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Gastric band operation

A gastric band operation is a type of weight loss surgery. It involves reducing the capacity of your stomach using an adjustable band so that you can only eat small meals.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

A gastric band can help you to lose excess weight if you're very overweight (morbidly obese). It works by creating a small pouch from the upper part of your stomach. This can only hold a little food, which means that you eat less because you feel full more quickly. By eating less you should lose weight.

A gastric band is adjustable, so it can be altered once it’s in place. This helps your doctor to control your weight loss. A gastric band can also be taken out if needed. However, removing the band may cause you to gain weight.

The band is placed around the upper part of your stomach. The band contains a circular balloon, similar to a tiny tube, which is then inflated through a port placed just under your skin. This creates a pouch of stomach above the band. When you eat, the pouch fills up quickly and the band then slows down the passage of food into the lower part of your stomach. The food then travels normally through the rest of your digestive system.

Studies show that on average, people lose between half and two thirds of their excess weight in the first two years after a gastric band operation.

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Gastric band surgery
How the operation is carried out

Details

  • Getting a gastric band Getting a gastric band

    Your doctor will only suggest surgery if you have tried to lose weight in other ways (such as with medicines, healthy eating and exercise) for at least six months and this hasn't worked. Surgery will also usually only be considered if:

    • you're morbidly obese with a body mass index (BMI) of more than 40, or you have a BMI of over 35 and also have a medical condition, such as diabetes or high blood pressure, that would be likely to improve if you lose weight
    • you’re generally fit enough to undergo surgery
    • you’re committed to losing weight and maintaining that weight loss by combining the surgery with lifestyle changes in the future, and are prepared to attend regular follow-ups

    In some areas of the country, you may still not be eligible for the procedure even if you meet these criteria. This is because of the high demand for weight loss surgery. If your GP thinks weight loss surgery could be beneficial to you, he or she will refer you to a bariatric surgeon (a doctor specialising in obesity surgery) to talk about your options.

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  • Preparation Preparing for a gastric band operation

    Your surgeon will explain how to prepare for your operation. For example if you smoke you will be asked to stop, as smoking increases your risk of getting a wound infection, a chest infection or a blood clot and slows your recovery. This is particularly important before a gastric band operation as being very overweight increases your risk of complications after your operation.

    Your surgeon may ask you to follow a low-fat, low-carbohydrate diet for a week before your operation. This helps to shrink your liver and makes it easier and safer to perform keyhole (laparoscopic) surgery and put the band in place.

    A gastric band operation is performed under general anaesthesia. This means you will be asleep during the operation. You will usually have to stay overnight in hospital after your operation.

    If you're having a gastric band operation, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon’s advice. At the hospital your nurse will check your heart rate and blood pressure, and test your urine.

    You will be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

    Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

  • Alternatives What are the alternatives to a gastric band operation?

    There are other types of surgery available that can help you to lose excess weight. These include sleeve gastrectomy and gastric bypass.

    Your surgeon will tell you about the options available and help you to weigh up the risks and benefits of each, to decide which is best for you.

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  • The procedure What happens during a gastric band operation?

    A gastric band operation usually takes about an hour.

    A gastric band is usually fitted using keyhole surgery. Keyhole surgery is carried out by making a number of small incisions in your abdomen (tummy), rather than one large cut.
    Your surgeon will make four to five small cuts in your upper abdomen in order to gain access to your stomach. He or she will use small instruments, guided by a laparoscope (a long, thin telescope with a light and camera lens at the tip), to place the band around the top part of your stomach. The band is then connected by a piece of fine latex tubing to the injection port, which is placed just under your skin.

    The band is locked in place so that it can't come undone. Afterwards, your surgeon will close the cuts with two or three stitches or small metal clips.

    The gastric band contains a circular balloon which is filled with saline (sterile salt water). Your surgeon can add or remove saline from the band after your operation through the injection port. This controls the size of the opening from your stomach and therefore how quickly the pouch empties. Some surgeons do this in the X-ray department. You're likely to have the volume of fluid in your band adjusted two or three times in the first few months after your operation. These adjustments are made to make sure you're steadily losing the right amount of weight, but can eat a reasonable amount without being sick.

    An image showing the position of a gastric band and access port

  • Aftercare What to expect afterwards

    You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

    You will have a drip put into a vein in your hand or arm to give you fluids. If you feel well enough, you can start to drink small amounts of water soon after your operation. You will be encouraged to get out of bed and move around as soon as you feel able as this helps prevent blood clots developing in your legs, and chest infections. You may also have a further heparin injection to prevent blood clots.

