Gastric band

Synonyms in the broader sense

Gastric banding, stomach reduction, gastroplasty, sleeve stomach, Roux En Y bypass, small intestine bypass, biliopancreatic version according to SCOPINARO, billiopancreatic diversion with duodenal switch, gastric balloon, gastric pacemaker, surgical obesity therapy

definition

The gastric band is an operative method of bariatric surgery to get extreme, morbid obesity under control when other measures such as diet and exercise have failed.
It is attached laparoscopically by means of a camera and very small abdominal incisions through which the camera and the surgical instruments are introduced.
Placing a gastric band tightens the stomach, making it impossible to swallow large amounts of food - this helps reduce weight.

introduction

Obesity is a very common problem nowadays, especially in western oriented countries.
Overeating as well wrong diet with too much fat lead to obesity.
In some cases, which are no longer rare today, the excess weight goes into the extreme form Obesity (obesity) over. The problem is not just that mental stress but especially the dangerous ones Consequences of being overweight.
Extreme obesity leads to:

• increased blood pressure
• Diabetes (type 2 diabetes)
• bad fat levels in the blood (dyslipoproteinemia)
• gout
• Heart disease
• stroke
• Lung disease: Shortness of breath up to sleep apnea syndrome (temporary cessation of breathing during sleep)

Hence, it is very important to manage your weight through healthy eating and exercise. If you lose control there are different ways to seek help.
You can get information almost everywhere: at Family doctor, in the pharmacy and many other contact points.
Please also read our article on this Consequences of being overweight

Epidemiology

According to the Federal Statistical Office, 60% of men and 43% of women in Germany were overweight in 2009.
According to the magazine FOCUS, 20% of the German population are considered obese.
In recent years, however, the Number of overweight children increased.
The overweight or Obesity on the Body Mass Index (BMI).

Body mass index

The BMI is a measure by which under, normal and overweight can be determined.
It is calculated using the following formula: Weight in kg / (height in m) ².
The assessment is based on the following table:

• 18-24.9 kg / m²: normal weight
• 25-29.9 kg / m²: overweight
• 30-34.9 kg / m²: Obesity grade 1
• 35-39.9 kg / m²: Obesity grade 2
• > 40 kg / m²: Obesity grade 3

In order to assess health risks in particular, however, is above all the Distribution of body fat relevant.

Belly fat is more dangerous as fat on the buttocks or extremities, because it leads to more comorbidities.
Therefore, the waist size certain: for women it should not be more than 80 cm, for men not more than 100 cm.

You can read more about the subject of "surgery with a gastric band" with requirements, surgical technique and risks of an operation here: Gastric band surgery

What is the cost of a gastric band?

There is no lump sum for the cost of a gastric band. The amounts for the necessary inpatient hospital stay, the actual operation and the necessary check-ups result in an amount that is usually between around 5,000 and 10,000 euros. The costs can vary greatly depending on the clinic. If complications such as a wound healing disorder occur, the costs can also increase significantly higher.

For more information, see: The cost of a stomach reduction

What are the prerequisites for the health insurance to pay for a gastric band?

The prerequisite for the assumption of costs for the insertion of a gastric band by the health insurance company in Germany is that there is a medical need for the procedure. This must be documented by a doctor and is tied to certain criteria. You must be extremely overweight (body mass index over 35-40) and have serious side effects. These include, for example, joint diseases or diabetes mellitus (“diabetes”). In addition, all conservative treatment methods such as diet changes and exercise programs must be exhausted, since an intervention such as the insertion of a gastric band is a last resort if all other measures to reduce weight have failed.

Among other things, it is required that at least one medically controlled weight loss attempt has already been carried out. Another prerequisite for the costs to be covered by the health insurance company is that the patient has been fully informed about the procedure and the consequences and is motivated to take this step. An application must be submitted to the health insurance company to cover the costs, as this is not a standard benefit. If the above requirements are met, the costs are often covered after a usually lengthy procedure.

What is the preparation for the operation like?

One of the essential aspects of preparation for the operation is the examination of whether there is a justified indication to perform the operation. In addition, the patient must be informed in a way that is understandable to him and given sufficient time to consent or refuse. Various examinations are another important aspect when preparing for the procedure.

