The Gastric Band is a device designed to produce a small upper gastric pouch, and a narrow adjustable opening into the mid to upper stomach. It causes a sense of fullness after only a several bites of food. It helps the patient to choose to reduce food intake, and to lose weight.

The Gastric Band is one of the procedures offered by Dr. Fermelia and is one of the surgical solutions at the Weight Loss Center at Cheyenne Regional Medical Center.

The Lap-Band (Allergan) was approved by the FDA in June 2001, for use in treatment of severe obesity.

The Realize band (Ethicon) was approved by the FDA September 2007.

How the Gastric Band procedure is performed

Gastric Banding is a laparoscopic procedure in which the stomach is neither opened nor stapled - a band is placed around the outside of the upper stomach. A small pouch is created at the top of the stomach with a narrow outlet. The device used to accomplish this is made of implantable polymer, and contains an adjustable balloon, which allows adjustment of the band, without re-operation. Adjustments are made by accessing the port (which implanted under the skin) with a needle inserted through the skin in the office setting.

Why Might a Someone Choose a Gastric Band?  The Appeal of Laparoscopic Adjustable Gastric Banding

• Laparoscopic Gastric Banding (LGB)is generally the safest of the weight loss procedures. The mortality (death rate) associated with the LGB is approximately ten times less than with Laparoscopic Gastric Bypass (LRYGB).  Mortalities and life threatening complications with weight loss surgery is extremely rare to begin with.
• With the Gastric Band, complications generally tend to be non life threatening but usually lead to reoperation, with revision and/or removal of the gastric band.  Reoperation rates are likely in the 3 to 6% range and there is an ongoing risk of reoperation over time.
• The Gastric Band is less “physiologically” disruptive. The recovery is faster and easier in general because it is generally a “smaller” procedure compared to the other procedures. The recovery time is the shortest of all the weight loss procedures.
  • Gastric Band Recovery from Surgery.  The Gastric Band is inserted laparoscopically, without a major incision, with just a short stay - usually overnight. It is possible to have the gastric band placed and go home the same day.  The recovery time is the shortest of all the weight loss procedures.  Return to work can be as short as a few days.  Commonly, patients will go back to non-physical or minimally physical jobs in one week.
•  The Gastric Band can be placed in most people with the “Virtually Scarless” technique. 
  • See our page on “Stealth” surgery.
• With Gastric Banding, there is no opening made into the stomach or intestine and there are no staple lines, so the risk of leakage and infection is profoundly reduced.
  • Gastric band erosion.  Please see below under complications and concerns.
• Gastric Banding does not radically reconfigure the intestine or the stomach and food passes through the digestive tract in the natural sequence.   This concept is very important to some patients who choose gastric banding.
• With Gastric Banding, vitamin and mineral deficiencies and metabolic problems are conceptually non-existent as a function of the band, however it has been theorized and demonstrated that weight loss surgery patients in general including band patients, may develop general vitamin deficiencies.  We recommend that band patients take a multivitamin with iron, consider calcium and vitamin D supplementation, and follow up with the Weight Loss Center at least yearly to get certain vitamin levels checked.
• Gastric Banding is reversible, by reoperation with laparoscopic removal of the band.   If the band is removed most patients will usually regain their weight. 
• Gastric Banding is potentially convertible to another weight loss surgery operation, if the patient fails to maintain the desired weight loss. Weight loss failure is most often a problem with behavior and compliance of the patient rather than a problem with the anatomy of the operation.  There would be concern that an anatomical change to another procedure will likely be met with similar problems with success, unless there are behavior changes.  We recommend that you make every effort to work with us to achieve the best results from your first procedure. 
  • A conversion is technically difficult and is associated with a higher risk.  
• Patients will most often find that their medical insurance will not cover the costs of weight loss surgery revisional surgery for weight loss failure.  We recommend that you choose the best procedure for you as your first procedure, because there is a good chance you will not be able to count on having a second procedure.
• Gastric Band patients continue to get a sense of fullness and help with controlling hunger with modest solid food oral intake.  
• The Gastric Band is the most affordable if you are paying for your surgery out of pocket.  Be aware that there are costs associated with the band fills.  Think carefully about the fact that you will likely have to also pay for any complications that may arise.
• The Gastric Band is adjustable.  The most important idea is that anatomy, the thickness of the stomach and where the band is placed surgically varies.  It is good that the band can be adjusted, especially because it tends to loosen over the course of weight loss.  Please see the page on Gastric band adjustment.

