The human body lays down fat stores if the calories in the food you eat exceed the energy you burn up. There are a number of complex processes which the medical profession are only just starting to understand that seem to contribute to increasing obesity - the appetite mechanisms go wrong and you continue to eat even though you do not need the calories. And of course, once your body is carrying the extra weight it becomes harder to burn up calories with physical activity.
Obesity surgery works by helping to reduce the number of calories that are available in your body. There are two ways this can be achieved surgically:
Restriction - by reducing the size of the stomach, only small meals can be eaten and the appetite is satisfied.
Malabsorption - by bypassing part of the small intestine, less calories from food are absorbed by the body.
There are several surgical procedures available; some have been widely used but are now largely discarded.
The current surgical options are:
- Laparoscopic adjustable gastric band placement
- Gastric bypass
- Sleeve gastrectomy
- biliopancreatic diversion
All theses procedures achieve significant and durable weight loss but carry different degress of risk from complications. Laparoscopic gastric banding is by far the least likely to be followed by severe complications or death and for this reason is currently the only procedure offered by our centres. Because it is the only procedure we carry out we have achieved very considerable experience and expertise in it.
LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING OPERATION
The laparoscopic adjustable gastric banding operation was developed to prevent the problems associated with the earlier procedures. It is done by placing a small collar around the upper part of the stomach, creating a very small stomach above it that fills quickly, resulting in a feeling of fullness. This usually lasts for some time as the food passes only slowly from the small pouch because of the restriction of the band. The opening from the stomach can be adjusted by injecting or withdrawing fluid from a balloon on the inside of the collar.
The laparoscopic adjustable gastric banding procedure has three major advantages:
1. IT IS ADJUSTABLE
The tightness of the band can be adjusted by injecting fluid into, or withdrawing fluid from, the balloon on the inner aspect of the band. This is achieved by passing a needle into the small reservoir that is implanted under the skin at the time of operation. If the band is too tight weight loss will be too rapid and there may be some vomiting. This is corrected by withdrawing some of the fluid from the band. Conversely, if there is inadequate weight loss more fluid can be introduced thus tightening the band.
2. THE BAND IS PLACED LAPAROSCOPICALLY
The laparoscopic adjustable gastric band is normally placed by laparoscopic or “keyhole” surgery. This means that there is no major abdominal incision. The operation is performed by passing a telescope into the abdomen through a small skin incision, and usually four other small incisions are made through which to pass instruments and to place the band. These are quite small puncture wounds. The absence of a major incision means there is very little pain post-operatively and an early return to full activities.
On rare occasions it is not possible to place the band by the laparoscopic method and an incision is required. The operation is still exactly the same, however recovery is usually a little longer.
3. IT IS REVERSIBLE
Although there is no intention of reversing the operation, if there were to be any unexpected development, the band can be removed, usually laparoscopically. The stomach will return to its normal shape.