Adam Goldstein, D.O., F.A.C.S.
The Band and the Surgery Described
There are several types of bariatric surgeries to help patients achieve substantial weight loss, including gastric banding, gastric bypass and sleeve gastrectomy. And within the gastric band category alone there are two types of bands.
But patients of Adam Goldstein, D.O., F.A.C.S., need not spend any time or mental anguish weighing one procedure against another. That's because Dr. Goldstein makes it clear that he hopped on the "band-wagon" some time ago and he's not getting off any time soon.
While he does other types of general surgery, the only bariatric procedure Dr. Goldstein performs is the gastric band, specifically using a device trademarked as the Lap-Band® made by Allergan Inc. because he personally considers it superior. (He has no financial interest in this band or company.)
"More patients are demanding the band because I think they understand that the risk of complications is so much higher with the gastric bypass," he said. "I have the training and skill to do all forms of weight loss surgery but I pared it down to only doing the band because I don't want to subject my patients to the risk of bypass surgery."
Even though he describes the band surgery as a "pretty simple concept," Dr. Goldstein says his patients can achieve weight loss almost similar to those who've undergone the more complex surgeries. But it is true that band patients may take longer to achieve the desired levels. (See gastric band/gastric bypass comparison.)
Here is his description of the procedure:
"The band is a ring with a tubular balloon lining the inside of the circle and it is placed around the upper stomach to separate a small amount of stomach (above the band) from the rest of the stomach below the band. What it does is create basically an hourglass, a distorted hourglass, out of your stomach, with a small pouch for ingested food above the band, a skinny part in the middle where the band fits, and a larger stomach at the bottom.
"It takes time for sand to go down an hourglass because it is skinny in the middle and that's the goal of the band. When the patient fills the small stomach area above the band with food, they feel satisfied, they stop eating, and that's it, the meal is over."
"Over the course of the next one to two hours that food will break down and make its way past the narrow ringed area and make its way into the main part of the stomach."
Therefore, the portions they eat are smaller (four to six ounces) than they would normally eat and eventually the decrease in calories causes weight loss.
The surgery requires periodic follow-up visits. The reason: the gastric band is fitted snugly around both stomach tissue and fatty tissue, and eventually the fatty tissue melts away.
"When the fatty tissue starts to disappear, the band becomes loose so it is very important that the patient tell me when they are not getting that same sense of satisfaction after eating a small amount of food," Dr. Goldstein said. "When the band is no longer as snug, and food goes through it more quickly, we have to tighten the band, in order to maintain the small stomach pouch size."
Tightening the band involves the other components of the band. Remember the tubular balloon ringing the inside of the band? It is attached to a short tube that connects to a port placed under the skin in the abdomen. By injecting or withdrawing saline solution through the port, the physician can expand or contract the ring.
Some bariatric physicians do this saline injection/withdrawal in the office, but Dr. Goldstein noted that this method does not provide any visual proof of how the band is placed or working. He explained:
"I do all these lap band adjustments in the fluoroscopy (x-ray) suite. I have patients drink some barium and using the fluoroscopy equipment so I can watch the barium go down and see exactly how tight the band is.
"If the band is loose I can push fluid into the port (which enters the balloon inside the ring) and that squeezes further on the stomach so the hole (stoma) is small again and it recreates that hourglass shape. They feel satisfied again after eating a small amount of food."
Only by visualizing the band under fluoroscopy can the surgeon see other problems with the band, he said. "Without fluoroscopy you have no idea whether the band is in the same position as when it was placed. Or maybe the band is tight enough and in proper position but the patient is overeating and the stomach pouch is being stretched."
Dr. Goldstein said he was trained by a surgeon who was involved in the initial medical trials of the Lap-Band™ and he was taught to use fluoroscopy to visualize the band in place.
"That's the way I do it and the reason is simple: You can see what you are doing," he said. "The patients know that the band is appropriately tightened and in good position when they leave the fluoroscopy suite, there is no guessing when it comes to the care of my patients."
