Not so popular now: The rise and fall of gastric banding

Gastric banding proved popular in the 1990s. However, its popularity has not lasted.

What we’ve learned in the last 30 years has changed our view on gastric banding and led us to recommend other types of bariatric surgery instead.

Here’s what you need to know about the rise and fall of gastric banding.

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What is gastric banding surgery?

It’s a weight loss surgery that helps through restricting the amount of food that can pass through into the stomach at any one time. That means you can’t eat very much and so lose weight.

The operation was usually performed via keyhole surgery where the surgeon place an adjustable silicone band around the upper part of the stomach. Squeezed by the silicone band, the stomach above the band becomes a tiny pouch with an outlet that’s about 2.5 cm wide.

That silicone band can be tightened or loosened by injecting or removing saline (sterile salt water) through a port device just under the skin. When saline is injected, the band fills up and becomes tighter. These adjustments can be made as needed to reduce side effects and improve weight loss.

The late 1990s – gastric band surgery gains popularity

Gastric banding (also known as a lap band) was a revolutionary weight loss procedure back in the late 1990s to 2000s.

It became popular because it:

Could be done through keyhole surgery (like other weight loss surgeries)
Enabled patients and doctors to adjust the level of restriction without the need for further surgery – simply add or remove saline using the attachment port to tighten or loosen the band
It could (theoretically) be reversed if necessary.

The ability to adjust the level of restriction was a huge selling point, especially compared to more permanent options such as the vertical gastric sleeve or gastric bypass surgery.

Sounds great, doesn’t it? So, what changed?

The fall of gastric band surgery in mid 2010s

Even though gastric banding seemed like an ideal weight loss option, experience with it over time has revealed a different story. We’re now aware of some glaring flaws with this procedure.

A key one is its high failure rate. It usually leads to a loss of about 35-45% of excess weight. But…only a niche group achieves long-lasting results.

Many patients manage to ‘cheat’ the band’s restriction. Instead of living on small, nutritious solid meals they opt for high-calorie drinks.

Other flaws of gastric banding include:

Significant side effects (band intolerance) such as:
- Significant volume reflux
- Regurgitation of food
Irreversible anatomical ‘damage’ to the oesophagus (feeding tube) and the upper parts of the stomach
- Long-lasting dilatation of the lower part of the oesophagus and disruption of the lower oesophageal sphincter (valve), which is important for reflux control
- Altering tissue quality in the upper stomach in certain instances – and therefore limiting revisional surgical options.

What now?

In light of these findings, most bariatric practices have moved away from gastric banding.

Many patients with gastric bands are now having revisional surgeries, replacing their gastric band with a more durable bariatric surgery option.

The alternatives include:

Roux-en Y gastric bypass
Sleeve gastrectomy (in selected patients)
Single anastomosis ileo-duodenal bypass (SADI-S).

The decision behind the most appropriate revisional surgery depends on factors such as:

The degree of reflux and lower oesophagitis/ known as Barrett’s oesophagus
The extent of dilatation of the lower oesophagus
Individual diet and food choices
Lifestyle choices – e.g. smoking and alcohol intake.

How can we help?

Obesity is a complex condition that requires long term weight loss management.

It is far more complicated than just simply eating the wrong foods or lacking discipline. Multiple biological and genetic factors predispose some people to be overweight and obese. Obesity often runs deep in some families where genetics impact an individual’s baseline metabolism and appetite.

Dr Qiuye Cheng is an accredited surgeon of excellence in bariatrics. He is highly experienced in managing obesity through individualised treatment options whether its primary or revisional weight loss procedures in addition to less invasive options like gastric balloon, endoscopic gastric bypass revisions and/or medical weight loss therapies. He works within a multi-disciplinary team that includes dietitians, psychologists and doctors to provide holistic care that helps you prepare for surgery and make lasting lifestyle changes after your procedure.

Dr Cheng operates at St George Private which is Australia’s highest volume bariatric hospital and is recognised as a leader in bariatric surgery. It is also Australia’s first internationally accredited Centre of Bariatric Excellence, recognised by the Surgical Review Corporation, which accredits Centres of Excellence around the world.

If you’d like to explore how weight loss surgery could help you, please get in touch.

Disclaimer

All information is general in nature and is not intended to be a substitute for professional medical advice. Any surgical or invasive procedure carries risks. Dr Qiuye Cheng can consult with you to confirm if this advice is right for you.