Laparoscopic Adjustable Gastric Banding
A gastric restrictive procedure. The Realize Gastric Band is a device designed to produce a small upper gastric pouch, and a narrow adjustable opening into the lower stomach. It causes a sense of fullness after only a few bites of food. It helps the patient to choose to reduce food intake, and to lose weight.
The Realize Gastric Band is one of the procedures offered by Dr. Fermelia and the Weight Loss Center.
The Laparoscopic Adjustable polymer Gastric Band (Realize Gastric Band®, Inamed) was approved by the FDA in June 2001, for use in treatment of severe obesity.
How the Realize Gastric Band procedure is performed
Gastric Banding is laparoscopic procedure, in which the stomach is neither opened nor stapled - a band is placed around the outside of the upper stomach to create an hourglass-shaped stomach, and to produce a small pouch with an adjustable narrow outlet. The special device used to accomplish this is made of implantable polymer, and contains an adjustable balloon, which allows us to adjust the function of the band, without re-operation.
The Appeal of Laparoscopic Adjustable Gastric Banding: the Realize Gastric Band
(Compared to the Gastric Bypass, Gastric Sleeve Resection, and the malabsorptive procedures.)
Safety. The Realize Gastric Band is the safest weight loss procedure. The mortality (death rate) associated with the Realize Gastric Band procedure is ten times less than with Gastric Bypass and over 20 times less than the malabsorptive procedures.
The Realize Gastric Band provides better short term and long-term safety. The problems with Gastric Banding are generally not life threatening, but usually need an operation to fix the problem or remove the band. Reoperative surgery is always somewhat more risky than the primary procedure.
Easier Recovery. The Realize Gastric Band is less “physiologically” disruptive. Gastric Banding is not as big a procedure than the other weight loss procedures. The recovery is faster and easier. The recovery time is the shortest of all the weight loss procedures.
Short Stay. The Realize Gastric Band is inserted laparoscopically, without a major incision, with just a short stay - usually overnight. The Lap Band can easily be a day surgery - you can go home the same day. The recovery time is the shortest of all the weight loss procedures and can often allow the patient to take just a few days to return work.
No Leaks. With the Realize Gastric Band, there is no opening made into the stomach or intestine and no staple lines, so the risk of leakage and infection is profoundly reduced, although rarely the gastric band can erode into the stomach and have to be removed.
Less Radical. The Realize Gastric Band does not radically reconfigure the intestine or the stomach and food passes through the digestive tract in the natural sequence order.
Vitamin Issues Minimized. With the Realize Gastric Band, problems with vitamin and mineral deficiencies and metabolic problems are virtually non-existent, although we still recommend a multivitamin, calcium and iron as well as long term blood tests of certain vitamins.
Reversible. The Realize Gastric Band is reversible, by laparoscopic removal of the band.
Conversion to other procedures. The Realize Gastric Band is potentially convertible to another operation, if the procedure fails to maintain the desired weight loss. A conversion is associated with a higher risk. Unfortunately, often conversions are often not covered by insurance companies, so make a good choice with your first weight loss procedure.
Less Hunger.Realize Gastric Band patients continue to get a sense of fullness with very little oral intake, similar to the other procedures.
Adjustable. The Realize Gastric Band is adjustable. Weight loss can be customized. The band is adjustable in the office setting.
Risks and Concerns of Laparoscopic Adjustable Gastric Banding
(Compared to the Gastric Bypass, the Gastric Sleeve Resection, and the malabsorptive procedures.)
Band Slip / Prolapse and Esopageal dilation: After the Realize Gastric Band is placed; the upper stomach pouch may enlarge in very rare cases, either due to slippage of the band, or stretching of the wall of the pouch. This may cause poor weight loss, reflux causing heartburn, and can lead to obstruction of the stomach outlet. Stretching of the upper stomach wall can, in rare cases, cause irreversible damage to the upper stomach and irreversable dilation of the esophagus. In some cases there may be a need to remove the band, and/or convert to a different weight loss procedure. Repeat operations are more risky. Careful follow-up with the surgeon, patient compliance, and careful adjustment of the band can help avoid such problems. A tighter band does not necessarily mean more weight loss. Proper band adjusment with your surgeon will decrease the risk of band slips and esophagus dilation.
Slow, progressive Weight Loss. Weight loss with the Realize Gastric Band is steady and slow. The goal is to lose one to three pounds a week. The dramatic weight loss seen with the Gastric Bypass is not the case, and resolution of medical problems associated with obesity will occur, but at a much slower pace with the Realize Gastric Band. Proponents of gastric bands argue that slow weight loss is better because there is less lean body weight (muscle) weight loss, which is true.
Overall weight loss. 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 Realize Gastric Band. The studies from Europe and Australia (as well as early studies in the United States) on the Realize Gastric Band demonstrate good weight loss and durable weight loss in general. However, there are more reports in the literature and much more discussion in national meetings regarding subsets of patients with poor results with Gastric Banding. Unfortunately, it is difficult to predict which patients will do well with Gastric banding.
In general, patients with BMIs from 35 to 49 will achieve long term average weight loss with the Gastric Band as low as 40% (Excess Body Weight loss) in some studies and generally about 50% in most studies. Long term average weight loss with the Sleeve is estimated 50 to 55% and in the Gastric Bypass RYGB an estimated 55 to 65%. Weight loss with the Sleeve and the RYGB is much more predictable than gastric bands. It is becoming obvious recently among surgeons who offer a variety of procedures that weight loss is more variable and less predictable with the gastric bands.
However the Lap Band may be an excellent choice for the right patient. Discuss this choice carefully with your surgeon.
The Weight Loss Center at CRMC: Surgical and Medical Weight Loss Solutions | Richard A. Fermelia, MD, FACS - Richard.Fermelia@crmcwy.org
421 E. 17th Street | Cheyenne, WY 82001 | Phone 307-633-7619 | Toll-free 866-633-7619 | Fax 307-633-7621
This program is designed and was conceived to benefit the people of Wyoming, with our unique circumstances: large traveling distances, small populations, weather