Gastric Band
A gastric band operation is a type of weight loss
surgery. It involves reducing the capacity of the stomach using an adjustable
band, so that the patient can only eat small meals. Usually, the patient will meet the surgeon carrying out the procedure, before the operation, to discuss their care. It may differ from what is described here, as it
will be designed to meet the individual needs.
Gastric Band Info
A gastric band can help a patient to lose excess weight, if they are very overweight (morbidly obese). It works by creating a small
pouch from the upper part of the stomach. This can only hold a little food,
which means that the patient eat less, because they feel full much more quickly. By eating
less, patients lose weight.
A gastric band is adjustable, so it can be altered
once it is in place. This helps the doctor to control the patient's weight loss. A
gastric band can also be removed (taken out) if necessary. However, removing the band may
cause the patient to gain weight.
The band is placed around the upper part of the stomach. The gastric band contains a circular balloon, similar to a tiny tube, which is
then inflated through a port placed just under the skin. This creates a pouch
of stomach above the band. When a patient eats, the pouch fills up quickly, and the
band then slows down the passage of food into the lower part of the stomach.
The food then travels normally through the rest of the digestive system.
Studies have shown that on average, people lose between
half and two thirds of their excess weight in the first two years after a
gastric band operation.
Getting a gastric band
The doctor will only suggest surgery if a patient has tried to lose weight in other ways
(such as with medicines, healthy eating and exercise) for at least six months
and this has not been successful. Surgery will also usually only be considered if:
- A patient is morbidly obese with a body mass index (BMI) of more than 40, or they have a BMI of over 35 and also have a medical condition, such as diabetes or high blood pressure, which would be likely to improve if they lose weight
- they are generally fit enough to undergo surgery.
· Patients need to be committed to losing weight and maintaining
that weight loss by combining the surgery with lifestyle changes in the future,
and are prepared to attend regular follow-ups. In some areas, patients may still not be
eligible for the procedure even if they meet these criteria. This is because of
the high demand for weight loss surgery. If a patient's family doctor or GP thinks weight loss surgery
could be beneficial to the patient, he or she will refer the patient to a bariatric surgeon (a doctor
specialising in obesity surgery) to talk about the available surgical options.
Alternatives to gastric bands
There are
other types of surgery available which can help people to lose excess weight. These
include sleeve gastrectomy and gastric bypass. The surgeon tell patients about the options
available, and they help them to weigh up the risks and benefits of each, in order to decide
which is best for them.
Preparing for a gastric band operation
The surgeon will explain how to prepare for the operation. For example if a patient smokes, then the patient will be asked to stop, as smoking increases the risk of getting a
wound infection, a chest infection or a blood clot, and slows post-operative recovery.
This is particularly important before a gastric band operation, as being very
overweight increases the patient's risk of complications after their operation.
The surgeon may ask the patient to follow a low-fat,
low-carbohydrate diet for a week before the operation. This helps to shrink their liver, and makes it easier and safer to perform keyhole (laparoscopic)
surgery and put the band in place.
A gastric band operation is performed
under general anaesthesia. This means that the patient is asleep during the
operation. Patients usually have to stay overnight in hospital after their operation.
If a patient is having a gastric band operation, they will
be asked to follow fasting instructions. This means not eating or drinking,
typically for about six hours beforehand. However, it is important to follow the surgeon’s advice. At the hospital, the nurse will check the patient's heart rate
and blood pressure, and test the urine.
Patients will be asked to wear compression stockings to help prevent blood clots
forming in the veins in the legs (deep vein thrombosis - DVT). Patients may need to have an injection of an
anticlotting medicine (called heparin) as well as, or instead of, wearing
compression stockings.
The surgeon discusses with patients what will happen
before, during and after the operation, and any pain patients may have. This is their opportunity to understand what will happen, and they can help themselves by
preparing questions to ask about the risks, benefits and any alternatives to
the procedure. This will help the patient to be informed, so that they can give their consent
for the procedure to go ahead, which they may be asked to do by signing a
consent form.
The operation to place a gastric band
A gastric
band operation usually takes about an hour. A gastric band is usually fitted using laparoscopic (keyhole) surgery. Keyhole surgery is carried out by making a number of small incisions
in the abdomen (tummy), rather than one large cut.
The surgeon will make four to five small cuts in the upper abdomen, in order
to gain access to the stomach. He or she will use small instruments, guided by
a laparoscope (a long, thin telescope with a light and camera lens at the tip),
to place the band around the top part of the stomach. The band is then
connected by a piece of fine latex tubing to the injection port, which is
placed just under the skin.
