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How
Does Gastric Banding Works |
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The Gastric
Band is an adjustable
implant.
This device has four basic components: the band, the expandable balloon attached to it, the reservoir (port), and a tube that connects the port to the balloon. The balloon is inflatable with a capacity of four cubic centimeters. At the time of surgery, the balloon is left empty. Only after a variable period, usually at least six weeks to eight months, the band is then inflated by injecting saline solution through the port.
One reason that there is a delay of at least six weeks before the first fill is that the surgery causes swelling of stomach tissues. Inflating of the balloon during this period could cause undue stress on the upper pouch and cause slippage of the band. For a similar reason, during the first weeks after surgery, a liquid diet is recommended. During this period, the band has time to settle in. The swelling subsides and the tissue surrounding the stomach will form adhesions and hold the band in place.
Inflation of the band, intake of solid foods, and vomiting during the early period can all be the cause of band slippage.
Does size matter?
Just as most people wear different shoe sizes, one size does not fit all, the same happens with the band. The implant is currently available in two sizes: circumferences of 9.75 and 10 centimeters. Some surgeons prefer one over the other, but they are basically the same. At the time of surgery, if one band does not fit properly, the surgeon will remove some fatty tissue from the surgical area to accommodate the band. If a band sits very snugly, a patient may experience early difficulty swallowing. This tends to resolve quickly after a couple of days.
Some people also experience early obstruction soon after the surgery. This is the result of surgery causing swelling of the tissue inside the band, therefore causing an obstruction to the flow of liquids and food through the stoma. In our experience, this also resolves in several days and does not require further surgery. This requires patience, or at the worst case, infusion of fluids intravenously in a hospital setting.
Once the six-week period has passed, the surgeon and his team will evaluate the need for an adjustment. Not all patients will need or receive an adjustment at this time. Those patients in which the band fits snugly after surgery, usually taller individuals and/or those with higher BMIs, may take as many as eight months before a fill is indicated.
The grand majority of patients do require a fill at six to eight weeks after surgery. By this time, the patient will have experienced the three week liquid diet, from clear liquids, to broths creams, and then protein, followed typically at the end of the third week by the transition into solid foods.
Most patients will feel no restriction whatsoever at six weeks. The explanation is simple. After surgery, the simple presence of the band will cause a satiety effect, the feeling of fullness. In other words, patients are not hungry. So the liquid phase is relatively easy to follow and you lose a lot of weight, which keeps the spirits up. By the third week, as you start on solids, most of the swelling related to the surgery has subsided. The band is totally deflated but the tissue has become thinner. After the third week and before your first fill, most people find that they can basically eat anything. When this occurs, it is time for an adjustment.
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