Nearly 36 percent of adults and almost 17 percent children in the U.S. were obese in 2010. Worldwide, the prevalence of obesity is increasing. In obese people, weight loss reduces the risk for cardiovascular disease and probably lengthens life, but nonsurgical treatments for weight loss are often ineffective and have a high failure rate. Some studies, such as the Swedish Obese Subjects Study, have suggested surgical treatment of severe obesity is the only effective therapy. While gastric banding and other surgical treatments for obesity have advantages, they have drawbacks, too.
Gastric Band Advantages
The most commonly performed weight-reduction surgery, and the surgery to which all others are compared, is the Roux-en-Y gastric bypass. This procedure permanently divides your stomach into 2 portions and “re-plumbs” your gastrointestinal tract. You must remain in the hospital for several days after surgery, and the procedure is difficult to reverse. In contrast, gastric banding does not permanently alter the architecture of your stomach or intestine, postsurgical recovery is rapid, the tightness of the band can be adjusted postoperatively and the procedure is generally reversible.
Although the complication rate for gastric bypass is higher during and immediately after surgery, people who undergo gastric banding are more likely to develop problems several months to years after surgery. According to a study published in the December 2011 issue of “Obesity,” about 2.5 percent of gastric band patients experience band slippage, where the band slides up or down from its original position on the stomach. Dilation of the stomach pouch above the band occurred in nearly 10 percent of people in this study, but recent changes in surgical techniques may help prevent this complication.
Approximately 6 percent of people in this study experienced band migration, which occurs when the gastric band gradually wears through the stomach wall. Gastric band migration often does not cause any symptoms, but may lead to life-threatening perforation, bowel obstruction or bleeding. Twenty-four of 200 patients had their bands removed due to a complication or discomfort.
Although malnutrition is not as common in people who had a gastric band procedure as it is in those undergoing gastric bypass, some nutritional deficiencies -- iron, vitamin B12 and calcium being the most common -- may occur after any weight-loss surgery. Routine supplementation is recommended after all such procedures.
If your gastric band is placed too tightly, you may develop acid reflux symptoms. With adjustable bands, this is usually addressed by loosening the band, which can be done without surgery. In some cases, acid reflux becomes a chronic problem requiring medications.
Less Weight Loss
A review in the October 2008 issue of "The American Journal of Medicine" analyzed data from 14 trials, comparing outcomes, complication rates and patient satisfaction among people who had undergone gastric bypass or gastric banding. This study also showed higher long-term complication rates in gastric band patients. It also revealed lower rates of weight loss among those who had gastric banding. On average, people who had gastric banding lost 25 percent less of their excess body weight than people who had gastric bypass. The single comparative trial evaluating patient satisfaction showed that 80 percent of gastric bypass patients were pleased with their procedure, while only 46 percent of gastric band patients were similarly satisfied.
Obesity is not merely a cosmetic issue. People who are extremely overweight are at risk for diabetes, cardiovascular disease and other chronic diseases. Weight-loss surgery an effective way for dealing with severe obesity and its associated health risks. But weight-loss procedures have significant differences, and your situation must be approached with your specific needs in mind. Your doctor can help you explore your options and decide if gastric banding is appropriate for you.