Gastric banding is one type of bariatric surgery that Childhood Obesity News has looked into. It started out with a pretty good reputation, and of course techniques always improve as doctors learn, but it has been overtaken in popularity. Six years ago, for a special report on the practice of “targeting” teenagers as potential gastric band customers, Reuters journalist Debra Sherman interviewed Dr. Mary Brandt.
In this context, the short term is defined as a month. Dr. Brandt, an investigator with the Teen-LABS (Teen-Longitudinal Assessment of Bariatric Surgery) project, cited a Swiss study which showed that in the 30 days after surgery, only 8% of patients experienced complications, which doesn’t sound so bad. But when the timeline stretched to 10 years, 40% of patients reported problems.
Looking at the big picture, almost half the patients were in less than optimal shape after a decade. So a person who underwent this type of surgery in adolescence, say, at age 15, could look forward to only a 60% chance of being problem-free at the young age of 25, with several more decades of life to look forward to.
What can go wrong?
In the short term, the patient faces the standard risks connected with any outpatient surgery, plus a few that are peculiar to this operation. There may be productive burping, or what the kids nowadays call “throwing up a little in your mouth.” The esophagus may be perforated or otherwise damaged and interfere with the ability to swallow.
In fact, 75% of the patients experience esophagitis. Nausea can go beyond the customary Saturday night throw-up after carousing. The article reported:
Intractable postoperative vomiting can develop depending on band positioning, gastric prolapse, or excessive incorporation of fat into the band device.
The band may also erode. If it slips, or wasn’t well positioned in the first place, another surgery is needed to correct it. Further surgery may also be needed to remove the band or port, replace the band or port, or correct a leak. Having a permanent hole in the skin of the abdomen is not even mentioned as an undesirable side effect, because it is an expected element of the outcome.
There may be infection, ulceration, stoma obstruction, gastric necrosis. And of course the small remaining pouch of stomach can enlarge over time, defeating the whole purpose.
In 2012, The New York Times learned from senior economist William Encinosa that one in 2,000 gastric banding patients died either during or immediately after surgery, and about 1% of the patients developed such serious complications as bowel perforation or blood clots. Doctors in the field were concerned about the less dramatic but more insidious long-term condition that could affect young people, namely malnutrition.
In the same year, Jennifer Corbett Dooren wrote for The Wall Street Journal about research that compared gastric banding with gastric bypass, and reported:
The study looked at what are considered treatment failures, which was measured by a reversal of the procedures, or patients who had a BMI of 35 six years after surgery. The failure rate for gastric banding was 48.3% compared with 12.3% for bypass.
The gastric-bypass patients had a higher rate of complications immediately after surgery. The study showed the early complication rate for gastric bypass was 17.2% compared with 5.4% for banding. But in the long term, there were more complications and more follow-up operations after gastric banding.
A 2015 report on LAGB (laparoscopic adjustable gastric banding) called it the least invasive weight-loss procedure, but noted that it had the highest long-term re-operation rate. Re-operations include adjustment of the band’s position, or its complete removal, or removal in conjunction with a different stomach-limiting technique. The band is deemed to be a long-term failure when weight loss just doesn’t occur, which is the reason for more than 70% of revisional operations.
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Source: “Special Report: Targeting Teens for Gastric Bands,” Reuters. com, 07/26/10
Source: “Gastrointestinal Complications After Bariatric Surgery,” gastroenterologyandhepatology.net, August 2015
Source: “Young, Obese and in Surgery,” NYTimes.com, 01/07/12
Source: “Bypass Beats Band for Weight Loss,” WSJ.com, 01/17/12
Photo credit: m01229 via Visual Hunt/CC BY