Gastric Band

The “band” is probably the operation most commonly performed in patients with morbid obesity in Europe. The band is placed laparoscopically and the patient may leave the hospital the same day. The reason that this operation has become so popular among surgeons and patients alike is that it is very easy technically. This is especially true for the usual simple general surgeon who does not have any expertise in the disease and the surgical options of morbid obesity.

When a band is placed at the highest part of the stomach, it divides the stomach to two compartments (one very small and one larger), which communicate with one another through a narrow “neck”, which is the band itself. When the patient swallows solid food, this fills up the small portion of the stomach quickly and the patient feels that he cannot eat more. This amount of ingested food then slowly empties through the narrow neck into the larger portion of the stomach, so the patient can now swallow more food. It needs to be well understood that the band gives the patient an early feeling of fullness, and thus inability to eat more, but does not do anything with the appetite, or the urge to eat. Patients with a band are not able to eat, but do want to eat.

As rational the band operation may look at first sight, it so happens that about 70% of such patients regain most of their weight initially lost within two years. This is the result of the uninhibited appetite, or drive to eat, which eventually leads them to realize that if they can in fact satisfy this urge they feel by consuming fluids (not solids) that can readily flow through the narrow neck that the band creates. This flow from the upper small part of the stomach to the lower large part is uninhibited because the fluid never fills up the small portion, so they keep consuming with no restriction whatsoever. The fluids usually consumed are high-calorie sweet taste, such as ice creams, chocolate, creams, etc. All this occurs because they cannot satisfy their appetite with solids, so they find ways to “cheat” the operation.

Having said this, the laparoscopically adjustable gastric band, or LAGB, may be a good surgical option for carefully selected patients, in whom all this analysis has been openly presented and understood. It cannot be overemphasized that for this operation to have long-term success, the cooperation by the patient is of paramount importance. Generally, patients with BMI not higher than 40, who are willing to work together with their surgeon and with their band may be benefited by LAGB.