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Gastric band operation

A gastric band operation is surgery to help you lose weight. It involves reducing the amount your stomach can hold by putting an adjustable band around it. You will meet the surgeon carrying out your procedure to discuss your care. Everyone is different so it may not be exactly as described here because it will be adapted to meet your individual needs.

A gastric band is designed to help you to lose weight. It may be an option for you if you're very overweight or if your weight is affecting your health. Doctors call this being morbidly obese. A gastric band 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. And eating less means you should lose weight. However, to get good results it’s important to make sure that you’re eating healthily, and exercising regularly. 

A gastric band is a tube-like balloon that goes around the upper part of your stomach. Your surgeon can inflate and adjust it by injecting liquid into a tube that's 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 slows down the movement of food into the lower part of your stomach. Food then travels normally through the rest of your digestive system.

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

Although you can have a gastric band taken out if you need to, it’s designed to stay inside your body long term. Removing the band may cause you to put weight back on.

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Gastric band surgery
How the operation is carried out
An image showing the position of a gastric band and access port

Details

  • Making a decision Deciding on a gastric band operation

    Your doctor will only suggest surgery if you have tried to lose weight in other ways and these haven't worked. These could include taking weight-loss medicines, eating healthily and exercising. You will usually only be able to have surgery if you meet the criteria below.

    • You're morbidly obese with a body mass index (BMI) of more than 40. Or, you have a BMI over 35 and also have a health condition that would be likely to improve if you lose weight. This could be diabetes or high blood pressure, for example.
    • You’re generally fit enough to undergo surgery.
    • You’re committed to losing weight and keeping the weight off by combining the surgery with changes to your lifestyle. You must also be prepared to attend regular follow-ups.

    If your GP thinks weight loss (bariatric) surgery could be beneficial to you, he or she will refer you. The referral process may vary in different parts of the country. In some areas you will be referred to a dietitian or a specialist doctor for a period of time before you're referred to a surgeon. It may be that this is a necessary step if your surgery is being funded by the NHS.

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  • Preparation Preparing for a gastric band operation

    Your surgeon will explain how to prepare for your operation. If you smoke, try to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery. Your surgeon will discuss with you what will happen before, during and after your operation, and any pain you might have. If you have any questions at this stage, ask your surgeon – no question is too small and answers can help set your mind at ease. To confirm your consent for the procedure, you may be asked to sign a consent form.

    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 will have the gastric band operation under general anaesthesia. This means you will be asleep during the operation. You will usually have to stay overnight in hospital after your operation but you may be able to go home the same day. Ask your surgeon how long you’re likely to need to stay in hospital.

    An anaesthetic can make you feel sick so it's important that you don't eat or drink anything for six hours before your gastric band operation. Follow your anaesthetist or surgeon's advice. If you have any questions, just ask.

    At the hospital your nurse will do some tests, such as check your heart rate, temperature and blood pressure, and test your urine.

    You will be asked to wear compression stockings to keep your blood flowing and help prevent blood clots forming in the veins in your legs. You will need to have an injection of an anticlotting medicine called heparin too.

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

    There are other operations that can help you to lose excess weight. These are the sleeve gastrectomy and the gastric bypass.

    Your surgeon will explain what options are available. He or she will help you to weigh up the risks and benefits of each, to decide which, if any, 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.

    Your surgeon will fit a gastric band using keyhole surgery. This involves making a number of small incisions in your tummy (abdomen), rather than one large cut.

    Your surgeon will make four to five small cuts in your upper abdomen to get to your stomach. He or she will insert a laparoscope (a long, thin telescope with a light and camera lens at the tip) to see inside. Your surgeon will place the band around the top part of your stomach. A piece of fine latex tubing connects the band to the injection port. This is placed just under your skin and is where fluid can be added or removed to adjust the size of the opening to your stomach.

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

  • Aftercare What to expect afterwards

    You will need to rest until the effects of the anaesthetic have passed. You might have some discomfort as the anaesthetic wears off. But you'll be offered pain relief as you need it.

