Gastric band
What is gastric band surgery and how does it
work?
A gastric band is an inflatable silicone
ring which can be used to control the amount of food passing from
the stomach into the digestive tract. The operation is normally
carried out as a laparoscopic (‘keyhole’ surgery) procedure while
you sleep under a general anaesthetic. When the ring is placed
around the upper part of the stomach, it creates a small pouch at
the top of the stomach with a small opening, or ‘channel’, to the
rest of the stomach. The size of the pouch and the channel both
depend upon how much the ring is inflated. During a meal, food
enters the pouch before passing through the opening into the main
part of the stomach. The rate at which food passes through depends
on the size of the channel between the pouch and the main part of
the stomach. The more the ring is inflated, the There is a small
port attached by thin tubing to the band. This port is placed just
under the skin allowing the band to be adjusted as necessary.
‘Niopam’ (an iodine-based fluid) can then be injected or withdrawn
to adjust the size of the opening between the upper and lower parts
of the stomach. This enables you to feel full sooner and for
longer.
This method of surgery is recommended for
patients with a BMI (body mass index) of 35 – 45. It is a
surgically proven method of weight loss when combined with a
supervised diet, activity and lifestyle programme. On average,
patients tend to lose 25% of their total body weight during
treatment.
What are the advantages of having a
gastric band?
Feeling full quicker and for longer than
usual. The procedure is less invasive and easier to reverse than
other surgical techniques designed to aid weight loss. The band is
adjustable, so we can vary the size of the opening between the
pouch and the main part of the stomach if necessary. Shorter stay
in hospital and shorter recovery time compared to having a gastric
bypass operation
Are there any risks associated with
this operation?
As with any operation, there are risks
associated with having a general anaesthetic. Specific to this
operation, there is a small risk of wound infection, chest
infection, deep vein thrombosis (‘DVT’ or blood clots in the legs),
pulmonary emboli (blood clot on the lungs). Most people will not
experience any serious complications from their surgery. The risks
increase for people who already have other medical conditions, such
as heart disease or high blood pressure. However, any problems that
do arise can be rapidly assessed and appropriate action taken.
There is a 5-10% risk of complications
associated with the gastric band that can occur after surgery.
These can include the band slipping or moving into the stomach, an
increase in the size of the stomach or gullet (oesophagus), rupture
of the ring or infection of the port. This may result in the band
or port needing to be removed, repositioned or replaced. Upto one
in 10 patients will need further surgery for these or other
complications.
There is a 1 in 1,000 (0.1%) risk of
death and a 5-10% risk of adverse effects (as listed above) caused
by having this treatment.
Are there any alternatives to this
operation?
What happens before the
operation?
A few weeks before your operation, we will
ask you to attend the Pre-admission Assessment Clinic. This
appointment is an opportunity to check that you are fully prepared
for your admission, treatment and discharge home. You may also have
routine investigations such as blood tests, ECG (recording of your
heart) or a chest x-ray done at this time to check your fitness for
surgery. An anaesthetist will also see you at this appointment.
Is there anything I should do to
prepare for my operation?
Please follow the pre-operative diet
sheet for bariatic surgery for two weeks before your
operation.
Make sure you go for a 30 minute walk every
day, as this is good cardiovascular exercise. This will help reduce
the risk of post-operative complications, as well as help you lose
some weight prior to surgery.
You should also do your breathing exercises
as discussed with you in clinic, whilst you are having your 30
minute walk each day.
Please do not have anything to eat (not
even sweets or chewing gum) or drink after midnight on the night
before your operation.
If you regularly take medicines in the
morning, you should take them before 7.00am, with a small sip of
water if necessary.
If you are diabetic, you
must not take your insulin or diabetic tablets on
the morning of your operation.
If you take blood-thinning medications
(such as warfarin or aspirin)
and/ or are allergic to any medications, please contact the ward
for advice before you come in to hospital.
What happens on the day of my
operation?
You will be admitted to the ward on the day
of your operation. Your temperature, blood pressure, respiration
rate, height, weight and urine will be measured to give the nurses
a baseline (normal reading) from which to work. We will measure you
for special stockings (sometimes known as ‘TEDS’) to prevent blood
clots (known as ‘DVT’ or ‘deep vein thrombosis’) from forming in
your legs following surgery. We may also start you on
anti-coagulant (blood-thinning) injections to help minimise this
risk.
