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Weight-loss Solutions
Laparoscopic gastric banding is a type of weight-loss surgery. It was developed by Dr Kuzmak from New Jersey in the United States in the 1980’s, and has been further refined and developed since then. It is our preferred procedure at OClinic. (
The gastric band is made from high grade medical silicon, a safe and inert material. It is placed around the top of the stomach by laparoscopic (keyhole) surgery. The operation takes about one hour, and is performed under a General Anaesthetic. Four or five small incisions are made on the upper abdomen, the gastric band is placed around the stomach, and a few holding stitches are placed around the band to keep it in the correct position. Next, an adjustable access-port is placed deep under the skin through one of the incisions and connected to the band by special tubing. (Remember as there is no cutting or stapling involved, gastric banding can be reversed at any time.) The skin incisions are closed by absorbable sutures which are invisible and do not need to be removed.
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| typical appearance of wounds after 2 weeks | typical appearance of wounds after 6 months in another patient |
Who's Gastric banding suitable for?
Gastric banding may be suitable if:
- you have a BMI of at least 30 and been struggling with your weight for many years despite several genuine attempts at weight reduction (click here to check your BMI)
- your weight problem is not caused by an underlying endocrinological disorder or medication
- you are at least 16 years of age (note there is no upper age limit- our oldest patient is 76)
- you are ready to actively participate in our ongoing multidisciplinary program
If you also have type-2 diabetes, high blood pressure, sleep apnoea, or other obesity related medical disorders, or have a family history of these problems, weight loss surgery may be especially beneficial in improving your health and longevity.
Temporary diet around the time of surgery
Before surgery: Optifast phase for 2 weeks
During your initial consultation with our dietitian, you will be asked to replace your regular meals with Optifast for 2 weeks prior to your surgery. The reason for this is to shrink the fat out of your liver, which will greatly improve access to the top of the stomach. This allows your surgery to be performed as safely and accurately as possible.
There are a number of things you can also eat during this phase to keep it more interesting- vegetables, soup, yogurt, calorie free drinks, etc. Our dietitian will provide you with a handout explaining everything clearly.
weeks 1&2 after surgery: fluid phase
In order to allow the band to settle in, it is important to have liquids only during the first 2 weeks. This is usually quite easy as most patients find they are not hungry after surgery because of the normal swelling. You may have any type of fluid you chose, provided you drink it slowly. Our dietitian will provide you with clear instructions to guide you through this period.
weeks 3&4 after surgery: soft food phase
During the 3rd and 4th week after surgery you may increase the variety of your intake to include soft and pureed foods, as the swelling will now be settling. Our dietitian will see you again at the beginning of this phase to help and guide you. Remember this phase is only temporary- you will be able to eat a wide variety of regular foods from week 5 onwards.
Eating with a band long term
Finally- normal food again!
Once the first month is over, the swelling around your band will have settled and the sutures healed. You are now able to once again return to a wide range of everyday solid food such as chicken, fish, soft meats, pasta, rice, fruit and vegetables.
The main difference now is that the quantity of food you need to eat in order to feel full will be much less. Eating out at restaurants is fine- most patients just order an entree. Patients commonly report that food even tastes better, as they are now taking the time to enjoy it.
We want you to maintain as wide a range of food choices as possible. In fact it is important for your band to work properly that you do eat proper solid food. The most important thing is to chew well and eat slowly.
There are a couple of food types that can be a problem such as fresh white bread and tough steak. On the other hand, toast or wholemeal breads are usually OK, and softer meats such as chicken, fish, veal, mince, etc work well. You will be seeing our dietitian on a regular basis, so just tell us if you are experiencing any difficulties.
How it Works
How does it work?
The band allows you to eat much less but still enjoy your food and feel satisfied. It seems to work by three distinct ways:
1. reducing background hunger (satiety)
2. allowing you to feel full with smaller meals (early satiation)
3. preventing overeating. (restriction)
The exact mechanisms by which these effects occur are still being researched, however it appears that the band alters the signals sent from the stomach back to the hypothalamus (appetite control centre in the brain). Stomach stretch signals are generated much earlier, and pressure from the band itself appears to create a background sense of fullness. The vagus nerves, which run on the stomach next to the band area, are important in bringing this information back to the brain.
How Much Weight is Lost
The average patient in our clinic sheds 60-70% of their excess weight within 2 years, and studies show that this is maintained long term. The majority is lost within the first 12 months. Well motivated patients may lose more than the average- up to 100%. Regular participation in our aftercare program is the key. We view it as a partnership.
The weight loss works out at between 0.5kg-1kg each week. This is a healthy and safe rate of weight change that will allow the rest of your body to catch up. If weight loss becomes too rapid it can lead to hair loss, lethargy, sunken complexion, and interruption to normal menstrual cycles- if weight is being lost too fast we simply remove some of the band fluid. This is another advantage of the gastric band.
