• Results, in contrast to lifestyle and pharmaceutical alternatives, in substantial, long-term weight loss for obese individuals - nonsurgical treatments in the morbidly obese are rarely successful in the long term
• Helps people lose as much as 40-50% of their excess weight; although for its benefits, it does not help with weight loss by as much as other bariatric operations
• Can have a major effect in the prevention of type 2 diabetes - in one study, bariatric surgery, compared with usual care, reduced the risk of developing diabetes by 96% at 2 years, holding at 78% after 15 years (the study of over 2,000 obese people included a large proportion of patients undergoing other types of weight loss surgery)
• As with any major weight loss achieved by obese people, there are numerous health benefits, from making it easier to move around and do daily activities to helping against asthma, gastroesophageal reflux disease (GERD), high blood pressure, high cholesterol and obstructive sleep apnea
• Is reversible (the band can be removed) and adjustable (it can be tightened or loosened in response to problems eating, if not enough weight is being lost, or there is vomiting after eating)
• Involves no cutting of the stomach or rerouting of the intestines
• Needs only a short time in hospital, usually less than 24 hours, and often with same-day discharge
• Among the weight loss surgical options, is linked to the lowest number of complications after surgery and the lowest risk for vitamin or mineral deficiencies
• Compared with other bariatric operations, the postsurgical demands are lighter in terms of dietary recommendations, vitamin and mineral supplementation, and follow-up care
• Compared with open surgery (which is albeit rarely done now; just 3% of bariatric procedures), fewer complications such as wound infections and postoperative hernias
• Psychiatric symptoms can improve among severely obese adolescents following laparoscopic adjustable gastric banding
• Employers, who often pay for health insurance, benefit from greater worker productivity, and after the faster recovery allowed by laparoscopic surgery.

Disadvantages and risks of gastric banding

Having a gastric band comes with some risks - as do many surgeries - and disadvantages.

The risks of anesthesia, the potential for which varies according to individual patients, include allergic reactions, breathing problems, blood clots in the legs that may travel to the lungs (pulmonary embolism), blood loss, infection, and heart attack or stroke during or after the surgery.⁴

The risk of death is low, ranging from 1%, and reaching 5% in high-risk individuals.¹³

Compared with other types of weight loss surgery, the gastric banding procedure:^3,4,6,10

• Produces weight loss more slowly and has less effect on diabetes resolution, with a higher proportion of patients failing to lose at least half of their excess body weight
• Requires a foreign device to remain in the body
• In a small number of cases, around 20%, the band can slip or have mechanical problems, or it may erode into the stomach, requiring removal
• May have problems with the access port, which can flip upside down, blocking access and requiring minor surgery. The tubing near the access port can also be punctured accidentally during adjustment access, again requiring minor surgery
• Vomiting or dilation of the esophagus can result from overeating, and it requires strict adherence to the postoperative diet and follow-up care
• Has the highest rate of needing revision surgery.

As with other types of weight loss surgery, gastric banding also carries these risks:^4,6,13

Weight loss surgery has the risks of any operation needing general anesthetic.

• Injury during the operation to the stomach, intestines or other abdominal organs
• Hernias
• Inflammation of the stomach lining (gastritis), heartburn, stomach ulcers
• Infection
• Gastrointestinal scarring that can lead to bowel blockage
• Poorer nutrition as a result of the restricted intake
• Increased likelihood of pregnancy following weight loss
• The reality of weight loss results may not match the expectations, and expectations for weight loss are higher than they are for the health benefits
• Psychological problems adjusting to body changes following weight loss surgery.

Other types of weight loss surgery

Laparoscopic gastric banding is one of the two most commonly performed bariatric surgeries.¹²

Diagram of surgical options.
Image source: The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Gastric bypass - also known as Roux-en-Y gastric bypass - is the other most common weight loss operation. It is similar to gastric banding in that it produces a small pouch in the upper stomach, allowing less food to be held.¹⁴

It differs, however, in that food does not pass into the lower part of the stomach but is redirected straight into the small intestine (jejunum) via a small hole in the pouch. The operation lasts 2-4 hours.¹⁴

The pouch is divided off using staples, to produce a volume of around one ounce or 30 milliliters. In addition to reducing food intake, the bypass has an effect on nutrient absorption by allowing less digestion to take place in the stomach.^2,14

Biliopancreatic diversion with duodenal switch - or simply "duodenal switch" - is a type of gastric bypass, the first part of which is the sleeve gastrectomy explained below.^3,7

The second part sees a large portion of the small intestine being bypassed, limiting absorption. In addition to affecting gut hormones, this procedure affects the way food mixes with bile and pancreatic enzymes.^3,7

Sleeve gastrectomy - vertical sleeve gastrectomy or "the sleeve." This operation involves simply removing a large portion of the stomach - about 80% - to leave a tube/banana-shaped sleeve that is able to produce less of the hormone ghrelin, which is involved in appetite.^3,7

The video below, produced by Sutter Health, shows what happens to the gut during a sleeve gastrectomy.

Robotics in bariatric surgery

The use of robots has advantages in weight loss surgery because of the challenging ergonomics for surgeons doing laparoscopic surgery in uncomfortable postures on big patients, leading to surgeon fatigue.¹⁵

Research has shown a lower rate of complications when robots are used to assist surgeons with weight loss procedures. While the cost of the operation itself is higher, overall costs may be reduced.¹⁵

All of the above types of weight loss surgery have called on robotics, but adjustable gastric banding was the first bariatric procedure performed with the aid of a robot.¹⁵

^References:

1.                        The incidence of bariatric surgery has plateaued in the US. Edward Livingston, American Journal of Surgery, 2010, volume 200, number 3, pages 378-385, doi: 10.1016/j.amjsurg.2009.11.007.

2.                        Weight loss surgery. American Family Physician, 2011, volume 84, number 7, page 815.

3.                        ASMBS patient learning center. Gainesville, Florida, US: American Society for Metabolic and Bariatric Surgery. Information published online, accessed August 2015.

4.                        Laparoscopic gastric banding. Bethesda, Maryland, US: National Institutes of Health, National Library of Medicine, MedlinePlus. Information published online, accessed August 2015.

5.                        Laparoscopic gastric banding. New York City: Columbia University Medical Center, Center For Metabolic And Weight Loss Surgery. Information published online, accessed August 2015.

6.                        Expert panel on weight loss surgery: executive report update. George Blackburn et al., Obesity, 2009, volume 17, pages 842-862, doi: 10.1038/oby.2008.578.

7.                        Bariatric surgery for severe obesity. Bethesda, Maryland, US: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Information published online, accessed August 2015.

8.                        Assessing the obese diabetic patient for bariatric surgery: which candidate do I choose? Marco Raffaelli et al., Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 2015, volume 8, pages 255-262, doi: 10.2147/DMSO.S50659.

9.                        Timing of bariatric surgery in people with obesity and diabetes. Luca Busetto, Annals of Translational Medicine, 2015, volume 3, number 7, page 94, doi: 10.3978/j.issn.2305-5839.2015.03.62.

10.                     Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Henry Buchwald et al., The American Journal of Medicine, 2009, volume 122, number 3, pages 248-256, doi: 10.1016/j.amjmed.2008.09.041, abstract.

11.                     Psychological outcomes and predictors of initial weight loss outcomes among severely obese adolescents receiving laparoscopic adjustable gastric banding. Robyn Sysko et al., Journal of Clinical Psychiatry, 2012, volume 73, number 10, pages 1,351-1,357, doi: 10.4088/JCP.12m07690.

12.                     Recent advances in bariatric/metabolic surgery: appraisal of clinical evidence. Wei-Jei Lee and Abdullah Almulaifi, The Journal of Biomedical Research, 2015, volume 29, number 2, pages 98-104, doi: 10.7555/JBR.28.20140120.

13.                     Expectations for weight loss and willingness to accept risk among patients seeking weight loss surgery. Christina Wee et al.,JAMA Surgery, 2013, volume 148, number 3, pages 264-271, doi: 10.1001/jamasurg.2013.1048.

14.                     Gastric bypass surgery. Bethesda, Maryland, US: National Institutes of Health, National Library of Medicine, MedlinePlus. Information published online, accessed August 2015.

15.                     Review of contemporary role of robotics in bariatric surgery. Vivek Bindal, Journal of Minimal Access Surgery, 2015, volume 11, number 1, pages 16-21, doi: 10.4103/0972-9941.147673.

Other useful references:

§  Health benefits of gastric bypass surgery after 6 years. Ted Adams et al., JAMA, volume 2012, volume 308, number 11, pages 1,122-1,131, doi: 10.1001/2012.jama.11164.

§  Best practice updates for multidisciplinary care in weight loss surgery. Caroline Apovian et al., Obesity 2009, volume 17, number 5, pages 871-879, doi: 10.1038/oby.2008.580.

§  2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.Michael Jensen et al., Journal of the American College of Cardiology, volume 63, number 25, pages 2,985-3,023, doi: 10.1016/j.jacc.2013.11.004.

§  Benchmarking best practices in weight loss surgery. Robert Lim et al., Current Problems in Surgery, 2010, volume 47, number 2, pages 79-174, doi: 10.1067/j.cpsurg.2009.11.003.

§  Weight loss at the first postoperative visit predicts long term outcome of Roux-en-Y gastric bypass using the duke weight loss surgery chart.Alessandro Mor et al., Surgery for Obesity and Related Diseases, 2012, volume 8, number 5, pages 556-560, doi: 10.1016/j.soard.2012.06.014.

§  Weight loss surgery. nhs.uk. London, UK: National Health Service, NHS Choices. Information published online, accessed August 2015.

§  Physiology of weight loss surgery. Chan Park and Alfonso Torquati, Surgical Clinics of North America, 2011, volume 91, number 6, page 1,149, doi: 10.1016/j.suc.2011.08.009.

§  The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Jo Picot et al., Health Technology Assessment, 2009, volume 13, number 41, pages 1-190, 215-357, doi: 10.3310/hta13410.

§  Efficacy of laparoscopic mini gastric bypass for obesity and type 2 diabetes mellitus: a systematic review and meta-analysis. Yingjun Quan et al., Gastroenterology Research and Practice, 2015, page 152852, doi: 10.1155/2015/152852.

§  Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Lars Sjöström et al., New England Journal of Medicine, 2004, volume 351, pages 2,683-2,693, doi: 10.1056/NEJMoa035622.

§  Effects of bariatric surgery on mortality in Swedish obese subjects. Lars Sjöström et al., New England Journal of Medicine, 2007, volume 357, pages 741-752, doi: 10.1056/NEJMoa066254.

§  Weight loss surgery for non-morbidly obese populations with type 2 diabetes: is this an acceptable option for patients? Rachael Summers et al., Primary Health Care Research and Development, 2014, volume 15, number 3, pages 277-286, doi: 10.1017/S146342361300025X.

§  Early benefits from weight-loss surgery. Heinrich Taegtmeyer et al., Journal of the American College of Cardiology, 2010, volume 55, number 16, page 1,754.