A blood sample, for example, and an EKG to assess cardiac function are routinely performed. Depending on the previous illnesses and the age of the patient, further examinations such as a determination of the lung function and a chest x-ray may be necessary. The patient's long-term medication must be checked by a doctor and possibly changed or paused for the operation (such as tablets for diabetes).

How does the operation work?

The insertion of a gastric band is now almost exclusively done via a laparoscopy using the "keyhole technique" (laparoscopy). General anesthesia with ventilation is required for this. In addition to a camera, the necessary surgical instruments and the gastric band are inserted into the abdominal cavity through several small incisions in the abdominal wall. In addition, the gas is filled with carbon dioxide so that the abdominal wall is lifted from the organs and the surgeon can visit the stomach.

This has to be exposed somewhat so that the gastric band can then be applied from the outside in the upper part of the hollow organ. This creates an artificial constriction that divides the stomach into a smaller front section and a larger rear section. This ensures that the stretch receptors in the anterior part of the stomach send the brain a saturation signal even after a small amount of ingested food.

During the operation, a so-called port is also inserted under the skin, which is connected to the gastric band via a tube. This port can be used to add or remove saline solution after the procedure and thus regulate the pressure that the band exerts on the stomach.This does not require a new surgical intervention but can be carried out on an outpatient basis with little effort. The operation is completed by removing the instruments, releasing the carbon dioxide and suturing the wounds.

For more information, see: Gastric band surgery

How long does the operation take?

The time required for a gastric band operation depends on the patient's circumstances (extent of obesity, possible previous operations) and the experience of the surgical team or center. The actual procedure, from inserting the instruments into the abdominal cavity to suturing the wounds, takes about an hour.
In addition, there is the time of preparation for the operation and induction of anesthesia as well as the anesthesia recovery after the procedure. Then you are monitored in a recovery room for a while and then come back to the ward. After two to three days you can usually be discharged home.

What does the follow-up treatment look like after the operation?

After the operation, the patient usually remains in the hospital for two or three days. There, daily checks of the wound conditions and the general condition of the patient are carried out. An essential aspect of the follow-up treatment after the insertion of a gastric band is the slow diet. On the first day after the operation, a liquid diet is started, which is taken slowly over the day. Depending on the hospital, the structure of the diet differs and the patient is given precise instructions on how to structure the structure of the diet. Usually the liquid diet is retained for the first two weeks after the procedure.

This is followed by a phase in which soft food is taken. Normal food is often on the menu after four weeks. Under no circumstances can you then eat what you want but must strictly observe several things. Eating and drinking should be separated in time so as not to overload the reduced stomach. In addition, the food has to be chewed very thoroughly so that the bottleneck created by the gastric band can be overcome.

In addition, sweets, sugary drinks (cola, lemonade but also juices!) And alcohol should be avoided due to the high calorie content. Since these can pass the stomach relatively unhindered, they otherwise stand in the way of the desired slimming effect. In addition, regular check-ups are an important part of the follow-up treatment. When and how often this is required depends on the clinic in which the operation was performed. The information is usually given to the patient in a preliminary discussion.

What kind of pain occurs after the operation?

The pain caused by the operation is felt differently by everyone. However, pain medication will be administered both during and after the procedure. However, should the pain become more severe, the doctor should be informed without hesitation, so that he can increase the dose or switch to another pain reliever. There is no need to simply endure the pain and there is no need to worry about the harmful effects of short-term use.

Because gastric band surgery is a keyhole surgery, some patients complain of tenderness in the abdomen or shoulders in the days after the operation. These are caused by the gas that is introduced into the abdominal cavity during this surgical procedure. After a few days, this pain subsides again. After surviving the operation and healing phase, pain or a feeling of pressure in the epigastric region may occur if larger quantities have been eaten than the narrowing in the stomach can pass. Care must then be taken to consume smaller portions.

forecast

Patients with an implanted gastric band have the Chance 40 - 60% theirs To reduce weight.
The gastric banding leads to the patient becoming restrict food intake got to:

• the food can no longer be swallowed
• the food must be carefully chewed to fit through the gastric band
• otherwise vomiting occurs quickly
• Sweet foods such as ice cream, milkshakes or chocolate mousse fit easily through the narrow opening of the gastric band

If the cause of the obesity is excessive consumption of desserts (so-called "sweet eater"), becomes the gastric band no influence have on it as long as the patient does not limit the consumption of these foods.
Therefore benefit people who prefer hearty dishes to a greater extent from gastric banding.

