Gastric banding

At gastric band surgery, a silicone band is wrapped around the upper portion of the stomach, which constricts the stomach. Read all about the method!

Gastric banding

The gastric Banding (English: gastric banding) is an operative method that suppresses the natural feeling of hunger in overweight people. During surgery, a silicone band is wrapped around the upper part of the stomach. This artificially creates a very small stomach pocket. If it fills with food, the stomach signals satiety. Because of a rather high complication rate, the method loses importance. Read all about the use, effects and risks of gastric banding.

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. E66

Product Overview

gastric Banding

  • What is a gastric band?

  • Course of the gastric band op

  • For whom a gastric band is suitable

  • For whom a gastric band is not suitable

  • Efficacy of gastric band surgery

  • Benefits of gastric banding over other procedures

  • Risks and complications

  • Diet with the gastric band

  • Gastric band: cost

  • Magenband: Health insurance often takes over the costs

What is a gastric band?

The so-called gastric band is a silicone tube, which is wound over an operation around the upper part of the stomach. He artificially divides the stomach into a small "forestomach" (pouch) and the large remaining stomach. The forestomach has a volume of only about 20 to 30 milliliters. That's about the size of a table tennis ball. If the forestomach is stretched by food intake, this gives the brain the signal of saturation. The gastric band is therefore an aid that helps to lose weight, above all, by suppressing the feeling of hunger.

The gastric band is hollow inside and connected via a small tube with a so-called port system. The port is a small chamber, which is implanted under the skin during gastric band surgery. With a special needle, liquid can be filled into the port chamber and thus into the gastric band. This allows the degree of gastric constriction to be regulated as needed: the more fluid is injected into the gastric band, the more it strangles the stomach. If fluid is withdrawn, the inner diameter of the gastric band increases again and the stomach has more space.

Course of the gastric band op

A gastric band surgery takes about 30 to 60 minutes and is performed under general anesthesia. The hospital stay usually extends from one day before surgery to three to five days after surgery. As a rule, the procedure is performed as so-called keyhole surgery (laparoscopy). In the keyhole technique, a total of five approximately two centimeters large skin incisions are set, over which the camera and the instruments are introduced. For implantation of the port, a slightly larger skin incision is also necessary at the lower edge of the sternum.

The silicone band is introduced via one of the working channels. With the instruments, the surgeon positions the band around the upper part of the stomach (cardia) and pulls it together like a cable tie. To be able to better estimate the size of the forestomach, a stomach tube with a small, deployable balloon is next introduced through the mouth into the forestomach. This is in the unfolded state about the size of a table tennis ball (volume about 20 - 30 ml) and corresponds approximately to the final volume of the forestomach.

The gastric band can be adjusted slightly more up or down after insertion of the gastric balloon or tightened a little firmer. Once the perfect position for the gastric band is achieved, it is still fixed to the surrounding tissue by several sutures.

Finally, the tube and the port chamber emerging from the gastric band are guided outwards through a cut in the area of ​​the abdominal wall and placed underneath the skin at the lower end of the sternum and sewn up. Through the port at any time a regulation of the gastric band diameter by liquid extraction or addition is possible.

About one month after gastric band surgery, the port is pierced for the first time to deliver a few milliliters of fluid. As a liquid (a maximum of 9 milliliters) usually a so-called X-ray contrast agent is used, which is visible in the X-ray image. Thus, for example, a leak in the gastric band can be identified in the X-ray image. The ability to work is usually given two to three weeks after surgery, depending on the profession.

For whom a gastric band is suitable

The gastric band is suitable for people with a body mass index (BMI) of ≥ 40 kg / m² (grade III obesity). If a person suffers from other metabolic diseases such as diabetes (diabetes mellitus), hypertension or sleep apnea because of his or her excess weight, gastric banding may be useful from a BMI of 35 kg / m².

In any case, it is a prerequisite that all conservative (non-operative) measures over six to twelve months have not brought sufficient success.These measures include, for example, nutritional counseling, exercise training and behavioral therapy (Multimodal Concept, MMK). For gastric band surgery, one should be at least 18 and at most 65 years old, whereby the intervention in individual cases can also be done in younger or older people.

For whom a gastric band is not suitable

Certain physical and mental illnesses speak against an obesity operation such as the gastric band: in particular, previous operations or malformations of the stomach, stomach ulcers and addictions or untreated eating disorders (for example, "binge eating" or bulimia) are important contraindications for a gastric band. Even pregnant women and people who take long-term anticoagulant drugs, must do without a gastric band.

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    Do I have to lose weight?

    Weight loss is high on the list of good intentions. In fact, obesity is not just an aesthetic question: if you are too fat, you are more likely to suffer from diabetes, cardiovascular disease or some types of cancer. But do you really have to fight every hip pad? And when does being overweight become critical? Find out if you can stay as you are.

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    When diets make you fat

    To be honest, most people lose weight less about their health than about being attractive. But this is a strategy that could backfire. For one thing, diets can make you fat. The shut down metabolism ensures that the pounds accumulate quickly again. Not infrequently you bring more on the scales afterwards than before. Many have been fat-starved - this threatens especially at more radical cures.

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    Not everyone has to get to the bacon

    Anyway, anyone who has a body mass index of 25 or more is considered overweight. This is calculated from the body weight (kg) divided by the square of the height (m2). But those who have no additional risk factors, such as high blood pressure, diabetes or a fatty liver, does not necessarily lose weight - despite higher BMI. With regular exercise, the biggest risks of being overweight can often be kept in check.

