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iodine-based fluid) can then be injected or withdrawn to adjust the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.
Bupa Health Information
How
gastric banding surgery is carried out (external factsheet)
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.