Gastric band operation

Published by Bupa's Health Information Team, November 2010.

This factsheet is for people who are having a gastric band operation, or who would like information about it.

A gastric band operation is a type of weight loss surgery. The capacity of the stomach is reduced using an adjustable band so that only small meals can be eaten.

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.

How gastric banding surgery is carried out

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About a gastric band operation

A gastric band operation can help you to lose excess weight if you're very overweight (morbidly obese). It works by reducing the capacity of your stomach, which means that you eat less because you feel full much sooner.

The adjustable band is a circular balloon, similar to a tiny inner tube, which is placed around the upper part of your stomach. The band is then inflated through a port which is placed just under the skin. This creates a pouch of stomach above the band. When you eat, the pouch fills up quickly and the food then passes slowly through the narrow opening created by the band, into the lower part of your stomach. The food then travels normally through the rest of your digestive system.

Your doctor will usually only suggest you may be suitable for a gastric band operation if you have tried other methods of weight loss, such as diet, exercise and medicines, and these haven't worked. This type of operation will also only be offered to you if:

• you're very overweight with a body mass index (BMI) of more than 40, or
  
• you have a BMI of between 35 and 40 and also have a medical condition, such as diabetes or high blood pressure, that might improve if you lose weight

A gastric band can be removed if needed. However, removing the band may cause you to gain weight .

What are the alternatives?

There are other types of surgery available that can help you to lose excess weight.

Another type of surgery is a gastric bypass operation. This is where your stomach is made smaller and the digestive system shorter.

Your surgeon will tell you about the options available to you.

Preparing for a gastric band operation

When you meet your surgeon, this is your opportunity to understand what will happen, and gives you the opportunity to discuss and ask questions about the risks, benefits and your alternatives. Your surgeon will tell you about the options available to you and the pros and cons of each.

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 excess weight also increases your risk of a complication. You may be given a preoperative diet to follow which is aimed at shrinking your liver. This gives your surgeon easier access to your stomach. You may be given printed advice in the form of a booklet.

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

You will be asked to follow fasting instructions before your surgery. 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 may check your heart rate and blood pressure, and test your urine.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. 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.

You may be asked to wear compression stockings and be given an injection of an anti-clotting medicine called heparin to help prevent blood clots forming in the veins in your legs.

What happens during a gastric band operation

A gastric band operation usually takes about an hour.

A gastric band is usually fitted using keyhole (laparoscopic) surgery. During keyhole surgery a number of small incisions are made in your abdomen (tummy), rather than one large cut.

Your surgeon will make a four to five small cuts on your upper abdomen. 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 to the injection port, which is placed just under the skin.

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

The gastric band contains a circular balloon which can be filled with saline. 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.

The gastric band is inserted empty and is adjusted by your surgeon a few weeks after your operation, once any swelling of the stomach caused by the surgery has gone down. Some surgeons do this in the X-ray department. You're likely to have 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.

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 inserted 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. This helps prevent blood clots in your legs or a chest infection. 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. You will be given 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 ten 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.

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 48 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 need 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 you need to stick to liquids, and then move onto pureed food. You may also be asked to take vitamin supplements.

You may also need to make other changes to your lifestyle, such as 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. Regular exercise will also help to reduce the problem of loose skin. Your dietician and surgeon will give you more advice about the foods you can eat and what other changes you need to make.

You may need to 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.

What are the risks?

A gastric band operation is generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

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 the healing wounds.

Once your gastric band is fitted, you may feel or be sick after eating, especially if you try to eat too much. 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. Most people aren't affected. 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 (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 the gastric band, or in your wounds. You may also develop a chest infection.
  
• Injury to your stomach or other organs in your abdomen during the operation. This may mean your surgeon has to swap 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 the 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. Your surgeon may suggest removing your gallbladder when you have your gastric band operation, or prescribe a medication called ursodeoxycholic acid to reduce your risk. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

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.

The exact risks are specific to you and will differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.