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The lap band is adjustable!

Risks, potential complications and concerns of Laparoscopic Adjustable Gastric Banding

• Gastric Band Slip and Prolapse: the upper stomach pouch may enlarge, due to slippage of the band or stretching of the wall of the pouch. If the band slips off to once side, it is called a prolapse.  If a slip or prolapse is detected early, sometimes if the band is emptied for awhile there can be some recovery from the problem.  The most common reason for this is persisting with a band that is too tight.  Please see the page on Gastric band adjustment.
  • In most cases there is need to re-operate and revise the band.  It is usually possible laparoscopically to remove the band and place it in the proper location.  On occasion the band is removed and converted to a different weight loss procedure, but it will likely be difficult to secure benefits from the insurance company for a different weight loss procedure. Repeat operations are more risky than the original procedure.
  • Slip or prolapse may lead to poor weight loss, reflux of gastric acid causing heartburn, and can lead to sudden obstruction of the stomach outlet, which can lead to emergency surgery or even severe illness and even death.
  • Stretching of the upper stomach wall can, in rare cases, cause irreversible damage to the upper stomach and the esophagus.
  Gastric band erosion.  One of the possible complications of gastric banding is erosion (0.5 to 3.8%) .  This is when the band erodes into the stomach and has to be removed through (usually) another laparoscopic surgery.  Erosions are not usually life threatening.  Erosion can be caused by damage to the stomach during surgery, but the biggest reason is over tightening of the band.  Please see the page on Gastric band adjustment.
• Esophageal dilation.  The esophagus may dilate which may be at least partially reversible if detected early, however it may be severe.  Usually the band has to be removed and the patient is not often a candidate to have a different weight loss surgery revision.  .  The most common reason for esophageal dilation is persisting with a band that is too tight.  Please see the page on Gastric band adjustment.
  • Esophageal dilation usually results in poor weight loss failure and removal of the band.
• The weight loss in Gastric Banding to be extremely variable and not as predictable as the other weight loss surgery procedures.  A good number of weight loss surgeons are beginning to recognize that not all patients who choose gastric banding lose appropriate amounts of weight.  The truth is there are many, many patients who have lost substantial weight and maintained weight loss with the band, but it can be difficult to predict for any individual. 
  • Patients who choose Gastric Banding have to be particularly committed to work to understand how the band works anatomically and physiologically.  They need to commit to eat according to certain principles that we will teach and continually reinforce.  Sustaining a commitment to these mechanics and ideas are absolutely necessary to be a long term success. 
• We generally counsel patients that if they are good “dieters”, they will likely do well with a gastric band.
• Know that with proper eating habits, hunger is curbed, not alleviated.
• The weight loss in Gastric Banding is steady and slow compared to other procedures. The goal is to lose one to two pounds a week.  For example if you need to lose 100 pounds, it may take a year or two to lose that much weight.
• The dramatic weight loss seen with the Gastric Bypass is not seen with gastric banding
• Some patients need the dramatic metabolic weight loss of gastric banding and gastric sleeve to be successful, but it is difficult to predict.  Your own sense of this is probably most important.
• Resolution of medical problems associated with obesity will occur, but at a slower pace.
• Slow and steady weight loss may be a very good thing.  There is good science behind the idea that less lean body mass (muscle) is lost by losing weight slowly.
• In our opinion, slow weight loss does not change the amount of excess skin the patient may have after substantial weight loss.
• Overall weight loss with Gastric Banding. Statistically, the weight loss may not be quite as good as other procedures in the short term and in the long term. This claim is strongly argued against by the proponents of the Gastric Band procedures. The individual patient will usually get enough weight loss with the band to alleviate or reverse or prevent most of the serious medical problems associate with morbid obesity.  Data and personal experience suggests patients will achieve average weight loss with the Gastric Band (40 to 50%),the Sleeve (estimated 50 to 55%), and the RYGB (estimated 55 to 65%).