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Gastric band operation

Gastric band surgery is a common type of weight loss (bariatric) surgery for people who are very overweight (obese). It involves putting an adjustable band (ring) around the top of your stomach. Your stomach then holds less food, which means you eat less and feel full more quickly. This helps you to lose weight.

A gastric band may be suitable if you haven’t been able to lose weight just by changing your lifestyle or by taking weight loss medicines. But it can only help you keep the weight off if you also eat a healthy diet and exercise regularly after the surgery.

Gastric band surgery
How the operation is carried out

Details

  • How does it work? How does a gastric band work?

    A gastric band is a circular balloon that fits tightly around the top part of your stomach. This creates a pouch of stomach above the band. When you eat, this top pouch fills up quickly so you feel less hungry. The band slows down the movement of food into the lower part of your stomach. Your surgeon can tighten or loosen the gastric band by injecting liquid into a tube that's placed just under your skin. This affects the rate at which food passes from the pouch into the lower part of your stomach 

    Research shows that people usually lose around half of their excess weight in the first two to three years after gastric band surgery.

    You can have a gastric band taken out if you need to. But it’s designed to stay inside your body for a long time. Removing the band may mean you put weight back on.

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  • Who can have a gastric band? Who can have a gastric band?

    You may be able to have a gastric band fitted if you're very overweight (obese) or if your weight is affecting your health. But your doctor will usually only suggest surgery if you’ve tried to lose weight in other ways and these haven't worked. You may have already tried weight loss medicines, eating healthily and exercising.

    If your GP thinks weight loss surgery could help you, they will refer you through a specialised obesity management service. You usually have to meet certain criteria to be considered for gastric band surgery. These include:

    • being very obese with a body mass index (BMI) of more than 40
    • having a BMI over 35 plus a health condition that should get better if you lose weight, such as diabetes or high blood pressure
    • being generally fit enough to have a general anaesthetic and surgery
    • being committed to losing weight and keeping the weight off by combining the surgery with lifestyle changes
    • being prepared to attend regular follow-up appointments 

    You won’t be able to have weight loss surgery if you have certain long-term health problems, such as inflammatory bowel disease or heart disease, or a psychological disorder. You also won’t be able to have a gastric band if you’ve had previous surgery to your stomach. It isn’t generally recommended for children or teenagers.

    If you meet the criteria above, you may be able to have gastric band surgery on the NHS, although this depends on availability in your local area. Another option is to have the surgery privately.

  • Decision-making Deciding on gastric band surgery

    A gastric band is a major operation with benefits and risks. It’s important to be aware of the pros and cons of the surgery and any alternatives. 

    Pros

    • Weight loss surgery can help you lose weight and improve your overall health.
    • Unlike other types of weight loss surgery, you can have a gastric band reversed.
    • You don’t usually need to take vitamin and mineral supplements after the first year following gastric band surgery.

    Cons

    • The amount of weight lost varies from person to person. It may depend on how often you have follow-up appointments with a dietitian afterwards. The more appointments you have, and the more often they are, the more weight you’ll lose.
    • The band may need to be adjusted at least six times in the first year after your surgery.
    • You may need to have gastric band surgery more than once, or the band removed, for example if the band slips down or leaks.

    Your surgeon will discuss with you what will happen before, during and after your surgery. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed so you feel happy to give your consent for the operation to go ahead. You will be asked to do this by signing a consent form.

  • Preperation Preparing for gastric band surgery

    Your surgeon will explain how to prepare for your operation. If you smoke, for example, you’ll be asked to stop. Smoking increases your risk of getting an infection after surgery, which can slow down your recovery. It can also make your surgery less effective and can lead to complications.

    Your surgeon or dietitian may ask you to follow a low-fat, low-carbohydrate diet for a week or two before your operation. This will help to shrink your liver and make it easier and safer to put the band in place. 

    You’ll have the gastric band operation under general anaesthesia. If you have a general anaesthetic, you’ll be asleep during the operation. You’ll be asked to follow fasting instructions. This means not eating or drinking, typically for six hours before your surgery. It’s important to follow your anaesthetist’s advice.

    You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.

    You’ll need to have an injection of heparin, which is a medicine that stops your blood clotting.

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

    The best way to lose weight is to make changes to your lifestyle by eating less and taking regular exercise. But this doesn’t work for everyone. Your GP can prescribe weight loss medicines, which can help you lose weight. If these don’t work, or you’re very overweight, they may suggest weight loss surgery instead.

    There are other types of weight loss surgery that can help you to lose weight. Like gastric band surgery, sleeve gastrectomy and gastric bypass work by making your stomach smaller. In a sleeve gastrectomy, part of your stomach is removed, restricting the amount you can eat. You won’t need further adjustments, but the operation can’t be reversed like a gastric band. A gastric bypass interferes with the digestion and absorption of food, as well as reducing the amount you can eat.

    Your surgeon will help you to weigh up the pros and cons of each type of surgery, to decide which is best for you.

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  • The procedure What happens during a gastric band operation?

    Gastric band surgery usually takes around an hour. 

    Your surgeon will fit a gastric band using keyhole surgery. This means they will make three to four small cuts in your tummy (abdomen), rather than one large cut. They will then insert a laparoscope (a long, thin telescope with a light and camera lens at the tip) through the cuts to see inside.

    Your surgeon will place the band around the top part of your stomach to create a small pouch. A piece of fine tubing connects the band to an injection port. They will place this just under your skin. Your surgeon can inflate or deflate the gastic band by adding or removing fluid through the injection port. This adjusts the size of the outlet from the pouch to the lower part of your stomach but doesn’t change the size of the pouch. 

    The band is fixed in place so it can't come undone. Afterwards, your surgeon will close the cuts with stitches.

    Your surgeon will probably use dissolvable stitches under your skin – you won’t be able to see these, and they’ll dissolve on their own.

  • Aftercare What to expect afterwards

    You may need to rest until the effects of the anaesthetic have worn off. You may also need some pain relief to help ease any discomfort.

    Having a general anaesthetic affects everyone differently. You may find that you’re not so coordinated or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important. Always follow your surgeon’s advice.

    You’ll have a drip into a vein in your hand or arm to give you fluids. If you feel well enough, you can start to sip some water soon after your operation. You’ll be encouraged to get out of bed and move around as soon as you feel able to. This will help to reduce your risk of getting a chest infection and the risk of blood clots developing in your legs.

    You’ll usually be able to go home the day after your operation. Make sure someone can take you home. And ask someone to stay with you for a day or so while the anaesthetic wears off.

    You’ll only be able to have fluids to begin with after your operation. Your surgeon (or a dietitian) will discuss with you when you’ll be able to start eating, and give you some printed information to take away. They will also advise you on when you can start to exercise again.

    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.

  • Recovery Recovering from a gastric band operation

    It may take you a week or two to recover from gastric band surgery and get back to your normal activities. But this can vary from person to person, so it's important to follow your surgeon's advice. 

    You may even notice some weight loss within a couple of weeks.

    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.

  • Losing weight Losing weight after gastric band surgery

    Once your gastric band is in place, it needs to be inflated. This will slow down the movement of food through your stomach, and help you to start losing weight. Your surgeon will inflate your gastric band with sterile fluid around four to six weeks after your operation. They can add or remove fluid from the band through a tube placed under your skin (the injection port). This will adjust the size of the opening into your stomach and determines how quickly the pouch empties.

    You’ll probably need to have the fluid in your band adjusted two or three times in the first few months after your operation. This will make sure you steadily lose the right amount of weight, but can also eat a reasonable amount of solid food without being sick. 

    You will need to change your eating habits after your operation. You’ll only be able to eat small meals. To start with, stick to liquids and then move on to puréed food. While you're first losing weight, you may need to take a vitamin and mineral supplement. But your body will still absorb food normally after gastric band surgery. So if you're following a healthy diet, you may not need to continue taking these supplements after the first year. Your surgeon or dietitian will give you all the information you need about what, and how much to eat.

    You may need to make other changes to your lifestyle too, such as drinking less alcohol and becoming more active. This will help you to lose excess weight – and keep the weight off. 

    Not everyone loses as much weight as they want to after the operation, and some people put weight back on after losing it. If this happens, your surgeon may suggest other treatments, such as gastric bypass surgery. But if you make the necessary changes to your lifestyle, such as exercising and eating healthily, you should lose weight.

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

  • Side-effects Side-effects of gastric band surgery

    After your surgery, you may have some side-effects, which should be temporary. If you experience any side-effects, it’s important to discuss these with your surgeon. 

    It’s possible you may have some bruising, pain and swelling on your skin around your wounds.

    Once your gastric band is fitted, you may feel sick or vomit after you eat, especially if you try to eat too much. Chew your food well and don't eat sticky or stringy foods that are difficult to digest. Eating smaller amounts and choosing carefully which foods you eat should help to reduce any nausea (feeling sick) as well as helping with weight loss.

  • Complications Complications of gastric band surgery

    Complications are when more serious, unexpected problems occur during or after your procedure.

    Being very overweight increases the risk of complications after surgery. Other health conditions linked to your weight, such as high blood pressure or diabetes, can also affect your recovery. If your surgeon comes across an unexpected problem during surgery, they may need to make a larger cut in your tummy. This won't affect how well the operation works but it may mean that you take longer to recover.

    Possible complications of any operation include bleeding or a blood clot, usually in a vein in your leg (deep vein thrombosis – DVT). Other complications that can be associated with gastric band surgery include the following.

    • You may develop an infection around your gastric band, the tube under your skin or in one of your wounds.
    • You could get a chest infection.
    • Your stomach or other organ in your tummy area (abdomen), such as your spleen could be injured during surgery.
    • Your gastric band may slip out of place, leak and deflate, or slowly work its way through your stomach wall. If any of these happen, the band will need to be repositioned, removed or replaced.
    • If you lose weight too quickly, you may develop gallstones. These can be painful and you may need surgery to remove them.

    If you have any fever, tummy pain, chest pain, breathlessness or constant vomiting after surgery, it’s important to contact your doctor or surgeon straight away.

  • FAQ: Gastric band removal Do I need to have a gastric band for life?

    A gastric band is intended to stay in place for a long time. This will help you to lose weight and keep it off. But gastric band surgery is reversible. The band can usually be removed using keyhole surgery and this won’t cause any long-term changes to your stomach. So you can have your gastric band removed at any time, if you want to. 

    If you do have your gastric band removed, you're likely to put back on any weight you’ve lost. This is because your stomach goes back to its original size once the gastric band is removed. So if you don't stick to a sensible eating plan, you’ll put weight on.

    Having a gastric band fitted is big decision, so it’s important that you’re aware of all the pros and cons before going ahead. Likewise, make sure you have all the information you need if you’re thinking of having a gastric band removed. Ask your surgeon for advice.

  • FAQ: Eating after surgery What foods should I eat after my gastric band operation?

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

    More information

    A gastric band makes your stomach smaller so that you can only eat small amounts of food at a time. It also makes you feel less hungry.

    For the first couple of weeks after your operation, you’ll need to purée your food. And eat four to five small meals in a day rather than fewer big meals.

    • Your food should be smooth and quite runny. So prepare it with a blender, masher or food processor. You can add extra liquid, such as gravy, sauces or juice, to make the food smoother and more liquid.
    • At each meal, eat only around five or six tablespoons. 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 unexpected at first – it tends to be more in your chest. It could feel heavy or tight.
    • Drink enough water or fluids every day. Aim to drink 1.5 litres (two and a half pints) in 100 to 200ml glassfuls between meals. 

    After the first couple of weeks, you can gradually start eating lumpier foods but you’ll need to chew them well. After about six weeks, aim to eat three meals a day and try not to snack between them.

    You need to make sure you’re drinking enough fluids. But it's best not to drink anything half an hour before meals or for one hour afterwards. Otherwise, you’ll feel full before you start eating. If you drink during a meal, it can make your stomach empty more quickly. You’ll probably find that fizzy drinks make you feel very uncomfortable so it's best to give these a miss. 

    If you eat too much or too quickly, or don't chew your food enough, it can make you feel sick or vomit. It's important to eat slowly so you know when you're full. Sometimes, food can get stuck in the opening from the pouch into the lower part of your stomach where the band is. Taking small bites of food and chewing it well can help prevent this from happening. If food does get stuck, it can make you feel uncomfortable but usually it will dislodge on its own. If it doesn’t, sipping a hot drink may help.

    There may be certain foods that you find difficult to eat once you have a gastric band – these include fibrous meat and white bread. Ask your surgeon or dietitian for more information about the foods you can eat after gastric band surgery.

  • FAQ: Excess skin removal Can surgery after weight loss remove excess skin?

    Losing a lot of weight may mean that you’re left with folds of excess skin. Once it’s been stretched, skin loses its tightness. Depending on where you lost the weight, you may have folds of excess skin on your tummy, 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. But it's usual to wait at least a year after your gastric band is fitted before you have any cosmetic surgery. This is to make sure that your weight is stable and isn’t likely to change significantly. 

