Gastric Banding at Sachsenhausen Clinic, Germany, Frankfurt

Gastric Banding

Gastric Banding at Sachsenhausen Clinic, Germany, Frankfurt

The so-called gastric band is a silicone bundle that is placed around the top of the stomach during surgery. It artificially divides the stomach into a small stomach and a big stomach. The small stomach has a capacity of only 20-30 milliliters, which roughly corresponds to the size of a ball for ping-pong. When the small stomach is stretched out by eating, it signals to the brain that it is full. The gastric band is an auxiliary device that helps during weight loss mainly by suppressing the feeling of hunger.

The gastric band is hollow inside and is connected through a small tube to the so-called access port system. A port is a small container that is implanted under the skin during gastric banding surgery. With a special needle, the port and the gastric band can be filled with liquid. This makes it possible to adjust the degree of tightening of the stomach if necessary. The more fluid is injected into the band, the more the stomach is constricted. If the liquid is pumped out, the inner diameter of the gastric band will increase again and the stomach will become more spacious.

Gastric Band Placement

Gastric banding takes about 30-60 minutes and is performed under general anesthesia. In most cases, the hospital stay is one day before surgery and from three to five days after it. As a rule, the intervention is performed laparoscopically (the so-called "keyhole surgery"). During this procedure, a total of 5 incisions are made in the skin, approximately two centimeters long, through which the camera and instruments are inserted. In order to implant the port, an additional longer skin incision along the lower edge of the sternum is required.

A silicone band is introduced through the surgical passage. The surgeon uses instruments to place the band around the upper part of the stomach (cardia) and tightens it just like a cable tie. In order to better determine the size of the small stomach, the next step is to introduce a gastric tube with a small inflatable balloon into the small stomach through the mouth. When inflated, it is the same size as a ping-pong ball (about 20-30 ml) and approximately corresponds to the target volume of the small stomach.

After inserting the gastric balloon, the gastric band can be moved slightly down or up or tightened a little bit. If the ideal position for the gastric band is found, it is additionally attached to the surrounding tissues with a few sutures.

Finally, the tube coming out of the gastric band is taken out through the incision in the abdominal wall area, placed and firmly sutured under the skin below the lower edge of the sternum. Thanks to the port, the diameter of the gastric band can be adjusted at any time by introducing and pumping out the liquid.

Approximately one month after the procedure, the port is punctured for the first time to introduce several milliliters of liquid. In most cases, the so-called contrast agent, which is visible on the X-ray image, is used as a liquid ( a total of max. 9 milliliters). Thus, for example, it is possible to detect leakage in the gastric band on the X-ray. Depending on the patient's job, it may take about 2-3 weeks to regain the ability for work.

Who Gastric Banding is Suitable for

Gastric banding is suitable for people with a body mass index (BMI) of more than 40 kg/m² (stage 3 obesity). If a person is overweight and suffers from metabolic diseases, such as diabetes mellitus, hypertension or sleep apnoea, gastric banding may already be advisable with a BMI of 35 kg/m².

However, in any case, it is essential that all conservative (non-surgical) measures have not resulted in any satisfactory results for more than 6-12 months. Such measures include, for example, nutritional counseling, physical exercise and behavioral psychotherapy (multimodal concept, MMI). Gastric banding is permitted between the ages of 18 and 65, although in some cases the operation may be performed on older or younger people.

Who Gastric Banding is Not Suitable for

Certain physical and mental illnesses make bariatric surgery, for example, gastric banding, difficult to manage. In particular, previous surgeries or congenital abnormalities in the stomach, gastric ulcer, addictive disorders and incurable eating disorders (e.g., compulsive overeating or bulimia) are serious contraindications for gastric banding. Pregnant women and people who have to regularly take medications that reduce blood clotting also have to refuse gastric banding.

Effectiveness of Gastric Banding

In comparison with other surgical techniques, gastric banding can provide a slight weight loss on average. Only a few patients have been able to normalize their weight with gastric banding (BMI ≤ 25 kg/m²). Insufficient loss of weight should be expected primarily if the patient consumes soft, high-calorie, fat-rich foods and beverages that can easily pass through the narrow opening of the gastric band.

Studies have shown that gastric banding can lead to a loss of up to 50% of excess weight over time. This information is often not understood correctly. This does not mean that the use of this technique results in a loss of 50% of the weight. If, for example, a patient has a BMI of 45 kg/m² before gastric banding, this means 20 kg/m² more than the normal weight (max. 25 kg/m²). If the patient has managed to bring his or her BMI down by 10 kg/m² to 35 kg/m² by means of gastric banding, this corresponds to a loss of 50% of the excess weight.

Advantages of Gastric Banding over Other Techniques

Gastric bandaging is a relatively simple intervention. If the surgery technique is correct, it poses minimal risk to the patient. Relatively low surgical risks in particular should not be underestimated in view of the fact that overweight people have higher surgical risks in any case. Another big advantage of gastric banding is that it is relatively easy to remove the band at any time, i.e. the intervention is completely reversible.

Risks and Complications

In general, there are usual surgical risks when placing a gastric band. These include bleeding, damage to organs, infectious diseases, suturing and anesthesia-related problems. There is also a risk of damaging the stomach during surgery.

But the results of recent research indicate that the share of complications during gastric banding is relatively high. The problem is not the operation in itself which is relatively safe, but the complications that can occur months or years after the operation. The most frequent specific complications of gastric banding include:

  • Gastric band displacement (approximately 5.5% of all cases)
  • Expansion of the small stomach because of its gradual stretching (dilation of the small stomach, in about 5.5% of cases)
  • Damage to the gastric band or to the tube that connects it to the port with a leakage of the solution (in approximately 3.6% of cases)
  • Esophagus stretching over the gastric band (in about 3% of cases)

In very rare cases, there may be more serious complications, such as a puncture of the stomach wall with the band (perforation of the stomach) or infection of the port. In some studies, the risk of repeated (revision) surgery after gastric banding is estimated at about 30-50%. This is a problem in view of the fact that any abdominal surgery may entail adhesions and scarring, which can greatly complicate subsequent operations and cause severe complications including intestinal obstruction.

Nutrition after Gastric Banding

Nutrition recovery begins exclusively with liquids on the first postoperative day. They are to be drunk slowly all day so as to stretch the throat. Then the doctor gives you a meal plan with a detailed description of your diet for the next four weeks. For about two weeks, the food is extremely liquid. In the next two weeks, the diet is just soft food. Approximately four weeks after the operation, the usual diet is finally provided. However, there are a few things that need to be taken into account:

  • The person who has a gastric band should not only eat less, but also eat in a different way than before. So that the food mass can pass through the narrowed area, it is necessary to chew each piece very carefully. Long-fibered meat (beef, pork) or vegetables are often a problem.
  • As the liquids remain in the small stomach for a relatively short period of time, you should not eat and drink at the same time.
  • The person who has a gastric band should avoid sweets, especially sweet drinks, as well as alcohol, high calorie soups and cereals. They pass freely through the narrowed area between the small and big stomachs, contribute to weight gain and thus impede weight loss.
Prof., Dr. med. Plamen Staikov

Prof., Dr. med. Plamen Staikov

Medical Director, Head physician

Holger Bahn

Holger Bahn

Senior physician

Dr. med. Konrad Stubbig

Dr. med. Konrad Stubbig

Head physician of Anesthesia Department

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