Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Obesity is a growing concern. Recent statistics show that 30% of Americans meet the criteria for obesity. By medical standards, obesity is defined as having a body mass index (BMI) of over 30 kg/m2. While lifestyle modification remains the cornerstone for treatment, surgical options are becoming more popular. One of the surgical treatments for obesity is called gastric banding, commonly known as lap-band surgery. Some of the specifics of gastric banding will be addressed in this article.
What is gastric banding?
Laparoscopic adjustable gastric banding (LAGB) is a surgical procedure that involves the placement of an adjustable belt around the upper portion of the stomach
using a laparascope. The band is made of silicone and can be tightened by adding saline to fill the band (like blowing air into a doughnut-shaped balloon). The band is connected to a port that is placed under the skin in the abdomen. This port is used to introduce or remove saline into the band.
LAGB ultimately restricts the size of the stomach and the amount of food it can hold. It also slows the passage of food to the intestine. By doing so, signals to the brain from the gut allow for a sensation of fullness and satiety with the consumption of less food.
This signal is sent from a small pouch created by the band in the upper stomach.
When the pouch fills, the same signal is sent to the brain that occurred
previously when the entire stomach filled.
What is a lap band?
The LAP BAND® is a specific device brand name and is made by Allergan Inc. The term is often used in the lay community interchangeable with gastric banding (similar to the way we interchange the brand name Kleenex for facial tissue). There are different sizes and models of the LAP BAND. There are also other companies that make gastric banding devices such as the REALIZE® adjustable gastric band (by Ethicon), the MIDBAND®, and the Heliogast® gastric band (which are not available in the US).
Who are candidates for the lap band system?
Generally, candidates for LAGB have a body mass index over 40 kg/m2, or are more than 45 kilograms over their ideal body weight. LAGB can be performed on a person with a BMI of 35-40 kg/m2 if there are
problematic medical conditions that are weight-related, such as high blood pressure (hypertension) ordiabetes.
Most surgeons and programs will want to note a history of failed weight loss
in the past using more conventional approaches. The procedure is indicated for
adults only, and is not to be performed on those less than 18 years old. All
patients must demonstrate an understanding of the procedure, and be willing to
adhere to the lifestyle changes that are needed to make this procedure
successful. Most large centers have a psychological assessment to assure that this last criteria is met.
LAGB is usually contraindicated if the potential patient has difficulty understanding the procedure, is emotionally unstable, or is dependent on drugs or alcohol. Those potential cases with a history of gastrointestinal problems such as ulcers need to be reviewed carefully. Similarly, those that have underlying medical conditions that make them high risk for surgery- such as heart or lung conditions- may be refused the procedure. Associated with these risks is a BMI of greater than 50kg/m2. In this group, there may be a request to lose weight prior to the procedure (although this seems paradoxical). Again, the risks of the procedure in this subgroup of obese patients may outweigh the benefits of surgery. By dropping the BMI under 50 kg.m2, outcomes may be better.
While there is growing discussion about offering LAGB to those with a BMI of 30-35 who have diabetes, there are no current guidelines to allow for this.
Considering Gastric Bypass Surgery? Important Questions to Ask Yourself
Bariatric surgery refers to surgery performed on the
stomach and/or intestines to decrease the amount of food that can be consumed
and, as a result, to help a person with extreme obesity lose weight. Adjustable
gastric banding and gastric bypass are the two main types of bariatric surgery.
In adjustable gastric banding, a reversible procedure, insertion of a band restricts the size of the opening from the esophagus to the stomach. The size of the opening to the stomach determines the amount of food that can be eaten. Gastric bypass is a permanent reduction in the size of the stomach in which a small pouch is created from the proximal portion of the stomach and attached to the intestine in a location that bypasses about 2 feet of normal intestine. The amount of food that can be eaten is limited by the size of the pouch and the size of the opening between the pouch and the intestine.