Adjustable Gastric Banding

The condition

The adjustable gastric band is strictly a restrictive procedure for the treatment of morbid obesity. The small intestine is not altered during this procedure. Currently two types of gastric bands are on the market in the United States: the “Lap-Band System”® and the newer “Realize Band”™.

The procedure

The adjustable silicone ring is placed around the stomach 1-2 cm centimeters below the esophagus.  This ring is attached to tubing, which is threaded under the skin to a round "port".  One can feel this port just under the skin in the center of the abdomen.  This port is used by the surgeon as an access to add or subtract water to inflate or deflate the bladder of the band. The stomach needs to heal from surgery before the first fill. So the first adjustment won't occur until around six weeks after surgery. Gastric bands need to be adjusted an average of four to six times in the first year after surgery. These fills are done to make sure the band is not too tight or too loose to encourage continued weight loss. Band adjustments are painless, and are usually done in the Radiology department under direct vision so the surgeon can see how tight to make the band in order to restrict food intake, but not make it so tight that one can't eat or drink anything.  After surgery the patient must be mindful about what, how and when to eat. This includes eating smaller meals, because the new stomach can hold only about a quarter-cup to a full cup of food at a time.

Risks

• Bleeding
• Infection
• Slippage of the band
• The band may erode into the inside of the stomach.
• The band can spontaneously deflate due to leakage.
• The stomach pouch can enlarge.
• The stoma (stomach outlet) can be blocked.
• Gastroesophageal reflux disease or GERD
• Death. The risk of death due to gastric banding surgery is about one in 2,000.
• Frequent visits for band adjustments or fills.
• The pouch may stretch with continued overeating.
• Failure to lose weight

Medical negligence

The above mentioned risks and complications are known to happen with the adjustable gastric banding and such complications do not necessarily constitute deviation from the medical standard of care.  The following examples however may be considered as medical negligence.

• Malpositioning of the band
• Failure to diagnose injury  (perforation) to the esophagus or stomach

• Misrepresenting to the patient the effectiveness of the procedure for loss of weight (studies have shown that this procedure will result in 20-25% of total body weight loss in 1-1.5 years)