Adjustable gastric banding is a form of restrictive weight loss surgery (bariatrics) designed for obesity patients with a body mass index (BMI) of 40 or greater - or between 35 – 40 with those who have co-morbidities that are known to improve with weight loss. The gastric band is an inflatable silicone prosthetic device which is placed around the top portion of the stomach via keyhole surgery /laparoscopic surgery. The placement of the band creates a small pouch at the top of the stomach which holds approximately 50mls. This pouch 'fills' with food quickly and the passage of food from the top to the bottom of the stomach is slowed. As the upper part of the stomach believes it is ‘full’ the message to the brain is that the stomach is full and this sensation helps the person to eat smaller portions, eat less and therefore lose weight over time. The band is inflated /adjusted via a small access port placed just under the skin [subcutaneous]. Radio opaque isotonic solution or saline is introduced into the band via the port. A specialist needle is used to avoid damage to the port membrane. The port may be placed in varying positions – surgeon’s preference - and may or may not be sutured in place. Ports vary in design and according to which one the many band manufacturers choose to include. As the fluid is introduced the pressure around the outside of the stomach is increase and in turn this decreases the size of the 'hole' that the food is able to pass. Thus, and increased restriction is produced and experienced by the patient. Over a period of time restriction is increased until patients feel they have reached a “sweet spot” where optimal weight loss can be reached with the minimal fluid required. This is an individual experience and timing cannot be predicted. There are approximately 7 - 8 adjustable bands on the market the amount of fluid required and total content is varied. If considering pregnancy ideally the patient should be in optimum nutritional status prior to conception and deflation of the band may be required prior to planned conception. This is also to be considered should morning sickness be present. The band may remain deflated during pregnancy and once breast feeding (or if bottle feeding 6/52 approx) is completed the band may be gradually re-inflated to aid post partum weight loss if needed. Gastric band placement, unlike traditional malabsorbative weight loss surgery e.g. Roux-en-Y gastric bypass surgery (RNY), Biliopancreatic Diversion (BPD_ and Duodenal Switch (DS), does not cut, mutilate, or remove any part of the digestive system. Removal would require a keyhole procedure and the stomach would return to it normal pre-banded state. Unlike those who have procedures such as RNY, DS or BPD it is unusual for gastric band patients to experience any nutritional deficiencies or malabsorption of micro nutrients. Calcium suppliments and Vitamin B12 injections are not routinely required following Gastric banding (they are with e.g. RNY).Gastric dumping syndrome|dumping] issues also do not occur since no intestines are removed or re-routed. Initial weight loss is slower than e.g. RNY. Although statistics indicate that over a 5 year period the weight loss outcome is similar / the same. Weight regain is possible with ANY weight loss procedures including the more radical procedures that initially result in rapid weight loss. World Health Organisation recommendation for monthly weight loss is ½ to 1 kgs per week and an ‘average’ banded patient may lose this. Clearly this is variable to the individual, their personal circumstances, motivation and mobility ability. A common reported occurrence for banded patients is regurgitation of non acidic swallowed food from the upper pouch. This is commonly known as PB’ing and is not to be considered normal but a point to review how the patient is eating. PB’ing is not ideal common occurrence and the person should think if they are eating too much, too quickly or not chewing their food. Occasionally the narrow passage into the larger / lower part of the stomach may become blocked by a large portion of unchewed or unsuitable food stuff. Further potential complications include – prosthetic fault (e.g. a leak) Physical damage – Erosion - the band may wear a small area on the outside of the stomach which can lead to Migration of the band to the inside the stomach. Slippage- an unusual occurrence where the lower part of the stomach may prolapse over the band and cause an obstruction. Psychological effect of any weight loss procedure must not be ignored.

Source: wikipedia.org