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Laparoscopic Adjustable Gastric Banding (LAGB), the Allergan LAP BAND® SYSTEM or the Ethicon REALIZE is purely restrictive weight loss surgery. Restrictive forms of weight loss surgery such as LAGB promote weight loss by limiting food intake and promoting a feeling of fullness (satiety) after meals. The LAGB surgery was developed for weight loss patients who wanted a safer, less complex alternative to gastric bypass surgery.
During laparoscopic adjustable gastric banding surgery, two medical devices are implanted into the body. The first is a silicone band that is placed around the upper stomach, creating a small stomach (limiting the amount of food that can be ingested) and a large stomach, The second is an injection port that is attached to the abdominal wall under the skin. Watch the Gastric Banding Surgery video. The port is connected to the gastric band by tubing. The silicone band is lined with an inflatable balloon that can be filled with saline via the access port in order to adjust the size of the stomach opening. Adding fluid tightens the band and increases weight loss, while removing liquid loosens the band and reduces weight loss.
Most patients are able to have the surgery performed laparoscopically. Laparoscopic adjustable gastric banding surgery is preferred by many because it is reversible, adjustable, and poses less risk than gastric bypass surgery. It does not involve stomach stapling, does not bypass the pyloric valve (the normal stomach outlet that controls the movement of food from the stomach to the intestines), and does not involve cutting and rerouting of the intestine. It does not cause malnutrition as with malabsorptive procedures and does not cause dumping syndrome as with gastric bypass surgery.
There are currently two brands of adjustable gastric bands available for use in the United States - the LAP-BAND® System and the REALIZE Band (US marketing name for the Swedish Adjustable Band). The LAP-BAND System received US FDA approval in 2001, while the REALIZE Band received US FDA approval in 2007.
- Adjustable without additional surgery (fills via access port)
- Reversible (if gastric band removed stomach returns to normal)
- Laparoscopic placement (minimally invasive surgery)
- Stomach is not cut, stapled and reshaped
- Pyloric valve (stomach outlet) is kept intact
- Intestines are not cut, bypassed, or rerouted
- Short hospital stay
- Quick recovery
- Very low mortality rate (only 1 in 2000 vs. 1 in 200 for Roux-en-Y gastric bypass)
- Lack of malabsorption (since part of the intestines are not bypassed)
- Absence of dumping syndrome
- Absence of anemia
- Fewer complications than other weight loss surgery procedures
Laparoscopic Adjustable Gastric Banding is a relatively safe type of weight loss surgery, but as with all surgery, it is necessary to consider the potential risks, complications, and side effects.
Some of the risks/complications of adjustable gastric banding surgery are:
- During surgery: hemorrhage; injury to spleen, stomach, or esophagus; conversion to open surgery
- After surgery: band slippage; balloon or tubing leakage; port or band infection; obstruction; nausea and vomiting
- Long-Term: band erosion into stomach; pouch dilatation: esophageal dilatation; failure to lose weight
Compared to non-surgical treatment options for obesity, at least two-thirds of the adjustable gastric banding patients are able to lose at least 50% of their excess weight and keep it off for ten years or longer.
In addition to losing excess weight, the weight loss usually leads to an improvement or resolution of health conditions associated with obesity, such as type 2 diabetes, high blood pressure, and severe sleep apnea.
Although the rate of weight loss in the first year is not as quick as with gastric bypass surgery, or the sleeve gastrectomy, the weight loss at five years after surgery is approximately the same. The rate of weight loss with adjustable gastric banding is approximately 1-2 pounds per week, an amount considered healthy. A more gradual weight loss leads to less nutritional deficiencies and a lower incidence of side effects, such as gallbladder problems and hair loss. Overall, Weight Loss surgery patients can expect significant weight loss results at a healthy rate with laparoscopic adjustable gastric banding.
The "LAP-BAND®" trademark uniquely identifies the first adjustable gastric banding device approved by the FDA in the United States in 2001, which is manufactured and sold by Allergan, Inc.
