Obesity is much more than just being overweight; it is a serious condition that affects our health in a wide range from heart diseases to diabetes and even some types of cancer. Sometimes diet, exercise or medication alone is not enough. In such cases, surgical application called "Adjustable Gastric Band", which can be considered an effective method, although not permanent, may come into play.
An adjustable gastric band is like a belt placed on the upper part of your stomach. But this "belt" is very different from the usual clothing accessory: It is a soft, inflatable silicone band.It partially separates the upper part of your stomach from the larger part below, creating a smaller pouch above. This allows you to feel full at a meal with a smaller amount of food than you would normally eat.
The great feature of this band is that its "tightness" can be adjusted over time. As your body weight changes, the amount of food you can tolerate may change. Or, when you lose a lot of weight, you may want to increase your oral calorie intake slightly. At this point, the diameter of the band can be narrowed or widened by passing a liquid through the band. This is done by inserting a very thin needle into a small valve-like structure called a "port", which is placed under the skin. Think of it like filling a bicycle tire with air, but with a liquid and of course under the supervision of a doctor.
AGB works through both mechanical (i.e. a tangible constriction) and neural-hormonal mechanisms. The mechanical part is that it reduces the stomach's capacity so that you feel full more quickly with less food. The hormonal and neural part occurs when the stretch receptors in the upper part of the stomach are activated. These receptors transmit the message to our brain "Enough is enough, I feel full!" earlier and stronger. This reduces the desire to continue eating.
AGB may not be suitable for every overweight person. Just as not every patient can take a powerful medication, this surgical method has certain requirements and prerequisites.
Body Mass Index (BMI) Assessment:
Especially people with a BMI over 35, or those with a BMI over 30 who have obesity-related comorbidities such as hypertension, diabetes, sleep apnea may be candidates for this surgery. In addition, BMI thresholds may differ between ethnic groups. For example, in individuals of Asian origin, even a BMI above 27.5 may be considered high risk.
Previous Weight Loss Attempts:
Individuals who have tried to achieve long-term weight control with methods such as diet, exercise, medication or behavioral therapy but have not been successful are usually referred to surgical options. In short, patients who say "I did everything I could, but it still didn't work" and can show a medical record of this may be more favorable to this surgery.
Psychosocial Status and Motivation:
The success of the surgical process is closely related to the mental health of the person. Serious psychiatric problems such as depression, eating disorders or addictions can make this surgery risky. For this reason, a comprehensive psychiatric evaluation is often performed before the operation. Because the success of the band depends on the person's ability to accept and sustain their new lifestyle.
Physical Fitness and Ability to Receive Anesthesia:
Conditions that increase the risk of surgery, such as severe heart or lung diseases, may prevent AGB from being performed or may require extra precautions. All kinds of risks are minimized through medical examinations, blood tests and imaging methods.
AGB is performed laparoscopically (closed). Much smaller incisions are made compared to conventional surgery; therefore, the healing process is faster and more comfortable. The main steps of the procedure can be summarized as follows:
General Anesthesia:
General anesthesia is administered before the operation so that the patient does not feel pain or move during the procedure.
Small Incisions and Abdominal Inflation:
Small incisions, each about 1-1.5 cm long, are made at several points in the abdomen. Carbon dioxide gas is then injected through this area to inflate the abdomen. This allows the surgeon to get a clear field of view with the camera and instruments.
Placement of the Band:
A tunnel is created behind the upper stomach area. In this tunnel, the silicone band is carefully placed and fixed to the stomach. When the band is in place, a small pocket is formed at the top of the stomach.
Fixing the Port:
The port to adjust the fluid in the patch is usually placed on the abdominal wall or muscle/fascia. You can think of this port as a small button under the skin. It is not visible from the outside, but it is easily found by the doctor with a special needle when needed.
Closing the incisions:
When all these steps are completed, the laparoscopic instruments are removed and the incisions are closed with sutures or surgical staples.
The surgery usually takes 30-60 minutes. Some patients can be discharged the same day, others the next day. This period varies depending on the general health condition of the patient and the course of the operation.
In the first few days after surgery, there may be gas pain or tenderness in the incision area. However, this pain is usually tolerable and can be controlled with painkillers. If the patient walks without exerting himself/herself too much, it will speed up the blood circulation and positively affect the healing process. Here is what you need to know about the postoperative period:
Diet:
It is not possible to start consuming solid foods immediately after surgery. According to the doctors' advice, a gradual diet is started: first clear liquids (water, unsweetened compote), then pureed and soft foods, and finally solid foods. This process usually takes 4-6 weeks. Our aim is to allow the tissues around the stomach to heal. During this phase, it is very important to take small sips and eat slowly.
Regular Follow-up and Band Adjustments:
In the first few months, it may be necessary to have several follow-up visits and adjust the band. If the band is too loose, you will not feel full quickly; if it is too tight, you may have difficulty swallowing and discomfort. Think of these adjustments as tightening and widening the hole in your belt, but they should be done under sterile conditions with the expertise of a doctor.
Return to Physical Activity:
Heavy exercise should be avoided in the first weeks after surgery. However, it is undesirable to stay still in bed for a long time. Light brisk walks accelerate the healing of the body and have a positive effect on mood. You can gradually return to a normal exercise routine in about 4-6 weeks, but it is better to plan this schedule with your physician.
Psychological and Social Support:
Obesity surgery involves not only physical change but also a radical transformation of lifestyle and habits. It is important to receive moral support from family, friends and perhaps a support group. Psychological support can be very helpful, especially for people with emotional eating habits.
As with any medical procedure, the Adjustable Gastric Band has some risks and disadvantages as well as advantages. Here is a summary of these:
Advantages:
Minimally Invasive (Less Incision): Since it is performed laparoscopically, suture scars are very small and healing is faster compared to open surgery.
