What is gastric banding surgery for teens?

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 a treatment choice 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 through the skin into the port and goes through the tube to fill the band. The fluid makes the band expand and squeeze tighter. A healthcare provider can control the size of the band by adding or removing saline through the port after the surgery.

When saline is added, the band tightens around the top of the stomach. This creates a small pouch where food goes during a meal. The food then slowly moves down into the rest of the stomach and is digested over time. The pouch is smaller than a whole stomach. So it makes a person full more quickly. It limits the amount of food they can eat.

After surgery, the band may need to be adjusted. This needs regular follow-up visits to a healthcare provider and injection or removal of saline through the skin into the port. At some point years after surgery, many bands will need to be replaced. This is done with another surgery.

Why might my teen need gastric banding 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 gastric bands have declined in use in both adults and youth because of negative long-term effects as well as high complication rates.

Some studies suggest that weight-loss surgery may improve the health of obese teens. A teen may be able to bypass health problems linked to obesity. These include type 2 diabetes, sleep apnea, high blood pressure, and heart disease. The surgery may also help lessen social problems, such as being bullied.

Due to concerns of long-term effects and complications, a healthcare provider will recommend the surgery only in special cases. A healthcare provider may advise surgery for a teen who has a body mass index (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 other ways to lose weight with no success.

Deciding whether your teen should have gastric banding surgery is complicated. Roux-en-Y gastric bypass or vertical sleeve gastrectomy may be more appropriate for adolescents and are recommended in the latest pediatric obesity guidelines for adolescents 13 years and older with severe obesity. 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 figure out if surgery is the right choice for your teen.

What are the risks of gastric banding surgery for a teen?

Like all kinds of surgery, weight-loss surgery has risks. The risks of gastric banding include:

• Infection, including wound infection, pneumonia, abdominal infection, and urinary tract infection

• Pain

• Too much bleeding. Your teen may need a blood transfusion or more surgery. Too much bleeding can be fatal.

• Blood clots in the legs that can travel to the lungs

• Poor wound healing

• Risks of anesthesia, including death

After surgery, the risks include:

• Nausea

• Vomiting

• Trouble swallowing

• GERD (gastroesophageal reflux disease) or heartburn

• Belly (abdominal) pain

• Saline leaking 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 more surgery to fix problems

How do I help my teen get ready for gastric banding surgery?

Before having this surgery, your child 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 the support of their family

A teen should not have the surgery if they have any of the following:

• Lack of interest in following the diet changes needed after surgery

• An untreated eating disorder or mental illness

• Is pregnant or breastfeeding 

If a teen has Prader-Willi syndrome, a comprehensive discussion with your healthcare provider about the risks and benefits of bariatric surgery would need to be done if surgery is being considered.

A gastric banding procedure is a major life change. Your teen will likely be asked to take classes to get ready 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 child will only be able to eat small amounts of food. Eating too much can lead to vomiting and other problems. Your teen will also need to take daily vitamin and mineral supplements. These are things that some children may not want to do, or may not remember to do.

Talk with your teen about all 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 child before and after surgery.

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 they are healthy enough for surgery

• Talk with a mental health counselor to make sure they are ready for surgery

• Go to nutrition classes or meet with a dietitian

• Meet any other requirements as noted by healthcare providers

Your child will also need to:

• Not take certain medicines during the week before surgery, such as ibuprofen

• Follow any directions for not eating or drinking before surgery

What happens during gastric banding surgery for a teen?

A gastric banding surgery takes about 30 minutes to 60 minutes. It follows this general process:

• An IV (intravenous) line is put into your child’s arm or hand. Medicine and fluids are sent through the IV. Your child will be given medicine (general anesthesia) to cause them to sleep through the surgery.

• The surgeon will make 1 to 5 small cuts in the belly. 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 placed 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 teen is taken to a recovery room. They are watched by a healthcare provider, and then sent to a hospital room.

What happens after gastric banding surgery for a teen?

Your child will likely stay in the hospital overnight. They will feel some pain and discomfort after surgery. This is normal. It's treated with pain medicine. The healthcare team may also have your teen up and walking a few hours after surgery. This will help your child recover faster.

On the day after surgery, your teen will likely have an X-ray. It makes sure that the gastric band is working normally. Your teen may be asked to swallow a liquid that can be seen on the X-ray.

When it’s time for your child 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 they can eat

• Make healthy food choices

• Not eat 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

Next steps

Before you agree to the test or procedure for your child make sure you know:

• The name of the test or procedure

• The reason your child is having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• When and where your child is to have the test or procedure

• Who will do the procedure and what that person’s qualifications are

• What would happen if your child did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or your child has problems

• How much you will have to pay for the test or procedure