Dr. Aparna Govil Bhasker
Bariatric & Laparoscopic Surgeon
Adjustable gastric banding was a bariatric procedure that was popular when bariatric surgery had just begun in India. During this procedure, an adjustable silicon band is placed around the upper part of the stomach. This divides the stomach into a smaller upper portion and a larger lower pouch. The band is attached to a tube which in turn is connected to an adjustable port. Band adjustment can be performed by inserting or withdrawing fluid in the band through this port. It is a reversible procedure and does not involve any permanent anatomical change. However, gastric banding went out of favour in the later half of last decade. Most surgeons practically stopped banding due to poor weight loss results. The Indian diet is very rich in carbohydrates and a simple restriction of the quantity of food did not help the weight loss in our population. Gastric banding is also very follow up intensive and needs regular tightening and loosening. Weight loss results suffer, if proper follow up is not performed by the patient or the doctor. Presently gastric banding does not even constitute 1% of all bariatric procedures being performed in India.
Offlate, in the last few years bands are being applied as an additional mechanism for long term weight maintenance for other bariatric procedures such as Roux-en y gastric bypass and sometimes even sleeve gastrectomy in india. Obesity is a chronic progressive disease. Bariatric surgery is the only method for sustained weight loss in patients suffering from morbid obesity. Most patients experience an acute drop in the weight in the first 2 years after bariatric surgery in mumbai. However, some degree of weight regain does happen in the long term. This happens due to various reasons. Stomach tissue is pliable and elastic. The stomach pouch or the sleeve of stomach tends to enlarge over a period of time, allowing the patients to be able to consume more quantities of food. In case of gastric bypass, the place where we join the stomach to the intestine (anastomosis) is initially about 1.5 cm in diameter. This also enlarges over a period of time, allowing the patient to eat more quantities. If the quality of the food being consumed is not good and then gradually the weight gain can happen. In addition to this, daily exercise level and dedication to lifestyle modification is equally important.
Banded procedures like the banded Roux-en y gastric bypass surgery in mumbai or banded sleeve gastrectomy consist of applying an inflexible band over the stomach pouch. This prevents the pouch from future dilatation and maintains restriction in the long term. Weight maintenance is better in the long term with banded procedures.
The flip side of banded procedures is that bands are foreign bodies and there is a chance of complications like band erosion into the stomach or band slippage. Band are inflexible and sometimes may also lead to difficulty in swallowing or vomiting. In case of complications such as band erosion, usually it is possible to remove the band endoscopically by an experienced bariatric surgeon or a gastro-enterologist. Bands also add to the cost of the surgery and make it more expensive.
In conclusion, overall long term weight maintenance with banded procedures is better but there is an additional cost as well as risk of complications associated with the band. In my practice I usually educate my patients about the pros and cons and then we together we take an informed decision.
Dr. Aparna Govil Bhasker is an accomplished Bariatric Surgeon and Laparoscopic Surgeon. She is very renowned and is extremely passionate about her field of specialization.
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Dr. Aparna Govil Bhasker is a visiting consultant at the following hospitals: