Laparoscopic adjustable gastric banding (LAGB)
The adjustable gastric band was initially developed at the Karolinksa Institute in Stockholm, and subsequently developed as a laparoscopic/keyhole operation. There are several different bands made by a variety of manufacturers. The LAGB is a well-established operation, which is supported by a large body of good quality scientific research. It is proven to be a very safe operation, which produces significant and sustained weight loss, across a population of surgical patients. In latter years it has become clear that there is a significant rate of revision surgery for problems such as infection, erosion, slippage, and leakage, and the operation is much less commonly performed, having been supplanted by the sleeve gastrectomy. As always, the weight loss achieved in an individual patient may be more or less than the population average.
This link will take you to the IFSO page on LAGB.
The sleeve gastrectomy was initially developed in the early part of this century as an operation to “bridge” the super-obese patient to a gastric bypass or bilio-pancreatic diversion. The idea was to achieve enough weight loss to allow the technically more demanding second stage to be performed more safely. It was observed that the sleeve gastrectomy could achieve very significant weight loss and it came to be used as a weight loss operation in its own right, in a wider range of patients. We now have more than a decade of good quality research/publications to look at, and the sleeve gastrectomy has now become the operation of choice for most patients requiring bariatric surgery.
The (laparoscopic/keyhole) sleeve gastrectomy is as safe as the LAGB and is a more effective operation. Like all weight-loss surgery, it can produce significant improvement in complications of obesity such as high blood pressure (hypertension), type 2 diabetes mellitus, and elevated cholesterol and lipids. The effect on diabetes is so strong that the surgery is now proposed as a front-line treatment of diabetes, in patients who are on the point between overweight and obese (BMI 30).
As always, the weight loss achieved in an individual patient may be more or less than the population average.
This link will take you to the IFSO page on sleeve gastrectomy.
There are various forms of gastric bypass surgery. The Roux-en-Y gastric bypass (RYGB) is a laparoscopic/keyhole operation that has long been popular in the USA and is therefore one of the most common weight loss operations around the world. It is an effective surgical options but it does come with a higher complication rate, both in the early phase and down the track from the surgery. It is a technically demanding operation and it still may be done as open surgery, especially in re-operative cases (ie when converting from a previous, unsuccessful, operation). In Australia, the bypass is often done as a “salvage” procedure when another surgical approach has failed (whether due to inadequate weight loss, or due to a complication).
As always, the weight loss achieved in an individual patient may be more or less than the population average.
This link will take you to the IFSO page on RYGB.
Re-operative surgery
Some patients will require a second (or subsequent) weight loss operation. Possible reasons include:
- failure to lose weight.
- a complication of the surgery.
- excessive weight loss.
The approach to each patient will be different, depending on a variety of factors which may include:
- condition of the tissues in the operative field (scarring and infection may be present).
- the symptoms that have actually motivated the patient to come along for consideration of further surgery, and what he/she wants to achieve with possible further surgery.
- the individual patient’s general fitness for surgery.
Orbera balloon
The Orbera is a balloon that is placed inside the stomach and inflated there. This is done at an endoscopy/gastroscopy procedure (a telescope test). The balloon creates a sense of being full and therefore can lessen hunger and help with weight loss. Currently, the balloon can only stay in place for 6 months and then has to be removed or changed. Gastric balloons are not a new technology and it has become clear that they are not able to provide long-term weight control in the surgical weight-loss group (BMI > 35 with complications or > 40 without complications), but that they are a very useful adjunct to achieve a kick-start to weight loss in patients in the BMI 28 – 30 (or so) range.