It’s been a week since we covered a very broad explanation of bariatric procedures, and the time is nigh for an in depth explanation of each one. We will start off this series with Restrictive Procedures.
These procedures produce weight loss by effectively diminishing the amount of food that a person eats. The main mechanism that drives all restrictive procedures is the following: a smaller stomach → faster satiety → less calories consumed → weight loss.
Yet there is a catch (there’s always a catch!) each procedure is special in its own way, producing the aforementioned effect plus something else. Lets talk about the adjustable gastric band (AGB) first:
An AGB is a surgical piece of equipment that is designed to be placed on the upper part of the stomach, right after its junction the esophagus. The band itself is constructed out of silicone and is shaped like a ring; it has an inflatable pouch on the inner part of the ring that can expand or contract depending on how much it is filled with saline solution.
The idea of a gastric band was first conceived by Wilkinson L. H. (1) when he attempted a series of procedures to reduce gastric size without interrupting digestive tract flow. The first gastric band was placed in 1978 by Wilkinson and Peloso (2) which was a non-adjustable mesh band that, although offered weight loss, was hindered by not being as customizable as today’s AGBs.
Travel back to the future (pun completely intended, see annexed image that’s completely unrelated to the subject) and we have wondrous growth in the AGB field. Now bands are adjustable (hence their name) via a subdermal port, from where saline fluid is injected and this fills the AGB to satisfy each patient’s thresholds.
After placement of the AGB and proper filling through the previously mentioned port, the patient is discharged with proper follow-up nutritional guidelines and documentation. There are ways to circumvent the AGB but these are strongly discouraged as they would further impede weight loss. On the contrary, the nutritional guidelines for the post-op lifestyle include better and healthier eating habits, portion control and proper vitamin supplementation.
So now that we are familiar with what AGB’s are and how they are designed, just how do they work?
To answer this simply, it decreases the amount of food that is needed to induce satiety. After awhile (this time varies from one person to the other) this decrease in food intake will lead to weight loss by forcing the body to use its stored fuels (adipose tissue AKA “fat”) for sustenance.
If you want to see a really cool video that shows you just how an AGB works its wonders look below!
The mechanisms by which appetite itself is regulated is rather complex and involves a series of biochemical and neurologic signaling pathways which will be covered in a further blog post!!!
Our next post in this series will continue with another restrictive procedure: Laparoscopic Sleeve Gastrectomy (AKA Gastric Sleeve).
Thanks for reading and have a great week!!!
-LIMARP Staff
References
1) Wilkinson LH. Reduction of gastric reservoir capacity. Am J Clin Nutr. 1980 Feb 1;33(2):515–7.
2) Wilkinson LH, Peloso OA. Gastric (reservoir) reduction for morbid obesity. Archives of Surgery. 1981 May 1;116(5):602–5.