21 Laparoscopic Adjustable Gastric Banding: Long-Term Management

Abstract

Laparoscopic adjustable gastric banding continues to be an effective treatment for severe and morbid obesity. The consistent safety profile continues to make it an attractive option. However without dedicated long-term postoperative management and maintenance, weight loss can be suboptimal and complications more frequent. Band adjustments are performed in either the office or the radiology setting and are used to titrate the band for optimal hunger and satiety control. Behavioral counseling and patient education are critical for patient understanding of the band as a tool for weight loss and health improvement. Early recognition of side effects and problems can avert serious complications which may require surgical correction or revision.

Review Questions and Answers

• 1. The best place to adjust a gastric band is:

  • a. In the operating room

  • b. In the office

  • c. In the radiology suite

  • d. b and c

    The answer is (d). Band adjustments can be performed either in the office or in the radiology suite under fluoroscopy. Both are valid ways to perform adjustments as long as they are done on a regular basis until the patient reaches the Green Zone.

• 2. A patient who is 3 years after LAGB comes in complaining of coughing in her sleep for the past 3 weeks. Her last band adjustment was over a year ago. What is the first test you order?

  • a. Chest CT

  • b. CBC

  • c. Esophagram

  • d. Upper endoscopy

    The answer is (c). Night cough means that the band is too tight and the patient is suffering from reflux. Since she did not have her band recently tightened, the cause of band obstruction is from either a band slippage, a hiatal hernia, or from decreased esophageal motility secondary to esophagitis. An esophagram is a simple test which will show the band position, pouch size, pouch emptying, esophageal diameter, and emptying.

• 3. The most common cause of vomiting after gastric banding is:

  • a. Eating too fast

  • b. Not chewing thoroughly

  • c. Having the band too tight

  • d. Eating tough meat

  • e. All of the above

    The answer is (e). Vomiting in an LAGB patient is more regurgitation of undigested food rather than vomitus, and is most often due to behavioral causes such as eating too fast and not chewing properly. Reinforcement of behavioral modification is helpful. Sometimes the band is overtightened, and this creates a very small stoma which may even be too tight for liquids to pass. In this case the band needs to be loosened.