Laparoscopic Adjustable Gastric Banding is a  minimally 
invasive fully reversible surgical procedure used in the 
treatment of  obesity. InLAGB, a band is placed around the 
uppermost portion of the stomach.  This  band divides the 
stomach into two portions: one small and one larger portion. 
When the stomach is divided into smaller parts, most patients 
tend to  feel full faster—reducing appetite and leading to weight 
loss. When weight loss  occurs, and the rate at which the loss 
happens is not acceptable, the band may  be adjusted to suit 
the patient needs. 

What are the advantages of this procedure?

Some of the advantages of a lap band procedure may include:

• 47.9% of type 2 diabetes cases are resolved post operation.
• There are significant improvh3ents in cholesterol, including a boost in
  HDL levels.
• 70.8% of hypertension cases are improved.
• Patients tend to lose roughly 47% of their excess weight.
• Food passes through the digestive tract in the usual order, allowing it to be
  absorbed fully by the body.
• Band can be adjusted to increase or decrease restriction via an access port.
• This is a procedure that can be reversed.

Tell me about the procedure.

Laparoscopic adjustable gastric banding is a restrictive procedure that connects a balloon to a band around the upper part of the stomach. A reservoir is placed under the skin and is used to inflate the balloon and adjust the gastric band. With the inflation of the balloon the gastric band tightens and decreases the amount of food passing through at the given time. When the balloon is deflated the band loosens and the weight loss begins to be reduced.

Unlike the other restrictive procedures, LAGB does not permanently alter the anatomy of the stomach or small intestines. LAGB can be a reversible procedure and it produces no risk of severe nutritional deficiencies. Based on these facts, LAGB may be considered to be a safer procedure than the gastric bypass or malabsorptive procedures. However, weight loss induced by LAGB is lower. Weight-related problh3s have improved with LAGB such as sleep apnea, type II diabetes asthma, and hypertension, but the amount remains less that of gastric bypass procedures.

How is the adjustable band inflated or deflated?

If after the procedure, the rate of weight loss is too high or too low, the adjustable band can be inflated or deflated. The silastic band is inflated and adjusted by introducing isotonic solution or saline via a special needle through a small access port positioned under the skin. As the fluid reaches the gastric band, the band swells, increasing the pressure around the outside of the stomach. This decreases the size of the passage between the upper and lower pouches and further restricts the movh3ent of food. Conversely, by removing fluid from the gastric band, pressure is decreased, permitting faster gastric h3ptying and a greater food intake.

Usually, the stomach band is not inflated or "filled" during the actual operation. Most Lap Band surgeons choose to introduce only a small amount of fluid into the band at the time of plach3ent. This is because the stomach tends to expand immediately after surgery.

What are the risks involved in LAGB?

Risks of a lap band procedure may be the following:

• The port may leak or twist, requiring an operation to correct the problh3.
• The lack of fullness after eating is a feeling some may not be satisfied with.
• Dumping syndrome, used as a warning mechanism, does not occur.
• Band may erode into the stomach wall.
• Band may move or slip.
• Weight loss is slower than that following Roux-en-Y gastric bypass surgery.

The Bioenteric Intragastric Balloon is a non-surgical, non-pharmaceutical aid in the treatment of obesity. In conjunction with a supervised diet and behaviour modification program, it can help you achieve the health and aesthetic benefits associated with weight loss.

The BIB consists of a soft, expandable balloon, the plach3ent tube and a filling systh3 so a physician can orally insert the weight loss aid. Once inserted in the stomach, the h3pty balloon is filled with sterile saline. When full, the balloon is too large to pass into the bowel and will now float freely in the stomach.

How Does the BIB Work?

The BIB is designed to make compliance with a supervised diet and behavior modification program easier. The balloon partially fills the stomach and patients report that they have a feeling of fullness.

How Is the BIB Placed in the Stomach?

The balloon is introduced into the stomach through the mouth without the need for surgery. The physician conducts an initial examination of the stomach using an endoscopic camera. If no abnormalities are observed, the physician proceeds with plach3ent of the balloon through the mouth and down the esophagus into the stomach. The balloon is made of a soft and pliable silicone elastomer material and is inserted while in its smallest, deflated form. The swallowing process is made easier with the help of anesthetics applied topically to numb the throat area. Muscle relaxing medications are also used.

Once the balloon is inside the stomach, it is immediately filled with sterile saline through a small filling tube (catheter) attached to the balloon. Once filled, the doctor removes the catheter by gently pulling on the external end. The balloon has a self-sealing valve, and at this point the balloon is floating freely in the stomach.

Plach3ent times vary but it will usually take 20-30 minutes, after which you will be monitored by the physician for a short time and then may return home.

Who can undergo this procedure?

The Bioenteric Intragastric Balloon is designed to assist with weight loss in people who are at least 40% above their ideal weight and who have failed to obtain prolonged weight loss with other weight control programs.

This procedure may be particularly useful for people considered too overweight or at increased risk for vital surgery. The use of the Bioenteric Intragastric Balloon to successfully reduce weight prior to surgery may help reduce the risks associated with surgical procedures on overweight patients.

How Long Is the Bioenteric Intragastric Balloon Used?

The balloon currently can be used for six months. Longer periods of use are not recommended. Over time the acidic content of the stomach will weaken the balloon material and cause the balloon to deflate. Should your physician recommend use of the balloon for longer than six months, it is necessary that the balloon be replaced with a new one when the six-month interval has been met.

While you are using the balloon, your physician may prescribe a course of oral medication to reduce your stomach acid (this may reduce the possibility of stomach irritation and damage to the balloon).

What Happens if the Bioenteric Intragastric Balloon Deflates Spontaneously?

If the balloon deflates before a scheduled removal you may or may not be aware that it has occurred. Your physician may place a colored dye inside the balloon in order to help you clearly identify early deflation by a change in the color of your urine.

The balloon is small enough that it may pass through the intestines and leave the body naturally, but there have been some cases in which it has had to be removed from the bowel surgically. If you suspect a deflation, you must notify your physician immediately.

How Will the Bioenteric Intragastric Balloon Be Removed?

The balloon is normally removed in the same way it was placed, via the esophagus and mouth. Prior to removal, you will be given a muscle relaxant and a topical anesthetic will be applied to numb the throat. Using an endoscopic camera, the physician will introduce a catheter through the mouth and into the stomach. The balloon will then be punctured and deflated. Once the balloon is deflated it can be grasped and removed.

How Much Weight Will I Lose with this Procedure?

It is important for you to understand that the Bioenteric Intragastric Balloon is an aid to weight loss and must be used in conjunction with a prescribed diet and behaviour modification program. Therefore, the amount of weight you lose will depend on how closely you follow your diet. How long you maintain weight loss will depend on how completely you adopt long-term lifestyle changes involving eating behavior and exercise.