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THE GASTRIC BAND PROCEDURE
| A Laparoscopic Adjustable Gastric Band involves the placement of a band or collar that creates a small pouch at the top of the stomach. This pouch fills with food quickly and the passage of food from the top to the bottom of the stomach is slowed. As the upper part of the stomach believes it is ‘full’, the message to the brain is that the stomach is full and this sensation helps the person to eat smaller portions and lose weight over time. |
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One of the benefits of the Gastric Band is the ability to inflate/adjust it via a small access port placed just under the skin. When fluid is introduced the band expands placing pressure around the outside of the stomach. This decreases the size of the passage in the stomach and restricts the movement of food and varying degrees. This means that it can be tailored to your requirements depending at what point in the weight loss programme you have reached.
The surgical laparoscopic weight management Gastric Band is ideal for patients who have BMI of over 35 or who are 100Kg above ideal weight. Normally you will have been obese for over 5 years and other diets have just let you down. The Laparoscopic Adjustable gastric Band is the most common form of obesity surgery performed in Europe.
The laparoscopic installation of an Adjustable Gastric Banding System is the most common form of bariatric surgery in Europe. It induces weight loss by reducing the capacity of the stomach, thus limiting the quantity of food that can be consumed at once. As there is no stapling, cutting or bypass involved, this procedure is thought to be the least traumatic kind of bariatric surgery.
How it's done
This procedure is performed under a general anaesthetic, and lasts between 20 and 40 minutes. An adjustable silicone band is introduced laparoscopically through the abdomen, using several tiny incisions, and placed around the upper part of the stomach (figure 5). The risk of band slippage is reduced to 1% by taking precautions to fix the device and immobilise the stomach. The resulting pouch greatly reduces the working capacity of the stomach, making the patient feel full early during a meal.
The gastric band, which contains an inflatable balloon on its inner ring, connects to an access-port or reservoir beneath the skin by a thin, kink-resistant silicone tube (figure 6). This port is generally placed in the upper left abdomen, and lets the surgeon adjust the size of the band, so as to control each patient's rate of weight loss. By adding saline through the port, the band's inner balloon is inflated, thereby decreasing the rate of food consumption - this is called a 'fill'. Similarly, the saline can be removed, causing an increase in the rate of food consumption.
Recovery
Hospital time lasts between one and two days. Some discomfort from the operation is common, but lasts only a week or less.
Dietary requirements
As the gastric band procedure is purely restrictive, the patient must not consume high-calorie liquids, which can ruin the process of weight loss. Besides this, the following guidelines are recommended:
- Eat at least three times a day.
- Eat only solid foods, as the band does not restrict liquids.
- Chew thoroughly, as this makes the food less likely to damage the band, and causes an earlier feeling of fullness.
- Do not drink liquids with your meals, as this can cause the food to be washed too quickly through the band.
A dietary consultant will provide personalised advice after the procedure.
Complications
Operative complications are very rare, as the stomach is not cut or stapled, but only mobilised. However, the following symptoms can occur after the operation.
Vomiting
Vomiting, while painful, can be productive; possible causes are eating too fast, eating too much and chewing too little. When vomiting is frequent the patient must adjust his or her eating behavior, or, if necessary, the band can be deflated a little.
Acid Reflux
Heartburn, the regurgitation of acid from the stomach into the oesophagus, is the most common symptom. It occurs when the band is too tight, or with the swelling of the stomach lining. Medical treatment or deflation of the band may be necessary if symptoms persist.
Slippage
This complication, which occurs less than 1 percent of the time, is when the upper stomach pulls the lower stomach through the band, thus pushing the band down on the stomach. This causes varying degrees of intolerance to solids or liquids, or even total obstruction. All slips require surgical repositioning, and sometimes the removal of the band as well.
Erosions
Although very rare, erosion does occur occasionally. The gastric band is subject to natural reactions, and can be dissolved. Every erosion requires surgical removal.
Port Problems
Rare complications include infection, seroma or hematoma. Breakage of the port can also occur, though the band itself is guaranteed not to break. Port leaks are rare and are usually related to the disconnection of the device or a sticking needle. A port replacement can be done under local anesthaetic as an ambulatory procedure.