    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 sip some water soon after your operation. You will 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 blood clots developing in your legs.

    You will 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.

    Your surgeon (or a dietitian) will advise you about what you can eat after you have a gastric band operation.

    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.

    The gastric band contains a circular balloon that your surgeon will inflate with sterile fluid, usually about four to six weeks after your operation. Your surgeon or doctor can add or remove fluid from the band through a tube placed under your skin (the injection port) to adjust the size of the opening from your stomach. This determines how quickly the pouch empties.

    You will probably need to have the fluid in your band adjusted two or three times in the first few months after your operation. These adjustments ensure you steadily lose the right amount of weight, while being able to eat a reasonable amount of solid food without being sick.

    The length of time it will take for the dissolvable stitches in your wounds 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, you will need to have them taken out. Your surgeon or nurse will tell you when and where to have them removed.

  • Recovery Recovering from a gastric band operation

    It usually takes about a week or two to make a full recovery from a gastric band operation and get back to your normal activities. However, this can vary from person to person, so it's important to follow your surgeon's advice.

    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.

    Having a general anaesthetic can really take it out of you. You might 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. If you're in any doubt about driving, contact your motor insurer to see what their recommendations are, and always follow your surgeon's advice.

    You may need to make considerable changes to the food you eat after your operation. You will only be able to eat small meals. To start with, stick to liquids and then move onto puréed food. While you're first losing weight, you may need to take a vitamin supplement. However, your body still absorbs food normally after a gastric band operation. This means that if you're following a healthy diet, you shouldn’t need to take vitamin supplements long term. Your surgeon or dietitian will give you all the information you need about what foods to eat and how much.

    It may be that you need to make other changes to your lifestyle too. This might mean cutting down how much alcohol you drink and becoming more active. This will help you to get the most from your gastric band operation and lose excess weight – and keep it off.

    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.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with a gastric band operation. We haven't included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon 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 operation. You're likely to 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 dry or stodgy foods. Eating smaller amounts and choosing foods that are easy to digest will help to reduce this too.

    Complications

    Complications are problems that occur during or after the operation and being very overweight increases the risk of them following any operation. You're more likely to have complications from the general anaesthetic and are at a greater risk of developing blood clots. Other health conditions linked to your weight, such as high blood pressure or diabetes, can also increase your risk of surgery being problematic.

    Possible complications of a gastric band operation are listed below.

    • An infection around your gastric band, the tube under your skin, or in one of your wounds.
    • A chest infection.
    • An injury to your stomach or other organs in your tummy area (abdomen), such as your spleen, during the operation.
    • 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.
    • 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 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.

    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. However, if you make the necessary changes to your lifestyle, such as exercising and eating healthily, you should lose weight.

  • FAQs FAQs

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

    Answer

    You can have a gastric band removed at any time. However, if you do, you're likely to put back on any weight you’ve lost.

    Explanation

    A gastric band operation is reversible. However, when you have a gastric band put in, you should expect it to stay in place long term. This will help you to lose weight and keep it off.

    If your gastric band is taken out, you lose the physical restriction on the amount you can eat. So if you don't stick to a sensible eating plan, you will put weight on.

    If need be, a gastric band can usually be removed using keyhole (laparoscopic) surgery.

    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 it removed. Talk to your surgeon for full advice.

    What foods should I eat after my gastric band operation?

    Answer

    In the first couple of weeks after your operation stick 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

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

    For the first couple of weeks after your operation, you will need to purée your food. And eat four to five small meals in a day rather than fewer big meals. We’ve put together some more detailed advice to help you.

    • Your food should be smooth and quite runny. Use a blender, masher or food processor to make it. You can add extra liquid, such as gravy, sauces or juice to make food smoother and more liquid.
    • Each meal should be around five or six tablespoons in quantity. 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 foods that are lumpier but be sure to chew them well. After about six weeks, aim to eat three meals a day and try not to snack in between meals.