    You will usually be able to go home the day after your operation and will need to arrange for someone to drive you home. Your surgeon or dietitian will give you advice about the diet that you need to follow in the weeks following your procedure.

    Your nurse will give you advice about caring for your healing wounds before you go home and give you a date for a follow-up appointment. You will need to go back to the hospital at intervals to have the gastric band adjusted.

    Your surgeon may use dissolvable stitches. The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure they should usually disappear in seven to 10 days. If you have non-dissolvable stitches or clips you will need to have them taken out. Your surgeon will tell you when and where to have them removed.

  • Recovery Recovering from a gastric band operation

    If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

    You will be asked to make major changes to the food you eat after your operation. You will only be able to eat small amounts at each meal. To start with, stick to liquids and then move onto puréed food. While you are first losing weight, you may want to take a vitamin supplement. However, because food is absorbed normally after a gastric band operation, if you are following a healthy diet, you shouldn’t need to take vitamin supplements long term. Your surgeon will give you all the information you need about what foods to eat and how much.

    You will also be asked to make other changes to your lifestyle, such as restricting the amount of alcohol you drink and becoming more active. These changes will help you to get the most from your gastric band operation and will help you to lose excess weight and keep it off. Being active will also help to tone your muscles and improve your posture.

    You may have regular blood tests after your operation. These are to check that you're getting all of the vitamins, minerals and nutrients you need to stay healthy.

    It usually takes about two weeks to make a full recovery from a gastric band operation, but this varies between individuals, so it's important to follow your surgeon's advice.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with a gastric band operation. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. You're likely to have some bruising, pain and swelling of the skin around your healing wounds.

    Once your gastric band is fitted, you may feel sick or vomit after eating, especially if you try to eat too much. This is most likely to happen in the first few weeks after your operation. Chewing your food well, eating smaller amounts and choosing foods that are easy to digest will help to reduce these side-effects.

    Complications

    Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis – DVT).

    Being very overweight increases the risk of complications following any operation. You're more likely to have complications from having a general anaesthetic and are more at risk of developing blood clots. If you have other conditions linked to your weight, such as high blood pressure or diabetes, these can also increase your risk of developing complications.

    Complications specific to a gastric band operation are listed below.

    • An infection around your gastric band, the port or in one of your wounds.
    • You may develop a chest infection, particularly if you smoke.
    • Injury to your stomach or other organs in your abdomen such as your spleen during the operation. This may mean your surgeon has to convert to an open operation by making a larger incision.
    • The gastric band may slip out of place, leak and deflate, or slowly work its way through your stomach wall. If this happens, the band may need to be repositioned, removed or replaced. Around one in 10 people with a gastric band may need to have it replaced in the future.
    • If you lose weight quickly you may develop gallstones. These can be painful and you may need surgery to remove them.

    During your operation your surgeon may come across an unexpected problem and may need to make a larger cut in your abdomen. This won't affect how well the operation works, but it may mean that you take longer to recover from the operation.

    Not everyone loses the right amount of weight after the operation, and some people put weight back on after they have lost it. If this happens your surgeon may suggest other treatments, such as gastric bypass surgery.

  • FAQs FAQs

    Can my gastric band be removed after I reach my recommended weight, or will I have it for life?

    Answer

    Your gastric band can be removed at any time, but if you do have it removed, you're likely to regain weight.

    Explanation

    The gastric band operation is reversible. When you have a gastric band put in you should expect it to stay in place permanently, so that you lose weight and maintain any weight loss.

    If your gastric band is taken out, your stomach will go back to the size and shape it was before the band was fitted. If you don't stick to a sensible eating plan, you will put weight on.

    If the band needs to come out for any reason, this can usually be done using keyhole (laparoscopic) surgery.

    If you're worried about having a gastric band fitted, or are thinking of having it removed, talk to your surgeon or GP for advice.

    What foods should I eat after my gastric band operation?

    Answer

    In the first month after your operation you will need to eat small amounts of puréed foods, to help your stomach heal properly. After that you can gradually start to eat solid foods. Eating small amounts of healthy foods that are low in fat and sugar will help you to lose excess weight and keep it off.

    Explanation

    As a gastric band operation reduces the size of your stomach and allows it to empty slowly, you will only be able to eat small amounts of food at a time.

