Gastric banding is a form of weight-loss (bariatric) surgery. It’s used to treat people with severe obesity who haven’t been able to lose weight through diet and exercise alone. It’s most often done in adults. But in some cases, it may be an option for a teen.
A gastric band is a soft, rubbery circle made of silicone. The band is attached to a thin, flexible tube (catheter). The tube is connected to a small, round port. During surgery, the band is put around the stomach, near the top. The port is put under the skin below the rib cage. Saline solution is injected with a needle and syringe into the port and goes through the tube to fill the band. The fluid makes the band expand and squeeze tighter. A doctor can control the size of the band by adding or removing saline through the port.
When saline is added, the band tightens around the top of the stomach and creates a small pouch of stomach where food goes during a meal. The food then slowly moves down into the rest of the stomach and is digested over time. Because the pouch is smaller than a whole stomach, it makes a person full more quickly. It limits the amount of food he or she can eat.
After surgery, the band may need to be adjusted. This requires regular follow-up visits to the doctor and injection, or removal, of saline through the skin into the port. And at some point years after surgery, the band will likely need to be replaced. This is done with another surgery.
Gastric bands are not yet approved by the FDA for use on anyone age 18 or younger. The surgery can still be done, but there is not enough research yet on how it may help or harm teens. Some studies suggest that weight-loss surgery may improve the health of obese teens. A teen may be able to avoid health problems linked to obesity. These include type 2 diabetes, sleep apnea, high blood pressure, and heart disease. The surgery may also help lessen the social problems, such as bullying by others. But experts are not sure about the long-term results of gastric banding for a teen's developing body.
Because the long-term results of weight-loss surgery for teens are not yet known, doctors will only advise the surgery in special cases. A doctor may advise surgery for a teen who has a BMI of 40 to 50 or more. Or surgery may be advised for a teen with a BMI of 35 to 40 or more and other health problems such as type 2 diabetes or sleep apnea. Surgery is considered if a teen has tried to lose weight through other means with no success.
Before having this surgery, a teen should:
Have reached physical growth at near-final adult height
Be mentally and emotionally mature
Understand and be ready to commit to lifestyle changes
Have a supportive family
A teen should not have the surgery if he or she has any of the below:
Lack of interest in following the diet changes needed after surgery
An untreated eating disorder or mental illness
Pregnancy or breastfeeding
A gastric banding procedure is a major life change. Your teen will likely be asked to take classes to prepare for life after the surgery. He or she will learn new ways of eating and drinking, and will need to commit to those changes to make the surgery a success.
After surgery, the small pouch at the top of the stomach fills up quickly. Your teen will only be able to eat small amounts of food. Eating too much can lead to vomiting and other problems. Your child will also need to take daily vitamin and mineral supplements. These are things that some teenagers may not want to do, or may not remember to do.
Talk with your teen about all of the changes that the surgery will mean. You can also ask your child’s healthcare provider about local weight-loss surgery support groups. These can help your teen meet others who have had the surgery, and ask questions about what it’s like before making a decision. You may also want to contact a dietitian who can work with your teen before and after surgery.
The weight-loss surgery should be done in a bariatric center of excellence with medical staff who are trained to work with adolescents. You can find a surgeon on the website of the American Society for Metabolic and Bariatric Surgery (ASMBS) at asmbs.org. Or talk with your child’s primary healthcare provider about a referral to a surgeon in your area who works with adolescents.
Like all kinds of surgery, weight-loss surgery has risks. The risks of gastric banding include:
Risks of anesthesia, including death
After surgery, the risks include:
Gastroesophageal reflux disease (GERD)
Leaking of saline from the gastric band
Stretching of the stomach or esophagus, leading to weight regain
The band eroding into the stomach tissue
The band slipping out of place
Need for additional surgery to fix problems
To get ready for the procedure, your teen will need to:
Have a physical exam
Have blood tests, ultrasound, and other tests to make sure he or she is healthy enough for surgery
Talk with a mental health counselor to make sure he or she is ready for surgery
Attend nutrition classes or meet with a dietitian
Fulfill any other requirements as noted by the doctor or medical staff
Your child will also need to:
Not take certain medicines during the week before surgery, such as ibuprofen
Not eat or drink the night before the surgery
A gastric banding surgery takes about 30 to 60 minutes. It follows this general process:
An IV line is put into your teen’s arm or hand. Medicine and fluids are sent through the IV. Your teen will be given medicine to cause him or her to sleep through the procedure (general anesthesia).
The surgeon will make 1 to 5 small cuts in the belly (abdomen). Through these small cuts, the surgeon uses small tools to do the surgery. These include a small camera that lets the surgeon see the surgery.
The surgeon will put the band around the top part of the stomach. The port is place under the skin, below the rib cage.
The small cuts are closed with stitches (sutures) or surgical glue. Bandages are placed on the cuts.
After the surgery, your child is wheeled to a recovery room. He or she is watched by a healthcare provider, and then sent to a hospital room.
Your child will likely stay in the hospital overnight. He or she will feel some pain and discomfort after surgery. This is normal, and is treated with pain medicine. The healthcare team may also have your teen up and walking a few hours after surgery. This will help your teen recover faster.
On the day after surgery, your teen will likely have an X-ray. This is to make sure that the gastric band is working normally. He or she may be asked to swallow a liquid that can be seen on the X-ray.
When it’s time for your teen to go home, you’ll be given instructions for how to care for your child’s incisions, and when to call the healthcare team.
After recovering from the surgery, your teen will need to:
Chew food completely
Learn how much food he or she can eat
Make healthy food choices
Avoid certain foods
Get regular physical activity
See a dietitian and other healthcare providers as often as needed
Have adjustments made to the band as needed
Have the band replaced when needed
The decision of whether a teen should have a gastric banding surgery is complex. Work with your child’s healthcare providers, talk with your teen, and spend time learning about the surgery and life after surgery. Together you can all determine if surgery is the right choice for your teen.