Obesity is a growing problem in America.
Despite the abundance of diets, weight loss drugs, and miracle exercise
products Americans continue to gain weight.
Most obese individuals have tried each of these weight loss methods
before without any success. What,
if any, are their options? This
paper will review new surgical treatments for obesity and weight management;
gastric banding and vertical banded gastroplasty.
It will look at the procedure, the rationale, effectiveness,
complications and lifestyle changes that follow gastric banding procedures.
Gastric banding and vertical banded gastroplasty seek to promote weight
loss in the same fashion, but they go about this in slightly different ways.
In gastric banding, a small synthetic band is placed around the
curvature at the top of the stomach, just below the end of the esophagus.
This band is tightened around this tube to create a small food pouch at
the top of the stomach. The pouch
typically holds between 1-3mL of food or liquid at a given time.
The pouch is connected to the stomach through a small opening ¼ an
inch wide through which food is permitted to past through the rest of the
digestive system. In vertical
banded gastroplasty, a synthetic band is placed around the lesser curvature of
the stomach and tightened. The
food pouch is created by this band and the same amount of food is allowed to
collect and then pass through the same size opening as the previous procedure.
Where the procedures differ is that in vertical banded gastroplasty
this pouch is then attached to the wall of the stomach with a series of
staples. This is done to help
prevent slippage of the band around the stomach opening. Both procedures are minimally
invasive and require only a day and a half of
These surgical procedures seek to advocate weight loss through the
severe restriction of food intake. The
food pouch only hold between 1-3 ml of food, which is equivalent to about ½
of a cup at any one meal. This
amount of food can be ingested without discomfort and will give a feeling of
satiation. Any amount of food
over this limit will be expelled from the person almost immediately and cause
great feelings of discomfort. The
theory is that by restricting food intake and providing the feeling of
satiation much more quickly, that obese people will be able to finally lose
the weight necessary to maintain good health.
After the first several weeks on a liquid diet, the person can resume
normal eating habits that are within the intake range.
Many Internet sites and doctors who perform these procedures tout these
gastric banding procedures as the most effective way to lose weight and
maintain weight loss for the obese patient.
They claim that there are few if any complications and that almost all
patients are able to meet and sustain their weight loss goals.
On the surface it looks like these new surgical procedures are the best
method of weight loss for the obese patient, but it sound like this is too
good to be true. The next
sections of this paper will try and determine whether these claims about
effectiveness and complications are true, and whether there are significant
lifestyle changes that must take place after a surgery such as this.
In a study by the Mayo Clinic (1997), they followed seventy patients
that had undergone gastric banding or gastroplasty from 1985-1989.
They monitored these patients post-operatively at one year and three
years following surgery. At the
one-year interval they found that patients had lost about 60% of the excess
weight that they had hoped to lose by undergoing the procedure.
At the three-year interval they found that only 38% of patients were
able to maintain half of their desired weight loss.
They monitored the weight progress through weigh-ins at the clinic.
A reason they cite for their low results in maintained weight loss is
the fact that 50% of the patients had devised a way to beat the restrictive
intake system. These individuals
discovered that they could eat milkshakes, ice cream, and puddings and that
these foods would rapidly slip through the restrictive pouch thus defeating
the restrictive food intake system designed by the surgery.
In another study conducted by G.A. Fielding and associates (1999), they
monitored 335 patients who had undergone gastric banding procedures.
They monitored patients weight loss over the course of eighteen months,
as well as monitoring for any side effects or complications that may arise
from surgery. All patients in
their study had previously tried many different dieting methods without
success and were between 34-86 on the body mass index scale.
The results in terms of weight loss showed differing results through
the 18-month period. For the
first three months after surgery, patients averaged an excess weight loss of
24%. At the year follow up, patients averaged an excess weight
loss of 52%, and at the 18-month follow-up patients were able to lose an
average of 62% of their excess weight. This
study also monitored for the occurrence of complications following surgery.
They found that only 12 patients out of the original 335 had
complications that required another surgery.
Among these patients the most common problem was gastric herniation
through the band and into the stomach. Other
problems included port-hole (into the stomach) obstruction and band slippage.
One last study, which provided an evaluation of both weight loss and
complications following the procedure, was conducted by Belachew and
colleagues (1998). This study
followed 350 patients over the course of 41 months.
They monitored for excess weight lost and any recent of late developing
complications tied to the surgical procedure.
They found that over the course of a fifteen-month period, patients
continued to lose weight and at the end of this period had lost an average of
57% of their excess body weight. After this time period the marked weight loss
tapers off to an average of 80% of excess weight lost, and after the 33rd
month patients actually started to gain weight back.