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    Five percent less already bring a lot

    From a BMI of 30 and more, however, it looks different. Then, by definition, the limit to obesity is reached and the risk of illness is considerably increased. You do not have to be leaner than that. A reduction in body weight by five percent already brings a lot for your health.

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    Inaccurate BMI

    But the BMI is just an inaccurate indicator. Very muscular people he is wrong to certify obesity, small, delicate individuals, however, rather late. More meaningful is the belly circumference. Because fat that accumulates in the abdomen, health is far more worrying than padding on buttocks and thighs. For women, the waist circumference should be below 88 cm and below 102 cm for men.

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    Risk fast weight gain

    You should also lose weight if you have gained a lot in a shorter time - for example, five kilos in half a year. Then you should at least slow down the increase in weight, otherwise there is a risk of rapid fat loss - with all the associated risks. The good news is: Kilos that you have quickly chewed are usually easier to get rid of than slowly grown upholstery.

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    Uncertain underweight

    To be thin is also not healthy. The risk of death for slightly overweight people is lower than for normal weight. And for underweight persons (BMI below 18.5), the risk of premature death is even higher than for those of high obesity (BMI over 35). Especially in the elderly, a few extra pounds act as a life insurance.

Efficacy of gastric band surgery

Compared with the other surgical procedures, gastric banding achieves on average the lowest weight loss. Only a few patients achieve their normal weight with the gastric band (BMI ≤ 25 kg / m²). Inadequate weight loss is especially to be expected when the patient ingests high-calorie and high-fat, soft foods or liquids that can easily pass through the narrowness of the gastric band.

Studies indicate that the gastric band can cause a long-term loss of about 50 percent of the excess weight. Often this information is misunderstood: this does not mean that the method will lose 50 percent of the initial weight. For example, if a patient has a BMI of 45 kg / m² prior to gastric band surgery, this is 20 kg / m² over normal weight (maximum 25 kg / m²). If the patient creates a reduction of his BMI by 10 kg / m² to 35 kg / m² through the gastric band, this corresponds to a weight loss of 50 percent of the excess weight.

Read more about the investigations

  • J1 investigation
  • J2 investigation

Benefits of gastric banding over other procedures

Gastric band surgery is a bit of a complicated procedure and, with the correct surgical technique, poses a minimal risk to the patient.The comparatively low surgical risk is therefore not to be underestimated, especially as overweight people already have a significantly increased surgical risk anyway. Another great advantage of the gastric band is that it can be removed at any time and relatively easily and thus the procedure is completely reversible.

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Risks and complications

Basically, the usual surgical risks exist when inserting a gastric band. These include bleeding, organ injuries, infections, wound healing disorders and problems due to anesthesia. Finally, there is a risk that the stomach will be injured during the operation.

However, recent study results of recent years suggest that the complication rate of gastric banding is relatively high. Not the relatively low-risk operation itself is therefore the problem, but the complications that can occur after months or years. The most common specific complications of gastric banding include:

  • Gastric band shift ("bandslippage", in about 5.5 percent of all cases)
  • Volume increase of the forestomach due to gradual dilation of the forestomach ("pouch dilatation", in about 5.5 percent of cases)
  • Gastric band leak or leakage in the connecting tube to the port with leakage (in about 3.6 percent of cases)
  • Elongation of the esophagus before the gastric band ("esophageal dilatation", in about 3 percent of cases).

In very rare cases, more serious complications may occur, such as perforation of the gastric band through the stomach wall into the stomach (gastric perforation) or infection of the port chamber with pathogens. In some studies, the risk of a need for reoperation (revision surgery) after gastric band surgery is estimated at about 30 to 50 percent. This is problematic insofar as adhesions (adhesions) and scarring can occur due to every abdominal surgical procedure, which can severely complicate follow-up operations and also cause massive complications up to intestinal obstruction.

Diet with the gastric band

After the operation, the first postoperative day begins with the preparation of liquids alone. These are taken only slowly and swallowed throughout the day. For the next four weeks, the hospital will provide you with a nutritional plan that describes the exact structure of the food. For about two weeks, it will only stay with liquid food. For the next two weeks, only soft food is on the menu. About four weeks after the surgery, you finally start again with normal diet. But there are some things to keep in mind:

  • Gastric bandents should not only eat less, they also have to eat differently than before. In order for the porridge to pass the bottleneck, every bite must be chewed very thoroughly. Problems often cause long-fiber meat (beef, pork) or vegetables.
  • Since liquids also fill the small forestomach, at least for a short time, you should separate your food and drink.
  • Sweets, especially sweet drinks, but also alcohol, high-calorie soups and porridge should avoid gastric band wearers. They pass unhindered through the constriction between the front and the rest of the stomach, making them thick and thus nullifying the weight loss effect.

Gastric band: cost

The gastric band costs are made up of different proportions: On the one hand, of course, the surgery itself. In addition, there are additional costs for the inpatient hospital stay and the control appointments to check the gastric band. The gastric band costs differ considerably depending on the doctor and the treatment costs. The price range is about 5000 to 10,000 euros.

Magenband: Health insurance often takes over the costs

A gastric banding (Gastric Banding) is not a regular benefit of the statutory health insurance, but the intervention is usually accepted by the statutory and private health insurance on request. However, the criteria already mentioned above must be fulfilled. The application itself must also be prepared very carefully in order to assess the chances of reimbursement for the project gastric Banding to increase.

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