The REALIZE Band is manufactured by Ethicon Endo-Surgery, a division of Johnson & Johnson. It was originally marketed outside of the United States as the Swedish Adjustable Gastric Band (SAGB), where it has been available commercially since 1996. It entered US clinical trials in 2003, and was approved in 2007 by the FDA for use in the United States.
Gastric Sleeve Surgery, also known as Gastric Sleeve Resection or Vertical Sleeve Gastrectomy (VSG), is a restrictive type of weight loss surgery that permanently reduces the size of the stomach. It promotes weight loss by limiting food intake and lessening the sensation of hunger; it does not involve intestinal rerouting or food malabsorption.
The gastric sleeve procedure has been gaining attention in recent years as an effective Weight Loss option, yet it is not a completely new type of surgery for weight loss. It has been performed by Weight Loss surgeons for quite some time, but usually as the first part of a two-stage operation. Originally, the gastric sleeve surgery was designed to be followed up by a second procedure, either gastric bypass or duodenal switch surgery, at a later date. The purpose of the two-stage approach is to make weight loss surgery safer for high-risk patients, particularly individuals with a high body mass index (BMI greater than 50 to 60) and/or with health conditions that make them unacceptable candidates for a single, combined restrictive and malabsorptive surgery.
In recent years, many weight loss surgeons have begun to perform gastric sleeve surgery as a stand-alone weight loss procedure. While long term results are not yet available, short term weight loss results have been primarily favorable, especially in low BMI patients (BMI 35 to 45).
During gastric sleeve surgery, the weight loss surgeon removes approximately 60 to 80% of the stomach along the greater curvature, leaving only a small tube that is between 50 ml’s to 150 ml’s, or the size of a banana. Watch the Gastric Sleeve Surgery video. The procedure helps to limit eating by reducing the overall size of the stomach and control hunger by removing the part of the stomach that produces the hunger-stimulating hormone Ghrelin.
The cutaway part of the stomach is removed from the body and not left in place as with gastric bypass surgery, therefore the stomach reduction is permanent and the gastric sleeve procedure is not reversible.
Short term results show that gastric sleeve patients who have had the stand-alone procedure can expect to achieve a 60 to 70% excess weight loss at 2 years. Long term results are not yet available. If weight loss is insufficient following gastric sleeve surgery, a malabsorptive weight loss procedure such as the duodenal switch may be performed in order to promote further weight loss.
- Promotes weight loss by restricting amount of food that can be eaten at any one time
- Reduces hunger since it removes the part of the stomach that produces the hunger stimulating hormone ghrelin
- Digestion occurs normally as the digestive system is not altered
- Does not cause malabsorption or nutritional deficiencies as it does not involve rerouting or bypassing the small intestine
- Less chance of developing ulcers than with gastric bypass surgery
- Dumping syndrome not likely to occur as the stomach outlet (pyloric valve) remains intact, unlike gastric bypass surgery
- Less complicated procedure than gastric bypass or duodenal switch surgery
- Can usually be performed laparoscopically on extremely obese patients
- Does not require a gastric band being implanted into the body
- Does not require adjustments or fills as with a LAP-BAND or REALIZE Band
- Safer than a combined restrictive/malabsorptive weight loss surgery for patients who have many health problems
- May be converted to gastric bypass or duodenal switch if necessary for additional weight loss
- As it is a purely restrictive weight loss procedure, inadequate weight loss or weight regain is more likely than with a procedure involving intestinal bypass
- With time, new smaller stomach pouch may stretch (also occurs with gastric bypass surgery)
- Although the gastric sleeve helps control hunger and limit amount of food that can be eaten at any one time, weight loss will not occur without a healthy, low-calorie diet and regular exercise (same as with other purely restrictive procedures such as LAP-BAND and REALIZE Band)
- The surgery is not reversible as a portion of the stomach is permanently removed
- Leaks or bleeding may occur along the stomach stapling edge
- All surgery and anesthesia involves some level of risk including bleeding, blood clots, infection, pneumonia, or complications
- Lack of published data for long-term weight loss results
Gastric bypass surgery is the most commonly performed surgical procedure for weight loss in the United States. The operation is major gastrointestinal surgery that permanently and substantially alters the stomach and intestines. The gastric bypass procedure yields impressive weight loss results, however, it is not performed for aesthetic reasons. It is used to treat morbid obesity and obesity co-morbidities through food restriction and malabsorption, helping significantly overweight individuals achieve lasting weight loss and improved health.