At the end of the 41-month period, patients had lost 64% of their
excess weight but were on an upward weight path.
In terms of complications, about 10% of patients suffered from staple
line disruption, which necessitated another surgery, and food intolerance was
common but needed no surgical attention.
In a study by Ovrebo, MD and colleagues (1998) they investigated the
occurrence of acid reflux in patients that have undergone gastric banding
procedures. They contrasted the
simple gastric banding procedure with the vertical banded gastroplasty, which
in addition to banding, staples the food pouch to the wall of the stomach. They wanted to measure the incidences of acid reflux in each
procedure and measure any possible differences between procedures.
They followed forty-three patients who underwent gastric banding or
vertical banded gastroplasty. The
patients were followed both before and after surgery to monitor for any
adverse symptoms and to measure the number of patients taking antireflux
medication. The team took pH
measures both before and after surgery. They
found that when undergoing gastric banding procedures, while 14% of patients
experienced acid reflux symptoms prior to surgery this increased to 63-69% of
patients who experienced symptoms after undergoing the procedure.
Approximately 81% of post-operative patients of gastric banding
procedures needed to take acid inhibitors by prescription.
In this same study they found that 32-33% of patients who underwent
vertical banded gastroplasty experienced symptoms before surgery, these
figures remained the same post-operatively.
It seems that this procedure leads to no increase in acid reflux
Another study examined the incidence of band erosion in patients who
underwent gastric banding procedures. Moreno,
MD and colleagues (1998) followed two hundred and fifty patients who underwent
a gastric banding procedure between the years 1987-1995.
They monitored the development of band erosion into the stomach,
necessary reparative surgery and long-term weight loss control.
They found that band erosion occurred in 7 patients, or 2.8% of all
patients served by the procedure. Six
of these patients required another operation to correct the banding problem.
Of these 7 cases, 2 were external band erosion where the band eroded
through the lesser curve of the stomach, and 5 were internal band erosion,
where the band eroded through the staples into the stomach.
These patients underwent another banding procedure without complication
and all but 1 of the patients achieved long-term weight loss goals.
It appears that each of the effectiveness studies is in basic agreement about the amount of excess weight lost by patients undergoing these surgical procedures. Patients that undergo this procedure will lose approximately 60-80% of their excess weight, but after losing this amount of weight it appears that the weight loss effects may not be sustained over time. As a greater amount of time passes the percentage of excess weight lost becomes less and less. It also appears that the complications from these procedures are not typically severe. While a few patients have complications that necessitate another surgery, the large majority of patients have few complications aside from acid reflux and food intolerance.
looks like the claims made by the internet sources referring to gastric
banding as the ultimately most effective weight loss procedure are not
entirely true. When examining the
scientific literature, it seems that a great amount of excess weight is lost
at first but that these effects may not continue for many years. The claims
regarding the safety and low occurrence of side effects made on the Internet
seem to be true. Scientific
studies concur with these sources on the few complications that may result for
a gastric banding procedure. While
the side effects are minimal and effectiveness seems possible both long and
short-term there are still changes in lifestyle that a person undergoing this
procedure should be aware of. Possible
candidates for this type of surgery need to know how this procedure can effect
their lifestyle and their eating habits for the remainder of their lives.
After having a gastric banding procedure, a person needs to chew food
extremely well to prevent a blockage in the pouch, is unable to eat large
meals or meals over one-half of a cup without discomfort for the remainder of
their lives. They also need to be
committed to lifelong medical follow-up to monitor the strength and possible
erosion of the band. It is also
important that people understand that this is not a miracle cure for obesity.
Without determination and commitment to success in maintaining weight
loss goals, this procedure will not provide continued success.
Balsiger, B. M., Luque-De Leon, E., & Sarr, M. G.
(1997). Surgical Treatment of
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Fielding, G. A., Rhodes, M., & Nathanson, L. K.
(1999), Laparoscopic gastric banding
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MacGregor, Alex. (1999). Gastric Banding. The
Story of Surgery for Obesity [On-line].
Moreno, Pau, et. al. (1998). Band Erosion in Patients
who have undergone vertical
gastroplasty: Incidence and Technical Solutions. Archives of Surgery,
NIH Publications: NIDDK Weight-control information
Ovrebo, K. K., Hatlebakk, J. G., Viste, A., Bassoe,
H. H., & Svanes, K. (1998)
reflux in morbidly obese patients treated with gastric banding or vertical
banded gastroplasty. Annals of Surgery, 228(1), 51-58.
Sugerman, Harvey J. (2000). The epidemic of severe
obesity: THe value of surgical
Mayo Clinic Proceedings, 75(7), 669-672.
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