Understanding Bariatric Surgery (Gastric Bypass and Sleeve Gastrectomy)

Previously, I touched on gastric bypass and sleeve gastrectomy, two very popular forms of bariatric surgery. In this post, I’ll introduce to you gastric band surgery. 

Gastric band surgery or gastric banding is another surgical option I recommend to treat obesity. Similar to gastric bypass and sleeve gastrectomy, gastric band surgery helps in weight loss by restricting the number of calories the patient consumes. It does not, however, involve any cutting or removing any parts of the stomach. So how does it work? 

Let’s find out!

How does gastric band surgery work?

Gastric banding involves placing a medical silicone band around the upper part of the stomach to reduce stomach size and minimise food intake. What the patient will get is a smaller stomach size as the stomach is now constricted. 

During surgery, the surgeon places a band around the upper part of the stomach with a tube attached to the band. The tube is accessible through a port to allow the surgeon to inject saline solution into the band to inflate it. 

I usually like to insert the port under the skin of the stomach for easy access. 

With the band, the patient’s upper stomach now becomes a small stomach pouch, with the rest of the stomach below. Having a smaller stomach pouch means the patient requires lesser food to reach satiety, which in turn reduces hunger and lowers overall food intake. 

What I like about gastric band surgery is that it allows for a lot more flexibility; the surgeon is allowed to adjust the degree of constriction depending on the patient’s goals and comfortability. What’s more, because no part of the stomach is removed, the body can still absorb nutrients and vitamins as usual.

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Who should do gastric band surgery?

In the past, gastric band surgery was strictly only recommended for patients with a BMI of 35 or above. Exceptions applied to those who had a BMI of 30-34.9 and obesity-related problems like sleep apnea, diabetes and hypertension. Due to the high risk of complications from these conditions, surgery to treat obesity was necessary. 

Today, due to improvements in surgical techniques, gastric band surgery is safer and available to more patients who need it. 

In general, I would recommend gastric banding or any form of bariatric surgery for individuals with a BMI of 30-35, only if:

  • They have obesity-related conditions that are affecting their quality of life 
  • They have tried various non-surgical approaches like medication, exercise and dietary changes with no results

Because bariatric surgeries require almost permanent lifestyle changes after the procedure, I would not require this type of treatment option to patients who:

  • Is currently abusing alcohol or drugs 
  • Have mental health issues or body image disorders. I especially will not recommend this procedure to patients who are depending on the surgery or any form of weight loss to improve their mental health
  • Do not understand and have difficulty accepting the risks and benefits, outcomes and lifestyle changes required of this surgery

Patients must understand that bariatric is not a shortcut or magical pill for weight loss. Even after surgery, they need to put in the effort to maintain or continue their weight loss journey like a regular person, which is adopting a healthy diet and exercising more. 

If they are willing to play their part and put in the effort, even with a constricted stomach, many patients can enjoy the benefits of a gastric band surgery and go on to lead fulfilling lives.

Benefits of gastric band surgery

  • Possibility of long term weight loss and a healthy life for those with obesity 
  • Faster recovery 
  • Less likely to get hernias and wound infections from the surgery 
  • Reduced risk of obesity-related conditions such as urinary incontinence, sleep apnea, diabetes and high blood pressure 
  • No nutrient malabsorption 
  • Improved overall quality of life 
  • The band can be removed or adjusted depending on weight loss goals and results 

On average, about 40 to 60 percent of excess weight can be lost, but this of course depends on the individual.

Risks of gastric band surgery

  • Some patients with an adverse reaction to anaesthesia may experience allergic reactions, pulmonary embolism, breathing problems, blood loss, infection or even a heart attack or stroke 
  • Slower weight loss compared to other types of bariatric surgery 
  • The band may slip or have mechanical problems. In worse case scenarios, the band may erode into the stomach, requiring complete removal
  • Overeating may lead to dilation of the oesophagus or vomiting, so I advise patients to avoid overeating and follow dietary recommendations closely 

As with all weight loss surgeries, gastric band surgery is no exception to these general risks as well: 

  • Hernias 
  • Inflammation of the stomach lining and stomach ulcers 
  • Wound infection 
  • Bowel blockage due to gastrointestinal scarring 
  • Lack of nutrition due to limited food intake, but this can be easily avoided with supplements and multivitamins that I will prescribe after every surgery

How does gastric band surgery compare to gastric bypass and sleeve gastrectomy?

In a gastric bypass, or Roux-en-Y gastric bypass, the stomach is stapled and attached directly into the small intestine. This reduces overall food intake and the absorption of calories and other nutrients. It is however difficult to reverse, causes some changes in the gut hormones and significantly reduces the amount of nutrients the patient takes in. 

In a sleeve gastrectomy, a big portion of the stomach is removed and shaped like a tube or banana-shaped sleeve. Patients who undergo this procedure find that the amount of food they need to feel full is drastically reduced, which I think is what makes this option a great choice for those who struggle with overeating. A sleeve gastrectomy however is not reversible and can disrupt metabolism. 

A gastric band surgery, as I discussed earlier in this article, requires just constricting the stomach with a band. This process is reversible, meaning if patients decide that they don’t need the band anymore, they can always get it surgically removed. 

In terms of deciding between the best bariatric surgery option, it ultimately depends on factors like your preferences and health condition. If you’d like to find out more, feel free to make an appointment with me or my team and I’d be happy to help!