    Although you need to make sure you’re drinking enough, 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. And 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 that you know when you're full. Sometimes food can get stuck in the opening from 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.

    Ask your surgeon or dietitian for more information about the foods you can eat after you have a gastric band operation.

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

    Answer

    Losing a lot of weight may mean that you’re left with folds of excess skin. 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. Studies show that people usually lose between half and two thirds of excess weight in the first two years after a gastric band operation. Losing this amount of weight can leave you with loose skin because once it has 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.

    It's usual to wait at least a year 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 so it's important to discuss your options with a plastic surgeon.

    Can I get pregnant if I have a gastric band?

    Answer

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

    Explanation

    Provided you get all the nutrients you need from your diet, weight loss surgery won't affect the growth or development of your baby. Some studies have found women who have weight loss surgery have fewer problems in pregnancy than women who are severely obese and haven't had surgery. For example, they were less likely to get pre-eclampsia and gestational diabetes, and had fewer stillbirths and miscarriages. Your baby is also less likely to be under- or overweight when he or she is born.

    If possible, it's best to wait for around 12 to 18 months after your operation before getting pregnant. This is to make sure that your weight is stable. Your doctor will want to ensure you're eating a well-balanced diet and are feeling physically fit before you get pregnant.

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

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

  • Resources Resources

    Further information

    Sources

    • Gastric banding. Medscape. www.emedicine.medscape.com, published 22 October 2013
    • Obesity in adults. PatientPlus. www.patient.co.uk/patientplus.asp, published 1 March 2013
    • Bariatric surgery. Medscape. www.emedicine.medscape.com, published 10 September 2012
    • Bariatric surgery. PatientPlus. www.patient.co.uk/patientplus.asp, published 1 March 2013
    • Bariatric surgery FAQs. American Society for Metabolic and Bariatric Surgery. www.asmbs.org, accessed 13 October 2014
    • Bariatric surgery procedures. American Society for Metabolic and Bariatric Surgery. www.asmbs.org, accessed 13 October 2014
    • Gastric banding. US Food and Drug Administration. www.fda.gov, published 8 July 2014
    • Report of the working group into: joined up clinical pathways for obesity. NHS England. www.england.nhs.uk, published 14 March 2014
    • Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. National Institute for Health and Care Excellence (NICE), December 2006. www.nice.org.uk
    • Clinical commissioning policy: complex and specialised obesity surgery. NHS Commissioning Board. www.england.nhs.uk, published April 2013
    • Laparoscopic lap band placement. Medscape. www.emedicine.medscape.com, published 9 May 2013
    • Pre op diet. British Obesity Surgery Patients Association. www.bospauk.org, accessed 13 October 2014
    • BOMSS guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery. British Obesity and Metabolic Surgery Society. www.bomss.org.uk, published September 2014
    • Gastric band. British Obesity Surgery Patients Association. www.bospauk.org, accessed 13 October 2014
    • GP guidance: management of nutrition following bariatric surgery. British Obesity and Metabolic Surgery Society. www.bomss.org.uk, published August 2014
    • Eid I, Birch DW, Sharma AM, et al. Complications associated with adjustable gastric banding for morbid obesity: a surgeon’s guide. Can J Surg 2011; 54(1):61–6. doi:10.1503/cjs.015709
    • Bariatric surgery (obesity surgery). Evidence-Based Medicine Guidelines. www.ebm-guidelines.com, published 10 March 2014
    • Hawkins W, Somers S. The management of bariatric surgery complications. Surgery 2013; 31(11):569–73. doi:http://dx.doi.org/10.1016/j.mpsur.2013.08.013
    • Post op diet for the gastric band. British Obesity and Metabolic Surgery Society. www.bospauk.org, accessed 14 October 2014
    • Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient – 2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic and Bariatric Surgery. Endocr Pract 2013; 19(2):e1–e36. doi:10.4158/EP12437.GL
    • Lap-band FAQs: questions most commonly asked by patients. Obesity Action Coalition. www.obesityaction.org, accessed 14 October 2014
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