Laparoscopic Gastric Banding – Indications, Procedure, Risk

Laparoscopic gastric banding is surgery to help with weight loss. The surgeon places a band around the upper part of your stomach to create a small pouch to hold food. The band limits the amount of food you can eat by making you feel full after eating small amounts of food.

After surgery, your doctor can adjust the band to make food pass more slowly or quickly through your stomach.

Gastric bypass surgery is a related topic.

Description

You will receive general anesthesia before this surgery. You will be asleep and unable to feel pain?.

The surgery is done using a tiny camera that is placed in your belly?. This type of surgery is called laparoscopy. The camera is called a laparoscope. It allows your surgeon to see inside your belly. In this surgery:

• Your surgeon will make 1 to 5 small surgical cuts in your abdomen?. Through these small cuts, the surgeon will place a camera and the instruments needed to perform the surgery.
• Your surgeon will place a band around the upper part of your stomach to separate it from the lower part. This creates a small pouch that has a narrow opening that goes into the larger, lower part of your stomach.
• The surgery does not involve any cutting or stapling inside your belly.
• Your surgery may take only 30 to 60 minutes if your surgeon has done a lot of these procedures.

When you eat after having this surgery, the small pouch will fill up quickly. You will feel full after eating just a small amount of food. The food in the small upper pouch will slowly empty into the main part of your stomach.

Why the Procedure Is Performed

Weight-loss surgery may be an option if you are severely obese and have not been able to lose weight through diet and exercise.

Laparoscopic gastric banding is not a “quick fix” for obesity. It will greatly change your lifestyle. You must diet and exercise after this surgery. If you DO NOT, you may have complications or poor weight loss.

People who have this surgery should be mentally stable and not be dependent on alcohol or illegal drugs.

Doctors often use the following body mass index (BMI) measures to identify people who may be most likely to benefit from weight-loss surgery. A normal BMI is between 18.5 and 25. This procedure may be recommended for you if you have:

• A BMI of 40 or more. This most often means that men are 100 pounds (45 kg) overweight and women are 80 pounds (36 kg) over their ideal weight.
• A BMI of 35 or more and a serious medical condition that might improve with weight loss. Some of these conditions are sleep apnea?, type 2 diabetes?, high blood pressure, and heart disease.

Risks

Risks for anesthesia and any surgery includes:

• Allergic reactions to medicines
• Breathing problems
• Blood clots in the legs that may travel to your lungs
• Blood loss
• Infection?, including in the surgery site, lungs ( pneumonia? ), or bladder? or kidney?
• Heart attack? or stroke? during or after surgery

Risks for gastric banding are:

• Gastric band erodes through the stomach (if this happens, it must be removed).
• Stomach may slip up through the band. (If this happens, you may need urgent surgery.)
• Gastritis? (inflamed stomach lining), heartburn? , or stomach ulcers .
• Infection in the port, which may need antibiotics or surgery.
• Injury to your stomach, intestines, or other organs during surgery.
• Poor nutrition.
• Scarring inside your belly, which could lead to a blockage in your bowel.
• Your surgeon may not be able to reach the access port to tighten or loosen the band (you would need minor surgery to fix this problem).
• The access port may flip upside down, making it impossible to access. (You would need minor surgery to fix this problem.)
• The tubing near the access port can be accidentally punctured during a needle access. If this happens the band cannot be tightened (you would need minor surgery to fix this problem.)
• Vomiting? from eating more than your stomach pouch can hold.

Before the Procedure

Your surgeon will ask you to have tests and visits with your other health care providers before you have this surgery. Some of these are:

• Blood tests and other tests to make sure you are healthy enough to have surgery
• Classes to help you learn what happens during the surgery, what you should expect afterward, and what risks or problems may occur
• Complete physical exam
• Nutritional counseling
• Visit with a mental health provider to make sure you are emotionally ready for major surgery. You must be able to make major changes in your lifestyle after surgery.
• Visits with your provider to make sure other medical problems you may have, such as diabetes?, high blood pressure, and heart or lung problems, are under control

If you are a smoker, you should stop smoking several weeks before surgery and not start smoking again after surgery. Smoking slows recovery and increases the risk of problems. Tell your provider if you need help quitting.

Always tell your provider:

• If you are or might be pregnant
• What drugs, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription?

During the week before your surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask which drugs to take on the day of your surgery.

On the day of your surgery:

• DO NOT eat or drink anything for 6 hours before your surgery.
• Take the drugs your provider told you to take with a small sip of water.

Your provider will tell you when to arrive at the hospital.

After the Procedure

You will probably go home the day of surgery. Many people are able to begin their normal activities 1 or 2 days after going home. Most people take 1 week off from work.

You will stay on liquids or mashed-up foods for 2 or 3 weeks after surgery. You will slowly add soft foods, then regular foods, to your diet. By 6 weeks after surgery, you will probably be able to eat regular foods.

The band is made of special rubber (Silastic rubber). The inside of the band has an inflatable balloon. This allows the band to be adjusted. You and your doctor can decide to loosen or tighten it in the future so you can eat more or less food.

The band is connected to an access port that is under the skin on your belly. The band can be tightened by placing a needle into the port and filling the balloon (band) with water.

Your surgeon can make the band tighter or looser any time after you have this surgery. It may be tightened or loosened if you are:

• Having problems eating
• Not losing enough weight
• Vomiting after you eat

Outlook (Prognosis?)

The final weight loss with gastric banding is not as large as with other weight loss surgery . The average weight loss is about one-third to one-half of the extra weight you are carrying. This may be enough for many people. Talk with your provider about which procedure is best for you.

In most cases, the weight will come off more slowly than with other weight loss surgery. You should keep losing weight for up to 3 years.

Losing enough weight after surgery can improve many medical conditions you might also have, such as:

• Asthma?
• Gastroesophageal reflux disease? ( GERD? )
• High blood pressure
• High cholesterol?
• Sleep apnea
• Type 2 diabetes

Weighing less should also make it much easier for you to move around and do your everyday activities.

This surgery alone is not a solution to losing weight. It can train you to eat less, but you still have to do much of the work. To lose weight and avoid complications from the procedure, you will need to follow the exercise and eating guidelines that your provider and dietitian gave you.