Weight Loss Surgery, Gastric Bypass

Adjustable Gastric Banding

Adjustable Gastric Banding (AGB) has been performed to treat morbid obesity since the 1990's. Since its availability on the world market, hundreds of thousands of these procedures have been performed. Various scientific studies, following patients who have had AGB have proven that this procedure is safe and effective in addressing morbid obesity when performed by a skilled surgeon. Based on these results United States Food and Drug Administration approved the use of one of these devices, Lap-Band, in USA in June, 2001. In September, 2007, a competing product, Realize band, was also approved for use in USA. To date neither product has been shown to be clearly superior to the other. The obesity-related medical problems that may be improved or cured with the AGB operation include diabetes mellitus of the adult onset type (so-called insulin resistant), hypertension, high cholesterol, arthritis, venous stasis disease, bladder incontinence, liver disease, certain types of headaches, heartburn, sleep apnea and many other disorders. Furthermore, this operation has resulted in marked improvements in quality of life.

In Adjustable Gastric Banding a Silicone band lined with an inflatable balloon is wrapped around the upper part of the stomach, to create an hourglass shaped stomach; it produces a small stomach pouch with a narrow outlet. The balloon is connected to a tiny reservoir that is placed under the skin of the abdomen through which the diameter of the band can be adjusted. Inflation of the balloon functionally tightens the band, narrows the outlet and thereby increases the weight loss; while deflation of the balloon loosens the band increases the size of the outlet and reduces the weight loss.

The AGB operation works by reducing food intake when feeling of hunger arises. AGB operation may be particularly suited to persons between 200 and 270 lb weight. For successful outcome following AGB, it is essential that patients follow up regularly with their surgeon to have the band adjusted. Without regular adjustment, the weight loss may halt and or reverse. As with all weight loss operations, patients with AGB are required to adhere to a simple and straightforward life style changes.

Excess weight loss with the Adjustable Gastric Band is lower than that with the Gastric Bypass procedure, typically about 50-55% of extra weight at 5 years. Some studies have documented weight loss equal to the Gastric Bypass with fewer complications; other groups have had disappointing outcomes. Some studies document a substantial number of patients, up to 30%, who have required re-operation for long-term complications of the adjustable band such as for port problems, erosions and slippage, or inadequate weight loss. Overall improvement in weight-related medical conditions has been observed, including Type II diabetes mellitus, high cholesterol, sleep apnea, heart burn, high blood pressure, and asthma. However, compared to the gastric bypass, the impact on co-morbidities appears to be somewhat less favorable. Remission of diabetes with AGB is seen in 80% at 2 yrs versus 93% at 9 years with the Gastric Bypass operation. Long-term results comparing AGB with gastric bypass are not yet available.

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