The band is locked in place so that it cannot come
undone. Afterwards, the surgeon will close the cuts with two or three stitches
or small metal clips. The gastric band contains a circular balloon which
is filled with saline (sterile salt water). The surgeon can add or remove
saline from the band after the operation through the injection port.
This
controls the size of the opening from the stomach, and therefore how quickly
the pouch empties. Some surgeons do this in the X-ray department. Patients are likely
to have the volume of fluid in their band adjusted two or three times in the
first few months after their operation. These adjustments are made to make sure they are steadily losing the right amount of weight, but can eat a reasonable
amount without being sick.
Recovery
from a gastric band operation
Patients need to rest until the effects of the
anaesthetic have passed. They may need pain relief to help with any discomfort
as the anaesthetic wears off. They will have a drip put into a vein in their hand
or arm in order to give them intravenous fluids.
If they feel well enough, they can start to drink
small amounts of water soon after their operation. They will be encouraged to get
out of bed and move around as soon as they feel able, as this helps prevent blood
clots developing in their legs, and chest infections. They may also have a
further heparin injection to prevent blood clots.
They will usually be able to go home the day after their operation, and they will need to arrange for someone to drive them home. The surgeon or dietitian will give them advice about the diet which they need to
follow in the weeks following their procedure.
Their nurse will give them advice about caring for their healing wounds before they leave hospital, and will give them a date for a follow-up
appointment. They will need to go back to the hospital at intervals to have their gastric band adjusted.
Their surgeon may use dissolvable stitches. The
length of time for dissolvable stitches will take to disappear depends on what
type have been used. However, for this procedure they should usually disappear in 7 to 10 days. If a patient has non-dissolvable stitches or clips, then they will need
to have them taken out. Their surgeon will tell them when and where to have them
removed.
If a patient requires pain relief, then they can take over-the-counter painkillers such as
paracetamol or ibuprofen (neurofen). Patients should always read the patient information which comes with their medicine, and if they have any questions, they should ask their pharmacist for advice.
General anaesthesia temporarily affects patients' co-ordination and reasoning skills, so they must not drive, drink alcohol,
operate machinery or sign legal documents for 24 hours afterwards. If they are in
any doubt about driving, they need to contact their motor insurer, so that they are aware of
their recommendations, and must always follow their surgeon's advice.
Patients will be asked to make major changes to the food they eat after their operation. They will only be able to eat small amounts at
each meal. To start with, they need to stick to liquids and then move onto puréed food.
While they are first losing weight, they may want to take a vitamin supplement.
However, because food is absorbed normally after a gastric band operation, if they are following a healthy diet, they should not need to take vitamin
supplements on the long term. Their surgeon will give them all the information they require about what foods to eat and how much.
Patients will also be asked to make other changes to their lifestyle, such as restricting the amount of alcohol they drink and
becoming more active. These changes will help them to get the most from their gastric band operation, and will help them to lose excess weight and keep it off.
Being active will also help to tone their muscles and improve their posture.
Patients may have regular blood tests after their operation. These are to check that they are getting all of the vitamins, minerals
and nutrients they need to stay healthy. It usually takes about 2 weeks to make a full
recovery from a gastric band operation, but this varies between individuals, so
it is important for patients to follow their surgeon's advice.
Risks of a gastric band operation
As with
every operation, there are some risks associated with a gastric band operation. The risk of these happening has not been included here, as they are specific to each patient, and they differ for every person. Patient must ask their doctor to explain how these risks apply
to them.
Side-effects
Side-effects are the unwanted but mostly temporary
effects patients may get after having the procedure. Patients are likely to have some
bruising, pain and swelling of the skin around their healing wounds.
Once the gastric band is fitted, patients may feel sick
or vomit after eating, especially if they try to eat too much. This is most
likely to happen in the first few weeks after their operation. Chewing their food
well, eating smaller amounts and choosing foods which are easy to digest will
help to reduce these unwanted and unpleasant side-effects.
Complications
Complications are when problems occur during or
after the operation. The possible complications of any operation include an
unexpected reaction to the anaesthetic, excessive bleeding or developing a
blood clot, usually in a vein in the leg (deep vein thrombosis – DVT).
Being very overweight increases the risk of
complications following any operation. Patients are more likely to have complications
from having a general anaesthetic, and they are more at risk of developing blood
clots. If a patient has other conditions linked to their obesity, such as high blood
pressure or diabetes, these can also increase their risk of developing
complications.
