According to the American Society for Aesthetic Plastic Surgery (ASAPS), bariatric surgery is the most common procedure performed in the United States for massive weight loss. For years, plastic surgeons have been performing bariatric surgery using the Lap Band System™. However, in September, the FDA approved the Realize™ Adjustable Gastric Band device by Ethicon Endo-Surgery Inc, Cincinnati, as an alternative.

“The Realize Adjustable Gastric Band is a procedure where a silicone band is placed on the upper part of the stomach that has an inflatable cuff on the inside of it that can be adjusted through an access port by injecting or removing saline,” says Trace Curry, MD, a general surgeon and medical director at the Center for Metabolic and Bariatric Surgery in Evendale, Ohio, who has performed more than 1,500 laparoscopic gastric band procedures.

“The concept is very similar to the Lap Band System,” Curry says. “There are some subtle differences between the two bands, but overall they accomplish the same thing—helping the patient to get full on a very small amount of food.”

HOW THE REALIZE BAND WORKS

Amberly, age 30, before Realize Adjustable Gastric Band Surgery.

The Realize Band, which consists of a silicone band, tubing, and an injection port, is placed around the upper part of the patient’s stomach, creating a small pouch that can hold only a small amount of food. The narrowed opening between the pouch and the rest of the stomach controls how quickly food passes from the pouch to the lower part of the stomach. The band allows the patient to eat less by limiting the amount of food that can be eaten at one time and increasing the time it takes for food to be digested.

The size of the band can be adjusted during a doctor’s office visit by adding or removing fluid from within the band via the injection port and tubing. The adjustments change the size of the narrowed opening. Inflating the band makes the opening smaller, causing food to pass more slowly. Deflating the band makes the opening larger, permitting food to pass more quickly.

“With the emergence of the new Realize Band into the marketplace, individuals seeking treatment for obesity now have greater choices when considering their options for laparoscopic adjustable gastric banding,” Curry says.

WHO IS A GOOD CANDIDATE?

Amberly, 3 years post Realize Adjustable Gastric Band Surgery.

The Realize Band is used by patients who have been obese for at least 5 years and for whom nonsurgical weight loss methods have not been successful. Surgeons should inform their patients, before undergoing this procedure, that they must be willing to make major changes in their eating habits and lifestyle, postsurgery.

According to Curry, patients who are good candidates for the Realize Band have a BMI greater than 35 and preferably less than 50. Although patients with a BMI above 50 can still be successful with gastric banding, many studies show more favorable weight loss with gastric bypass for these patients. Patients with stomach or intestinal disorders or infection, and those who are being treated with steroids, should not undergo the procedure.

POSTSURGICAL REGIMEN

After surgery, patients begin to lose weight for up to 3 years, Curry says. The goal for his patients is 1 to 2 pounds per week for the first year.

See also “Options for Obesity” by Rima Bedevian in the October 2007 issue of PSP.

According to Curry, following a strict diet and exercise regimen postsurgery is crucial in order to begin shedding pounds.

“We recommend 30 minutes of cardio at least three times per week for all of our patients,” Curry says. “A standard 10,000-step-per-day plan with a pedometer is an alternative plan for those with busy schedules who cannot find the time to exercise.”

As with any surgically implanted device, the Realize Band does carry some risks, and physicians say that it should not be seen as a method for losing weight.

Trace Curry, MD, is director of The Center for Metabolic and Bariatric Surgery in Cincinnati and medical director of JourneyLite of Cincinnati. He has performed more than 1,000 gastric band procedures and is a proctor for Ethicon Endo-Surgery’s Realize Adjustable Gastric Band and for Allergan’s Lap-Band System.