Adjustability: Being able to fine-tune the speed of weight loss and the capacity to eat provides great flexibility.
Reversible Feature: Compared to other bariatric surgeries (such as gastric sleeve or bypass), the anatomical integrity of the stomach is preserved. The band can be completely removed if desired in the future.
The digestive system is not bypassed: Since the absorption mechanism is unchanged, the risk of vitamin-mineral deficiency is lower than, for example, with gastric bypass.
Disadvantages:
Band Slippage or Erosion of the Gastric Wall: Undesirable situations such as the band changing its position over time (slippage) or damaging the stomach wall may occur. These problems may require additional surgical interventions.
Inadequate Weight Loss or Weight Regain: AGB provides weight loss at a lower rate and slightly slower than some other methods (e.g. gastric bypass or gastric sleeve). Without extra effort and regular follow-up, the weight can be regained.
Mechanical Failures: Technical problems such as blockage, perforation, fluid leakage in the port or tube can be seen in rare cases. This may require a repeat intervention.
The Need for Regular Check-ups: One of the biggest responsibilities of AGB is the obligation to consult a healthcare provider for regular adjustments. Neglecting these follow-ups may negatively affect the success of the surgery.
The rate of weight loss with AGB may vary from person to person. In general, it is estimated that about 40-50% of excess weight (the difference between ideal weight and current weight) can be lost within a few years. However, in some people this rate may be higher, while in others it may be lower.
Since the band does not change the absorption process of the digestive system, most of the work falls back on the patient. If the person does not maintain healthy eating habits or returns to a sedentary lifestyle, it may not be possible to lose or maintain the desired weight. It should not be forgotten that bariatric surgery is not a "magic wand"; its effect occurs as the person adapts to the new life order.
In individuals who undergo gastric banding, significant improvements are seen in comorbidities such as type 2 diabetes, high blood pressure and sleep apnea in parallel with weight loss. In particular, benefits such as a decrease in insulin resistance and better control of blood sugar improve the quality of daily life. Reduced joint pain, a more active life and improved mood are also commonly reported positive effects.
There are conditions or risk factors that are not suitable for everyone. For example, general anesthesia may be risky for people with advanced heart or lung disease. Surgery can also pose additional challenges for those with active infections or chronic bowel disease. People with eating disorders (e.g. uncontrolled binge eating, severe bulimia) or psychiatric disorders should have these conditions treated first. In addition, this method cannot be used in people who are known to have an allergic reaction to the foreign body implanted in their stomach.
The ability to attend regular doctor's appointments and the willingness to work with support teams such as nutritionists or psychologists are crucial for long-term success. If a person does not have the means or motivation to maintain such check-ups, the AGB may not be a wise choice.
Eating Habits:
Overfilling your plate can negate the satiety signal the band is trying to give. Each bite should be chewed well and eaten slowly. An overlooked detail: the consumption of liquid calories (e.g. high-sugar drinks) can exceed the restriction imposed by the band. Therefore, sugary drinks should be avoided as much as possible.
Protein Focused Diet:
Centering your meals around protein sources (e.g. fish, chicken, lean red meat, eggs, cheese, legumes) will help you maintain muscle mass and keep you fuller for longer.
Regular Exercise:
Let's say you have a band on your stomach, but you eat thousands of calories a day and never move. Then the effect of the band is limited. Walking for at least 30 minutes most days of the week can make a big difference. Later on, taking up a sport you enjoy, such as swimming or cycling, can go a long way in maintaining weight.
Do not neglect vitamins:
Gastric band does not cause malabsorption; it is advantageous in this respect. Nevertheless, attention should be paid to vitamin and mineral intake, especially during periods of low-calorie nutrition. If necessary, your physician or dietitian may recommend multivitamins or additional supplements.
Psychological Support and Follow-up:
After AGB, there may be difficulties such as returning to old eating habits and succumbing to cravings. At this point, getting regular psychological support or joining a support group can help you cope better. Remember, the band is only a physical barrier; it does not eliminate emotional eating behavior.
Long-term Check-ups:
The band needs to be checked regularly. Monthly or every few months, it is possible to adjust the tightness of the band and detect complications such as possible leaks and slippage early. This is critical for long-term success.
The Adjustable Gastric Band can be a real ray of hope for many people who suffer from overweight and have not been successful with other methods. The fact that it is less invasive and reversible, especially compared to other bariatric surgery methods that dramatically change the anatomy (such as gastric bypass or gastric sleeve), makes this method attractive. However, the long-term adaptation of the person to their new life, both physically and mentally, plays a decisive role in the success of the band.
If you are considering this method, you should definitely undergo a comprehensive medical evaluation and information process. The speed of weight loss may be a little slower than other methods, but if your goal is not only speed but also a sustainable and reliable method, AGB becomes a good option. It is important to remember that the band's job is only to help you control your appetite and portions; the real work depends on your determination, lifestyle changes and regular follow-up.
Life is a marathon and the fight against obesity is not a sprint. The Adjustable Gastric Band can be thought of as an "assistive equipment" that gives you support along the way. However, like any auxiliary equipment, it also needs maintenance. The settings should not be neglected and the rules of use should be carefully applied. In this way, both healthy weight loss is experienced and the person's future life becomes better quality.
For those who aim for a more energetic, more confident and healthier life, the adjustable gastric band should be considered as a serious option. As long as you know all the pros and cons, consult with experts and set out on this path with a determined mindset. Because every positive change you make in your body and life is one of your future health investments. If you take the right steps on this path, the band will only be a tool to give you the support you need. This will make it easier for you to find the balance between your eating habits and your body, and in the long run, you can live a much healthier life.