Complications specific to a gastric band operation
include:
- An infection around the gastric band, the port or in one of the skin wounds.
- Patients may develop a chest infection, particularly if they smoke.
- Injury to their stomach or other organs in their abdomen (e.g. their spleen) during the operation. This may mean the surgeon has to convert to an open operation by making a larger incision.
- The gastric band may slip out of place, leak and deflate, or slowly work its way through your stomach wall. If this happens, the band may need to be repositioned, removed or replaced. Around one in 10 people (10%) with a gastric band may need to have it replaced sometime in the future.
- If a patient loses weight quickly, then they may develop gallstones. These can be painful and patients may need surgery to remove them (laparoscopic cholecystectomy).
- During the operation, the surgeon may come across an unexpected problem and may need to make a larger cut in the abdomen. This will not affect how well the operation works, but it may mean that patients take longer to recover from the operation.
- Not every patient loses the right amount of weight after the operation, and some people put weight back on after they have lost it. If this happens the surgeon may suggest other treatments, such as gastric bypass surgery.
FAQs about gastric bands
Q: Can my gastric band removed after I reach my
recommended/ desired weight, or will I have it for life?
A: Your gastric band can be removed at any time, but
if you do have it removed, you are likely to regain weight.
Explanation
The gastric band operation is reversible. When you
have a gastric band put in you should expect it to stay in place permanently,
so that you lose weight and maintain any weight loss.
If your gastric band is taken out, your stomach
will go back to the size and shape it was before the band was fitted. If you
don't stick to a sensible eating plan, you will put weight on.
If the band needs to come out for any reason, this
can usually be done using keyhole (laparoscopic) surgery.
If you are worried about having a gastric band
fitted, or are thinking of having it removed, talk to your surgeon or GP for
advice.
Q: What kind of foods can I eat after my gastric band
operation?
A: In the first month after your operation you will
need to eat small amounts of puréed foods, to help your stomach heal properly.
After that you can gradually start to eat solid foods. Eating small amounts of
healthy foods that are low in fat and sugar will help you to lose excess weight
and keep it off.
Explanation
As a gastric band operation reduces the size of
your stomach and allows it to empty slowly, you will only be able to eat small
amounts of food at a time.
For the first four weeks after your operation the
food you eat should be puréed. This allows your stomach to heal properly. You
should also try to have four to five small meals in a day rather than three
normal-sized meals. The main rules to follow are listed below.
·
Your food should be like smooth baby food. Try
using a blender, masher or food processor to make it. You can add extra liquid,
such as gravy, sauces or fruit juice to your food to make it more smooth and
liquid. Avoid actually eating baby food as it has a very low protein content. Each meal should be around five or six tablespoons
in total. Eat slowly and take small mouthfuls.
·
As soon as you start to feel full, stop eating. The
feeling of fullness you get after a gastric band operation may be different
from the feeling you had before. A full stomach may give you a heavy or tight
feeling in your chest. Drink enough water or fluids every day. You should
drink 1.5 litres in 100 to 200ml glassfuls between meals. Don't drink when you
have your meals. After the first four weeks you can gradually start
eating foods that are lumpier, but make sure you chew them well. Long term you
should aim to eat a healthy balanced diet. This will help you to maintain your
weight loss and to get all the nutrients and energy you need to stay healthy.
Eat three meals a day and don't snack in between
meals. Don't drink anything half an hour before your meals or for one hour
afterwards. This is because fluid will make you feel full if you drink before a
meal and it can make your stomach empty more quickly if you drink during a
meal. Don’t drink fizzy drinks as these can make you feel very uncomfortable.
You should eat a healthy balanced diet, with small
amounts of protein, such as lean meat, fish and eggs, and small amounts of
carbohydrate, such as potatoes and bread. Eat four or five portions of fruit
and vegetables a day and low-fat foods, such as skimmed milk and low fat
cheese. You can still have occasional sugary, high-fat foods such as chocolate
in small amounts.
Eating too much, too quickly, or eating solid food
that has not been chewed enough can make you feel sick or vomit, so it's
important to eat slowly, so that you know when you're full. Foods such as meat
can also get stuck in the opening from your stomach where the band is. Take
small bites of food and chew it well to prevent this from happening. If food
does get stuck it can make you feel uncomfortable, but usually the food will
dislodge on its own. If it doesn’t, then drinking small sips of a hot drink may
help. Talk to your surgeon or dietitian for more
information about the foods you can eat after your gastric band has been
fitted.
