Gastric Banding 

Introduction
Obesity is a growing nationwide epidemic. Obesity is associated with serious health problems, including heart disease, diabetes, and high blood pressure.  Doctors may recommend the gastric banding weight loss surgery for people that are very obese and have not lost weight with diet and exercise. 
 
Laparoscopic gastric banding reduces the size of the stomach to assist in weight loss.  Because the weight loss surgery is performed laparoscopically using small incisions, recovery is faster and less complicated than with other weight loss procedures.  Laparoscopic gastric banding can result in a 40% to 60% weight loss over the first three years after the procedure.
 
Gastric banding is not a quick fix for obesity.  Instead, gastric banding requires preparation and careful consideration.  You should anticipate making permanent lifestyle changes, including diet and exercise following the weight-loss surgery.
 
Doctors may recommend gastric banding for people:
• With a Body Mass Index (BMI) of 40 or more
• With a Body Mass Index of 35 or more and a serious medical condition, such as type 2 diabetes, heart disease, high blood pressure, arthritis, or sleep apnea, that might improve with weight reduction
• That are not dependent on drugs or alcohol
• That do not smoke
• That are mentally stable

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Anatomy
When you eat, your tongue moves chewed food to the back of your throat.  When you swallow, the food moves into the opening of the esophagus.  Your esophagus is a tube that moves food from your throat to your stomach.  Muscles in the wall of the esophagus slowly squeeze the food toward your stomach. 

A ring of muscles is located at the bottom of the esophagus.  It is called the lower esophageal sphincter (LES).  The LES opens to allow food to enter the stomach.  The LES closes tightly after the food enters.  This prevents stomach contents and acids from backing up into the esophagus.  The esophagus does not secrete mucus that protects it from stomach acids. 

The stomach secretes mucus to protect its lining from the acids.  Your stomach produces acids to break down food for digestion and processes the food you eat into a liquid form.  The processed liquid travels from your stomach to the small intestine.
The small intestine is a tube that is about 20-22 feet long and 1 ½ to 2 inches around.  The duodenum is the first part of the small intestine.  It is a short C-shaped structure that extends off of the stomach.  The jejunum and the ileum are the middle and final sections of the small intestine.

Your gallbladder works with your liver and pancreas to send bile and digestive enzymes to the first part of your small intestine.  Your small intestine uses these digestive products to further break down the liquid from your stomach so your body can absorb the nutrients from the food that you ate.  The remaining waste products from the small intestine travel to the large intestine.

Your large intestine, also called the large bowel or colon, is a tube that is about 5 feet long and 3 or 4 inches around.  The lower GI tract is divided into sections, including the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal, and anus.  The appendix is located on the cecum, but it does not serve a purpose in the digestive process. 
 
The first part of the colon absorbs water and nutrients from the waste products that come from the small intestine.  As the colon absorbs water from the waste product, the product becomes more solid and forms a stool.  The large intestine moves the stool into the sigmoid colon, where it may be stored before being traveling to the rectum.  The rectum is the final 6-inch section of your digestive tract.  No significant nutrient absorption occurs in the rectum or anal canal.  From the rectum, the stool moves through the anal canal.  It passes out of your body through your anus when you have a bowel movement.

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Treatment
Preparation for Laparoscopic Gastric Banding

You weight loss surgeon will request that you visit other health professionals.  You will need a complete physical including blood tests, ultrasound, and lab tests.  Your doctor will document that you are healthy enough for surgery.

You will participate in classes to learn more about the laparoscopic gastric banding procedure and healthy eating.  By attending classes about gastric banding, you will gain an understanding of the preparation process before surgery, the surgical procedure, what to expect during recovery, realistic outcomes, and risks.  You will learn about healthy eating and healthy living before and after your weight loss surgery. 

You will meet with a mental health provider.  The decision to have weight loss surgery is a very individualized and personal.  A mental health provider can help determine if you are ready for such a dramatic lifestyle change.

Lap-Band Gastric Surgery

Laparoscopic lap-band gastric surgery is a short procedure, usually one hour or less.  You may stay overnight in the hospital, although some people go home the same day as the surgery. You will receive general anesthesia for the lap-band surgery. 

To begin, your surgeon will make a few small incisions in your abdomen. She will insert a laparoscope through the incisions during your surgery. A laparoscope is a thin tube with a viewing device.  The laparoscope transmits images to a monitor.  The images allow the surgeon to view the inside of the body during the procedure.

The surgeon performs the procedure by passing thin surgical instruments through the other small incisions during the lap band procedure. Your surgeon will create a small pouch in your stomach by placing a band around the upper stomach.  The band divides the stomach into two sections, the pouch is in the upper smaller section and the other portion of the stomach is the lower larger section.  The band constricts the stomach to create a narrow opening between the two sections. 

The band is hollow and adjustable in size.  Your surgeon can adjust the size of the opening by filling the band with saline solution through a port placed beneath the skin.  The band size can be increased or decreased in the same manner following surgery. 
 
Recovery
 
Because lap-band stomach surgery uses small incisions, it is associated with a fast recovery time and minimal scarring.  Most patients return to work one week after surgery.
 
Outcome
 
Follow your doctor's instructions carefully following lap-band surgery.  You will need to adopt a long-term plan for eating and exercise.  You will begin on a liquid diet, then a pureed diet, and advance slowly to solid healthy foods. Most people eat small portions of solid healthy foods the third week after surgery. 
 
The new pouch is substantially smaller than your stomach; about the size of an egg.  The pouch will fill quickly when you eat and empty slowly.  You will feel fuller sooner and less hungry.  Eating too much food can cause vomiting or pain.
 
Your doctor will adjust the size of the band six weeks after your procedure.  You will receive band adjustments periodically thereafter, depending on how much weight you lose and how much you can eat. 
 
You can expect to lose 40% to 60% of your excess weight over the first three years.  Your success depends directly on your ability to follow your diet and exercise plan.  In many cases, medical conditions associated with obesity resolve or improve following weight loss.

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Complications
Gastric banding weight loss surgery is associated with certain risks, including those associated with general surgery.  Your doctor will review the risks of laparoscopic gastric banding with you prior to the procedure. People that are not able to follow diet and exercise recommendations regain weight or fail to experience weight loss. The band is removable with surgery.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.