By Dr Vivienne Miller, GP and Fellow, The Royal Australian College of General Practitioners
Despite lack of public funding and financial disincentive, laparoscopic gastric banding surgery continues to rise in Australia as a treatment for morbid obesity and its complications. However, laparoscopic gastric banding has been especially criticised for being a “quick surgical fix” for obese patients who do not want to work to control their weight in a non-invasive fashion. In reality, the dietary modifications and self-control required by patients long-term do not make this choice a particularly easy option.
Research has proven that for appropriately chosen, motivated patients, laparoscopic gastric banding puts diabetes into remission and reduces the complications of morbid obesity.1,2,3
Gastric bypass surgery (the most common type of weight loss surgery performed in Europe) carries a higher short-term risk and complication rate (especially for serious issues, including death) but has a better long-term success rate.2,3 Alternatively, laparoscopic gastric banding is the main form of weight loss surgery in Australia.
Research shows that the side-effect and complication rate of laparoscopic gastric banding increases over time, although most of these complications are not serious. 2,3 The serious issues include oesophageal ulceration, oesophageal and gastric pouch dilation (77% of cases may be managed non-surgically)4, incisional hernias, port migration and access complications, band slip and erosion ( sited in approximately 1-10% of cases)4, infection, gastric prolapse, stomal obstruction and aspiration pneumonia.2,3,4 However, improvements in surgical techniques have resulted in reduced immediate and short-term complication rates.2,3 The risk of surgical revision is now approximately 10%, according to Prof. Paul O’Brien, an Australian pioneer in laparoscopic gastric banding.2
Common complaints after laparoscopic gastric banding include nausea and vomiting, regurgitation, constipation, anorexia, dumping syndrome and diarrhoea.5 A multivitamin and appropriate supplementation are recommended to reduce nutritional deficiencies, especially pertaining to calcium, vitamin B12 and vitamin D. 3,5
Many of the complications of laparoscopic gastric banding may be reduced if the surgeon is experienced with the procedure, and if the patient maintains long-term motivation to continue with the appropriate diet and follow-up suggested.2 When side-effects and complications of the procedure are taken into account, morbidly obese people who chose non-surgical management are still more likely over the long-term to suffer serious medical problems and die as a result of their condition, compared to those who have laparoscopic gastric banding.2,3
1. Fazekas, M, and Depczynski, B. Nutritional Management before and after Bariatric Surgery in Patients with Diabetes. Diabetes Management Journal Vol 53 p10
2. Bray, K. Are you considering surgery to help you lose weight? Choice, 29 July 2014
3. Victorian Government Department of Human Services, Surgery for morbid obesity: Framework for bariatric surgery in Victoria’s public hospitals, March 2009
4. Eid, I., Birch, D. et al. Complications associated with adjustable gastric banding for morbid obesity: a surgeon’s guide. Canadian Journal of Surgery. 2011 Feb; 54(1): 61–66.
5. Shannon, C., Gervasoni, A. & Williams, T. Growing Epidemics The Bariatric Surgery Patient Nutrition Considerations. Australian Family Physicians, Vol. 42, No.8, August 2013 pps 547-552