Gastric Band

The surgery involves placing a hollow silicone band around the upper part of your stomach. The band is attached via a tube to a small access port which is placed under the skin of your abdomen. Through this port, your health professional will add or remove saline solution from your band to adjust its tightness in order to control the flow of food through the stomach.

The gastric band, combined with the recommended changes in your eating habits, will help reduce your weight, and hence reduce your BMI (body mass index). It will also improve obesity-related conditions you might have such as type 2 diabetes, high blood pressure and sleep apnoea.

If you have tried to lose weight by eating healthier and exercising but these measures were not effective, then you might qualify to have a bariatric procedure to help you with your weight loss.

In general, weight loss surgery could be an option for you if:

• Your body mass index (BMI) is 35 or higher, or if your BMI is above 30 and you also suffer from obesity related medical conditions which may improve with the surgery (e.g., diabetes, high blood pressure or sleep apnoea).
• If you are of Asian or Afro-Caribbean origin and your BMI is more than 32.5 (or you a have a BMI more than 27.5 and you also have type 2 diabetes or other weight-related medical issues).
• You are committed to healthy life after surgery by maintaining lifestyle and diet changes in the long term.

A gastric band is an effective weight-loss surgery which reduces your weight and improves many of the obesity related medical conditions you might have. It will also improve your ability to perform routine daily activities and can help improve your quality of life.

Aftercare and Recovery:

When you wake up after the operation, you will be in the recovery area of the operating department. The recovery team will ensure you are not in pain and that you are safely woken from the anaesthetic. Then you will be transferred to either the ward or the High Dependency Unit based on the pre-operative assessment of your medical problems.

On your first night following surgery, the nursing staff will monitor you carefully, checking your blood pressure and other vital measurements regularly. You will be allowed to drink fluids freely. Pain killers and anti-sickness medications will be given to you as needed.

The morning after your operation you will have breakfast (blended diet) and feel so well you will be keen to go home. You will usually have 2 weeks of blended diet, followed by 2 weeks of soft/lumpy diet. After that you can progress to a normal solid diet, just in much smaller quantities now. Both the surgeon and the dietician will review you on the ward before you leave and provide further advice if needed.

Band Adjustment:

Following discharge, you will have follow up appointments with the medical team to adjust the amount of fluid in your band. Band adjustment is a simple procedure which is done in the outpatient clinic. A special needle is used to pierce your access port and gradually inflate or deflate the band using saline solution. This will adjust the tightness of your band around the stomach and consequently control the flow of food from the pouch to the lower part of the stomach. The band should be tight enough to slow the flow of food through the stomach, but not too tight to completely block this flow.

It usually takes a few adjustments until the optimal band tightness is achieved. It is expected that your initial follow-up appointments will be on a monthly basis. Once the optimal tightness is achieved, we can start to space your follow up visits out. Your attendance to these appointments and adherence to the post-op eating plan is very important to achieve the optimal results.

Here are several potential complications of the gastric band operation. Your surgeon will explain these risks to you in detail during your consultation with him/her before the operation.

In general, early postoperative complications of gastric bands are rare, particularly in the hands of an experienced bariatric team like Phoenix Health. However, the rate of late complications is high. This is mostly related to faults occurring with the banding device or a change in its position necessitating corrective surgery. About 20%-50% of patients may require some kind of corrective surgery in the first five to ten years following gastric band insertion.

The following are the serious or frequently occurring risks with gastric bands:

Early complications:

• Bleeding (blood transfusion may be required)
• Infection and wound pain
• Organ, bowel or vascular damage including risk of splenectomy (removal of spleen). In some of these circumstances it may not be possible to insert the band
• Conversion from laparoscopic (keyhole) to open surgery
• Anaesthetic complications (heart attack, chest infection, sickness and vomiting).
• DVT and pulmonary embolism (blood clots in the legs and lungs)

Late complications:

• Fault in the device or change of position (needing corrective surgery):
• Band slippage (acute or chronic) and pouch dilatation (10-40% risk long-term)
• Band erosion (serious but rare complication <1%)
• Band, band tubing and/or access port problems (infection, unbuckling, disconnection, leakage, blockage, port flip, port erosion)
• Chronic oesophageal (gullet) stretching
• Food bolus obstruction and chest pain
• Marked limitation portion size and restricted speed of eating
• Nausea, vomiting and acid reflux
• Nutritional deficiencies and hair loss (uncommon)
• Gallstone formation (10% risk of future cholecystectomy)
• Excessive weight loss and/or loose skin on belly, thighs, arms and breasts.
• Poor or no weight lossWeight re-gain
• Psychological difficulties adapting to weight loss and its consequences.

Your surgeon will discuss with you your estimated mortality risk from this surgery. This varies greatly between patients as everyone has different risks based on their weight and other illnesses.  The gastric band is a safe procedure with the average risk to life of around 1 in 1,000. To put this into perspective, the average risk of death after a hip replacement is about 1 in 250.