The patient who undergoes such an operation must be aware that he will not be able to eat normally like other people afterwards. It takes much longer to eat.

The implantation of a gastric band also affects it positive on due to being overweight occurring comorbidities out.
By losing weight, patients can:

• the Blood sugar level normalize
• the Lower blood pressure and
• a Sleep apnea syndrome improves or disappears
• Joint disease decrease
• depressions improve or disappear

Most patients report a significant increase in quality of life.

Side effects

The Gastric band While changing unhealthy lifestyle habits at the same time, it is a good method to lose weight effectively and any existing comorbidities such as the Blood sugar disease (Diabetes mellitus) or the high blood pressure (hypertension) to counteract. However, the process also has disadvantages.

When inserting (implantation) of the gastric band is an invasive procedure that, like any operation, various risks, like for example:

• Bleeding
• Infections
• Injury to organs in close proximity to the stomach
• the formation of bruises, blood clots and annoying scars

conceals.

But not only the procedure itself can lead to the occurrence of complications. It can even after a successful gastric band implantation long term various side effects arise.

A common side effect The gastric band implantation is the occurrence of Vomitwhich can be extremely stressful for the patient. Vomiting occurs particularly when the food is not chewed long enough or swallowed too quickly. From frequent vomiting acidic gastric juice it can be long term too Tooth damage come. Therefore, patients will be given a gastric band regular visit to the dentist recommended.

Frequent vomiting also carries the risk of aspiration. This is what aspiration means Ingestion of liquids or food into the windpipe. In the worst case, it can even be too acute shortness of breath come and thus there is a potential danger to life.

Another problem that arises when the food is not chewed long enough or swallowed too hastily is that food components are too large Close the gastric passage can.

In addition, food components that linger in the stomach too long can cause the Gastric mucosa irritate and become one Inflammation of the stomach lining to lead.

Also the passage from Medicines in tablet form can be obstructed by a gastric band and thus, for example, delay the onset of the drug's effect. This must be taken into account especially in the case of patients with comorbidities.

The gastric band itself can also cause problems. So over time, the gastric band can be Change position, that means walking up or down. This process is called Slippage designated. On the one hand, a change in the position of the gastric band can cause it to Gastric occlusions come. On the other hand, the gastric band can slip in such a way that it no longer has any tightening effect on the stomach and thus the gastric band functionless becomes.

Furthermore, if the pressure on the stomach wall is too high, the gastric band can even with this grown together or in the Incise the stomach. This process is called penetration designated. The penetration The gastric band can in the worst case Bleeding and cause perforations in the stomach wall.

If the gastric band slips (Slippage) or to allow the gastric band to grow into the gastric wall (penetration) is a re-operation requiredwhich again harbors the risks mentioned above. If necessary, then other methods of stomach reduction be considered. The risk of having another operation due to a Slippage or penetration of the gastric band increases the longer the gastric band is in the body.

In rare cases it can too Leak in the gastric band come, whereby the actual function of the gastric band is canceled. The gastric band then has to be replaced again as part of a surgical procedure.

In most cases the gastric band needs to be adjusted four to five years be replaced due to wear and tear or blockages.

Because the gastric band off silicone exists is in principle also one Intolerance reaction Another possible side effect against the silicone is conceivable.

It is important that after gastric band implantation unhealthy lifestyles be filed. The gastric band makes the stomach smaller, which means that overall less food and only smaller food components can be ingested. Often especially prepare Vegetables, fruits, meat and bread Discomfort while eating, causing some patients to start eating soft or liquid foods. Tasty soft or liquid dishes are in particular desserts such as pudding, lemonade and ice cream. Another important side effect of the gastric band can even become one in the long term Increase in weight of the patient come. This reverse effect in turn has one negative influence on possible comorbidities like blood sugar disorder (diabetes mellitus) or high blood pressure (hypertension). In addition, this type of diet results in a lack of the essential components of healthy food (Vitamins, Minerals, trace elements) comes and so other side effects like fatigue, Hair loss, Muscle spasms or even osteoporosis (Bone loss) can arise. Hence, it is important that the patient post-gastric band implantation absolutely learned healthy eating habits and takes enough time to eat.

