Gastric Banding

How Gastric Banding works

Adjustable gastric banding.

Gastric banding involves placement of a low-pressure soft band around the uppermost part of the stomach. The gastric band forms the stomach into two sections, with a small opening between the sections allowing food to pass through. As this section of the stomach fills and stretches, nerves in the stomach wall send signals to the satiety centre of the brain causing you to feel satisfied for up to several hours.

The gastric banding will assist you to avoid over-eating and to decrease your overall daily food (calorie) intake. As your eating patterns change and you become accustomed to eating less, you can achieve sustainable weight loss, which in turn can lead to a healthier lifestyle with reduced risk of obesity-related health problems.

Although the gastric banding is a tool for helping you to induce sustainable weight loss it is not a self-acting slimming device. Your post-operative dietary and behavioural compliance, including exercise, is essential for successful weight loss as well as avoiding complications.

The advantages of Gastric Banding

Gastric banding has a number of advantages over other weight loss procedures:

• Gastric Banding restricts the amount of food that can be consumed at a meal
• Food consumed passes through the digestive tract in the usual order allowing it to be fully absorbed into the body
• Gastric Banding can be placed using keyhole (laparoscopic) surgery
• Gastric Banding can be adjusted to increase or decrease restriction
• Gastric Banding surgery can be reversed

The Gastric Banding operation

The gastric banding procedure is normally performed by using keyhole (laparoscopic) surgery, which is a minimally invasive surgical technique where instruments allow access to the stomach through small 1-2 cm holes in the abdomen compared to a single large incision 15 cm or more in length. The surgeon views the inside of the abdomen on a TV while performing the operation. The potential advantages of laparoscopic surgery are that it may result in a quicker recovery and less pain than traditional open surgery.

Adjusting the gastric band

During the operation a titanium fluid port will be attached to firm tissue structures of the abdominal wall and will sit permanently under the skin. The port is attached to the gastric band via a thin catheter and allows your doctor to add or subtract fluid from the band according to your individual requirements.

Risks of gastric banding

There are a number of risk factors that you need to be cautious of with this gastric banding procedure:

Infection and gastric band migration

An infection may develop either in the port area or in the abdomen, and in some instances this may cause the band to migrate into the stomach. In such a case, reoperation normally is necessary.

Leakage of the Gastric Band

Leakage from the gastric banding or from the connecting tube between the balloon and the port may require reoperation. The balloon is made of fragile material, and leakage can occur either shortly after surgery or many years later. In the event of leakage, the gastric band can normally be easily replaced with a new one. Nowadays this is a rare complication, but you must be aware that there is a possible risk that in the long term the gastric band may need to be replaced with a new one.

Slippage of the gastric band and pouch dilatation

The gastric band may slip, and the pouch (the part of the stomach above the gastric band) may become too enlarged, and a reoperation may be necessary.

Punctures in the silicone band and port dislocation

The injection port may dislocate. When injecting into the port, there is always the risk of puncturing the silicone tube. However, should either of the above occur, they both can easily be corrected with a small operation under local anaesthesia.

General Advice and Possible Minor Side-effects with gastric banding

Vomiting

Patients may vomit or feel pain after food intake. This can be caused either by a poor eating behaviour, or by the narrowing of the band following the injection of fluid into the balloon. By eating slowly and calmly, you will learn to listen to the signals from your stomach. Regular vomiting is definitely a warning sign. In such cases, the amount of liquid in your band may need to be readjusted.

Vitamins

During the phase of rapid weight reduction, vitamin supplements are advisable. A liquid vitamin mixture containing multivitamins, in particular vitamin B complex, is recommended for at least the first six months following gastric banding surgery.

Pregnancy

The period between surgery and weight stabilisation is considered to be a period of starvation. It is not advisable to become pregnant during starvation, despite the fact that the foetus has priority over the mother with regard to food. Should you nevertheless get pregnant, it is advisable to remove all the fluid from the balloon. You should wait until your weight has stabilised before becoming pregnant.

Medication

Tablets must be broken down into small pieces or crushed before they are taken. Patients should consult their doctor about this matter.

Constipation

Many patients feel constipated after gastric banding surgery. This is mainly because the reduced food intake leads to less faeces and thus fewer bowel movements. If laxatives become necessary, it is advisable to abstain from so-called bulking agents and instead use liquid laxatives, such as lactulose.

Doctor appointments

After surgery you must undergo regular check-ups as an outpatient. Generally, these check-ups will be carried out monthly, but soon visits should become less frequent. The gastric band will gradually be filled via the injection port during the first 18 months following surgery. During this period, your weight loss and level of well-being will be monitored. Once your weight has stabilised, check-ups will be necessary only when problems occur or on an annual basis.

Physical activity

It will be important to alter not only your eating habits, but also your level of physical activity. Patients are generally recommended to start exercising slowly. As weight loss is achieved, physical activities will gradually become easier.

Post-operation diet advice

The changes to your digestive system mean that you will need to follow a specific diet. A dietician will see you before you are discharged from hospital to assist you with the changes needed for your new lifestyle.

• Eat small, frequent meals at least six times per day.
• Everyone tolerates foods differently. Avoid those foods known to cause you problems.

Dumping syndrome
When food or fluids move too quickly through your digestive system, it’s called 'dumping syndrome'. Symptoms of dumping syndrome are:

• Nausea
• Dizziness or light-headedness
• Weakness and fatigue
• Rapid pulse
• Abdominal cramping
• Diarrhea

Tips to help avoid dumping syndrome

• Don’t drink liquids with your meals. Wait a half to one full hour after eating food to drink something.
• Limit sweets. Use sugar-free foods and drinks in place of regular sweet foods or drinks.
• Lactose (milk sugar) may also cause diarrhea and cramping. Drink lactose-free or lactose reduced milk.
• Avoid carbonated drinks and alcohol.
• Eat slowly and chew your food carefully.

Special note:
A multi vitamin should be introduced to your diet before your operation, and you will need to continue this after your operation. To ensure you are meeting all your vitamin dietary requirements (B12 etc), you should also have blood tests taken six monthly.

More information

All of the information you need to know, pre and post-operatively, will be made available to you in separate information packs given to you before and after your surgery. Our practice nurse, Kylie, will also be able to assist you with any questions that you might have at any time about gastric banding.

Additionally you can find further information on the Weight Loss Surgery Australia website.