most commonly perform two types of gastric
banding operations.
- Vertical gastric banding (VGB), also called verti-
cal banded gastroplasty, partitions the stomach
into two vertical segments. Surgical staples sep-
arate the segments, leaving a narrow channel
between them. The small gastric pouch limits
the amount of food the person can consume. A
silicone band constricts the channel between
the two gastric chambers to significantly slow
the flow of food from the upper gastric pouch
to the lower segment of the stomach. Food
travels through the gastrointestinal tract in the
normal way though moves through the stom-
ach much more slowly than normal. - Adjustable gastric banding (AGB), also called lap
banding, partitions the stomach solely through
the use of an inflatable silicon band applied so
that it creates a gastric pouch that can hold
about 1 ounce. A narrow catheter extends from
the band to a port implanted beneath the SKIN.
The surgeon gradually inflates the balloon with
sterile saline during follow-up office visits to
increase constriction of the stomach.
Gastric banding operations are laparoscopic,
greatly reducing operative and postoperative risks
and complications, and have the added benefit of
being reversible. Most people return to normal
activities within four weeks after the surgery.
However, gastric banding has the lowest success
rate among the bariatric operations. Weight loss is
more gradual than with other operations. Over
time the stomach can stretch to hold considerably
more volume, depending on how much food the
person attempts to consume on a consistent basis.
Because food continues to the small intestine and
digestion of it remains unaffected, a person who
consumes high-CALORIEfoods after a gastric band-
ing operation may end up losing little if any
weight.
About 80 percent of people who undergo gas-
tric banding operations lose weight after surgery
and about 50 percent reach the goal of losing 50
percent of their excessive weight within the first
year after surgery. About 20 percent, however, do
not lose weight because their lifestyle habits
remain unchanged and their stomachs quickly
regain capacity.Risks and Complications
Any bariatric operation is major surgery with
inherent risks, including excessive bleeding during
or after the operation and INFECTION. Infection in
the early postoperative period is a particular risk
with any surgery on the gastrointestinal tract.
Leakage of gastrointestinal contents into the
abdominal cavity can cause PERITONITIS, a poten-
tially life-threatening infection of the membrane
that lines the abdominal cavity. Emergency sur-
gery may be necessary to treat peritonitis. BLOOD
clots may break free from blood vessels at the
operative site, traveling through the body until
they lodge in blood vessels too narrow to carry
them any farther. Blood clots can occlude (block)
arteries or veins anywhere in the body, including
the LUNGS (PULMONARY EMBOLISM), BRAIN(STROKE),
andHEART(MYOCARDIAL INFARCTION).Though the risk dying as a consequence
of bariatric surgery is less than 1 percent,
many people who have OBESITYalso have
other health conditions that increase
their risk profile. It is important to fully
understand the risks of surgery com-
pared to the risks of the obesity.About 50 percent of people who undergo
bariatric surgery experience complications after
the operation, most of which are manageable
postoperatively though may become chronic. Mal-
absorptive operations that bypass the small intes-
tine have high risk for vitamin, mineral, and
protein deficiencies. One in three people who
undergo a weight loss operation develops chronic
nutritional deficiencies with long-term health
consequences such as OSTEOPOROSIS and ANEMIA.
One in five requires additional surgery to repair
problems such as fistula (abnormal opening) or
HERNIA. The rapid weight loss of bariatric surgery
triggers GALLBLADDER DISEASE, especially the forma-
tion of gallstones, in half of people who undergo
bariatric surgery.
Milder common complications include GAS-
TROESOPHAGEAL REFLUX DISORDER(GERD); belching;bariatric surgery 287