THE GASTRIC BALLOON PROCEDURE
The Intra gastric balloon is in most situations to help and to motivate weight loss at a more professional way. This procedure is simple, NON-invasive and temporarily for 6 months.
The intra gastric balloon is also a good option if the patient is unsure about surgery. It is medically proven that a good result with the balloon indicates a good result with the gastric band. If, on the other hand, the balloon does not work, then the band may be similarly ineffective, and the gastric bypass procedure is recommended instead. |
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The gastric balloon is placed in the stomach to create an early feeling of fullness during a small meal, causing a marked reduction in energy intake and weight reduction (above). The best candidates are obese patients who do not fulfill the criteria for bariatric surgery, or super-obese patients who must lose weight prior to bariatric surgery, in order to prevent complications after the operation.
How it's done
The balloon is guided endoscopically by a surgeon or a gastroenterologist, a procedure much like a classic endoscopic examination of the stomach (gastroscopy). For BOSC patients: it is performed with anaesthesia. The process lasts approximately 20 minutes. Because of the sleeping drug during the procedure the patient wakes up relaxing and has less vomiting problems afterwards.
The balloon is filled, via an external catheter, with air or a saline solution, depending on the type of balloon used. When filled, the balloon expands and floats freely within the stomach; it remains in place for a maximum of 6 months before removal, again by endoscopy.
Weight loss
In many studies, the mean percentage of excess weight loss was found to be 36 - 60 percent. This is depending of BMI and after care. The weight loss was accompanied by improvements in obesity-related conditions, such as type-2 diabetes and hypertension.
Because the balloon must be removed after 6 months, long-term maintenance of weight loss is limited. For good long-term results, it is necessary to combine the balloon system with a system of behaviour for weight loss. The balloon's value is to chiefly therapeutic, to induce behavioral changes after the procedure that can be maintained over a long period of time.
In the case of super-obese patients, bariatric surgery is recommended after the removal of the balloon.
THE GASTRIC BY-PASS PROCEDURE
How it's done
There are two main steps in Roux en Y Gastric Bypass surgery. First, we cut a small pouch from the top of the stomach, from which the rest of the stomach is separated (figure 1). This greatly reduces the size of the stomach, causing the patient to feel full early during a meal. Second, we connect this pouch to the small intestine (jejunum), bypassing the main stomach and much of the intestine (figure 2). This allows fewer calories to be absorbed from food by the intestinal lining (figures 3 and 4).
Technology
The gastric bypass procedure can be done either by open surgery, with an incision in the upper abdomen, or by laparoscopic (keyhole) surgery. The latter involves a small video camera and tiny instruments inserted into small holes in the abdomen: it results in less pain, fewer scars and most often a faster recovery.
Recovery
Hospital time varies from three days after laparoscopic surgery to four days after open surgery. The patient will feel discomfort for several days after the operation, and will be unable to digest solid foods as the body adjusts to the surgery. In order to prevent blood-clots, it is essential that the patient wear anti-thrombotic stockings and take injections of light molecular heparins (blood thinner) for ten days after the operation.
Dietary requirements
After surgery, the patient will be able to consume only small quantities of food; some patients will experience further restrictions on specific food-types. A dietician will be available to offer personalised advice.
Results and success rates
The Roux en Y Gastric Bypass method is unique in that it diminishes both the intake of food and the absorption of energy from that food. This malabsorption, however, is considerably less severe than the results of specific malabsorptive procedures, such as biliopancreatic diversion, and it does not cause diarrhoea, bad odours or serious deficiencies in vitamins or other minerals.
Most patients can achieve a 60-90 percent loss of their excess body weight, and maintain long-term weight loss with great success. Even more important is the improvement of general health: serious disorders such as diabetes, high blood-pressure and cholesterol levels, degenerative arthritis and sleep apnoea may improve or even vanish after surgery.
Risks
There are risks associated with all bariatric surgeries; these include peritonitis - a leak from the stomach or lower intestine into the abdominal cavity - and internal bleeding, which sometimes necessitates relaparoscopy. Infections and hernias are also possible, but much rarer.
After surgery there is the possibility of other symptoms, such as iron and vitamin B12 deficiencies, stomach ulcers and 'dumping'. Dumping occurs when food moves too quickly through the stomach or small intestine, causing nausea, sweating and faintness. To avoid these symptoms, an appropriate low-calorie diet is prescribed. |
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