Long-term side effects from gastric banding

A gastric band can lead to side effects and long-term effects even after a long time. On the one hand, swallowed objects or chunks of food can block the stomach passage. In the worst case, this can make another emergency operation necessary. In most cases, however, large portions quickly lead to vomiting. Long-term consequences of frequent vomiting in those who wear a gastric band are tooth damage and an increased risk of pneumonia caused by ingested vomit (aspiration pneumonia).

Another possible complication is cutting the gastric band into the organ. In addition, the tape can slip. In both cases, another operation to remove the ligament is also required. In addition, the repeated piercing of the port for pressure regulation of the gastric band can lead to an infection of the foreign material due to the spread of germs. In such a case, too, the entire system usually has to be removed, as otherwise life-threatening blood poisoning can threaten.

Gastric band and alcohol- is that possible?

Patients wearing a gastric band should avoid alcohol whenever possible. The purpose of the gastric band is to help reduce the intake of food and calories so that the patient can lose weight. Alcoholic drinks are extremely high in calories and can be consumed almost unhindered despite the gastric band.
Therefore, the desired effect of the gastric band is counteracted by the consumption of alcohol. The patients lose weight less or not at all. However, the influence of alcohol on the body of those who wear a gastric band is no more harmful than it is to healthy people. Alcohol can therefore be consumed in moderation and not too often with a gastric band.

Gastric band and pregnancy- is that possible?

In principle, pregnancy is also possible in women who have a gastric band. There is no recommendation to remove this if you wish to become pregnant. However, many doctors advise unblocking the ligament during pregnancy. There are no scientific studies that allow a clear recommendation. However, there are many women who have had normal pregnancies without complications or limitations despite having a gastric band.

What are the alternatives to the gastric band?

In order to achieve weight loss, a reduction in calorie intake with diet on the one hand and increased calorie consumption through sufficient physical exercise should always be in the foreground. If these measures do not lead to success even with professional support and if other conservative measures such as diets have also been exhausted, a drastic measure from the field of bariatric surgery can be considered. It is an umbrella term for surgical interventions that are used to reduce body weight and combat extreme obesity. Inserting a gastric band is just one of several possible alternatives.

One possibility is to perform a stomach reduction by surgically removing part of the stomach. This reduces its capacity, so that food intake is limited by a faster onset of satiety. A frequently used example is the creation of a gastric sleeve.

A gastric bypass, on the other hand, is a surgically produced bypassing a large part of the stomach. Here, too, the goal is to achieve a reduction in capacity through surgical reduction of the stomach. When inserting a gastric balloon made of silicone, on the other hand, no surgery is required, only a gastroscopy. The balloon introduced into the stomach cavity is filled and, due to its displacement, creates a faster feeling of satiety.

Another alternative to the gastric band follows a completely different approach to the goal of reducing body weight: a so-called gastric pacemaker can use electrical impulses to delay emptying of the stomach into the intestine, so that the patient is full longer. Whether this method achieves just as good or even better results as those mentioned above has not yet been clearly established through studies. The basic requirement for all of the alternatives mentioned is that the patient is motivated to accept the procedure as support for the goal of long-term body weight reduction.

How can you remove a gastric band?

The removal of a gastric band, like the application, requires a surgical procedure under general anesthesia. Even if the actual removal can be carried out more quickly, the effort involved in the removal is not significantly less.
An alternative to removing the gastric band can be to unblock it completely through the port. This can be done quickly and easily and does not require an inpatient hospital stay or an operation. However, this alternative is only an option if there are no compelling reasons for the complete removal of the gastric band. This can be the case, for example, if there is inflammation caused by the foreign material or if the gastric band has slipped off. If a gastric band fits well and the patient can live with it, a gastric band does not have to be removed but can remain in the body for life.

Summary

Gastric banding is one

• surgical
• little risky
• effective method

to get extreme obesity under control.
Advantages are one Weight reduction and associated with it clearly decreased health risks such as lowering blood pressure or blood sugar.

However, after the operation, the patient will no longer be able to eat normally. He has to eat extremely slowly and significantly reduce the amount of food.

However, a particular advantage of the implantation of a gastric band over other surgical measures such as stomach reduction lies in the Reversibility. You can put the gastric band back on and finally remove it. This is useful when the patient has become accustomed to normal eating habits. Then he will be able to eat normally like other people again.