The surgeon will explain the procedure to
you in detail before asking you to sign a consent form. This is to
make sure that you understand the risks and benefits of having the
operation.
All make-up, nail varnish, jewellery
(except wedding rings, which can be taped into place), body
piercings and dentures must be removed. One of the nurses will then
come and prepare you for the operating theatre.
What happens after the
operation?
You will wake up in the recovery room
before you are taken back to the ward .
Please tell us if you are in pain
or feel sick.
We have tablets/ injections that we can
give you as and when required, so that you remain comfortable and
pain free.
You may feel light-headed or sleepy after
the operation. This is due to the anaesthetic and may continue
until the next morning. It is also common to have a sore throat for
2 or 3 days after having a general anaesthetic. This sometimes
happens because the anaesthetist (specialist doctor) has to pass a
tube down your windpipe to give you the anaesthetic gases that keep
you asleep during the operation.
Four hours after your operation we will ask
you to stand up and start moving around.
Please make sure that you do your breathing
exercises 10 times every two hours (between 8.00am and 10.00pm) and
walk around for 10 minutes every two hours. You can combine doing
your breathing exercise with walking around as you did before your
operation.
Your wound will have been closed with
absorbable sutures (stitches) that will dissolve within 7 – 10 days
after surgery.
When can I start eating and
drinking again?
You will be allowed to start slowly sipping
unlimited amounts of water, tea, coffee, milk, squash, ribena or
bovril the day after surgery.
- Days 2 – 6 after surgery, you will be on a liquid diet
- Days 7 – 13 after surgery, you will be on a puréed diet
- Weeks 2 – 4 after surgery, you will be on a soft diet
- After 4 weeks, you can return to a regular diet
For further details, please see the diet
plan given to you before surgery by the dietician.
When can I go home?
Provided you are well enough, you may be
able to go home the day after your operation. Your surgeon and/ or
physician will visit you on the ward to check your recovery from
the operation.
If possible, please arrange for someone to
come and collect you by car on the day of your discharge home, as
you will not be able to drive yourself or travel on public
transport.
It is important that you make the necessary
plans as you will be expected to make your own arrangements for
going home unless your doctor feels that there are special reasons
why you need hospital transport.
You should continue to go for a minimum of
a 30 minute walk every day, as this is good cardiovascular
exercise.
Is there anything I need to watch
out for at home?
You may feel different sensations in your
wound such as tingling, itching or numbness. This is normal and is
part of the healing process. However, if you experience a high
temperature or fever, swelling, pain, discharge or excessive
redness around the wound site, please contact us as you may have an
infection.
If you are unable to swallow or are having
difficulties in swallowing, this may be because your band has
slipped. Please contact your doctor or clinical nurse, using the
numbers given to you before you go home.
What happens next?
1 week after surgery
You may still have some abdominal
discomfort due to your wound, which will ease over the next few
weeks. You can take painkillers for this if necessary. You should
be able to return to work at this time.
Make sure that you do your walking
exercises for 10 minutes every two hours. Continue following a
predominantly liquid diet as instructed by your dietician. See your
diet sheet for ideas and meal plans.
2 weeks after surgery
You should now be able to start on a diet
of puréed foods. See your diet for ideas and meal plans.
You may experience symptoms of restriction
(difficulty in swallowing), but most people are able to tolerate a
puréed diet without any problems. We will ask you to return to the
outpatient clinic to see your surgeon so that s/he can check your
wound and that the band is not causing you any difficulties. Make
sure that you continue to walk for 30 minutes each day.
3 weeks after surgery
You can now start eating a diet of
predominantly soft foods. Make sure that you continue to walk for
30 minutes each day.
4 weeks after surgery
You can start eating ‘normal’ food
(solids), but be careful with any food that does not crumble in
hand, such as bread or broccoli because they can swell in the
stomach causing bloating.
6 weeks after surgery
We will send you an appointment for the
outpatient clinic. Your doctor or clinical nurse specialist will
make the first adjustment of your band if necessary. This is
perfomed in the outpatient setting an takes approximately 10
minutes. It is not painful as the skin over the port is
generally numb.
7 – 52 weeks after
surgery
You will not have scheduled clinic
appointments during this time, but instead we will ask you to
request an appointment to see the doctor, clinical nurse specialist
or dietician as and when you need to for band adjustments.
1 year after surgery
We will now see you in the outpatient
clinic once a year. Your doctor will give you a physical
examination and check results of your blood tests.
Please continue to attend the support group
meetings when you can.