    For the first four weeks after your operation the food you eat should be puréed. This allows your stomach to heal properly. You should also try to have four to five small meals in a day rather than three normal-sized meals. The main rules to follow are listed below.

    • Your food should be like smooth baby food. Try using a blender, masher or food processor to make it. You can add extra liquid, such as gravy, sauces or fruit juice to your food to make it more smooth and liquid. Avoid actually eating baby food as it has a very low protein content.
    • Each meal should be around five or six tablespoons in total. Eat slowly and take small mouthfuls.
    • As soon as you start to feel full, stop eating. The feeling of fullness you get after a gastric band operation may be different from the feeling you had before. A full stomach may give you a heavy or tight feeling in your chest.
    • Drink enough water or fluids every day. You should drink 1.5 litres in 100 to 200ml glassfuls between meals. Don't drink when you have your meals.

    After the first four weeks you can gradually start eating foods that are lumpier, but make sure you chew them well. Long term you should aim to eat a healthy balanced diet. This will help you to maintain your weight loss and to get all the nutrients and energy you need to stay healthy.

    Eat three meals a day and don't snack in between meals. Don't drink anything half an hour before your meals or for one hour afterwards. This is because fluid will make you feel full if you drink before a meal and it can make your stomach empty more quickly if you drink during a meal. Don’t drink fizzy drinks as these can make you feel very uncomfortable.

    You should eat a healthy balanced diet, with small amounts of protein, such as lean meat, fish and eggs, and small amounts of carbohydrate, such as potatoes and bread. Eat four or five portions of fruit and vegetables a day and low-fat foods, such as skimmed milk and low fat cheese. You can still have occasional sugary, high-fat foods such as chocolate in small amounts.

    Eating too much, too quickly, or eating solid food that has not been chewed enough can make you feel sick or vomit, so it's important to eat slowly, so that you know when you're full. Foods such as meat can also get stuck in the opening from your stomach where the band is. Take small bites of food and chew it well to prevent this from happening. If food does get stuck it can make you feel uncomfortable, but usually the food will dislodge on its own. If it doesn’t, then drinking small sips of a hot drink may help.

    Talk to your surgeon or dietitian for more information about the foods you can eat after your gastric band has been fitted.

    Will I need surgery after weight loss to remove excess skin?

    Answer

    Losing a lot of weight can cause your skin to become loose. This means that you may be left with folds of excess skin after your weight loss. Cosmetic surgery can help to reshape the parts of your body where you have extra skin.

    Explanation

    Most people who have a gastric band operation will lose weight. On average, people lose around half of their excess weight in the first two years after a gastric band is fitted. This amount of weight loss can cause your skin to become loose. Once it has been stretched, skin loses its tightness. This means that you may be left with folds of excess skin after your weight loss. Excess skin is most common on your abdomen, face, bottom, breasts, upper arms and thighs.

    You may find this extra skin uncomfortable or embarrassing. The skin in these areas can also become irritated, painful or infected. Cosmetic surgery can help to reshape the parts of your body where you have extra skin.

    It's usual to wait for between 12 and 18 months after your gastric band is fitted before you’re able to have any cosmetic surgery. This is to make sure that your weight is stable and isn’t likely to change significantly.

    Cosmetic surgery isn’t suitable for everyone and can cause further health problems. If you’re interested in cosmetic surgery after your gastric band operation, discuss your options with your doctor. He or she may recommend that you see a plastic surgeon.

  • Resources Resources

    Further information

    Sources

    • Gastric band. British Obesity Surgery Patients Association. www.bospa.org, accessed 10 September 2012
    • Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. National Institute for Health and Clinical Excellence (NICE), January 2010. www.nice.org.uk
    • Bariatric surgery. eMedicine. www.emedicine.medscape.com, published June 2012
    • Gastric band post op eating plan. British Obesity Surgery Patients Association. www.bospa.org, accessed 10 September 2012
    • Exercise programmes. British Obesity Surgery Patients Association. www.bospa.org, accessed 10 September 2012
    • Bult MJF, van Dalen T, Muller AF. Surgical treatment of obesity. Eur J Endocrinol 2008; 158:135–45 www.eje-online.org
    • Management of obesity. Scottish Intercollegiate Guidelines Network (SIGN), February 2010. www.sign.ac.uk
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    Produced by Pippa Coulter, Bupa Health Information Team, December 2012.

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