“ LAGB can achieve effective, safe and stable long-term weight loss. In experienced hands, the complication rate is low. Follow-up is paramount. ”
Reasons to perform gastric banding
Since many years gastric banding is an important surgical procedure in the repertoire of bariatric departments.
Although various bariatric departments currently shifted their focus to the gastric bypass and the gastric sleeve, gastric banding has specific advantages that should be taken into account.
It is a safe and relatively simple procedure, which is well documented over longer periods of time.
Next to that gastric banding is completely reversible, leaving the anatomy intact and keeping options open to perform other kinds of bariatric surgery later.
Limitations of Gastric Banding
Fig. 1: different levels of dietary discipline required in different bariatric procedures
Since gastric banding requires more dietary discipline than gastric bypass and sleeve gastrectomy (see fig. 1), it is clearly not a surgical option suitable for every patient.
Sweet eaters and patients with disorganised lives will find it hard to achieve their goals through gastric banding, but those who do qualify for the procedure will find a good chance of resolving their morbid obesity and its associated co-morbidities without running the risk of severe complications as associated with gastric bypass and sleeve gastrectomy.
Long Term Results Gastric Banding
Various long term studies like the one by O’Brien (1) have shown an average success rate of more than 50% for gastric banding, but it must be noted that the post-operative follow-up program has proven to be of paramount importance in achieving such good results by Steffen (2).
These findings are also e.g. supported by the 12 year experience of Favretti (3), confirming a very low complication rate.
|By sutures without plication||By tissue ingrowth without plication||Center||Maaseik, Belgium||Lodz, Poland|
|Year of Surgery||2003-2009||2005-2009|
|No. of Implanted MiniMizer bands||583||372|
Fig. 3: Low complication rates, satisfying medium term EWL by Claessens and Szewczyk (4)
One of the most common complications with gastric banding is band slippage, which is virtually reduced to 0% using direct fixation of the gastric band on to the stomach wall, avoiding the gastro- gastric plication (see fig. 2).
Bariatric Solutions has specifically developed the MiniMizer Extra, the only gastric band which can be used in gastric banding without having to make a gastro-gastric plication. 10 Fixation loops allow for direct fixation with sutures or indirect fixation, based on tissue ingrowth. Collet already described the superior effect of the loops in reducing the complication rate of band slippage in 2005 without increasing the erosion/migration rate.
These finding are supported by 7 and 5 year follow up series by Claessens and Szewczyk (4), with limited complication rates and EWL’s between 55-60% (see fig. 3).
Gastric banding is a viable and successful option to start bariatric surgery with, as long as proper patient selection and follow up programs are in place.
- Systematic Review of Medium-Term Weight Loss after Bariatric Operations
Paul E. O’Brien, MD, FRACS; Tracey McPhail, BSc; Timothy B. Chaston, BAppSci, PhD; John B. Dixon, MBBS, PhD, FRACGP, Obesity Surgery, 16, 1032-1040
- Successful Multi-Intervention Treatment of Severe Obesity: A 7-year Prospective Study with 96% Follow-up
Rudolf Steffen & Natascha Potoczna & Norman Bieri & Fritz F. Horber
- Laparoscopic Adjustable Gastric Banding in 1,791
Consecutive Obese Patients: 12-Year Results
Franco Favretti; Gianni Segato; David Ashton; Luca Busetto; Maurizio De Luca; Marco Mazza; Andrea Ceoloni; Oscar Banzato; Elisa Calo; Giuliano Enzi
- Gastric banding with fixation but without plication (90 kb)
Frank Claessens, Steven Bessemans, Tomasz Szewczyk
- Dr. Claessens MiniMizer Video (67 MB)