Gastric Banding

• What is gastric banding surgery?
• Why is the procedure performed?
• What are the benefits of gastric banding?
• What are the risks of gastric banding surgery?
• How are patients prepared for the surgery?
• What is involved in the surgery?
• What happens after the operation?

What is gastric banding surgery?

Gastric banding is an operation performed under general anaesthetic. A surgeon will place an adjustable band around the top of the stomach to create a small pouch to hold food. The band is attached via a thin tube to a small “port” or reservoir, which is placed under the abdominal skin at the time of surgery. This port allows the surgeon to increase the tightness of the band (by injecting fluid into the reservoir) at a later stage. In Australia, laparoscopic (key-hole surgery) is the most common method used to perform gastric banding. This procedure is considered simple and safe for people who are very overweight and experience complications because of their weight.

Why is the procedure performed?

Surgery is considered to help morbidly obese patients lose weight. This is because a person who is obese is more likely to suffer from physical and psychological illness than a healthy weight person. In particular, overweight patients are more at risk of heart disease, diabetes, high blood pressure, high cholesterol, heart attacks or stroke, sleep apnoea, depression, and osteoarthritis. Losing weight has been shown to reverse or reduce these conditions. Laparoscopic gastric banding is performed on people who are morbidly obese. This means they have a Body Mass Index (BMI) of more than 40. (The normal BMI is 18.5 – 24.9. Calculate your own BMI here.) A person’s weight is not the only consideration in having this procedure. Some people who have a BMI of 35 or more may be considered if they also have medical problems such as heart disease, diabetes, high blood pressure, high cholesterol or severe arthritis. Before a person can be considered for surgery, they must have made multiple, previous significant attempts to lose weight on their own. This includes dieting, exercise, and possibly medications for aiding weight loss. Most surgeons require a patient to show they are motivated to lose weight before they have surgery. If a person is highly motivated they are more likely to follow their specialised eating plan and attend regular follow-up after surgery.

What are the benefits of gastric banding?

Gastric banding creates a small pouch before the stomach in which food becomes trapped when it is ingested. The benefit of this is there is a smaller capacity for solid food to be held and a person will feel full more quickly. Food in the pouch is digested more slowly and so a person’s sense of “fullness” can last longer after meals. Studies have shown that this procedure cause an average of 23kg of weight loss at 2 years, and up to 43kg of weight loss at 5 years. Most patients who try to lose weight without this surgery do not lose any weight at all over a long period. Laparoscopic banding surgery is considered the safest of all the types of surgery performed to reduce weight. In most cases, patients will only be in hospital for 24 hours. After surgery, there is an improvement in many obesity related diseases. Studies 2 years after the laparoscopic banding procedure have shown improvements in;

1. Blood pressure
2. Cholesterol
3. Asthma
4. Diabetes
5. Gastro-oesophageal reflux
6. Heart failure
7. Sleep apnoea
8. Depression
9. Infertility
10. Blood clots

What are the risks of gastric banding surgery?

Laparoscopic gastric banding surgery is more complex to perform than some other types of surgery. However most surgeons who perform this operation are highly experienced. The surgeon who performs this procedure should discuss the complications with you prior to the operation. The overall rate of complications is also low. There is a very low risk of death with this operation, less than 0.5%. As with any form of surgery, there is a small risk of infection, wound problems, blood clots or lung problems. There are measures to minimise these complications that your doctor may prescribe. There is a risk of the band slipping or the pouch dilating. These problems may require further surgery in about 25% of cases. In less than 2% of people there is a risk that the band may erode into the stomach lining. After the surgery, some patients can have vomiting related to eating. This does not happen in all patients and can be reduced by eating small portions. This procedure is not always successful. A small number of patients will not lose weight with this surgery. However, in those patients who lose weight rapidly, there is a risk that they can develop gallbladder inflammation, which may require removal of the gallbladder.

How are patients prepared for the surgery?

A person is usually referred to see a surgeon by their GP. The surgeon will discuss the procedure, its risks and benefits. There are also a number of criteria a patient should meet. The person should have a BMI of more than 40. In some situations a person with a lower BMI may be considered for surgery if they have medical problems such as high blood pressure or diabetes. To be eligible a person must also have made multiple, significant attempts to lose weight on their own. There are a number of professionals that form a team to look after patients who have gastric banding surgery. The team may include nurses, a dietician, social worker, physiotherapist and anaesthetist. A person will have to attend multiple appointments with these professionals. In most cases a person will need to see at least the surgeon, dietician and anaesthetist, prior to surgery. Many centres also ask patients to see a psychologist before they are considered for surgery. The role of the psychologist is to interview the patient and discuss emotional and social factors, which might influence their ability to lose weight. Their involvement is important to help identify those people who will do well, or not-so-well following this surgery. After surgery, a person will attend follow-up sessions with many health professionals. It is important to understand prior to surgery that long-term follow-up is a part of the treatment plan.

What is involved in the surgery?

The laparoscopic gastric banding surgery involves an adjustable silicone band being placed around the top portion of the stomach. During this procedure, a person will be kept asleep by a general anaesthetic. The surgeon will use several small probes to introduce the band into the abdomen and then place it around the top portion of the stomach. There will be several small cuts on the surface of the abdomen from the probes used. Attached to the silicone band is a small port or reservoir, which will be inserted under the skin at the time of surgery. The person will be able to feel a lump under the skin where the port is situated. This port will allow the surgeon to adjust the tightness of the band at a later stage.

What happens after the operation?

After the surgery, a patient will wake up either in the operating room or just outside. It can take a few hours to feel back to normal after an anaesthetic. In most cases, a person will be ready to return home a day after surgery. It is advisable that a family member or friend be available to pick a patient up from hospital and stay with them for the first 24 – 48 hours. It is expected that you may be a bit sore following the operation over the wounds. However most people are able to resume daily activities soon after the surgery. Discuss with the surgeon prior to the operation how much time they would recommend off work. There is a strict follow-up plan after the operation. The plan for review is different for each surgeon and hospital. It is important to attend all appointments made for you after surgery. In a hospital setting, the patient may visit with allied health (such as physiotherapy, dietician) and a surgeon. If you suspect there is a problem after surgery it is a good idea to visit with your general practitioner and call your surgeon to discuss your concerns. A person who follows the eating plan set out by the dietician and exercises regularly, will have the best chance of losing weight. It is important to see your doctor regularly for check-ups. This will allow doctors to monitor how much weight you lose and the speed of weight loss. Some patients will also be monitored with regular blood tests. If you plan to become pregnant after this surgery you should discuss this with your doctor. The most important part of follow-up after the surgery is learning to adjust your diet. After surgery, patients need to eat more slowly. You should eat three standard meals a day and try not to snack between. A dietician will advise people on which specific foods are best. All patients should avoid sugary drinks (e.g. ice-cream shakes, soft drinks) and liquid meals (e.g. protein shakes) as these will pass straight through the pouch created by the stomach band, and will not give a person a sense of “fullness”. These drinks are a potential cause of failure to lose weight after surgery. It is possible that the band may need to be adjusted at a later stage to maintain weight loss. Your doctor will advise you of any symptoms to watch out for that may require special treatment. It is also important to tell other doctors you may see about having had this procedure.

References

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