Gastric banding (synonym: gastric banding) is a surgical procedure used in bariatric surgery. It may be offered for obesity with a BMI ≥ 35 kg/m2 or greater with one or more obesity-associated comorbidities when conservative therapy has been exhausted. See below for additional indications. Along with weight loss, gastric banding can reduce the increased risk of metabolic (metabolic-related) or cardiovascular (cardiovascular) disease. Gastric banding is usually used as a treatment option only after all conservative weight loss measures under medical supervision have failed. Currently, gastric banding is usually performed as a minimally invasive procedure during laparoscopic surgery.
Indications (areas of application) for bariatric surgery [according to the S3 guideline: Surgery for obesity and metabolic diseases, see below]
- In patients with a BMI ≥ 40 kg/m2 without concomitant diseases and without contraindications, bariatric surgery is indicated after exhaustion of conservative therapy after comprehensive education.
- Patients with a BMI ≥ 35 kg/m2 with one or more obesity-associated comorbidities such as type 2 diabetes mellitus, heart failure, hyperlipidemia, arterial hypertension, coronary artery disease (CAD), Nephropathy, obstructive sleep apnea syndrome (OSAS), obesity hypoventilation syndrome, Pickwick syndrome, nonalcoholic fatty liver (NAFLD), or nonalcoholic fatty liver hepatitis (NASH), Pseudotumor cerebri, gastroesophageal reflux disease (GERD), bronchial asthma, chronic venous insufficiency (CVI), urinary incontinence, immobilizing joint disease, fertility limitations, or polycystic ovary syndrome (PCO syndromeM) should be offered bariatric surgery when conservative therapy is exhausted.
- In certain circumstances, a primary indication for bariatric surgery may be made without a prior attempt at conservative therapy. The primary indication may be given when any of the following conditions exist: in patients.
- With a BMI ≥ 50 kg/m2.
- In whom a conservative therapy attempt was classified by the multidisciplinary team as not promising or hopeless.
- With particular severity of concomitant and secondary diseases that do not allow postponement of a surgical intervention.
Contraindications
- Unstable psychopathological conditions
- Untreated bulimia nervosa
- Active substance dependence
- Poor general health
- Lack of indication – should obesity be caused by a disease (e.g., hypothyroidism, Conn syndrome (primary hyperaldosteronism, PH), Cushing’s disease, pheochromocytoma)
Before surgery
Before the gastric band can be used, a detailed physical examination and an adequate medical history of the patient must be taken. Exclusion of any disease that may be considered the cause of the obesity present must be performed. Thus, hypothyroidism (hypothyroidism), adrenocortical hyperfunction (Conn syndrome, Cushing’s disease, pheochromocytoma), mental diseases or disorders must not be present.
Surgical procedures
The basic principle of gastric banding surgery is the constriction of the entire stomach by a horizontally implanted band. The constriction divides the stomach into two parts, with the upper portion representing the small gastric reservoir. Nowadays, implantation of an adjustable band is performed so that precise adjustment of the constriction can be made. Laparoscopic Gastric Banding – Perigastric Technique
In this form of gastric banding surgery, after placing a special balloon probe in the stomach, the gastric band is implanted. Successful closure of the gastric band is followed by formation of a gastric sleeve over the band. Laparoscopic Gastric Banding – Pars-flaccida technique.
Unlike the perigastric technique, the pars-flaccida technique involves cutting the vagus nerve. The outcome of the two laparoscopic operations differed only slightly in various studies.
After surgery
After surgery, the patient should be mobilized as soon as possible to avoid complications such as thrombosis (venous vessel occlusion) or pulmonary embolism (pulmonary artery occlusion).Obese patients in particular are at increased risk of circulatory complications and pressure ulcers, so special attention must be paid to this. Contrast imaging is performed on the first postoperative day to verify correct placement of the gastric band.
Possible complications
- Thrombosis (vascular disease in which a blood clot (thrombus) forms in a vessel).
- Pulmonary embolism (occlusion of a pulmonary artery by a blood clot).
- Wound healing disorders
- Slippage of the stomach through the gastric band and subsequent gastric distension.
- Erosive migration of the band into the stomach
- Gastric perforation (rupture of the stomach)
