Banded Gastric Bypass

What is Banded Gastric Bypass? 

Banded gastric bypass surgery is a procedure conducted laparoscopically to help with weight loss. In this procedure, gastric bypass surgery is performed followed by placement of an adjustable silicone band around the upper part of the stomach to reduce its capacity to hold food. 

Indications for Banded Gastric Bypass

A banded gastric bypass is indicated in the following cases:

  • Individuals with a body mass index (BMI) greater than 40 kg/m2 
  • Individuals with a BMI between 30 and 40 and who have at least one comorbidity that is associated with obesity

Benefits of Banded Gastric Bypass

The advantages of banded gastric bypass surgery include:

  • The adjustable band can help control the amount of food intake, thereby facilitating significant weight loss. 
  • Reduces the chance of regaining weight by preventing the expansion of the upper part of the stomach over time.
  • Comparatively safe and effective procedure as it is less likely to produce complications such as internal hernias or bowel obstruction.

Contraindications of Banded Gastric Bypass

Contraindications to banded gastric bypass include the following:

  • Inflammatory diseases of the gastrointestinal tract (eg, Crohn’s disease, oesophagitis)
  • Cirrhosis, portal hypertension, esophageal or gastric varices
  • Previous gastric perforation near the site of band placement or gastrostomy
  • Severe heart or lung disease
  • Autoimmune connective tissue diseases (eg, systemic lupus erythematosus, scleroderma)
  • Chronic use of steroids or other immunosuppressant medications
  • Chronic pancreatitis

Pre-operative Preparation for Banded Gastric Bypass

Preparation for a banded gastric bypass includes the following:

  • Fasting 4-6 hours prior to the operation
  • Stopping anticoagulants 3- 5 days before the operation
  • Undergoing necessary blood tests and other investigations
  • Providing informed consent

Banded Gastric Bypass Procedure

Generally, gastric banding is a minimally invasive procedure that involves the following the general steps:

  • You will lie down on the operating table in the supine position (on your back) and anaesthesia will be given by anaesthetist.
  • The banded gastric bypass surgery procedure involves making a few small incisions over the upper portion of the abdomen to insert laparoscopic instruments that visualise the inside of the abdomen and faciliate surgery.
  • The stomach is divided with surgical staples to create a small upper section and larger lower section. 
  • The small intestine is cut and its lower part is attached to the upper section or pouch of the stomach thereby bypassing the larger lower section of the stomach and part of the intestine.
  • A silicone band is placed around the new stomach pouch to help control the flow of food and delay the emptying of the stomach. The band can be adjusted after surgery to help you achieve your weight-loss goals. 
  • The gastrostomy site also may have a marker placed to facilitate imaging and other evaluations of the bypassed stomach if the need arises. Lastly, all incisions are closed and bandaged.

Follow up after Banded Gastric Bypass Surgery

After the banded gastric bypass surgery, you should return for follow-up after 4 to 6 weeks for any needed band adjustment . You will be educated regarding how much to eat and what type of foods to eat, as well as advised on exercise routines. The band ensures that the stomach pouch does not increase in size over time, thus helping with weight loss maintenance.

Side-effects of Banded Gastric Bypass Surgery

Side-effects of a banded gastric bypass may include:

  • Dysphagia (difficulty swallowing)
  • Nausea
  • Vomiting
  • Ulcers
  • Fistula
  • Haemorrhage (bleeding)
  • Need to re-operate

Complications of a Banded Gastric Bypass

As with any surgical procedure, there are certain risks and complications with banded gastric bypass surgery that include the following:

  • Access port problems
  • Band erosion
  • Band slippage
  • Esophageal dilatation
  • Inter-abdominal bleeding
  • Gastroesophageal stenosis (narrowing)
  • Stomal ulcers
  • Intestinal perforation 
  • Rarely, death