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Weight Loss Surgical Center

LAPAROSCOPIC (KEYHOLE) INSERTION OF AN ADJUSTABLE GASTRIC BAND

A Weight Reduction (Bariatric Surgery) Procedure

Bariatric Surgery OptionsThe laparoscopic gastric band involves the placement of an approximately 1/2 inch belt or collar around the top portion of the stomach. This creates a very small pouch and a fixed outlet into the lower stomach. The band is inflatable (you could think of this as a car tyre) and can be filled with sterile liquid, via an injection port that is placed beneath the skin below the lower end of your breast bone. The size of the outlet from the small pouch into the lower stomach is adjusted by the injection or withdrawal of saline via the port.

Anticipated Benefits from the adjustable gastric band:

Please understand that band is an effective tool for weight loss only if accompanied by appropriate dietary and life-style modification. You may expect to lose 1-2 lbs per week during the first year after proper band adjustment. Weight loss is likely to slow down and then plateau during the second year. As a broad generalization, 40-50% of your excess weight may be lost by the end of the second year. The band is a life-long tool to sustain this weight loss but there can be some weight regain after the initial drop in weight.

The band is not inflated at insertion, so there will not be any restriction to food intake immediately after the operation. The first "band-filll" should be done at 6-8 weeks after the operation, preferably under x-ray control. Subsequent band adjustments will be required to achieve a satisfactory degree of restriction such that satiety is reached with small portions of healthy meals. Please note band will be effective for weight loss only when proper adjustment is achieved.

Preparation before the operation

You need to strictly follow a special diet (a detailed diet sheet will be given to you) for 7 days prior to the operation. Please consume only liquids on the day prior to your operation. Depending on the scheduled time of the operation, you will be advised regarding a period of fasting. Please make sure that you have informed the surgeon regarding all your medications so that you may be advised correctly regarding any restrictions.

Side-effects and Complications

The operation is carried out very carefully and with great attention to detail, using up-to-date technology and current guidance from expert organisations. For the vast majority of patients, this is a technically straight-forward and safe procedure that causes minimal pain and requires only overnight hospital-stay. The entire team (surgeon, anaesthesiologist, nurses and other hospital staff) will have your well-being as their paramount concern. However, you need to be aware that this is a major intra-abdominal operation which, like most other procedures on the human body, caries some risk of side-effects, complications and limitations. It is fully understandable that a description of complications may cause anxiety but you do need to be fully informed. Please do not hesitate to ask as many questions as necessary to clarify any doubts or concerns.

Complications During or Soon After the Operation:

Bleeding is a risk of any laparoscopic operation and can occur from injury to a blood vessel during insertion of a cannula (a tube that conducts the operating instruments) or during dissection (separation of tissues) to create the tunnel for the band. Bleeding can usually be controlled by laparoscopic techniques and serious bleeding is very uncommon during this operation.

Damage to the oesophagus (gullet) or stomach can occur during creation of the tunnel for the band. With the use of proper technique and instruments, such damage is very uncommon. Rarely, if such damage occurs and is not recognised during the procedure, it can result in serious infection within the abdomen (peritonitis).

Difficulty to complete the operation by the keyhole technique may be encountered very occasionally. A well-recognised difficulty is the inability to move the liver so as to gain safe access to the upper portion of the stomach. If such an unforeseen problem is countered, a sensible option is to terminate the operation and then discuss further options. It is very rare to need to "convert" to a traditional, open operation with a long incision on the abdomen in order to manage an intra-operative problem.

Infection is uncommon, with use of proper sterile precautions and a dose of antibiotic at the start of the operation, but can occasionally occur. One of key-hole incisions on the abdominal wall may become infected and this can usually be treated effectively with antibiotics. Infection around the injection port, which may cause local pain, swelling, redness or discharge and fever, is a more serious issue. Once port-infection has occurred, it is very difficult to eradicate with antibiotics and usually requires removal of the port (with replacement at a later date). Similarly, infection around the band is very uncommon but, if it does occur, the band may have to be removed.

