Gastric band

Dr. med. Fabian Sinowatz is a freelancer in the medical editorial team.

More about the experts All content is checked by medical journalists.

The gastric banding is an operative method that suppresses the natural feeling of hunger in overweight people. During the operation, a silicone band is wrapped around the upper part of the stomach. This artificially creates a very small stomach pouch. If this fills up while eating, the stomach signals that it is full. Because of the rather high complication rate, the method is becoming less important. Read everything you need to know about the use, effects and risks of the gastric band.

What is a gastric band?

The so-called gastric band is a silicone tube that is looped around the upper part of the stomach during an operation. It 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. This is roughly the size of a table tennis ball. If the forestomach is stretched by eating, this gives the brain the signal of satiety. The gastric band is an aid that helps you lose weight, especially by suppressing the feeling of hunger.

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 If fluid is withdrawn, the inside diameter of the gastric band increases again and there is more space for the stomach.

Procedure for gastric band surgery

Gastric band surgery takes about 30 to 60 minutes and is performed under general anesthesia. The hospital stay usually extends from one day before the operation to three to five days after the operation. The procedure is usually carried out as a so-called keyhole operation (laparoscopy). With the keyhole technique, a total of five approximately two centimeter skin incisions are made, through which the camera and instruments are inserted. To implant the port, a slightly larger skin incision is also required on the lower edge of the sternum.

The silicone tape is inserted through 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. In order to be able to assess the size of the forestomach better, a gastric tube with a small, inflatable balloon is inserted into the forestomach via the mouth. When unfolded, this is about the same size as a table tennis ball (volume approx. 20-30 ml) and roughly corresponds to the final volume of the forestomach.

After inserting the gastric balloon, the gastric band can be adjusted up or down a little or tightened a little more. Once the perfect position for the gastric band has been reached, it is fixed with the surrounding tissue by several sutures.

Finally, the tube leading from the gastric band and the port chamber are led outwards through an incision in the area of the abdominal wall and placed under the skin at the lower end of the sternum and sewn in place. The port can be used to regulate the diameter of the gastric band at any time by taking or adding fluids.

About a month after the gastric band surgery, the port is pierced for the first time in order to introduce a few milliliters of fluid. A so-called X-ray contrast medium, which is visible in the X-ray image, is usually used as the liquid (a maximum of 9 milliliters in total). With this, for example, a leak in the gastric band can be identified in the X-ray image. Depending on the job, you are usually able to work again two to three weeks after the operation.

For whom a gastric band is suitable

The gastric band is suitable for people with a body mass index (BMI) of ≥ 40 kg / m² (obesity grade III). If a person is overweight and suffers from other metabolic diseases such as diabetes mellitus, high blood pressure or sleep apnea, a gastric band can make sense from a BMI of 35 kg / m².

In any case, the prerequisite is that all conservative (non-operative) measures over a period of six to twelve months have not been sufficiently successful. These measures include, for example, nutritional advice, exercise training and behavior therapy (multimodal concept, MMK). For gastric band surgery, you should be at least 18 and at most 65 years old, although the procedure can also be performed on younger or older people in individual cases.

For whom a gastric band is not suitable

Certain physical and mental illnesses speak against obesity surgery such as gastric banding: 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. Pregnant women and people who take anticoagulant medication on a long-term basis also have to do without a gastric band.

Effectiveness of gastric band surgery

Compared to the other surgical procedures, the gastric banding results in the lowest weight loss on average. Only a few patients achieve their normal weight with the gastric band (BMI ≤ 25 kg / m²). Insufficient weight loss is to be expected above all if the patient consumes high-calorie and high-fat, soft foods or liquids that can easily pass through the tightness of the gastric band.

Studies indicate that with the gastric band a long-term loss of about 50 percent of the excess weight can be achieved. This information is often misunderstood: This does not mean that 50 percent of the initial weight is lost with the method. For example, if a patient has a BMI of 45 kg / m² before gastric band surgery, this is 20 kg / m² above normal weight (maximum 25 kg / m²). If the patient manages to reduce 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.

Advantages of gastric banding surgery over other procedures

Gastric band surgery is a slightly complicated procedure and, if the surgical technique is used correctly, poses minimal risk for the patient. The comparatively low risk of surgery should not be underestimated, especially because overweight people already have a significantly increased risk of surgery. Another great advantage of the gastric band is that it can be removed relatively easily at any time, making the procedure completely reversible.

Risks and Complications

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

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

Displacement of the gastric band ("band slippage", in about 5.5 percent of all cases)
Increase in volume of the forestomach due to gradual expansion of the forestomach ("pouch dilatation", in about 5.5 percent of cases)
Gastric band leak or a leak in the connection tube to the port with fluid leakage (in around 3.6 percent of cases)
Expansion of the esophagus in front of the gastric band ("esophageal dilation", in about 3 percent of cases).

In very rare cases, more serious complications can occur, for example the gastric band piercing the stomach wall into the stomach (gastric perforation) or infection of the port chamber with pathogens. In some studies, the risk of having to have another operation (revision operation) after gastric band surgery is estimated to be around 30 to 50 percent. This is problematic in that any abdominal surgery can lead to adhesions and scarring, which make subsequent operations very difficult and can also cause massive complications, including intestinal obstruction.

Diet with the gastric band

After the operation, the diet begins with fluids alone on the first postoperative day. These are taken slowly and in sips throughout the day. For the next four weeks you will receive a nutrition plan from the hospital, which exactly describes the structure of the food. For about two weeks, there is only liquid food. In the next two weeks, only soft food is on the menu. About four weeks after the operation, you finally start again with normal food. But there are a few things to consider:

Gastric band wearers are not only allowed to eat less, they also have to eat differently than before. So that the food can pass the bottleneck, each bite must be chewed very carefully. Long-fiber meat (beef, pork) or vegetables often cause problems.
Since liquids also fill the small forestomach, at least for a short time, you should separate eating and drinking at different times.
People who wear a gastric band should avoid sweets, especially sweet drinks, but also alcohol, high-calorie soups and porridge. They can get through the constriction between the fore and the rest of the stomach unhindered, make you fat and thus destroy the slimming effect.

Gastric band: cost

The gastric band costs are made up of different components: On the one hand, of course, the operation itself. In addition, there are further costs for the inpatient hospital stay and the check-up appointments to check the gastric band. The gastric band costs differ considerably depending on the doctor and the treatment effort. The price range is between 5,000 and 10,000 euros.

Gastric band: Health insurance often pays the costs

A gastric banding is not a standard benefit of the statutory health insurances, but the procedure is usually taken over by the statutory and private health insurances on request. To do this, however, the criteria already mentioned above must be met. The application itself must also be prepared very carefully in order to increase the chances of receiving the costs for the gastric band.

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