Laparoscopic adjustable gastric banding (LAGB) or Laparascopic Gastric banding is one of the least invasive weight loss treatments available for obesity. It's done with a few tiny abdominal cuts, instead of with one large cut. The surgeon puts instruments through the cuts. One of those instruments is a laparoscope, a tool with a tiny camera. Using this, a silastic band is placed around the stomach just below the junction of esophagus (food pipe). This forms a small pouch thus creating an hour-glass effect. The silicon ring passes around the stomach, thus giving a small outlet, that allows only as much food as the size of an eraser, to enter the distal stomach. The reservoir is placed under the skin in the midline just below the chest such that it can easily be felt while lying down. A needle can be injected through the skin into the reservoir and to add or remove fluid to adjust the size of the stomach outlet.
The hour glass configuration only constricts the upper stomach thus acting as a pure restrictive operation. Since the outlet is small, food stays in the pouch longer and one also feels satiated for a longer time. The small pouch ensures that the patient feels full after eating only small amounts of food. This causes weight loss. As its name suggests, this is an adjustable gastric band Scheduled follow-up visits will be at 6 weeks, monthly for the first six months and yearly thereafter or as and when medically required.
Why might I need a laparoscopic adjustable gastric banding?
LAGB is used to treat severe obesity, which is linked to high blood pressure, high cholesterol, type 2 diabetes, sleep apnea, and arthritis. It is recommended for people who have tried other weight loss plans without long-term success. Once you lose a significant amount of weight, your risk falls for these weight-related health problems. Adjustable gastric banding may help you live longer if you can't lose weight in other ways.
Indications
- Presence of serious sequelae of morbid obesity
- 30 kg overweight or BMI > 32 with co-morbidities
- BMI> 35 with or without co-morbidities
- Large volume eaters
The sleeve gastrectomy originated as the restrictive part of the duodenal switch operation. In the last several years, it has also been used as a staging procedure prior to a gastric bypass or duodenal switch in very high risk patients. It has also been used as a primary, stand-alone procedure.
How is Sleeve Gastrectomy Performed?
Most sleeve gastrectomies performed today are performed laparoscopically. This involves making five or six small incisions in the abdomen and performing the procedure using a video camera (laparoscope) and long instruments that are placed through these small incisions.
Sleeve gastrectomy is a restrictive form of operation in which approximately 2/3rd of the left side of the stomach is removed laparoscopically using endoscopic staplers. The stomach thus takes the shape of a hockey stick or sleeve. It can be performed as either first stage of a two-stage procedure for super obese (BMI >60) where it can be followed with malabsorptive surgery or as a single stage procedure by itself.
The capacity of the stomach ranges between 60 - 100 cc. Unlike many other forms of bariatric surgery, the outlet valve and the nerves of the stomach remains intact while only the stomach size is drastically reduced. Though a non-reversible procedure, the part of the stomach that contains Ghrelin, the hormone for hunger is removed; it drastically reduces your appetite and hormones that controls diabetes.
The hour glass configuration only constricts the upper stomach thus acting as a pure restrictive operation. Since the outlet is small, food stays in the pouch longer and one also feels satiated for a longer time. Scheduled follow-up visits will be at 6 weeks, monthly for the first six months and yearly thereafter or as and when medically required.
Who Should Have a Sleeve Gastrectomy?
This operation has been used successfully for many different types of bariatric patients.
In patients who undergo LSG as a first stage procedure, the second stage (gastric bypass) is performed 12 to 18 months later after significant weight-loss has occurred, the liver has decreased in size and the risk of anesthesia is much lower. Though this approach involves two procedures, we believe it a safe and effective strategy for selected high-risk patients.
Indications are:
- Presence of serious sequelae of morbid obesity
- 30 kg overweight or BMI > 32 with co-morbidities
- BMI > 35 with or without co-morbidities
- Large volume eaters
Metabolic syndrome
Metabolic syndrome is the name for a group of risk factors that increases the chance of developing heart disease, diabetes and stroke.
You must have at least three metabolic risk factors to be diagnosed with metabolic syndrome.
- A large waistline indicating abdominal obesity or "having an apple shape." Excess fat in the stomach area is a greater risk factor for heart disease than excess fat in other parts of the body, such as on the hips.
- A high triglyceride level (or you're on medicine to treat high triglycerides). Triglycerides are a type of fat found in the blood.
- A low HDL cholesterol level (or you're on medicine to treat low HDL cholesterol). HDL sometimes is called "good" cholesterol. This is because it helps remove cholesterol from your arteries. A low HDL cholesterol level raises your risk for heart disease.
- High blood pressure (or you're on medicine to treat high blood pressure). Blood pressure is the force of blood pushing against the walls of your arteries as your heart pumps blood. If this pressure rises and stays high over time, it can damage your heart and lead to plaque buildup.
- High fasting blood sugar (or you're on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes.
The treatment of Metabolic Syndrome by surgical methods is called Metabolic Surgery.
Metabolic surgery
Experiments were done in the last half of the 20th century to see if diseases like high lipids and cholesterol could be treated with surgical procedures such as intestinal bypass.
In 1995, Dr. Walter Pories and his research team published an article titled "Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus". Since that landmark paper, much evidence has been accumulated showing that surgery can cure/improve several metabolic diseases, especially adult onset or Type 2 diabetes mellitus.
In 2009 the American Society for Bariatric Surgery (ASBS) changed its name to the American Society for Metabolic and Bariatric Surgery (ASMBS) to promote information on the beneficial effects of surgeries for weight loss in treating metabolic diseases, especially Type 2 Diabetes Mellitus (T2DM).
Today, the term Metabolic Surgery is used to describe weight loss treatments and procedures to treat metabolic diseases, especially, type 2 diabetes.
Gastric Bypass and Bilio-pancreatic diversion have resulted in control/ cure of diabetes. This surgery can only be performed in obese patients with BMI > 35.
However, the need for control of diabetes in non-obese patients led to the development of Ileal Interposition surgery or Duodenojejunal bypass surgery for diabetics who do not require gastric bypass. This can be performed in thin type 2 diabetics with BMI as low as 30 or with sleeve Gastrectomy in overweight/obese diabetics.
Ileal interposition is a procedure where a segment of last part of small intestine (ileum) is interposed between 2 parts of small intestine (jejunum) just beyond stomach. No part of small intestine is removed or bypassed. Duodenojejunal bypass is similar to gastric bypass except that the small bowel anastamosis is done to the duodenum instead of the stomach. These two procedures give patients good stomach volume to eat.
Only few centers around the world are performing these procedures. Over 80% normal weight patients with T2DM have achieved diabetes resolution within 7 days - 3 months of surgery. Similarly, over 85% of obese diabetics have diabetes resolution after surgery. Diabetes resolution may vary subject to age, duration of diabetes, period of insulin intake.