WEIGHT LOSS (OBESITY) SURGERY / GASTRIC BAND REMOVAL
If you had a gastric band but not lost weight or have problems with a band like vomiting, restrictions, or have developed complications of a band like a slippage/erosion or simply want to remove it then please contact Dr. Girish Juneja
GASTRIC (STOMACH) RESTRICTIVE PROCEDURES GASTRIC BANDING DUBAI
Another restrictive gastric approach is laparoscopic gastric banding. This procedure, which was approved in the U.S. in June 2001, is popular since it is “ high tech ” (utilizes a laparoscope, an instrument which is inserted into the abdominal cavity) and recovery time is only a few days. Basically, an adjustable band is placed around the upper portion of the stomach, resulting in (essentially) a much smaller stomach. This restricts the amount of food that can be eaten, similar to the vertical banded gastroplasty (see above).
The European literature (where the procedure has been performed for a longer period of time) shows that weight loss is similar to that seen with vertical banded gastroplasty. Clinicians in the U.S. report less weight loss than our European colleagues. Complications include band slippage, erosion of the band into the stomach, dilation of the oesophagus, and infections, many of which require removal of the device.
SURGICAL RESULTS, COMPLICATIONS, AND NUTRITIONAL DEFICIENCIES:
Mean estimated excess body weight loss and complications from a study published in Obesity Research 2008 are as follows:
- At 7 Years: < 50% Of Excess Body Weight Lost
- At 9 Years: < 40 % Of Excess Body Weight Lost
- Major Late Complications Related To This Specific Surgery:
- Band Eroding Into The Stomach: 3.3%
- Slippage: 6.5 %
- Leakage: 9.8%
- Major Reapportion: 24.4%
- Nutritional Deficiencies From Gastric Banding:
- Rarely Significant Nutritional Deficiencies From The Surgery Itself
- Thiamine Deficiency If Persistent Vomiting
- Occasional Protein Deficiency From “ Induced ” Dietary Changes
The lap band is, in essence, a variation of an old surgery (gastric banding) that was abandoned in the 1980′s because of a high incidence of complications (bleeding and obstruction). This newer approach is less invasive than the “ old ” banding procedure and the band can be adjusted (tightened or loosened) as appropriate. Many clinicians recommend this procedure for older individual (60-65 years old) who would otherwise not be a candidate for surgical intervention.
SG produces weight loss & improvement in sugar control by following mechanisms
- Produces early satiety as a purely restrictive procedure
- Reduces plasma hunger hormone (ghrelin) levels by removing a great part of the Ghrelin production tissue.
- Diabetes reversal by some hormonal changes after sleeve surgery
– In sleeve surgery, resection of the fundus of stomach removes the major site of ghrelin release, therefore appetite decreases
COMBINATION RESTRICTIVE/MALABSORPTIVE PROCEDURES
Arguably, the “ gold standard ” in obesity surgery is the Roux-en-Y Gastric Bypass. This procedure involves both a “ restrictive ” procedure by decreasing the size of the stomach by stapling across the top of it and a “ malabsorptive ” component, achieved by bringing-up and attaching a portion of the small intestine directly to the stomach (thus “ bypassing ” part of the small intestine ). This surgery is much better tolerated than the “ old ” intestinal bypass surgeries done in the 1960s and early 1970s , but still results in significant nutritional deficiencies long-term (see below).
There is usually only mild malabsorption of nutrients (as compared to the old intestinal bypass surgery). This surgery causes gastrointestinal hormonal changes, which result in decreased hunger and improved satiety or fullness. Individuals undergoing this surgery will lose significant amounts of weight (mainly body fat as opposed to lean body mass or muscle tissue). Weight maintenance is generally excellent with small increases in weight occurring over subsequent years. Like any obesity surgery, the patient will require lifelong medical follow-up and treatment of the medical complications that usually occur, especially the vitamin B12 deficiency and anaemia.
Surgical Results, Complications, and Nutritional Deficiencies (reference: Gastroenterology. 2002 Sep;123(3):882-932):
Mean estimated excess body weight loss and complications:
At 2 years: approximately 66% of excess body weight lost
Major complications related to this specific surgery:
- Marginal Ulcers at the site of anastomosis (“ attachment ”) of the intestine to the stomach
- Stomal stenosis (“ narrowing ” ) at the stomach outlet, resulting in nausea and vomiting
- Leakage of intestinal contents
- Stomach staple line disruption resulting in the ability to consume large volumes of food
- “ Dumping Syndrome ” wherein consumption of food (especially carbohydrates) results in nausea, vomiting, diarrhea, abdominal pain, flushing, rapid heartbeats.
Nutritional Deficiencies from Roux-en-Y Gastric Bypass:
- Vitamin B12
- Vitamin D
This procedure is now usually laparoscopically, which offers a faster surgical recovery, but with the potential for more severe surgical complications.
BILIOPANCREATIC BYPASS PROCEDURES (AND SIMILAR EXTENSIVE INTESTINAL BYPASS PROCEDURES)
In these procedures, the digestive juices from the liver and pancreas are diverted to the distal small intestine near the entrance to the large intestine. Thus, food enters the stomach, rapidly transverses the distal small intestine (where absorption of nutrients primarily occurs), and is then delivered to the large intestine (where excess water from the stool is removed). This results in marked malabsorption of nutrients with subsequent marked weight loss (up to 80% of excess body weight). Since there is marked malabsorption of essential nutrients, the probability of vitamin, mineral, and protein-calorie malnutrition is significant. These procedures are generally best avoided since the marked nutrient malabsorption can result in severe long-term complications.