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The adjustable gastric band is made of soft silicone and is equipped with a firmly attached inflatable balloon. This balloon is connected by a tube to an access port. The band is positioned around the upper part of the stomach (almost always by "keyhole" or laparoscopic surgery) so as to create a small pouch. This small pouch lies above the band and has a capacity of 15 to 20 ml. The remaining stomach lies below the band.
Gastric banding induces weight loss through 2 mechanisms:
1. By restricting the amount of food that the stomach can hold at any time by inducing an early feeling of satiety.
2. By slowing down the emptying of the pouch, thereby decreasing food intake.
The size of the pouch outlet is adjusted by regulating the volume of fluid in the balloon through the access port. The access port is situated under the skin usually in the upper abdomen and is easily accessible by your doctor with a non-coring needle.
Since the insertion of the adjustable gastric band does not involve any stapling, resection or shortening of any part of the stomach or intestines, the function of the digestive tract remains intact. All ingested foods will still be absorbed by the body the same way that it was before the operation. It is still very important to avoid foods of high caloric content such as ice cream, custards and chocolates.
Lap band surgery is almost always done through the laparoscopic approach. Five small incisions are made in the abdomen to introduce a camera and instruments and the adjustable gastric band is positioned at the upper end of the stomach.
Once the band is placed in position, the connecting tube and access port are inserted and secured to the upper abdominal wall. All incisions are closed with absorbable sututres which do not need to be removed.
The weight will be lost gradually and should commence immediately after surgery. The amount of weight loss will depend partly on the amount of fluid injected into the balloon to provide a feeling of satiety. The amount of weight loss in the long term will depend on the patient ie on how carefully the patient follows the recommendations regarding eating habits, diet and exercise. The rate of weight loss we like to see is 0.5 to 1.0 kg per week. On average it is expected that 50 to 60% of excess weight will be lost in the long term.
This also means a long term commitment to follow up by your bariatric clinic as data clearly shows the importance of follow up for successful weight loss.
At our clinic there is a team dedicated to your goal of weight reduction and to the management of any complications that may arise from the gastric band.
Weight related comorbidities such as diabetes, obstructive sleep apnoea and hypertension resolve along with successful weight loss.
Whilst the laparoscopic or keyhole approach has helped decrease the length of hospital stay by decreasing the postoperative recovery period, the insertion of the gastric band is not without complications because of the weight of the patient and his/her premorbid condition.
As with any surgical procedure, lap band surgery,comes with a few associated risks. Whilst your surgeon will endeavor to minimize risks, complications may occur which may have permanent effects.
Following lap band surgery, some patients have trouble adjusting to their new eating habits, they repeatedly eat too quickly or too much and then regurgitate.
An infection may develop in the port area in the abdomen and in some instances the infection may involve the band. In such a case, re-operation may be necessary. It is very important that you do not let anyone apart from your surgeon or a bariatric practitioner inject or remove fluid from your port as infection can occur if the proper aseptic technique is not complied.
This is uncommon (approximately 1-2%) and may need treatment via drainage of the infection, antibiotics or removal of the band, catheter and port.
Leakage from the gastric band or from the connecting tube between the balloon and the port may occur. The gastric balloon is made of fragile material and, if too much fluid is injected, leakage will occur. Leakage from the connecting tube can occur if the injecting needle is inserted incorrectly. Leakage from the port can occur if the incorrect needle is used for injecting or removing fluid from the port. Hence it is important that only an experienced person such as your surgeon or bariatric practitioner be allowed to manipulate the amount of fluid in your band. In the event of leakage, the gastric band can normally be replaced with a new one, but this will require re-operation.
This is a major long-term concern that occurs in approximately 3% of people. Following gastric banding, the band may slip and the pouch (the part of the stomach above the band) may become too large. This problem can arise months or years after the procedure. This is a rare complication as, at operation, the band is placed in a special tunnel and special measures to fix the band securely are performed. However, it can occur if the rules of eating and ignoring the signs of fullness are not adhered to. If this occurs, a re-operation may be necessary.
This is a rare (approximately 2%) but major complication which may occur some months or years after the gastric banding operation. The band may erode from the outside of the stomach into the stomach. It is more common in patients in whom the band is over inflated but may also occur in bands that have an acceptable volume of fluid. It again emphasises the need for appropriate follow up by the team in our clinic. If this complication were to occur the band needs to be removed by either endoscopy (through the mouth) or reoperation.
This symptom of "sub sternal burning" plus regurgitation arises when the opening or outlet from the small pouch is too tight causing food or liquid ingested to spill up or back into the oesophagus. This can be prevented by not eating or drinking for 2 to 3 hours before lying down or going to bed. The reflux symptoms can also be alleviated by having some fluid removed from the gastric band.
The tooth surface is composed of mineral (calcium) which is susceptible to acid attack. If the resting environment around the tooth changes such as constant sugar ingestion, ingestion of acidic foods, poor cleaning technique or stomach acids from gastric reflux/regurgitation, calcium will be dissolved from the tooth. The end result is tooth decay. This can be prevented quite easily by good dental hygiene practice (eg simply brushing your teeth well after reflux or regurgitation occurs and at least three times a day after meals).
Gallstones often occur in the obese. If you have not already had a cholecystectomy (had your gallbladder removed) you may be asked to have an ultrasound before your operation to determine whether you have any stones. If there are any present, then your surgeon may recommend removal of your gallbladder. If no stones are present, you may still develop stones as a result of the weight loss after surgery. Removal of the gallbladder and gallstones can be done via keyhole surgery. It is recommended that your team at our clinic be involved in this treatment as adjustments will need to be made to the band during such surgery.
This can occur especially if you have lost a lot of weight or lose it very quickly. It usually occurs on the arms, breasts, abdomen and thighs. Exercise during weight loss can reduce the amount of flabby skin and help tone up your body. About 20% of patients have surgery for this condition.
Excessive skin folds can become a problem, especially in summer. Rashes and other skin conditions can be of great concern especially under the breasts and abdomen.
Some of these late complications can occur so it is important that you are aware of them. Iron, Folic Acid and B12 Deficiencies - these deficiencies may occur in many patients after surgery for weight reduction. They are usually a result of an imbalanced diet due to the small amount of food being consumed. We recommend that you follow the dietary instructions from our dietician and if necessary take a multivitamin supplement. At our clinic, we will endeavour to have your levels of vitamin B12, folate and iron checked annually.
Please discuss any of these problems with our Clinic Multidisciplinary Team
If you have concerns about any other complications which have not been addressed above please raise these concerns with either your surgeon or bariatric practitioner.