GASTRIC BANDING COMPARISON
Gastric banding is a restrictive technique used to reduce the volume of the stomach and slow the passing of food. However, it does not hinder the digestion of food.
This band is placed around the upper part of the stomach, thus restricting the gastric sack. Very little food is required to fill this sack and the feeling of fullness appears rapidly. The food passes slowly into the gut similar to an hourglass.
Gastric banding is the only adjustable technique. The band is connected to a control unit placed under the skin by a small tube. The band can be tightened or loosened by injecting a liquid through the skin, into the control unit.
In the event of a complication, ineffectiveness or on request by the patient, the band can be removed during a new operation.
The operation itself usually lasts about 1 hour and 2 to 3 days of hospitalisation are needed.
The Le Goff Technique differs from traditional gastric banding essentially in two aspects:
THE METHOD OF FIXING THE GASTRIC BAND
- Dissection against the stomach in a narrow channel
- Removal of the fat from the anterior wall of the oesophagus to see the muscularis to stitch
- Plicature of the greater tuberosity to surround the gastric band in an anatomic sleeve
- Stitching of the stomach plicature to the oesophagus
THE SURGICAL GESTURES THAT REDUCE THE APPETITE
- Reduction of the stomach cavity by plicature of the greater tuberosity almost entirely eliminated.
- Section of the branches of the left vagus nerve leading to the lower oesophagus thus slowing the emptying of the stomach.
- Stimulation of the hunger centres in the lower oesophagus due to the pressure exerted by the plicature (gastric valve), thus patients feel far less or not at all hungry
The expected weight loss from gastric banding is of the order of 40 to 60 % of the excess weight, representing total weight loss of 20 to 30 kg.
Numerous mechanical complications may occur after the operation, even several years later. Problems may occur with the unit, such as infections, movement of the unit, pain where the unit is placed or splitting of the silicon tube connected to the unit. Furthermore, vomiting or the inability to eat may occur when the band slips and the pouch dilates. Disorders of the oesophagus (reflux, esophagitis, motor issues, etc.) and wounding to the stomach caused by the band (stomach erosion, migration of the band) should also be considered.
However, the mortality rate is only estimated at 0.1 %.
(Source: Haute autorité de santé, HAS).
While this method presents low post-operative mortality (4 deaths in the 30 days following the operation, PMSI data, 2011), it usually fails due to unstable fixing of the band.
DIFFERENCE IN WEIGHT LOSS :
- More than 2.5 times more effective in the medium-term due to reduction in stomach volume thanks to the plicature of the stomach and very significant increase in fullness with the Le Goff Technique.
- 3 to 5 times more effective in the long-term as fewer complications linked to solid fixing of the band which hardly moves with the Le Goff Technique.
DIFFERENCE IN COMPLICATIONS :
- More than 20 to 30 times dilatation in traditional gastric banding.
- More than 30 times erosion in traditional gastric banding.
The solid fixing of the Le Goff Technique means that the percentage of complications is evaluated over 20 years, whereas for traditional gastric banding, the band is rapidly removed after 3 to 4 years maximum. (The percentage of complications is considered over a much shorter period of time).
DIFFERENCE IN MORTALITY :
- Non-negligible yearly mortality in traditional gastric banding (4 deaths in 2011).
- Zero mortality over 20 years in the Le Goff Technique.