Gastric bypass surgery is a term describing any of the various forms of weight loss surgery that involve reducing stomach size and bypassing a portion of the small intestine. All forms are similar in that a large portion of the stomach is sectioned off to reduce the amount of food that can be eaten and the small intestine is divided and rerouted to reduce the absorption of calories.
Gastric bypass surgery uses both a restrictive and malabsorptive approach to weight loss.
- A restrictive procedure is one that limits the amount of food that can be eaten at any one time. In gastric bypass surgery, this is done by creating a new smaller stomach that forces smaller meal portions.
- A malabsorptive procedure is one that reduces the amount of food absorbed by the digestive system. In gastric bypass surgery, this is done by bypassing the upper portion of the small intestine. Since the food passes thru less of the intestines where digestion takes place, food is only partially digested and there is less absorption of nutrients and calories.
When first developed the late 1960's, gastric bypass surgery used a loop bypass with a larger stomach. The loop configuration resulted in bile reflux, however, and the operation was modified into the Roux-en-Y (RNY) configuration that is popular today. With Roux-en-Y gastric bypass, a limb of the small intestine is attached to a very small stomach pouch. This form, unlike the initial loop configuration, prevents bile from entering the upper part of the stomach and esophagus. The remaining stomach and first portion of the small intestine are bypassed.
The Roux-en-Y is now the most common variation of gastric bypass surgery. It has been proven in numerous studies to result in durable weight loss and an improvement in health problems associated with obesity. Although not without risk, the results have earned it the distinction as the gold standard for Weight Loss surgery. The procedure has been accepted by most weight loss doctors and insurance companies as an effective treatment for morbid obesity when diets and exercise fail.
In Roux-en-Y gastric bypass surgery, the stomach is divided into a smaller, upper pouch and a larger, lower section, and the small intestine is divided and rerouted. The new smaller stomach pouch is created at the top of the stomach where the food enters from the esophagus using surgical staples to completely separate it from the lower portion of the stomach. The remaining larger, lower portion of the stomach is bypassed but not removed from the body.
Then, the lower portion of the small intestine is attached to the new stomach pouch. The upper part of the small intestine is bypassed in the digestion process. Since the natural stomach outlet is located in the cutaway portion of the stomach it is also bypassed, so a new stomach opening called a stoma is created at the connection between the new stomach pouch and reattached small intestine. Watch the Roux-en-Y Gastric Bypass video.
- More rapid weight loss following surgery than with purely restrictive methods
- Smaller stomach limits amount of food that can be eaten at any one time
- Intestinal rerouting limits amount of calories absorbed by the body
- Intake of sweets controlled because of Dumping Syndrome
- Resolves and/or improves certain obesity-related health conditions as weight loss occurs
- Complex operation, surgery risks include infection, leaks, and blood clots
- Vitamin and mineral deficiencies, can lead to metabolic bone disease and anemia
- May experience ulcers, bowel obstruction, or reflux
- Dumping Syndrome
Dumping Syndrome, which can cause nausea, diarrhea, and weakness, occurs when sweets enter the bloodstream too quickly. Gastric bypass surgery can cause dumping syndrome because the digestive system has been altered and foods enter the intestines more quickly. Dumping syndrome controls the intake of sweets and high calorie foods. It is considered both an advantage and disadvantage of gastric bypass surgery.
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