Band Adjustments
Everybody is different- one size does not fit all!
The adjustability of the band is a significant advantage over other weightloss procedures, as it allows its effect to be customised for each patient to properly control hunger. It also allows this control to be maintained as the stomach loses its surrounding fat with weight loss. Another benefit of being adjustable is that the band can be easily loosened if you fall pregnant, or become ill.
During your gastric band surgery, a small access-port is placed deep underneath one of your abdominal scars. This port is connected to the band by thin tubing. The access port allows the size of your band to be adjusted with a high degree of precision using sterile saline.
The first adjustment is performed 6 weeks after surgery. Several adjustments are usually performed in the first year to fine-tune the size of the band. When the size of the band becomes just right you are in the ‘green zone’. In the green zone you should still be able to comfortably eat a wide range of food choices, but your hunger will be greatly reduced allowing you to feel satisfied by less. Contrary to what many people expect, weight loss is actually best when you are in the green zone, rather than being tighter.
Do adjustments hurt?
A special needle called a Huber needle is used to deliver saline into the port. This needle differs slightly in shape from a conventional needle and will not damage your access-port. Adjustments are usually quite painless, usually no more than a gentle pinch. Most patients are pleasantly surprised at just how quick and painless adjustments are. We do however have local anaesthetic available should you prefer it.
Who performs the adjustment?
Adjustments are performed in the clinic and only take a few minutes. They are a crucial component of gastric band aftercare and must only be performed by doctors with adequate training and experience. At OClinic Dr Taylor and Dr Edwards review patients on a monthly basis in the first year or two to check on hunger levels and amount of food needed to feel full, and base the need for an adjustment accordingly. As you lose weight each month, the amount of fat around your stomach diminishes, therefore your band needs to be regularly adjusted to keep up with this change. (if this is not done you may start to drift into the 'yellow zone' and your weight may plateau). Once your goal weight has been reached, further adjustments are needed much less often, and clinic appointments can usually be reduced to once a year.
Risks
Are there any risks?
No surgery is completely risk free- however gastric banding is very safe. The risk of a serious complication during surgery is less than 1%. It is much safer than other types of weight loss surgery, which is the main reason why it is the preferred option for the overwhelming majority of Australian patients.
It is important however that your surgeon is well trained and experienced in the gastric banding procedure- don’t be afraid to ask how many gastric banding procedures he/she has performed and what their complication rate is.
Problems that may occur long term include band slippage, erosion, and access-port issues. All up the chance of something happening to your band that requires another operation to correct is about 10% long term. Fortunately most problems are quite straight forward to fix, allowing your band to continue to provide ongoing hunger and portion control. At OClinic we pride ourselves on supporting our patients longterm, and being readily available to help if any issues arise. However it is wise to maintain an appropriate level of health insurance so that any problems that may arise can be corrected at minimal cost to you.
Procedure Animation
Now let's see a real gastric banding procedure.
Below is a real gastric banding procedure- caution: contains real surgical footage!
The procedure is really quite simple- first the left lobe of the liver is lifted up to expose the stomach organ. Because the liver normally covers the stomach, a fatty liver can make access more difficult. This is why we use a low carbohydrate diet such as Optifast for 2 weeks before surgery in order to shrink the liver back down to a normal size.
The next steps involve creating a tunnel behind the stomach for the band. It is important that this tunnel is in the correct place to ensure the stomach pouch is the right size.
After the band is brought through the tunnel it is locked into its circular shape. To prevent the position of the band slipping, 5 sutures are used to stabilise the stomach around the band. These sutures are very important to reduce the risk of band slippage- we have found the risk of slippage in our experience is less than 1% with this 5 suture technique. (These sutures do not damage the stomach, and can be easily taken out if a patient ever decides to have the band removed.)
The last part of the procedure involves connecting the white tubing to the access-port, which is placed under the skin near the umbilicus. The access-port cannot be seen from the outside, but is still close enough to the surface to perform an adjustment in the clinic without needing specialised equipment or Xrays.
(click here if does not play)
Would like to see more real surgery?
Below are links to view another gastric banding procedure. It is unedited and live, and was performed by Dr Craig Taylor at the Mater Private Hospital as part of a training demonstration for General Practitioners. A microphone was used by Dr Taylor throughout the procedure to explain the procedure in detail as well as answer questions from the audience.
The 30 minute long video has been broken into 3x10min clips which can be viewed on Youtube via the following links:
Part 1: www.youtube.com/watch
Part 2: www.youtube.com/watch
Part 3: www.youtube.com/watch
Further Reading
click here to read a recent article written by Dr Taylor that discusses the advantages and disadvantages of Gastric Banding. This article was recently published in the respected medical journal Cardiology in General Practice.
click here to read about the Sleeve Gastrectomy
click here to read about costs
click here to read about real patient experiences and testimonials
Click here to go back to the homepage and check your Body Mass Index to see if you are suitable for our weight loss program.