    Removal of excess skin after losing a lot of weight may not be possible on the NHS.

    Cosmetic surgery isn’t suitable for everyone so it's important to discuss your options with a plastic surgeon.

  • FAQ: Pregnancy and gastric bands Can I get pregnant if I have a gastric band?

    Yes, you can get pregnant. But it's best to wait at least a year after you have a gastric band fitted before you do. 

    More information

    Some research has found that weight loss surgery can make it easier for women to conceive if they’re very overweight. If possible, it's best to wait for around 12 to 18 months after your operation before getting pregnant though. This is to make sure that your weight is stable. Your doctor will want to make sure you're eating a well-balanced diet and are feeling physically fit before you get pregnant.

    If you do get pregnant, your doctor will closely monitor your weight gain and check that you're getting the right nutrients. You’ll probably have checks around every three months and may need to see your dietitian more often. You’ll also need to have your band adjusted during your pregnancy, or perhaps deflated altogether. This will make sure you gain the right amount of weight to keep you and your baby healthy. 

    As long as you get all the nutrients you need from your diet, weight loss surgery won't affect the growth or development of your baby. Women who have weight loss surgery often have fewer problems in pregnancy than women who are severely obese and haven't had surgery.

    If you're planning to get pregnant or have found out you’re pregnant, speak to your doctor for advice.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Laparoscopic surgery. OSH Operative Surgery (online). 2nd ed. Oxford Medicine Online. oxfordmedicine.com, published October 2011
    • Upper gastrointestinal surgery. OSH Operative Surgery (online). 2nd ed. Oxford Medicine Online. oxfordmedicine.com, published October 2011
    • Bariatric surgery. The MSD Manuals. www.msdmanuals.com, last full review/revision February 2014
    • Bariatric surgery. PatientPlus. patient.info/patientplus, last checked January 2015
    • Obesity. Oxford handbook of endocrinology and diabetes (online). 3rd ed. Oxford Medicine Online. oxfordmedicine.com, published March 2014
    • Gastric banding. Medscape. emedicine.medscape.com, updated August 2015
    • Bariatric Surgery for Obesity. National Obesity Observatory. August 2010. www.noo.org.uk
    • Obesity. Oxford handbook of nutrition and dietetics (online). 2nd ed. Oxford Medicine Online. oxfordmedicine.com, published January 2012
    • Gastric band. British Obesity Surgery Patients Association. www.bospauk.org, accessed September 2016
    • Obesity: identification, assessment and management. (NICE), November 2014. www.nice.org.uk
    • Joint Briefing: Smoking and Surgery. Action on Smoking and Health, www.ash.org.uk, published April 2016 
    • BOMSS guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery. British Obesity and Metabolic Surgery Society (BOMSS). September 2014. www.bomss.org.uk
    • Having surgery. Royal College of Surgeons. www.rcseng.ac.uk, accessed September 2016
    • Anaesthesia explained. The Royal College of Anaesthetists. 5th ed. November 2015. www.rcoa.ac.uk
    • Nursing patients requiring preoperative care. Oxford handbook of adult nursing (online). Oxford Medicine Online. oxfordmedicine.com, published August 2010
    • Surgery. Oxford handbook of clinical medicine (online). 9th ed. oxfordmedicine.com, published January 2014
    • Laparoscopic gastric banding. Medscape. emedicine.medscape.com, updated April 2015
    • Bariatric surgery: treatment & management. Medscape. emedicine.medscape.com, updated June 2016
    • Gastric band post-op diet. British Obesity Surgery Patients Association. www.bospauk.org, accessed September 2016
    • GP Guidance: Management of nutrition following bariatric surgery. British Obesity & Metabolic Surgery Society. August 2014. www.bomss.org.uk
    • Laparoscopy. Royal College of Obstetricians and Gynaecologists. 2015. www.rcog.org.ukGallstones and cholecystitis. PatientPlus. patient.info/patientplus, last checked October 2013
    • Primary Care Management of Post-operative Patients. British Obesity & Metabolic Surgery Society. 2014. www.bomss.org.uk
    • The role of bariatric surgery in improving reproductive health. Scientific Impact Paper No. 17. October 2015. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk
    • Personal communication, Mr Stephen Pollard, Consultant General Surgeon, 18 October 2016
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