Laparoscopic Adjustable Gastric Banding

 
Laparoscopic
Adjustable
Gastric Banding
What is a gastric banding?
Gastric banding restricts the amount that someone can eat. It is for patients who are very overweight to try to achieve substantial and permanent weight loss. It is an operation to put an inflatable band around the stomach to divide it into two parts. The smaller half of the stomach at the top takes less food to make you feel full. Food then passes slowly through the opening left by the band into the lower half of the stomach. After that, the food continues on into your intestines as normal.
Once the band is in place, it can be adjusted by inflating or deflating it. This is done by injecting it with fluid through a small tube from a reservoir which is attached just under your skin. It can be adjusted in this way until the right level of restriction is established. It usually takes at least two adjustments to complete. The first one is usually six weeks after surgery.
What does laparoscopic mean?
The operation is carried out laparoscopically, which is also known as keyhole surgery. This means that the surgeon makes five to six small incisions (cuts) in the abdomen (belly) to get to the stomach. The surgeon may decide to convert to an open procedure (the conventional way of carrying out this operation through a longer incision) if they think it would be safer.
What does the operation involve?
The operation takes approximately one hour. For some patients, the surgery can be technically difficult depending on body-build or previous surgery. In these circumstances the operation can take longer.
Before the operation
You will come into hospital on the day of surgery.
You will wear anti-embolism socks (like very tight stockings) to prevent blood clots forming in your legs.
The anaesthetist will see you before or on the morning of surgery.
After the operation
You will probably have:
1. Oxygen and a tube in your nose
2. A drip in your arm
You will be allowed to sip water and as soon as you feel able after you return to the ward. As soon as this is established, you may drink as much clear liquid as you like.
You may need laxatives to help you regularly open your bowels.
The physiotherapist will help you to exercise and to get out of bed.
You will usually be ready to go home one day after the operation.
You will have dissolvable stitches (that disappear naturally after a while)
You will be seen in the clinic about 6 weeks after surgery for your first band fill (to tighten the band)
At home
You may feel tired for a while after surgery but can generally go back to work after two weeks
Take gentle exercise.
No heavy lifting, such as children, luggage. You will need to arrange some assistance if lifting is part of your everyday life.
Do not drive till you can depress the brake pedal hard as if you are doing an emergency stop.
Keep the wound clean by taking a shower rather than a bath.
Watch for signs of wound infection such as:
1. pain
2. redness
3. swelling
4. discharge (oozing)
Are there any risks from the surgery itself?
This is a common and safe procedure, but every procedure has some risks associated with it. These are related to the anaesthetic and the surgery itself:
Bleeding rarely occurs during the operation. If this happens, you might need a blood transfusion which will be done at the same time as the operation.
Damage to internal organs: this can happen as a result of placing instruments in the abdomen. This is rare (1 in 1000) but higher in patients who have previously had surgery to the abdomen. If an injury does happen, open surgery may be needed which involves a much bigger incision.
A blood clot may occur in the legs or in the lungs which means you will require medication to keep your blood thin for several weeks or months.
Hernia can occur as a result of the incisions into the abdomen but it is less likely with laparoscopic surgery as the incisions in the muscle of the abdominal wall are quite small (a hernia is a bulge of the intestine through a weak point, caused by surgery).
Infection: can occur in the wounds, lungs and urine, in fact anywhere because of the nature of the surgery and the tubes into and out of your body post-operatively. It is important that you do not ignore signs of infection (see above) as they can become serious very quickly.
Heart Attack: This can be as a result of the physical stress of surgery or pre-existing heart problems.
Hair loss: This can also occur as a result of the stress of surgery and is usually temporary.
Overall the figure published in medical journals for all these risks together ranges from 5% to 20%, so we believe 15% is a reasonable figure to consider. In most patients these complications will be mild, but in a small proportion may lead to an emergency re-operation, a period in intensive care and/or an extended hospital stay. The risk of death at the time of operation is very small. However, information in medical journals tells us that the risk of death due to complications (as described above) is about 0.1% Therefore, we believe 1% (one death in a hundred operations) is a reasonable figure to have in mind.
Long Term Consequences of Gastric Banding
This operation is reversible although the band can be kept in for life.
For your safety you must remain under medical follow-up whilst the gastric band is in place. This will involve several visits in the first year and at least an annual visit after that.
We view this as a partnership between you and us. It is very important that you understand you will be taking the major share of the responsibility, by coming to the appointments that we send you.
What are the benefits of the surgery?
This surgery is a proven method of weight loss.
When combined with a supervised diet, increased activity and behaviour modification, it can lead to long-term weight loss and the associated health benefits.
Weight loss is more than with non-surgical programmes alone.
Average excess weight loss is 50% (for example, if a patient is 10 stone over weight then we would expect him/her to lose on average 5 stone).
Balancing Risks
We feel it is important for patients to have a clear view of the commitments and risks associated with this surgery. However, these have to be balanced against the longer term risks of remaining severely overweight.
We advise that you discuss these issues carefully with appropriate family members or friends.
Because the two sets of risks (risks of being overweight and risks of surgery for weight loss) occur on a different timescale, it may be difficult to consider one against the other.
Therefore please ask whatever questions you wish.
If you have any questions or worries, please contact for advice on 0207 1008083
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