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Laparoscopic Adjustable Gastric Banding

 

The procedure is done laparoscopically and involves implantation of an inflatable gastric band made of silicon to be placed around the upper part of the stomach. This procedure does not involve any cutting or stapling of the stomach.

The silicon band is adjustable and the inner diameter can be modified by inflating or deflating it with saline. This band creates a tiny pouch of the stomach which is meant to restrict the amount of food intake. The outlet is also small which ensures an earlier sensation of fullness and satiety with smaller quantities of food, both of these mechanisms result in weight loss. This surgery is considered as the simplest and the least invasive of the bariatric procedures. There is monthly adjustment of the band which is required to achieve best results.

 

Nutritional guidelines after bariatric surgery:

After all Bariatric and Metabolic procedures, the rationale of nutritional care is two-fold. Firstly, sufficient energy and nutrients helps in supporting tissue healing after surgery and the preservation of lean body mass during the period of extreme weight loss.

Secondly, the foods and beverages consumed after surgery should decrease reflux, cause early satiety, while maximizing the weight loss and, ultimately, weight maintenance.

After bariatric surgery the diet progresses in 4 phases, starting from clear liquids, then pureed, afterwards slow progression from soft to normal diet.

Patients are advised to avoid 5 “S” i.e. Sugar, Spirits, Straw, Soda and Smoking, not only until the desired weight loss is achieved but also as directed by the bariatric Surgeon/Nutritionist. (Ideally Lifelong!!)

Sugar and spirits are avoided to prevent dumping and also to aid weight loss.

Straw and soda may cause bloating and patients may suffer with abdominal discomfort, pain or feeling of fullness.

Smoking is prohibited for good respiratory functions and to prevent stomal ulcerations.

Basic Rules:

  • Eat frequent and small meals.
  • Chew well and eat slowly.
  • Eat your proteins first.

Avoid drinking liquids along and for 30 minutes before and after meals as drinking beverages along with meals can cause early satiety and may hinder adequate protein intake.

Listen to your body – each patient may have different capacity and appetite to eat; one should listen to his/ her signals from body as to when to stop eating.

ASMBS Supplement Recommendations to prevent Micronutrient Deficiency after bariatric surgery

  • All patients should take at least 12 mg vitamin B1 daily to maintain blood levels and prevent its deficiency.
  • All post-WLS patients should take 350–500 mg vitamin B12 supplementation daily.
  • Post-WLS patients should take 400–800 mg oral folate daily from their multivitamin.
  • Women of childbearing age should take 800–1000 mg oral folate daily.
  • Post-WLS patients should receive at least 18 mg of iron from their multivitamin.
  • Menstruating females and patients who have undergone RYGB, SG,MGB or BPD/DS should take at least 45–60 mg of elemental iron daily (cumulatively, including iron from all vitamin and mineral supplements)
  • The appropriate dose of daily calcium from all sources varies by surgical procedure:

    MGB, BPD/DS: 1800–2400 mg/d
    LAGB, SG, RYGB: 1200–1500 mg/d.
  • The recommended preventative dose of vitamin D in post-WLS patients should be based on serum vitamin D levels: Recommended vitamin D3 dose is 3000 IU daily, until blood levels of 25(OH)D are greater than sufficient (30 ng/mL)
  • Post-WLS patients should take vitamins A, E, and K, with dosage based on type of procedure:

    LAGB:     Vitamin A 5000 IU/d and vitamin K 90–120 ug/d.
    RYGB and SG: Vitamin A 5000–10,000 IU/d and vitamin K 90–120 ug/d
    LAGB, SG, RYGB, BPD/DS: Vitamin E 15 mg/d
    DS: Vitamin A (10,000 IU/d) and vitamin K (300 mg/d)
  • All post-WLS patients should take > RDA zinc, with dosage based on type of procedure:

    MGB, BPD/DS: Multivitamin with minerals containing 200% of the RDA (16–22 mg/d)
    RYGB: Multivitamin with minerals containing 100–200% of the RDA (8–22 mg/d)
    SG/LAGB: Multivitamin with minerals containing 100% of the RDA (8–11 mg/d)
  • All post-WLS patients should take > RDA copper as part of routine multivitamin and mineral supplementation, with dosage based on type of procedure:

    MGB, BPD/DS or RYGB: 200% of the RDA (2 mg/d)
    SG or LAGB: 100% of the RDA (1 mg/d)
    SG: Sleeve Gastrectomy
    RYGB: Roux-en-Y- Gastric Bypass
    MGB: Mini Gastric Bypass
    OAGB: One anastomosis Gastric Bypass
    BPD/DS: Bilio-Pancreatic Diversion with Duodenal Switch
    LAGB: Laparoscopic Adjustable Gastric Band