Laparoscopic Gastric Band
At the latter part of the 1970s, several surgical approaches were developed whose sole purpose was to limit food intake of the gastro intestinal tract without continuity disruption. In 1978 a non adjustable band was located around the upper part of the stomach by open procedure. The early 1980s brought further developments with the implantation of Gastric Bands that were non adjustable and made from various materials, including gore tex, dacron vascular prosthesis, silicone covered mesh, and marlex mesh, among others. In addition, a 10.5 cm polypropylene gastro clip with a 50cc pouch with a fixed 1.25 cm stomach outlet, which was abandoned later due to abnormally high rates of gastric erosion. These early restriction attempts using clips, bands, and meshes, displayed a high failure rate due to difficulty in achieving correct stomach diameter, intractable vomiting, food intolerance, erosion, pouch dilatation, and stoma slippage. In spite of these difficulties, it was determined that silicone was the best tolerated material for a gastric device, with far fewer tissue reactions and adhesions than with other materials. However, adjustability became the mainstay of these early pioneers.
The Adjustable Gastric Band is a hollow band made of sylastic. The band is located around the upper portion of the stomach to create a small stomach pouch. This pouch initially holds 2 ounces of food, but will eventually hold 4 to 6 ounces. The upper portion of the stomach is now restricted which results in a longer lasting sensation of being full because the nerves, located in the upper area of the stomach, signal the brain that you're full. The band further works by slowly allowing the food you eat to be released into the lower portion of the stomach for digestion. A tube that ends with a port attached, just below the ribs, to abdominal muscles, is then attached to the band. The port's purpose is to provide access to the band by which saline can be added slowly filling the band which causes increased restriction of the stomach. Immediately after surgery the band is empty. About six weeks after Gastric Band surgery, or whenever a plateau in weight loss is reached, the surgeon adds a small amount of saline in the band. Only small amounts of saline are added each time although the band can hold about 4 to 5 cc's of saline. The amount of fill added during each visit vary according to individual patient circumstances.
The Laparoscopic Adjustable Gastric Band surgical procedure is performed under anesthesia in a hospital operating room. During surgery three to five one-half inch to two inch incisions are made in the upper abdomen. Barring complications, the procedure takes about one hour to perform. Some complications are serious enough to make a laparoscopic procedure impossible, and all patients undergoing this procedure should be aware of this fact. If this is the case, the surgeon will convert to an open procedure with a five inch incision and longer recovery period. Many surgeons allow patients to return home the same day, however, some surgeons may require their patients to stay overnight pending release from the hospital about 24 hours post surgery. Although most Gastric Band patients feel quite well after two or three weeks, full recovery takes six weeks.