Deep vein thrombosis and pulmonary embolism (blood clots) are an important concern after operations in obese individuals. Please avoid continuous travel of more than 3 hours for approximately 4 weeks before or after surgery. Ladies should stop taking any oral contraceptive pills four weeks prior to the operation. You will be given an anti-coagulant ("blood-thinning") injection prior to the operation and on the following morning before discharge from hospital. Some patients may be advised to take the anti-coagulant injection for a further period at home. In addition, you will be fitted with special compression stockings prior to the operation. You should continue to wear these stockings until you return to your normal level of activities after the operation. Special boots, which intermittently compress your calves, are applied during and for some hours after the operation. The precautionary measures significantly minimize the risk of the thrombosis but cannot entirely eradicate this problem. Please be as mobile and active as possible after the operation and drink plenty of liquids. Thrombosis of the leg veins may produce a painful, swollen calf but is often "silent". Pulmonary embolism (blood clot in the lungs) may cause chest pain and breathlessness.

Myocardial infarction (heart attack)

Pneumonia (lung infection) or sleep apnea (failure to breath)

Intermediate and Long Term Complications

Difficulty to tolerate the band: Correct adjustment of the band is very important in order to obtain the full benefit. Some individuals may require several adjustments in order to get into the "green zone". If the band is too tight, it can lead to quite severe heartburn, vomiting and dilatation of the oesophagus (gullet). Very occasionally, a patient "just cannot live with the band" and will request band-removal.

Unsatisfactory weight loss or weight-regain. A small proportion of patients with fail to achieve the anticipated weight loss or will put weight back on after initially good weight loss. There is usually a combination of reasons for such "failure" of the band. Painstaking attention to diet and life-style, along with proper band-adjustment, are critical issues. There can be structural problems, such as dilatation (widening) of the stomach pouch or mechanical failure of the band. In some patients with inadequate weight loss, it may be necessary to consider removal of the band followed by a stomach "stapling" operation, such as the gastric bypass.

Mechanical failure of band. Like any other artificial device that is implanted into the human body (e.g. artificial joints), there can be mechanical problems. The injection port can move out of position or develop leakage and require to be re-fixed or replaced. The tubing that extends from the port to band can break and an operation becomes necessary for re-connection. If there is leakage of fluid from the band itself, then band-replacement would become necessary.

Band slippage. The wall of the stomach is sutured around the band to hold it in the correct position. With proper technique, it is uncommon for the band to move out of position but "slippage" can occur. A slipped band may constrict the gullet and cause difficulty with swallowing. Another pattern of slippage can strangulate the wall of the stomach with very serious consequences. Slippage usually requires urgent re-operation.

Band erosion. This is another uncommon but potentially serious complication, where the band has worked its way through the wall of the stomach. Erosion results in loss of restriction and infection or bleeding. The band will require to be removed in such a situation.

Need for further intervention or re-operation. Follow-up of large numbers of gastric band patients indicates that up to 30-40% of patients may require a further operation for correction of one or more of the above-described problems, during the first 10 years after band insertion. We do not currently have reliable longer term data but is reasonable to assume that risk of long-term implant related problems and need for revisional surgery will increase when the band has been in place for a longer duration.

Care After the Operation

Pain: There is often a sensation of tightness in the upper abdomen and pain around the key-hole incisions. It is also quite common to experience pain around the left shoulder. Pain-killer tablets are usually required for only a few days after the procedure. If you experience severe or prolonged pain, please get in touch immediately.

Nausea and constipation: It is quite common to be nauseous ("feeling sick") for several days after the operation. Please comply with the instructions from the dietician to minimize discomfort. Because of a side-effect of the pain-killers and reduced oral intake, you may suffer constipation after the operation. It is important to remain well-dehydrated by drinking plenty of liquids and you may take laxatives if necessary.

Please follow the instructions of the dietician very carefully.

Please do not undertake any vigorous physical activity for 6 weeks.

Your first band fill should be 6-8 weeks after the operation.

You should take an over-the-counter multivitamin and mineral capsule (e.g. Forceval) daily, starting about two months after the operation.

In case of pregnancy or major illness, decompression of the band is often necessary.

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