03.Pros and cons
Adjustable gastric banding (lap-banding) is promoted as safe and easy. The adjustable gastric band, which could be inserted laparoscopically (using key-hole surgery), revolutionised bariatric surgery in the early 1990s, promising a low-risk, minimally invasive and reversible procedure.
Short-term effects of the gastric band are encouraging, with an appropriate rate of weight loss (about 0.5kg to 1kg per week) and few major medical complications over the first one or two years. Total weight loss peaks at about three years, with about 50% of excess weight lost. For many people, this resolves or improves obesity-related conditions such as type 2 diabetes, high blood pressure and sleep apnoea.
Complications arising from gastric banding
- band problems (erosion through the stomach wall, slipping out of position, leakage of saline)
- oesophagitis (inflammation, irritation, or swelling of the oesophagus)
- reflux and vomiting (although this can usually be resolved by adjusting the band)
- port problems (displacement, leakage, port-site infection)
- enlargement of the stomach pouch.
Estimates for the number of people affected vary, from 1% to 18%.
What does it cost?
At present, most surgery is done in private hospitals, costing between $10,000-$13,000. Even with private health insurance, out-of-pocket costs are in the order of $3000 to $5000.
What you can and can't eat
Post-surgery, soft kilojoule-laden foods and drinks such as ice-cream, milkshakes, custard and jelly, melted chocolate are a no-no. Rules also include no large meals, eating a healthy, balanced diet to make sure nutritional needs are met, and chewing food very thoroughly.
Some studies have found that weight loss isn’t always sustained over the long term, and weight tends to creep back up (though for many people the gains are relatively minor). Complications appear to continue over time - one study found that 76% of subjects experienced one or more complications related to the device over 13 years. Ulceration of the oesophagus and respiratory problems may also appear over the medium- to long-term.
Gastric bypass surgery is the most common bariatric surgery procedure in Europe. This appears to be more effective in the long-term – and although short-term risks and complications (including death) are higher, in the medium- to long-term they’re fewer.
Despite these concerns, 95% of bariatric procedures in Australia involve laparoscopic adjustable gastric banding. There are even calls for it to be made more widely available in public hospitals.
We've come a long way
Professor Paul O’Brien, an Australian pioneer in the field, points out that much has changed since 1994 when he first started. He estimates about half of his early patients needed some sort of revisional surgery to correct problems, similar to the failure rates reported in various long term (10 years or more) follow-up studies.
These days O’Brien believes that with improvements in both operating technique and devices, the likelihood of someone needing follow up surgery is closer to 10%. Success depends partly on the experience of the surgeon, and on the patient: if they don’t follow the rules, and eat too much or too quickly, the chances of something going wrong are much greater.
So it’s not risk-free, and having the surgery is certainly not a decision to take lightly. However, extremely obese people who remain obese are much more likely to die prematurely than people who’ve had the surgery and lost weight.