Laparoscopic Gastric Band

Section: UGI Sub-section: Bariatrics Curriculum:

Principles

• Restrictive procedure
  • Limit volume of the proximal part of the stomach
  • Tight, adjustable locking silicone ring placed around upper stomach
    • Infusion port placed in subcutaneous tissue
• High volume (9mL), low pressure bands preferred
  • ? Some compression on Vagus Nerve leading to early satiety
• NB: Pure restrictive procedures, may lead patients away from bulky, healthy fibrous food to high calorie food such as simple sugars/ high energy liquids (maladaptive eating)
• Contraindications
  • Hiatal Hernia
  • Portal Hypertension
  • Previous PUD
• Procedure of choice for women with subfertility
  • Band can be deflated for pregnancy
• Expected weight loss
  • 50-60% EWL at 2 years
  • 40% cure in T2DM (improved in 80%)

Procedure

• Peritoneum from Angle of His (where cardia meets oesophagus) to top of spleen divided
• Band placed via lesser omentum
  • Pars flaccida approach
• Gastric fundus sutured over the band securing it 1cm below GOJ
  • Suturing carried as far posterolaterally as possible
  • This is the most common site of fundal herniation
• Aim for 15ml pouch
• Learning curve ≈ 15

Post-op Management

• Diet
  • NBM 1/7
  • Then Liquids 1/52
  • Puree diet 1/52
  • Soft 1/52
  • Then E+D
• Balloon
  • Inflate initially with 4mL
  • Then wait at least 6 weeks (or until weight plateaus)
  • Next inflation = 1 mL
  • Delay further inflation as long as possible
    • To minimize erosion risk

Pros and Cons

• Pros
  • Relatively easy surgery
  • Adjustable
  • Reversible/removable
  • No risk of nutritional defects
  • Can easily be converted to Roux-en-y/Sleeve
• Cons
  • Failure of weight reduction in up to 50% at 3 yrs
  • High complication rate (up to 20%)
  • Regular follow-up needed
  • Popularity declining due to modest weight loss and high revision rates

Complications

• Early
  • Port site infection
  • Food bolus obstruction
• Late
  • High rate of reoperation ~ 20%
  • Band Slippage
  • Band Erosion ~ 1%
  • Oesophageal Dilation (Pseudoachalasia)
  • Oesophagitis
  • Tubing and port complications
  • Leakage of access tubing 10%
  • Port rotation 5%
  • 5% morbidity
  • 0.02-0.1% mortality