Q: Will I require another operation/ more surgery after weight loss with a gastric band, in order to remove any excess skin?
A: Losing a lot of weight can cause your skin to become loose. This means that you may be left with folds of excess skin after your weight loss. Cosmetic surgery can help to reshape the parts of your body where you have extra skin.
Explanation
Most people who have a gastric band operation will
lose weight. On average, people lose around half of their excess weight in the
first two years after a gastric band is fitted. This amount of weight loss can
cause your skin to become loose. Once it has been stretched, skin loses its
tightness. This means that you may be left with folds of excess skin after your
weight loss. Excess skin is most common on your abdomen, face, bottom, breasts,
upper arms and thighs.
You may find this extra skin uncomfortable or
embarrassing. The skin in these areas can also become irritated, painful or
infected. Cosmetic surgery can help to reshape the parts of your body where you
have extra skin.
It's usual to wait for between 12 and 18 months
after your gastric band is fitted before you’re able to have any cosmetic
surgery. This is to make sure that your weight is stable and isn’t likely to
change significantly.
Cosmetic surgery isn’t suitable for everyone and
can cause further health problems. If you’re interested in cosmetic surgery
after your gastric band operation, discuss your options with your doctor. He or
she may recommend that you see a plastic surgeon.
Gastric banding
Gastric banding is a purely restrictive procedure
in which a band is placed around the top part of the stomach. This creates a
small pouch above the band, with the main part of the stomach below. The band creates a narrowing between the top and
bottom part of the stomach. The band is filled with fluid via a port (small
chamber) placed under the skin.
This stops the food from passing quickly into the
stomach, keeping food sitting in the pouch. The food stimulates the nerves at
the top of the stomach to give you a feeling of fullness.
You should fill up quickly, and stay full for
longer, even after only a small amount of food (the amount eaten by a toddler).
The stomach and intestines are not cut, stapled or
removed when placing the band. Therefore digestion and absorption are not
affected. If you need further operations in the future, the
band can be removed and the original shape of the stomach will return to
normal. The band is not filled with fluid at the time of
surgery. Your first band fill will usually be about 6 weeks after surgery.
These procedures are performed in X-ray or in the outpatients department and
take up to 30 minutes.
You may need your band tightened more than once, to
create the correct amount of restriction from the band. Your dietitian or
surgeon will discuss this with you, based on your food intake, eating skills
and weight loss.
Expected weight loss
You will tend to lose weight steadily over 2 years
following surgery. On average, people lose about 50–60% of their excess body
weight. There is, however, a large variation in results and weight loss is
not guaranteed. Adherence to dietary advice is necessary to achieve these
results. The dietitian will discuss with you what changes
you would need to make to your eating patterns to have the best weight loss
results.
Advantages
- The amount of food you can eat is restricted.
- You may feel fuller quicker and stay fuller for longer.
- The band can be adjusted to increase or decrease the restriction via the access port under the skin on your stomach.
- You can lose on average 50–60% of your excess weight.
- The surgery itself has fewer risks than the Roux-en-Y gastric bypass and the sleeve gastrectomy, because it is a shorter procedure and the stomach and intestines are not cut, stapled or removed.
- The stomach and intestines remain intact so food is digested and absorbed as normal.
- The surgery can be reversed (although you will probably regain the weight).
Disadvantages
- Weight loss is slower than following the Roux-en-Y gastric bypass or the sleeve gastrectomy.
- Weight loss may not start until many months after surgery, until the band is filled to the optimum level for your stomach.
- The surgery will not always create the feeling of fullness.
- The port or band may leak and deflate, which may require another operation to correct the problem.
- The band may move or slip (2–5% of cases)—you may need to have all the fluid removed from your band for a period of time, or need another operation to remove or replace it.
- The band may erode into the stomach wall and need another operation to remove or replace it (1% of cases).
- The band or port may become infected and need to be removed.
- You may suffer from worsening gastro-oesophageal reflux (heart burn), ulceration, gastritis, bloating, difficulty swallowing, dehydration and constipation.
- Nausea and vomiting may occur, particularly in the first few days after surgery—vomiting is also common if you eat too quickly or eat too much.
- For successful weight loss, you will have to follow dietary changes and have self control.
- Should you require any other type of emergency or elective surgery in the future, the gastric band should not cause any problem.
- However, the surgeon performing the operation must be informed about your gastric banding prior to surgery.
- 10% of people fail to lose the expected amount of weight with the band.
- The access port may twist so be inaccessible for band fills—you may require another operation to correct the problem.
Source: NHS Choices.