More information on gastric band

This information sheet has been provided to help answer some of the questions you, your family and friends may have about GASTRIC BANDING.

All the health care professionals involved in your care will also be happy to answer any questions you may have about your operation and your care after surgery.

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 done 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 smaller the opening and therefore the food passes through more slowly.

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. ‘Niopalm’ (an iodine-based fluid) can then be injected or withdrawn to adjust the size of the opening between the upper and lower parts of the stomach.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.

If you have access to the internet, there is a very good video about this operation and other types of weight loss surgery at
www.mayoclinic.com/health/gastricbypass/ MM00703

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?

1. Feeling full quicker and for longer than usual.

2. The procedure is less invasive and easier to reverse than other surgical techniques designed to aid weight loss.

3. 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.

4. Shorter stay in hospital and shorter recovery time compared to having a gastric bypass operation.

Are there any risks associated with this operation?

Specific to this operation, there is a 10% risk of complications, which 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. One in 10 patients will need further surgery for these or other complications.

There is also a 10% risk of:

• wound, chest or urine infection

• deep vein thrombosis (‘DVT’ or blood clots in the legs)

• pulmonary embolism (blood clot on the lungs)

• hernias

• bleeding.

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.

Please note that there is a 1 in 1, 000 risk of death caused by having this treatment.

Are there any alternatives to this operation?

• Lifestyle management

• Drug treatment

• Gastric bypass surgery

• Sleeve gastrectomy

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 bariatric surgery for two weeks before your operation. This is to shrink the size of your liver. If you have not lost any weight in the two weeks prior to surgery, your operation may have to be abandoned.

• 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.

• If you take blood-thinning medications (such as warfarin or aspirin) and/ or are allergic to any medications, please contact the ward or us for advice before you come in to hospital.

• If you are a smoker, you must stop smoking at least 6 weeks before your operation. This will reduce the risk of chest troubles, as smoking makes your lungs sensitive to the anaesthetic. If you stop smoking, it improves your chances of a good result. It will also improve wound healing.

• All infections (such as coughs and colds) must be cleared up before you have your operation.

• 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.

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 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. It also gives you the opportunity to ask any remaining questions you may have.

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 or the High Dependency Unit.

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 skin staples, which will be removed at your first post-operative clinic visit approximately 7 – 10 days after surgery.

You can remove the dressing covering your wound 48 hours after your operation and have a shower the following day.

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 as soon as you are fully awake after your operation.

• Days 2 – 6 after surgery, you will be on a liquid diet.

• After day 7, you can start having puréed food, moving on to soft then regular food as tolerated.

For further details, please see the diet plan given to you before surgery by the dietitian.

When can I go home?

Provided you are well enough, you may be able to go home the same day or the morning 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, please contact us immediately. If you have any swelling, pain, discharge or excessive redness around the wound site, please contact your GP 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 dietitian. See your diet sheet for ideas and meal plans.

• We will ask you to return to the outpatient clinic to see us so that we can check your wound, remove any clips and also make sure that the band is not causing you any difficulties.

2 weeks after surgery

• You should now be able to start on a diet of puréed foods. See your diet sheet 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.

• 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 cannot be mashed with a fork, such as bread or broccoli, because they can swell in the stomach and cause 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.

12 weeks after surgery

• You will have appointments to see us to check your progress. Your doctor or clinical nurse specialist will also adjust your band at this appointment if required.

20 - 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 dietitian as and when you need to.

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.