From the Guidelines
Gastric banding is indicated for individuals with a BMI of 35 kg/m² or greater who have failed to achieve or maintain significant weight loss through non-surgical methods, and should be considered as part of a comprehensive treatment plan that includes lifestyle interventions and medical management. The decision to undergo gastric banding should be based on a thorough evaluation of the individual's overall health, medical history, and potential risks and benefits of the procedure 1.
Key Considerations
- Candidates for gastric banding should have a BMI of 35 kg/m² or greater, or a BMI of 35-40 kg/m² with obesity-related comorbidities such as type 2 diabetes, hypertension, sleep apnea, or osteoarthritis 1.
- Patients should demonstrate a history of failed weight loss attempts through diet, exercise, and medication, and should be committed to long-term follow-up care, as gastric banding requires regular adjustments and monitoring 1.
- The procedure is generally not recommended for those with significant psychiatric disorders, active substance abuse, or certain medical conditions that increase surgical risk 1.
- Gastric banding works by creating a small pouch at the top of the stomach with an adjustable band, restricting food intake and creating earlier satiety, but has declined in favor due to higher complication rates and less sustainable weight loss compared to other bariatric procedures like sleeve gastrectomy or gastric bypass 1.
Potential Complications
- Band slippage, erosion, port infection, and pouch dilation, which may require band removal or revision surgery 1.
- Micronutrient deficiencies, which can increase after bariatric surgery, and therefore preparation for surgery and long-term nutritional monitoring and follow-up are essential components of bariatric surgical care 1.
Recommendations
- Gastric banding should be considered as part of a comprehensive treatment plan that includes lifestyle interventions and medical management, and patients should be thoroughly evaluated and monitored to minimize potential risks and complications 1.
- Patients should be committed to long-term follow-up care, and should undergo comprehensive medical, psychological, and nutritional evaluations to ensure they can adhere to the required lifestyle changes 1.
From the Research
Indications for Gastric Banding
- Gastric banding is indicated for obese individuals with a body mass index (BMI) of 40 or higher, or those with a BMI of 35 or higher with serious obesity-related comorbidities, such as type 2 diabetes, hypertension, dyslipidemia, and sleep apnea 2.
- The procedure is also considered for patients with type 2 diabetes and a BMI of 30 to 35 if hyperglycemia is inadequately controlled despite optimal medical treatment for type 2 diabetes 2.
Guidelines for Gastric Banding
- The choice of procedure is conditioned by the benefit-risk ratio and patient-related parameters, particularly BMI and comorbidities 3.
- Gastric banding has the lowest short-term surgical risk, but it has the highest re-operation rate compared to other bariatric procedures, such as sleeve gastrectomy and Roux-en-Y gastric bypass 3.
- The effectiveness of gastric banding on weight loss is lower compared to other procedures, such as sleeve gastrectomy and Roux-en-Y gastric bypass, but it is still a viable option for some patients 3.
Contraindications for Gastric Banding
- A BMI of 50 kg/m2 or higher is considered a contraindication for gastric banding due to high complication rates and low success rates in terms of weight loss 4.
- Patients with a high risk of complications, such as chronic dilatation of the proximal gastric pouch, acute dilatation, and intragastric migration of the prosthesis, may not be suitable candidates for gastric banding 4.
Comparison with Other Treatments
- Gastric banding leads to greater sustained weight loss and higher HDL cholesterol compared to a diabetes and weight management program, but the achievement of American Diabetes Association targets for glucose, lipids, and blood pressure is similar with both treatment strategies 5.
- Gastric banding is a viable option for patients with type 2 diabetes and obesity who have not responded to medical management, but it should be considered on a case-by-case basis, taking into account the patient's individual characteristics and medical history 5.